Brad Paisley talks about the importance of clean water for the 1 out of 7 people around the world who lacks access. Please join our Water=Hope campaign today at Donate $10 by texting H2O to 25383; you will receive a confirmation, reply YES. It really is that simple!

During the past month and a half, I have been working and an intern with the Boone Watershed Partnership, Inc. (BWP) a non-profit organization currently in the process of performing restoration projects on two creeks, Sinking Creek and Gap Creek. Sinking Creek is mainly located within Johnson City, while Gap Creek is located mainly in Elizabethton. Both creeks are an essential asset to these two Appalachian communities. Both of these creeks are on the 303(d) list, meaning that they are not capable of sustaining life. Sinking Creek has been put on the list due to E.Coli pollution, while Gap Creek’s main problem is sediment.

Most of the work that I have been doing has been with Project Manager, Sarah Ketron. The main focus of the Sinking Creek project is to inform the community of the pollution in Sinking Creek and inform them on how they can help. On July 9th, Sarah, Gary Barrigar (President of BWP), and I went on a Septic Survey. On this trip, we went door to door asking people if they were connected to the sewer. Part of the grant given to the BWP from the EPA allows the BWP to assist residents in getting connected to sewer, if they are not already. The BWP pays all the costs, except for the monthly tap fee. This is a huge benefit to residents, considering this is something that could cost thousands of dollars. Also, if a resident is currently using a septic tank and is not able or does not wish to connect to sewer, BWP will assist in emptying or repairing the current septic tanks and/or field lines. BWP pays 100% of the costs. Once again, this is a huge incentive for the rural communities, considering the amount of money they would have to pay without BWP assistance. Sarah and I will be conducting another survey this weekend.

Aside from the two restoration projects that are currently up and running, the Boone Watershed Partnership, Inc. also assists in clean ups of other streams and rivers. So far, I have assisted with one clean up. BWP teamed up with Wal-Mart of Elizabethton to help clean up a portion of the Doe River in Elizabethton. We managed to clean out about four truck loads of trash and debris in about three hours. The community living along this portion of this river really appreciates what BWP is doing and even sometimes come out and assist in the clean up. It’s a really good feeling knowing that what you’re doing is helping others, especially in such rural Appalachian communities.  Thank you LoveEverybody  foundation for the ASPIRE Appalachia scholarship support.


twanda blog 3a

Happy Birthday to you. Happy Birthday to you. Happy Birthday dear Tata. Happy Birthday to you. We love you Tata. We love you Tata. We love you dear Tata. Happy birthday to you. Happy Birthday Madiba!! Happy Birthday Madiba!! Happy Birthday to you!!! HIP HIP…HOORAY

Today millions of people sung Happy Birthday to Former South African President, Nelson Mandela’s 93rd birthday. Now known as Mandel Day, July 18 is an international holiday adopted by the United Nations. July 18 is more than just a day to celebrate the anti-apartheid heroic leader’s birthday; this day is a global movement to commemorate his life’s work and honor Mr. Mandela’s legacy through an act of kindness – 67minutes to be exact. Sixty-seven minutes represents the number of years Mr. Mandela dedicated to ensure equality for South Africa, from 1942 until his retirement from public service in 2009.

To celebrate Mandela Day, Megan Quinn and I had had the opportunity to volunteer our time in a small informal settlement near Randfontein, Gauteng. Along with our field supervisor, Ms. Betty Nkoana we had the opportunity to plant vegetables in a garden dedicated to the township and its people. Project Hope UK also donated soccer balls and soft toys to the local crèche (child care center) in that township.

