Reflective Essay on Internship in Public Health

An Overview of public health internship placement

The internship training was held at Naguru Teenage Information and Health Centre (NTIHC). NTIHC was Established as a voluntary activity by a Swedish gynecologist and several volunteer counselors in November 1994. Naguru Teenage Information and Health Centre located in Kampala, Uganda is a pioneer in providing youth-friendly adolescent sexual reproductive health services and information primarily targeting adolescents and young people aged 10–24 years.

NTIHC offers peer support and medical services such as diagnosis, treatment, and management of sexually transmitted infections, pregnancy testing, antenatal care, postnatal care, post-abortion care, family planning services, infertility, nutrition, and hygiene. In addition, NTIHC handles menstrual problems and problems of growing up like acne. Young people are also given treatment for other ailments like malaria, skin problems, abdominal pains, headaches, other pains, and discomforts

Further, NTIHC also offers behavioral change advocacy and capacity building; providing training to other health centers, distributing adolescent health policies and guidelines, offering internships and volunteerism, and providing information on rights and responsibilities. Below is the NTIHC organizational structure on which the healthcare center operates.

NTIHC organisation structure

Who are Adolescents/Young People and what Public Health Relevance of the Placement

An adolescent is a person between 10-19 years while a young person is defined as being between 10-24 years of age. Adolescence is a period of transition from childhood to adulthood and is characterized by physical, psychological, social, and behavioral changes [1]. As young people transform from childhood to adulthood, they become more vulnerable to many health challenges particularly those related to reproductive health which include, early/unwanted pregnancies, unsafe abortions, STIs/HIV/AIDS, female genital mutilation, and psychosocial problems such as substance abuse, delinquency, truancy, and sexual abuse. As a result of the above problems, many adolescents drop out of school and some lead a compromised and vulnerable life as both adolescents and adults [1][2].

While it is easy for adolescents to seek services for common illnesses such as malaria, and upper respiratory tract infections, they are less likely to use services for sexual and reproductive health complaints. Barriers like; long waiting times, long queues, and poor quality of services such as lack of privacy, rude service providers, and many others, delay adolescents from seeking reproductive health care services. Failure to access healthcare services may lead to poor health and death among adolescents with health problems [3].

Therefore, NTIHC ensures that adolescents and young people are enriched with adolescent-Youth Friendly Health Services (ADYFHS)[footnoteRef:1] that help to mitigate the multiple health challenges and behavioral risks that they are faced with. This is being done in a manner that ensures the availability, acceptability, affordability, and accessibility of youth-friendly healthcare services for all young people including those in conflict and hard-to-reach environments [4][5]. In addition, NTIHC uses the family- environment as the best place to address the basic needs and rights of adolescents, which include shelter, food, education, health care, social and economic support, spiritual development, and overall well-being. This has helped to ensure that adolescents access promotive, preventive, and curative health services relevant to their stage of maturation and life circumstances. [1: Broad-based health and related services provided to young people to meet their individual needs in a manner and environment that attracts and sustains their interest in utilizing such services.]

Work tasks during the internship period

I have had an opportunity to work with all the NTIHC departments, that is to say; advocacy and research, service delivery, finance, and administration. This was so grating and it helped me get a feeling of how the organization conducts its work. Specifically, for my internship, I was tasked to deliver ADYFHS to adolescents and young people to help them improve and promote their health. Health promotion is the process of enabling people to increase control over and improve their health [6]. Below are the internship-specific tasks;

Community outreach; I offered counseling and Psycho-socio support to Tuberculosis-TB/HIV/, Elimination of mother-to-child transmission of HIV and syphilis (MTCT) Patients, Orphans to maintain maximum adherence to antiretroviral (ARV) drugs. I was also given an opportunity to organize and lead the medical staff to community health camps, and night outreaches in bars and brothels to offer free medical services mainly to the minority populations like LGBTIs, female sex workers, orphans, widows, and street kids. Further, I offered peer education to the community with the aim of helping them make good health choices like family planning, and home sanitation to prevent epidemic outbreaks like yellow fever, malaria, cholera, and many others.

Antenatal care; I attended to pregnant girls and young mothers who had come for antenatal services at the healthcare center by measuring their blood pressure, body weight, and pulse and offering antenatal education. With this group, I had an opportunity to lead 2 educative seminars entitled Sexual gender-based violence and Elimination of mother-to-child transmission which was attended by over 50 pregnant girls. I also educated young mothers and pregnant girls about family planning, hygiene, and healthy feeding.

Main Health talk discussions; Specific focus was sexual reproductive health and rights. I conducted health talks with young people who had come to receive medical services. I educated and informed them about the importance and availability of ASRHR[footnoteRef:2]. This has helped to scale up the demand for ASRHR. [2: Adolescent sexual reproductive health and rights]

Laboratory and toll-free helpline; I worked in the laboratory where I was tasked to enter data for different tests such as; pregnancy, HIV, malaria, hemoglobin, viral load, syphilis, and many other infections. I also worked with the toll-free helpline where clients call in and ask about issues related to sexual problems, relationships, hygiene, child care, substance abuse, and other health-related issues.

Weekly report writing and participating in radio talk shows were also part of the work I was tasked to do.

How public health themes are addressed in the workplace

1) Public health goals and strategies

What are the organization’s public health goals and guidelines? If you can, account also for the motives behind these goals and guidelines.

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NTIHC’s goal is to increase an understanding of Sexual Reproductive Health Rights and access to appropriate Youth Friendly Services for young people. To deliver such services, the healthcare Centre operates with 4 guiding principles as stated below;

Services: NTIHC values the provision of quality youth-friendly services to young people regardless of race, gender, education status, or religious affiliation. It Provides timely and appropriate information to young people, if young people are given accurate information, this helps them in making well-informed decisions.

