Decisions, Decisions

If you know me at all, you know how much I hate making decisions. And, when asked how I made a decision, I cannot tell. There is never a decisive point in which I know I've made a decision. Of the big decisions in my life (college, study abroad, living situations, med school, grad school), I cannot tell you how I made that decision. One day, I'm unsure and the next day I'm not. One moment I can't stop debating and the next I have a decision. And, apparently, all my indecision stresses people out.

Luckily (or fatefully?) all of my decisions turned out to be the right ones for me. I thrived at William and Mary, fell in love with India, made some of my best friends, and grew in New Orleans. But yet, I still constantly question myself when it comes to making a big decision.

I am, at heart, a scientist. I like to have just one answer be the correct one. I like to use deductive reasoning to come to the one and only answer. Yet, it is never like that. Why was William and Mary better than Franklin and Marshall? Why India instead of Poland? Why New Orleans instead of Washington, DC? Really - I have no idea. In retrospect, they were all good decisions that helped me grow and change and learn and make me the person I am today.

So now, my decision for what to do this summer: Sierra Leone or the unknown. What to do?

More on healthcare in New Orleans

As you may know, I've been spending quite a lot of time working on a project for a local community health clinic. My project, determining the extent and reasons for missed mammograms, required much digging, time, and patience. The first step was to determine the extent of the problem.

The clinic I volunteer with provides (almost) free primary care services on a first-come, first-serve basis. As recommended by the National Cancer Institute, women over a certain age are recommended for yearly mammograms. Luckily, there is another clinic in New Orleans that offers free mammograms. However, the process of getting a mammogram at this clinic is time consuming and frustrating.

Let me walk you through what I did and observed. First, I went through the files of all the women who were referred for a mammogram but did not have a report (to see if they actually did have a report). After finding few missed reports (the vast majority did not have a report), I went to the mammography clinic to determine if the women referred got a mammogram but the report was never sent. Again, although there was a higher number of reports, the majority were still missing a report.

Side note - while looking for reports, I waited with women who were getting a mammogram. Remember, these are the women who took time out of their day to get a mammogram. This is what is encouraged. Yet, some of the women waited over 3 hours - and they had an appointment! Those who did not have an appointment waited even longer.

Continuing on with a recounting of my work... Finding the majority of women referred for a mammogram did not get one, I did a phone survey to determine the "barriers to care," the fancy way of asking why they didn't go get a mammogram. What did I find?

THEY DIDN'T KNOW ABOUT THE APPOINTMENT!!!

Most women said they would have gone if they had known about it and feel it's very important to get a mammogram yearly. Many even gave me lovely anecdotes to impress upon me how important it was to be healthy and do what the doctor says.

The whole process was very frustrating. The women who try to take care of their health end up waiting absurd amounts of time with little information about how much longer it will take until their time comes. The women who don't know about the appointments have few resources to remedy the problem. And this is only my research on mammograms. Imagine all the other broken systems...

New Orleans Health Care Another Katrina Casualty: Loss of Hospitals And Professionals Slows Rebuilding
www.washingtonpost.com/wp-dyn/content/article/2005/11/24/AR2005112400730.html

After the Storm — Health Care Infrastructure in Post-Katrina New Orleans
http://content.nejm.org/cgi/content/full/354/15/1549

Breast Cancer Risk Assessment Tool
http://www.cancer.gov/bcrisktool/Default.aspx

Most Older Women Don't Get Mammograms: Study Shows Rate of Regular Screening Is Lower Than Previously Believed
http://www.webmd.com/news/20060620/most-older-women-dont-get-mammograms

Why Women Don't Get Mammograms (And Why They Should)
http://www.hoptechno.com/book55.htm

ओप्शन तो राइट इन हिन्दी

सो नो इ हवे थे ओप्शन तो राइट इन हिन्दी? अन्योने व्हो क्नोव्स हिन्दी वांट तो तेल मी इफ थिस इस कोर्रेक्ट? बेकाउसे इफ आईटी इस, इ थिंक इ मिघ्त राइट इन थे टेक्स्ट अल थे टीम बेकाउसे आईटी लूक्स सो बेऔतिफुल!