Ms. Nkoana was also invited to speak during the program as an honored guest and representative of Project Hope UK by the Executive Mayor of the West Rand District Municipality, Councillor Mpho Nawa. Ms. Nkoana spoke about Project Hope UK’s intentions in the community, especially when dealing with orphaned and vulnerable children; and the potential changes that NGOs can contribute to the community. The program also included a campaign and demonstration of building “clean” and safe fires during the winter season.  This campaign, Winter Clean Fires, is known as the “make fire like granny” method. It was implemented because air pollution is a major problem in South Africa, especially in more dense and low income communities, where individuals depend on coal for space heating and cooking as the most affordable means of energy. The “make fire granny” method is done by putting coal first, then paper, followed by wood and then lighting the fire. When the wood catches fire, put a handful of coal on top to ignite the coal at the bottom. During the demonstration, this method was found to emit less smoke, burn longer, save coal, and is much safer for human health than the traditional method of just burning coal in a tin can. Lastly, we ended the day by distributing parcels of food and cooking materials to citizens of the informal settlement.

It was truly amazing to see an entire community and country come together for a day of giving and kindness. I feel that Mandela Day has truly represented what the Frist Global Leaders Program aims to achieve through supporting scholars, such as Megan and I. I also look forward to finishing these last few weeks in South Africa by making a lasting impact on the Munsieville community through some the projects that are scheduled, such as the waste clean-up initiative in Little Mshenguville and the homestead gardens with the local grannies.

megan quinn and children

During the last two weeks, my colleague, Twanda Wadlington and I have had the opportunity to collaborate with another local non-government organization (NGO) to implement a health promotion program during the winter school break.  Legae La Bana (Home for the Children) is a local NGO focused on providing daily meals and social support to the orphaned and vulnerable (OVC) children in Munsieville.  The program centered on health related issues, while incorporating team building, arts, sports, and academics.  The program also assisted in identifying student leaders in the community that can assist with future Thoughtful Path projects. 

The second week of the program kicked off with the West Rand District’s monthly orphaned and vulnerable children (OVC) meeting.  The meeting was hosted by Legae La Bana in Munsieville.  Project Hope UK Project Manager, Betty Nkoana, Twanda, and I were invited as honored guests.  The meeting provided an opportunity for all of the governmental and non-governmental organizations that serve the OVC to meet together, discuss issues surrounding OVC, and continue implementation of programs. 

Munsieville’s Got Smarts Trivia competition took place on Wednesday, July 13th.  We had 26 children in attendance.  The game offered an opportunity to showcase the intellectual abilities of the children and for us to teach them about specific topics.  Topics included health, science, math, English, and South African history.  I was genuinely amazed at the level of some of the answers we received.  For example, one of the health questions asked participants to identify pollutants in the environment.  One extremely bright teenager mentioned that pollutants in their environment not only stem from illegal waste disposal and vehicular pollutants, but beauty products that contain certain chemicals can also pollute the environment and affect the ozone layer.  The children really enjoyed the competition, taught us a lot, and gained more information about the topics covered. 

Thursday, July 14th proved to be an extremely educational and successful day.  We conducted a sexually transmitted disease (STD)/sexually transmitted infection (STI) workshop with the OVC.  Due to the fact that some of the children may not have parents, live in foster care, or do not have parents that actively participate in their lives, early onset of sexual intercourse, teenage pregnancy, and STDs can be quite prevalent with this population.  Educating children early can aid in preventing some of the negative health effects associated with early onset of sexual intercourse.

The workshop began with a simulation of how easily and quickly STDs can be spread.  Each individual was given a piece of paper and was instructed not to look at their paper and to trade the paper with the other individuals participating in the game.  Individuals were told to remember how many people they traded with.  The number of times that an individual traded their paper illustrated the number of sexual partners.  Meanwhile, the pieces of paper either listed a common STD, pregnancy, or were blank (no STD, no pregnancy).  Following five minutes of trading papers, one by one the participants were instructed to open their paper and tell how many times they traded papers.  Twanda and I discussed the basic epidemiology of teenage pregnancy and each of the STDs.  We explained transmission, symptoms, and treatment.  Participants seemed to have a clear understanding of HIV/AIDs due to local public health campaigns, but were not familiar with many of the other common STDs (gonorrhea, chlamydia, HPV, herpes).  Prevention of STDs and pregnancy, as well as communication of STD status with partners was discussed.