Clients: NTIHC values meaningful participation and involvement of young people in its programs. The work of NTIHC is guided by respect and acceptance of clients without any sort of discrimination.

Staff: NTIHC values staff with a high level of commitment to serving young people, and teamwork among the staff is highly recognized. In addition, time management by staff is considered one of the most valuable resources of the organization.

Other providers of ASRH services: Meaningful partnership with various stakeholders in ASRH complements NTIHC programs and fills the gap that NTIHC is unable to fill. The Health Centre values sharing of knowledge in a mutual and respectable way among partners and believe in learning from others as others also learn from NTIHC.

Accounting for these goals and guidelines

Uganda has a very young population (estimated at 34.8%) like in most developing countries, in addition to high youth unemployment (estimated at 36%), young people face a lot of sexual and reproductive health rights (SRHR) challenges. Such challenges often lead to high teenage pregnancies, complications of unsafe abortions, pregnancy-related complications, high maternal mortality, STIs, and HIV/AIDs [2][7]. Therefore, the focus of this youth-friendly Centre is to make Sexual Reproductive Health (SRH) services more friendly, attractive, and accessible to young people (in-school and out-of-school) between 10-24 years old.

2) A public health issue

(a) Identify a well-defined public health issue you worked with at your place of work.

Adolescent pregnancy in relation to accessing maternal healthcare services.

(b) Why is this particular issue important?

Adolescent pregnancy is one of the major areas of concern within the health fraternity and statistics specific to Uganda indicate that over 30.4% of girls aged 15-19 have an unmet need for contraception but cannot access such services while 17.2% of girls die as a result of childbirth and abortion-related complication. In addition, almost half (41.1%) of adolescents do not attend the acceptable number of antenatal care, this makes it an important issue to be given concern[8].

3) Organizational knowledge

(a) Give a description of the organization around which the public health work is built.

Naguru Teenage Information and Health Centre (NTIHC) is the pioneer program that specialized in providing youth-friendly Adolescent Sexual Reproductive Health (ASRH) services for adolescents and young people of 10-24 years in Uganda. It delivers medical and non-medical healthcare services both at the facility and in the community (schools, marketplaces, prayer centers, etc) under the youth-friendly model.

4) The population perspective

The healthcare Centre targets adolescents and young people of 10-24 years. It addresses a high-risk group because young people become more vulnerable to health complications as they transform from childhood to adulthood. Therefore, through ADYFHS, NTIHC helps to mitigate the multiple health challenges and behavioral risks that young people are faced with.

5) Practical public health work

(a) Describe how the workplace conducts public health work in practice.

NTIHC operates daily from 8 am-5 pm and work is mainly done in groups. NTIHC has customer care providers these registered clients have come for health care consultations, diagnosis, and treatment, antenatal doctors who specialized in giving maternal healthcare services to pregnant girls and young mothers, counselors are responsible for guiding, educating, and supporting those with health issues more so HIV/AIDS, medical doctors diagnose those with health problems and prescribe the needed medication, drug dispensers give out medication to clients as prescribed by the doctor, laboratory technicians are responsible for carrying out different tests on clients as recommended by the doctor, administration and finance board schedules, monitors and finances all activities carried out at NTIHC respectively.

6)Ethical question, the connection between theoretical and practical knowledge, and reflection (a) Identify and reflect upon any ethical issue(s) you encountered in your public health workplace.

NTIHC delivers services to young people of 10-24 years but on many occasions, I have received clients who are less and above the targeted age seeking medication. Following the facility ethics and guidelines, these clients were denied medication and I had to send them away but in relation to a right to healthcare and health equality, it was unethical to deny them treatment, because a right to healthcare is a fundamental human right to all human beings without any segregation.

The internship practice helped me develop real-touch professional experiences related to my field of work. In addition, I had an opportunity to interact with a service staff of various professional backgrounds like; social workers, social scientists, statisticians, information technologists, accountants, financial managers, doctors, midwives, nurses, laboratory technologists, and many others also added more on my understanding of the employment sector. The internship has further helped me get a real touch experience of the public health theories I studied in class. In conclusion, my internship experience has been so amazing, and I feel, I have met my expected learning objectives of the course.

References

1. E. Kemigisha et al., “Sexual health of very young adolescents in South Western Uganda: a cross-sectional assessment of sexual knowledge and behavior,” Reprod. Health, vol. 15, no. 1, p. 148, Dec. 2018.
2. A. M. N. Renzaho, J. K. Kamara, N. Georgeou, and G. Kamanga, “Sexual, Reproductive Health Needs, and Rights of Young People in Slum Areas of Kampala, Uganda: A Cross-Sectional Study.,” PLoS One, vol. 12, no. 1, p. e0169721, 2017.
3. I. Yakubu and W. J. Salisu, “Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review,” Reprod. Health, vol. 15, no. 1, p. 15, Dec. 2018.
4. E. Saurman, “Improving access: modifying Penchansky and Thomas’s Theory of Access,” J. Health Serv. Res. Policy, vol. 21, no. 1, pp. 36–39, Jan. 2016.
5. R. Penchansky and J. W. Thomas, “The Concept of Access: Definition and Relationship to Consumer Satisfaction,” Medical Care, vol. 19. Lippincott Williams & Wilkins, pp. 127–140.
6. S. Kumar and G. Preetha, “Health promotion: an effective tool for global health.,” Indian J. Community Med., vol. 37, no. 1, pp. 5–12, Jan. 2012.
7. UNFPA, “Uganda youthful population.”
8. S. Neal et al., “The causes of maternal mortality in adolescents in low and middle-income countries: a systematic review of the literature,” BMC Pregnancy Childbirth, vol. 16, no. 1, p. 352, Dec. 2016.