This past semester I took: Biostatistics, Epidemiology, and Health Care Financing and Delivery Systems. I worked hard this semester and had to find a balance between work, school, and my personal life.  What I found the most difficult was finding the right balance between studying a lot and spending time with my wife.  I think I found it by mid October, but we’ll see how it goes next semester.

I went into this semester with a bit of an academic chip on my shoulder because various people didn’t think I could succeed. Some questioned whether or not I could complete the heavy math classes like Biostats or Epi based on my test scores and transcripts.  Well, I think it is safe to say that I’ve proved them wrong.

Now that I’m further into my public health studies, I think it is proper to temporarily stop writing under this blog name. I haven’t given up my goal to medical school. Rather, I would like to write about public health and medicine under my name, rather than The Road to Medical School. I’ll be posting the link to the new blog after I do some minor changes to it. Brit and I are flying to Hawaii on Tuesday and we’ll be back in Savannah by the New Year. Look out 2012. 2011 was a great year and I’m coming at your hard.

My Epidemiology final date was changed, again. I picked it up on Thursday night and have two weeks to write an essay.  As I wrote in a previous post, I was worried about whether or not I am going to receive an A in the class.  We have a total of 3 essays to write and I received one of them back on Thursday. My professor liked the paper, so that’s a confidence boost.

For my Monday night class, we may or may not have a final.  If I don’t have to take it, I’m pretty sure I will get an A in the class.

I’m pursuing leads on an internship in Savannah and a newsletter editor position for an American Public Health Association subcommittee. There’s not much public health in Savannah, so I’m working hard on creating projects.

Epidemiology is an interesting topic, but my professor is terrible. It’s been a wash all semester and it’s my first real introduction to dealing with a bad professor. It’s a frustrating experience because I know I do not need to depend on anyone in particular for my learning, but for such a foundational public health class, I feel I need more than just a text to absorb the material. Right now I have an A in the class, but my second test I received an 86% on it. The tests are from some main test bank and do not reflect any of the material we read or from the lectures. The questions are worded on how much can one person recall certain phrases from the book. Some questions were like comparing two lines on a graph in the book and which one had a greater percentage. Again, recalling things from a book, that you can’t open while taking the test. I want to do well in all of my classes, but especially for a foundation class. If I want to do any more academic work, that letter grade will always be there. If I don’t do well on my papers and my final, I could see my grade drop down to a B which would disappoint me.

I felt stressed for about two weeks straight. The paper was a group paper which can go either great or really bad, depending on your partner. My partner is a smart girl so I didn’t think any problems would come up. Also, we are all in graduate school now, so I would think undergraduate excuses have been exhausted at this point. My partner and I had planned to meet one weekend afternoon and discuss our research on the Patient Protection and Affordable Care Act (PPAC) and it’s affect on US Health Care costs and expenditures. Long story short, my partner ended up in the hospital and could not meet with me to write the paper. No biggie. I just had her send the articles she found for the paper and I would write the paper. After a few days, I had a decent 7 page paper.

One of my tests I was really worried about because I didn’t feel as comfortable with the material as I did with the first test. There were a few multiple choice questions that I did not know. I guessed and turns out, I guessed right on all of them. I received an A on the test, but I feel like I dodged a bullet. My grade could have been worse, so I am trying to learn from those weeks and study more efficiently now on.

I don’t know what my last test score is because the professor was in Baltimore last week for a public health conference.

I plan on moving this blog to a broader name instead of a focused, themed blog. I don’t feel comfortable discussing about topics outside of my goals to get into medical school in this blog. I have not dropped my goal to get into medical school, but rather have writings that reflect more of my broaden medicine experience. I’ll work on it in December.

I’m surprised the most about my epi test score. It’s not as high as I would like it to be. However, it is higher than the score I was predicting. The test really did not test us on the concepts we learned in class and in the book. A lot of the questions were about the most random stuff in the book. There were no questions testing us about applying concepts and what the results of the concepts meant. It was absurd.

1/3 of the semester over with. I’m happy with my progress, but I’m trying not to get too ahead of myself. I still have a lot left to do this semester. I’ll celebrate in December.

I’m getting used to lectures again. Class discussions are easy for me, but I noticed some of my peers have either a hard time discussing things/don’t want to talk.

I recently had a big Biostatistics test on Wednesday. I feel good about how I did, but I reserving judgement until I actually see my test score. I did really take my time on this test and rechecked my answers. I caught an error in one of my summations which threw off the rest of my calculations, so I’m happy I at least caught that.

I talked to The Navy again about joining to help pay for the MPH program. I would join under their Health Services Collegiate Program (HSCP). The only problem is that The Navy has added a Health Administrator concentration requirement to MPH degree pursuers or holders. AASU doesn’t do MPH concentrations, but I talked to the department chair and he said we could work something out and call it a concentration. Hopefully things will work out.

I have no regrets about attending AASU. My classes are always less than 25 students. It’s nice school and they gave me a break on tuition.

I’m learning a lot of new insights about the US medical system. Right now I’m learning the basics of research methods through my Biostatistics and Epidemiology classes. My other class, Health care delivery and financing, is more of a seminar class. We’re currently going through a historical account of US medicine and how it became what it is today.

I really like living in Savannah so far. I guess there is a familiarity that I miss about being on The West Coast, but I’m not missing living on that side of the US.

Here’s a picture of the front of the boat:

Judging by the picture, you would think it is a peaceful boat ride. There was only one time in Cambodia where I felt we were in danger–this time. Many times on the boat I thought about if our travel insurance death benefit would cover this boat ride and pay out to our family members.