The children in the Munsieville community are very aware of the health issues in their community and identified several issues and solutions on Friday June 15th.   The children were broken into two groups and asked to highlight some of the health issues in the community and identify feasible solutions.  Both groups listed crime as a major threat in the community.  Additionally, one group listed teenage pregnancy and STDs as a key issue for young females.  The other group focused on illegal dumping of waste and listed several potential solutions (additional garbage bins, changing community opinions of waste disposal, etc.).  The solutions listed will be incorporated into the waste management initiative we hope to begin next week.  Further, the other issues identified by the children will be compiled to inform future Project Hope UK/Thoughtful Path Munsieville projects.

The final day of the Winter Break Program was celebrated with a showcase of the children’s talents and skills on Saturday.  Soccer and netball served as the main events of the day.  We also had children create a banner for Legae La Bana, recite poems and perform dance routines.  These events provided the children with a safe, positive activity to participate in on Saturday.  Moreover, the events gave the children an opportunity for physical activity and increased their self-esteem.  All of the children received a certificate of achievement for completion of the Winter Break Program.

The last two weeks have not only provided an opportunity to break the cycle of poor health and change the lives of some of the most vulnerable members of the community, but they have also humbled me and taught me a great deal.  It genuinely amazes me just how smart, capable, and resilient children can be regardless of where they may live or what material items they possess.  The two weeks that we spent with the children will hopefully lay the foundation for positive change and greater overall health not only for these individuals, but for their families and the community as well.  I am extremely honored to work with this community and Project Hope UK and to represent East Tennessee State University and the Frist Global Health Leaders.  That said, I can’t wait to see what more we can accomplish in the next few weeks!  

by Bill Frist, MD

This weekend marks the celebration of the independence of a new nation, the Republic of South Sudan. A close friend, Ken Isaacs, was there to witness the joy:

"Today the Republic of South Sudan declared its independence from Sudan. Hundreds of thousands of people were present as well as dozens of dignitaries and international representatives.

There were parades of the various military units of the South. Youth groups, wounded veterans, police corps and other citizen groups also marched past the grandstand.

I have never seen or experienced such joy in Sudan. People cheered as loud as thunder. They sang and cried with tears of joy."

I'm often asked why do governmentt service? I wrote and introduced to Senate the Sudan Peace Act on Jan 25, 2001 after medical mission trips with World Medical Mission/Samaritans Purse to southern Sudan. It became law Oct 21, 2002. The Act helped pave way for Comprehensive Peace Agreement and committed the US to involvement in the peace process. Today, the culmination in INDEPENDENCE for millions of people. Politics matter. Medicine as a "currency for peace."

In celebrating this momentous occasion, I reflect upon a patient, in Lui, Sudan, on whom I operated years ago. Here is his story from my book, A Heart to Serve:

"During our last case on our final day before departure, a message came to the operating theater that a patient in the recovery room wanted to see “the American doctor.” By that time, all I wanted to do was to go back to my tukul, wash up, tumble onto the mat, and fall asleep. But I couldn’t refuse this last request. Dick, David, and I walked next door to the one-room hut that we were using as a recovery room. In the darkness, I could vaguely make out the silhouette of a man lying on a bed in the corner. Drawing closer, I saw white bandages covering the stump of what had been his left leg; a similar dressing covered his right hand.

But what drew my attention was not the man’s injuries, but his bright smile, a smile that, even in the darkness, seemed to illuminate the man’s dark brown face. I noticed a Bible beside his bed, not an unusual sight at a Samaritan’s Purse clinic. I leaned over, put my hand on the man’s shoulder, and through an inter- preter, I asked why he wanted to see the American doctor.

The man told me his story. Two years earlier, his wife and children had been murdered during the war. Even as he spoke of the atrocity, he continued to smile, and his eyes remained bright. I nodded as I listened, my own heart breaking at the thought of losing my wife, Karyn, and our three boys in a senseless, seemingly endless war. I knew there was no way I would be smiling. “Then eight days ago,” he said, “I stepped on a landmine. I lost my leg and my fingers,” he raised his hand slightly, so I could see that most of his hand was gone. And yet he continued to smile. I nodded again, trying desperately to understand. I listened as he told how he had been brought to the hospital at Lui from about twenty kilometers away, and how the American doctors had saved his life.