Classes This Semester!

I don't think I've ever been quite to excited about all of the classes I am taking! It's such a nice feeling to really want to take classes. In fact, my biggest challenge was trying to schedule all the classes I wanted to take. But, here is the final list. The course descriptions are from www.sph.tulane.edu (courses).

Social and Behavioral Aspects of Global Health (Mark VanLandingham, Mai Do)
This course covers the behavioral, social, and cultural aspects of health and disease in both developed and developing countries. Students learn how behavioral and social theories are relevant to health promotion and disease prevention efforts. They also learn how factors that protect or erode health operate at multiple levels (including individual, community, societal, and global levels), and how interventions are developed to improve health by addressing critical factors at each of these levels. The course also addresses the roles of culture, race, and ethnicity in the conceptualization of health and illness. (It's a core class.)

Tropical Virology (Dan Bausch)
This course covers the broad area of virology with an emphasis on viruses of public health concern in developing and tropical countries. Both historically problematic and emerging viruses are covered. Topics include the molecular biology, epidemiology, and pathology of selected viruses. Focus is placed on developing an understanding of the molecular aspects of the viral life cycle that give rise to transmission and pathogenic characteristics, especially in the context of the co-evolution of the virus and host. Additional topics include the interactions between the virus and host immune response, as well as viral control and the development of vaccines and anti-viral pharmaceuticals.

Epidemiology of Infectious Disease (Susan Hassig)
This course provides students with the knowledge and skills required for the investigation, control, and prevention of a variety of infectious diseases. Students will explore the characteristics of a range of specific disease agents, compare their impact on populations, practice approaches used to investigate disease outbreaks, and examine local and global efforts to monitor, control, and/or eradicate selected infectious diseases. Zoonotic diseases are included in the course.

Survey of Environmental Health (Assaf Abdelgani)
Major environmental health problems, including water quality, wastewater, occupational health, trace elements in the environment, municipal and hazardous waste, food protection, vector control, and air quality are discussed. (Another core class.)

Preventative Tropical Medicine (Richard Oberhelman)
This course presents the basic principles of preventive medicine in the context of the special environment (physical, biological, and social) of tropical developing countries. Emphasis is placed upon the prevention and control of infectious diseases of major public health importance. Vaccine preventable diseases are given special emphasis. In addition to presenting concepts and theoretical methods of disease control, detailed examples of actual programs are provided.

Program Skills in Crisis and Transition
This course is designed to equip students with a set of skills related to the assessment and analysis of the social, economic, and policy aspects of complex political emergencies, as well as post-conflict/transitional settings. The course covers selected topics in preparedness, response, and transition in complex political emergencies, and their effects upon the civilian populations and the agencies that seek to assist them. Students develop skills in the following areas: information management, program operations management, and policy and context analysis. In terms of information management, students develop the capacity to adapt surveys to conflict-affected settings and utilize a series of rapid assessment approaches and participatory rural appraisal techniques for data collection. Students also learn to identify and utilize the principal components of crisis prevention and early warning information systems. In terms of program operations management, students develop skills in the construction of a logistics management system appropriate for emergency settings, and learn how to develop key programs of particular importance in post-conflict and transitional settings. In terms of policy and context analysis, students are equipped with analytical skills related to assessing potential harmful effects of humanitarian assistance, international political aspects of humanitarian work, international humanitarian law, and opportunities for promoting conflict resolution, capacity building, and development through humanitarian assistance.

It's going to be a busy, but interesting, semester!

Krewe du Vieux and Football

This weekend was great fun! After a stress-filled week of trying to figure out my life (aka my class schedule), I relaxed, slept, and had fun New Orleans-style. [Don't worry... or get excited... New Orleans-style fun does not always include raucous drinking and/or flashing.]