Finally, I couldn’t resist the obvious question. “Why are you smiling?” I asked. “Or should I say, how can you possibly be smiling?” “Two reasons,” he said through the interpreter. “One, because you come to us in the spirit of Jesus. And two, because you are an American doctor.”

“What do you mean?” I asked.

The man rose up on the bed as best he could on his mutilated limbs and uttered words that would remain indelibly impressed in my heart. “Everything I have lost,” he said, his eyes bright in the darkness, “my family, my leg, my hand—will be worth the sacrifice if my people can someday have what you have . . . in America.” He paused, then spoke as if uttering a prayer: “Free- dom. Freedom to live and worship as we please. The freedom that America represents.”

I swallowed hard. I looked up at Dick and David, and I could tell that they, too, had been moved by the man’s statement about the values that so strongly characterize the United States. Over the years, I’ve been back to Africa many times. I’ve made medical mission trips to the Congo, Uganda, Kenya, Sudan, Tanzania, and Mozambique. I’ve never seen that man again, and I probably never will. But I’ve never forgotten his smile and his heart.

Moreover, in recent years, I have become increasingly convinced that medicine can truly be a currency for peace in our world—a way for America to reach out in friendship and com- passion, creating lasting friendships with people on every conti- nent. Looking back, the awareness of that truth may have begun in that dark room, fostered by a man who had lost nearly everything but his faith in God and his hope for freedom." (A Heart to Serve, pp. 11-13)

Appalachia/ASPIRE Scholar

Health eating katie baker

Having reached the midpoint of my summer field experience, I can’t help but reflect on the past seven weeks and realize that this was the most ideal placement for me.  The Tennessee Cancer Coalition (TC2), its members, and my supervisors have encouraged and supported me in my efforts to develop a comprehensive skin cancer prevention program for high school students.  I must also take the opportunity to thank Big Kenny and the Love Everybody Fund.  Without that support, I wouldn’t be able to devote the time, energy and passion necessary to complete a project of this magnitude.

Since my last post, I have made significant progress on the program.  First, I interviewed a local melanoma survivor, Sabrina Fields, who attributes her cancer to excessive sunbathing and indoor tanning during her teenage years.  Our meeting was video recorded, and I plan on integrating “Sabrina’s Story,” as I am currently calling it, into my program.  In fact, I anticipate that segments of this video will serve as prompts for each of the four modules I’m developing, modules that will be delivered in four sessions during four consecutive weeks.  Second, I met with Lori Grabner from the Department of Health Science Education at David Crockett High School here in East Tennessee.  During our call, Lori was able to share her perspective on how best to reach high school students, emphasizing the need for interactive activities and the integration of multiple teaching methods.  Lori also suggested a “vehicle” for program dissemination throughout the state.  I will soon be contacting the state consultant for Tennessee HOSA (Health Occupations Students of America) to see if the organization would be interested in adopting the program.  Tennessee HOSA is comprised of 360 health science educators and over 11,000 students.  Lori has also offered to serve as the pilot site for the program; I hope to pilot the project in August of 2011.

Healthy Eating for Cancer Survivors

June 28, 2011

Cardiovascular Associates, Kingsport, Tennessee

Of course, program development is not the only focus of my field experience.  I have also attended, assisted with, planned and executed several outreach events.  Last week, I had the opportunity to assist with and attend a healthy eating class tailored to the nutritional needs of cancer survivors here in Appalachia.  East Tennessee State University’s College of Public Health & Department of Community Health were generous enough to donate water bottles, first-aid kits and pens (see photo) to each class participant.  During the class, Kathy Visneski, a local oncology nurse, presented information on the importance of fruit and vegetable consumption, choosing lean meats and low fat dairy products, and avoiding processed foods.  She was joined by Marie Browning, a holistic nutritionist from Kingsport, TN, who prepared a menu complete with oven-“fried” chicken, a summer corn salad with a yogurt-salsa dressing, and blueberry soft-serve.  This was a very different experience for me, as I almost always find myself on the prevention side of cancer.  I was able to recognize the importance of survivorship, particularly for those impacted by melanoma, the cancer I focus on day in and day out. 

Washington County Health Council Meeting

July 6, 2011

Munsey United Methodist Church, Johnson City, Tennessee

After assisting with sun safety outreach at the Blue Plum Festival, Christen Minnick of the Washington County Health Department (Christen in now with the Northeast Tennessee Regional Health Office), invited me to speak on the topic of my choosing at an upcoming meeting of the Washington County Health Council.  I chose to present on the need to ban indoor tanning for minors in our area; I thought this to be an appropriate topic for this group, as they could potentially influence local policy.  The Council members were very receptive to my message, and several members shared their insight with me after the meeting.  I was even asked to present to the staff of the Washington County Health Department during one of their staff meetings in August (and of course, I agreed).  This experience served to drive home the fact that people truly are interested in this topic and in skin cancer prevention.  I am very much looking forward to future opportunities to share my message throughout our region.

Twanda learning to floss

On June 30, 2011, my fellow ETSU Frist Global Health Leader, Megan Quinn and I had the opportunity to meet with the Orphan and Vulnerable Children Coordinator of a local NGO in Munsieville, Lagae La Bana (Home for the Children). This organization focuses on servicing orphaned and vulnerable children with daily meals and social support throughout the year. During that meeting, it was decided that a program for those children would be implemented during winter break from school. The program focuses on engaging children in the area of academics, arts, sports, and health issues of the community. This program also seeks to engage pensioners and non-working adults in developing a cooperative. This cooperative will seek to start a project that benefits the community through government funding.

The program began officially on July 5, 2011 with introductions of all participants and a teambuilding exercise called the Human Pretzel. During the introductions the children were given the opportunity to introduce themselves through expressive drawings without the use of words. The children seemed to enjoy these activities and they opened the lines of communication and partnership among the children. Due to the success of the team building exercise and we decided that it would be a good idea to begin every session of the program with a teambuilding exercise. These exercises would give the children and adults a sense of confidence and self-awareness.

The second day of the program was all about basic hygiene techniques such as oral health and hand washing. I led the oral health education of the session, while Megan led the hand washing education. We thought it was best to open session with one question posed to the group, “What is the smallest thing that you can think of?” This question received an array of answers from birds to germs. Of course we were looking for answers related to “germs”. I then asked the group, “What is the first thing that you do when you get out of bed?” Again I received a variety of answers from “eating breakfast” to” brushing my teeth”. These open-ended questions led to the importance of oral health. During the oral health session the group was taught the proper method of brushing their teeth in a circular motion, brushing the tongue, and the proper method of flossing. Most of the group had never seen or used floss before; so this was another new, yet exciting experience for the group to engage in. To conclude the oral health education, I asked the group, “What happens if you do not brush your teeth on a regular basis?” The group responded with tooth decay, bad breath, plaque build-up, and diseases. We then went further to discuss the types of diseases that occur from bad oral hygiene, such as gingivitis and bleeding of the gums. The oral health education ended with questioning from the group, which was very impressive. The group asked many questions ranging from sharing toothbrushes to the proper time to change a toothbrush. Each participant was given tooth brushes donated by the Thoughtful Path: Munsieville.

Megan then led the hand washing portion of the workshop. She taught the participants the importance of hand washing, the difference between using cold water and hot water, and the importance of using soap. Megan also discuss how easily germs spread from hand to mouth, person-to-person, and described the infectious diseases that can occur if hands are not washed regularly or properly with warm water and soap; especially before meals and after using the restroom.