Friday, after lovely Preventative Tropical Medicine, I headed over to Handsome Willy's for their free hard-shell crabs. No, I did not eat said crabs, but because they were free, everyone was there. Hung out for a bit there until the rain and miserable cold finally forced us inside to Janna's to meet her adorable guinea pig. After much oohing and aahing, TJ, Katherine, Janna, Dawn and I headed to get some food (1. because hard-shell crabs do not fill one up, and 2. TJ and I were frankly disgusted by the smell of crabs). We ended up at Juan's Flying Burrito on Magazine and I don't think a burrito has ever tasted so good. The talking died as soon as we got our food!

Saturday dawned - cold again. I headed with Emily and TJ to a TA session for SPSS. I LOVE SPSS!!! It is quite possibly the coolest program in the world! It's a database analyzer that is Excel times 1,000,000. I don't think I need to say more.

Saturday lunch consisted of my leftover burrito. The burrito lived up to its potential - even half warm and a day old, it was yummy. Lazed around the house for a bit (cleaned my room), then got ready for my first Mardi Gras Parade.

The Krewe du Vieux parades around Marigny and the French Quarter on a Saturday night, so it is not quite as kid-friendly as some of the other parades. But, it is great fun! Although it was FREEZING cold (look at the pictures), Alana, Laura, Megan and I had a raucous time trying to get as many beads and throws as possible. It's true, beads may not be worth 50 cents, but they are in high demand and we fought to get the most and the best (although we didn't do so well - there were 2 adorable kids who got almost every throw and good necklace - but they were adorable and gave us the beads they didn't want!).

After being outside in almost freezing weather, we headed back to my house on the streetcar to warm up. Did I mention that, although we planned on taking the streetcar down to the Quarter, it NEVER CAME, so we walked the whole way, bringing our hours outside up to 4?!? We, needless to say, were very cold and it took us several more hours, some warm pizza, blankets and a heater to finally warm back up again! Emily joined us to watch "Hairspray," although we never actually watched it. But we made plans to watch it on Sunday (which we did).

Sunday dawned, a little warmer, but still cold. The Patriots played the Chargers and won :(. Then, in a most interesting game, the New York Giants beat the Green Bay Packers in overtime! I also managed to get Megan, Alana, and Laura very invested in the game! So, Superbowl Sunday should be very interesting, with an undefeated team and a 10wins in a row team. Go Giants!

The Holidays and Back to Nola

Christmas and New Years - wonderfully exhausting. I went shopping in King 0f Prussia, for myself and my dad (did his shopping...). On the Saturday before Christmas, the family and I headed up to New Jersey for my uncle's surprise 60th birthday party! He was definitely surprised. We drove back home, to turn around on Christmas day to go to Connecticut. I finally met my cousin's son, Eli, who they adopted from Ethiopia in the summer. He's adorable! We had lots of fun watching him and making him laugh. The whole family also had a blast playing Stewart's Wii. Who knew?

Liam and Denis

Dad (even with a cast, he's competitive), Denis, Aunt Margie
Mom, Me, Eileen (I think Eileen just beat me)

Mom, Colette, Me (I think I just beat Colette!)

After Christmas, I headed down to DC (actually NOVA) to visit Tiffany and Arielle, my roommates in college. I took the Chinatown bus from Philly to DC - quite convenient. Arielle, Tiffany and I fell right back into the swing of things (after not seeing each other for over 6 months) by talking non-stop, shopping for shoes, and watching movies. It was great to hang out with some familiar people :)

After crawling all up and down the Northeast (Connecticut, NY, NJ, PA, DC), I flew back to Nola on January 2nd.

January 3rd I began my spring intersession class, Training Methodologies in Developing Countries. A picture of the class:

The class was amazing - I met so many interesting people and feel like I really learned how to use appropriate training methods! Now I just need some practical experience. In the few days between end of the intersession and start of official classes, I'm going to work on finding a practicum for this summer. If you have any suggestions, please let me know!

Goodnight, goodnight!
Parting is such sweet sorrow.
That I shall saw goodnight,
Till it be morrow.