Beginning July 7, the adults serviced by Lagae La Bana decided that they would love to begin a bakery cooperative for the community. With the help of Megan and me, it was decided that we would assist the group in developing a proposal for funding from the local government to develop the cooperative. We are also trying to establish a relationship with other businesses in the area so the cooperative may have mentors in the areas of their interests (i.e. bakery, ceramics, business development and CV building).  During this day, the children were asked to divided into to groups and list common health issues that affect their community and to suggest solutions. The children were then asked to present their ideas. This activity showed the children how to work in groups, communicate, and to serve as leaders in their respective groups.

The first week of the program ended with the children participating in “book clubs”.  With this project, the children were divided into four reading groups and four of the older children were chosen as group leaders. We selected the leaders based on their communication and writing skills, and overall confidence with being leaders.  Each child was then given an age appropriate book donated to the Thoughtful Path: Munsieville program by Project Hope UK last December.  Throughout the book club program; the children will continue to meet with their respective groups, develop their reading skills, and summarize their books to the best of their ability.

This week’s experiences have been exhilarating to say the least and we are looking forward to next weeks’ events. Next week the program will focus on teen pregnancy, sexual education and substance abuse; CV/resume’ building; and sports and art. The program will close with a showcase of the displayed projects developed by the participants of the program. Participants also will be presented a certificate of participation.

Emma apatu co workers

Developing Strategies to Promote Healthy Diets to American Samoan Youth

Summer school is currently in full swing throughout American Samoa. In the morning time you will often see several school children walking or taking the bus to school with their backpacks on chatting with their friends and local street vendors selling fresh banana, taro, and bok choy to passersby.  By 9:00 many classes are in session with bright eyed students soaking in morning lessons. By mid-day students are offered a generous snack/lunch.  During break periods and afterschool, it is common to see students hanging out by the fales (a hut like structure).

Over the past two weeks, I have been actively working on a Healthy Food Assessment for school aged children in American Samoa.  The purpose of this assessment is to gather ideas from students, teachers, parents, and school administrators on how to promote healthy diets to American Samoa’s school aged children and information on school aged children’s access to healthy foods. With the assistance of two community liaisons, Sharon and Marie, from the American Samoa Land Grant office and the staff at the two local high schools, I have been able to conduct eight interviews. All of the interviews were conducted at one of two high schools, Fa’asao Marist private school which has approximately 200 students and Leone High school, a public school with an estimated 1,000 students.

Currently, I am transcribing and analyzing the transcripts and will be summarizing the findings that will go into a final report that will be submitted to Dr. Dan Aga who is the Chair of the American Samoan Food Policy Council.  In addition, to the interview information, I am also working on a school-based policy analysis to complement the interview findings.  

I am definitely learning a lot by being able to apply knowledge that I have learned in my doctoral program to a real world setting and by immersing myself in another culture.  

I am so proud to be here serving as a Frist Global Health Leader !

Munsieville megan quinn

Over the past two weeks, I have had the opportunity to experience the beauty of South Africa, relish in the culture, and learn from the local people.   My colleague, Twanda Wadlington and I are based in the West Rand district of the Guateng province, specifically working in the Munsieville township.  We are both working with Project Hope United Kingdom’s “Thoughtful Path” program.

The Thoughtful Path program aims to engage and empower the community to create positive health and social change for the orphaned and vulnerable children in Munsieville.  The community, community based organizations, and the local government are typically involved in all aspects of the various projects associated with the Thoughtful Path.  That said, we have had the opportunity to meet with a variety of different community members and organizations during our time here.  

On Monday, June 20th, we were included in a meeting between the Thoughtful Path and Safe and Sound Learning.  Safe and Sound Learning focuses on raising the level of qualifications for early childhood development (ECD) teachers and has played an integral role in training several of the teachers in Munsieville.  Locally, ECD centers are called crèches and there are several throughout the Munsieville community.  Project Hope, in conjunction with Safe and Sound learning plan to train twenty crèches owners over the next few years.  Training of local crèches owners will provide positive change for the development of hundreds of young children.  In addition, we plan to work with Safe and Sound to establish a monitoring and evaluation program to document specific educational, health, and social indicators for the young children of Munsieville.  This process will be informed by assessing current methods that are utilized and accompanying Safe and Sound Learning staff on site visits of the Munsieville crèches.  Quality education and skills development in early childhood has proven to create better learners throughout the lifespan.  Additionally,  children who receive education and skills at a young age become healthier more productive adults, one of the overall aims of the Thoughtful Path.

Thursday, June 23rd served as the kick-off for a new youth service program on economic development.  Due to our work in the community, Project Hope was invited to attend the festival as honored guests.  The new program “One job per needy household for 100 days”  complements the existing National Youth Service program and aims to provide skills to youth to create economic development in the West Rand region.  Youth, in South Africa, defined at ages 18-35, and serves as one of the age categories with the highest levels of unemployment in South Africa.  Developing the skills of the youth in Munsieville will not only aid in economic development, but it will reduce crime rates and create a healthier community.  Several government officials from the West Rand district were present and provided inspirational speeches to the local youth.  The head of the Department of Infrastructure from the West Rand district commended the American youth that have come to their area, recognizing Twanda and me for our dedication to working in their district and making positive health changes in the Munsieville community.  Additionally, local youth dancers, performers, and scholars were highlighted during the program. 

We were able to truly experience just how compassionate and empowered the Munsieville community is on Friday, June 24th during the Thoughtful Path workshop.  The Thoughtful Path program consists of seven different “hubs”:  early childhood development, after school care, youth support and development, community strengthening, child/youth sports program, child rights and protection unit, and community based organization capacity building.  The leaders and key players of each of the hubs were invited to attend the workshop.  I was truly inspired by the genuine level of concern and compassion these individuals have for their community and the health of its citizens.  This group of individuals hold the key to making positive, sustainable changes in the lives of vulnerable children in the Munsieville. 

The workshop held several purposes: to inform and update the community regarding specific projects, to train the leaders about the monitoring and evaluation process, and to formally introduce the key stakeholders to Twanda and me.  Twanda and I were responsible for providing the monitoring and evaluation training.  The community members all possessed varying levels of education, so our main goal was to make sure everyone fully understood the key components of monitoring and evaluation.  Monitoring and evaluation are integral parts of the research process and can help to inform researchers if a program is successful or needs modification and where to allocate resources.  Specifically, Project Hope aims be able to generalize the Munsieville model to other similar communities around the world.  This goal will not be achieved if monitoring and evaluation processes are not integrated into programming. 

Twenty-two community leaders attended the workshop and learned the key components of monitoring and evaluation.  The training included an overview of data and data collection, monitoring, and evaluation.  Local, health-related examples were utilized to provide a practical component of the training.  Further, community leaders were divided into their hubs to apply their learning to programs specific to their projects.  Training the community leaders serves as one of the best ways to reach the most people in the Munsieville community.  As we have seen in our short time here, the community leaders play an integral role in engaging the community and providing successful programs.

This week has proved to be extremely successful, especially opening the doors of communication and collaboration with the community leaders.  I look forward to continuing to serving this dynamic community and improving the overall health status of its citizens.     

My internship with the Tennessee Cancer Coalition (TC2) is going very, very well!  I have made significant progress on the skin cancer prevention toolkit through consultation with experts in the TC2 – Jackson region, the TC2 Skin Cancer Resource Committee Chair from Knoxville, and one of my local supervisors who represents the American Cancer Society.  I will be contacting a melanoma survivor from Appalachia as well as a local high school health educator in the coming days in an effort to incorporate their input and experiences into the program as well.  Additionally, we will be adding another sun safety awareness event to our schedule.  On July 16th, we will provide no-cost educational materials and sun protection aids (i.e., visors, SPF 15 sunscreen, etc.) to those participating in health screenings during the Johnson City Farmers’ Market.

TC2 Summit on Cancer in Tennessee

June 16th & 17th, 2011

Franklin, Tennessee

As a part of my internship experience, I was invited to attend TC2’s 2011 Summit on Cancer in Tennessee which brought together researchers and academicians, physicians, nurses and other allied health professionals, cancer registrars, employers, health education and outreach professionals, community organizations, legislators, patient navigators, grassroots advocates and volunteers, and cancer survivors to focus on transforming the latest knowledge into strategies that communities, institutions, businesses, and individuals can employ to reduce the cancer burden in our state. 

I attended several interesting sessions, which I will describe below, and I even won first place in the Student Poster Competition for my poster titled, “Skin Cancer Prevention in Young Women: Evaluating a Measure of Pathological Tanning.”  The poster highlighted the prevalence of indoor tanning dependence and abuse among a sample of college undergraduates as determined by the Structured Interview for Tanning Abuse and Dependence (SITAD).

Pre-Conference Melanoma Workshop

When reviewing the Summit program, I was thrilled to see a pre-conference workshop on skin cancer.  During this session, we heard from Tara Bankes, a pathology assistant with Knoxville Dermatopathology Laboratory (KDL), Dr. Roy King, a dermatologist with KDL, and Richard Boland, a melanoma survivor. 

From Tara, I learned that 90% of skin cancer cases are caused by UV radiation and that 1 in 5 people (1 in 3 Caucasians) will be diagnosed with some form of skin cancer during their lives.  She also pointed out that melanoma, the deadliest form of skin cancer, is most common among 25- to 29-year-old females.  She took us through the ABCDs of melanoma detection, which stand for: Asymmetry, Border Irregularity, Color, and Diameter, adding an E to the acronym, which stands for Evolving.  Dermatologists believe the “evolution” of moles may be the most tell-tale sign of melanoma development and tell patients to pay particular attention to any changes in size, shape, color, elevation, bleeding, itching or crusting.  Tara stressed the importance of skin cancer prevention with the message to COVER UP YOUR SKIN with SPF 30 sunscreen and lip balm, hats, sunglasses, and umbrellas and to limit sun exposure between the hours of 10:00 AM and 4:00 PM.  She also emphasized that sufficient levels of Vitamin D can be acquired by spending just 15 minutes in the midday sun, and that sunless tanning products (i.e., spray-on tanning, self-applied lotions and creams) are the way to go for people desiring a tan.

Dr. King shared his work on the development of a melanoma database for Knox County.  He and his team have compiled over 6,000 cases from the area and have come to several conclusions:

  • From 1998-2007, there was an 82% increase in the incidence of invasive melanoma.
  • Melanoma incidence is 46.8% higher in 20- to 29-year-old females when compared to males in the same age group (likely attributable to tanning beds).
  • There are more tanning facilities per capita in Knox County than in almost any other city in the country, and the prevalence of tanning among middle schoolers there is 15%.

HPV Vaccination in Appalachia

I also attended a session during which two  ETSU professors presented their work on HPV Vaccination in Appalachia.  Dr. Sadie Hutson of the ETSU College of Nursing and Dr. Kelly Dorgan of ETSU’s Department of Communications reported on their study in a presentation titled, “Beliefs and Knowledge of HPV and Cervical Cancer in Appalachia.”  Here, I learned that Appalachian women face an excessive cancer mortality risk and that 18- to 24-year-olds in this region are surprisingly unaware of HPV.  Drs. Hutson and Dorgan conducted interviews and focus groups in Northeast Tennessee and Southwest Virginia and came to the following conclusions:

  • Appalachian women face an HPV Vaccination Protection Dilemma, where they perceive two types of “threats”: 1) unknown side effects that potentially outweigh the benefits of avoiding cancer; and 2) non-vaccination and the acquisition of cervical cancer.
  • Limited knowledge, skepticism with regard to HPV vaccine commercials, and confusing risk all interplay to keep Appalachian women locked in the protection dilemma.
  • Appalachian women often operate in “spheres of silence,” meaning that HPV and the HPV vaccine are not discussed by (1) providers and/or (2) the community.

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