When we arrived at the dock at Sihanoukville, these ghetto ass boats tie up to the dock. Next thing I know, the group leaders tell us to: “Jump down to the boat”. No gangway, no rope ladder, just hop right it.
Say what? I’m a tall guy and I had to drop down at least my leg length, I had to wait for the perfect bounce when the water pushed the boat up high.

During the boat ride, Brit was terrified. I managed to take a picture of Brit and me on the boat:

Many times she asked me if we could go back, my answer: no because there are no boats to go back. The water was so rough on our trip out to some secluded island I remember seeing our right side of the boat, pitched significantly to the right, parallel with a swell approaching our boat. I remember saying to Brit: Oh shit, this is a big one.

It doesn’t help that the boat driver shuts off the engine. During those few seconds, time really does stop. The swell hits the boat and we take one some water. Engine starts back up and we’re on our way to some remote island.

Once we get to this secluded island, we’re reminded that we’re still in Cambodia:

Here’s a picture of the boats tied on the island. They would not pass any safety standards in America:

When we signed up for Travel Insurance, I made sure to the get max death policy for times like these. When we talked about volunteering in Cambodia, I never thought of putting my life in danger. I guess it is good that this is my only story of a near death experience while volunteering in Cambodia.

From the conversations we’ve had with other NGOs and with a consultant that helps organisations set up nonprofits in Cambodia, there’s two ways an origination can achieve nonprofit status in Cambodia. The first way, the most preferred way, is the bribe the various Cambodian governmental offices so that your application “doesn’t get lost”. After about a month, you have nonprofit status.

The second way is a very long process of building relationships with other NGOs and develop projects that you show to the different governmental offices demonstrating that you can handle nonprofit work in Cambodia. You will also have to deal with your application being lost between the different governmental offices which then you have to start the approval process over again. This route can take anywhere from several months to several years.

GSC decided to take the second route. Brit and I came in right when the organization is building relationships and developing programs in Cambodia. While it is exciting helping at a nonprofit start-up, it also helps put into perspective when people say “don’t go to a new medical school because they are still working out many problems and you will be the guinea pig”. There are a lot of GSC problems that we had to deal with while in Cambodia. I’ll write about those later.

At times I questioned why the hell are we meeting with a certain NGO. An inherent problem with GSC is that they specialize in short volunteer trips. This causes a problem when you’re trying build relationships with other NGOs. Most NGOs have established projects with long-term goals, so they do not want short volunteer workers. While 6 weeks such as our trip can be long for some people, in terms of NGO work, it is very short. In Cambodia there are not many other NGOs to work with because they want volunteers for several months. This leaves GSC with a smaller pool of partner NGOs. We worked with two NGOs to help build our curriculum.

One of the first NGOs we met with is and international organization called Friends-International

Friends-International is doing great things in Cambodia and they have developed an excellent marketing campaign that helps deter child sexual abuse. But because they’re so hands on, they had very little of their material to offer to us. What they were helpful on was giving us an insight into the Cambodian culture and how willing children are to seek help. Cambodian children will generally not seek help when there are problems in their house because they don’t want to project that there are problems in the household.

Our second NGO partner that we worked with was Khmer Youth Association (KYA). KYA is an interesting partner because I feel that they work on the same type of project that we were working on, HIV/AIDS prevention education, but yet different. Our approach to preventing HIV/AIDS was abstinence, but also ways to protect yourself when you chose to have sex. KYA, however, only focuses on abstinence.

Anyone with a brain knows that abstinence only education does not work. Just ask Sarah Palin.

At times during our meeting with the KYA Teen Reproductive unit was tense. At one point, one of their staff members yelled at us in broken English. Turns out that there was a communication problem between GSC and KYA. After much discussion between our group (without our executive director of GSC) and KYA, we decided to have KYA do a general health talk prior to our lectures.

If you followed any of my tweets on twitter, I expressed frustration about how the meetings were going. Because of communication problems between GSC and KYA, it put our team in a difficult position of figuring out how we can help each other. I feel we shouldn’t have been the ones figuring that out at the time. Our time was wasted and it took away from our curriculum building time. Organisation partnerships should be figured out prior to sending volunteers out. It also didn’t help that our executive director was in and out of these planning meetings.

I do feel we worked with KYA because they agreed to work with us. But because they have a different philosophy on how to teach HIV/AIDS prevention, it caused tension between KYA and GSC. KYA focuses on abstinence only education, they really were of no use to us when it came to talking about safe sex. We would ask if there was any program or teaching materials that they were willing to share for promoting safe sex and they out right said no and “because we only focus on abstinence education, we don’t believe in teaching anything outside of it”. At one point, they questioned why were working with our age group, and felt the material we were presenting was too mature. This tension boils down to different organisation philosophies and how to approach a problem.

This leads me to the final point:
It is important to build NGO relationships only if the organisation philosophies are aligned together.

We again worked with a partner Non Governmental Organization (NGO) called Transform Cambodia. Their mission is to take children of various ages from the slum areas, teach them English, and good Christian values in hopes they will lead a good life. They operate 11 education centers in Phnom Penh and they will open 3 more this fall. We were given 2 centers to teach at with 2 days to teach at each center.  Because the Transform centers supplant the children’s education with the public system, the kids go for a half day at Transform and the rest of the day at public school. We had very little time to teach a lot of topics to these children.

We spent two weeks in Phnom Penh. During our first week, the three of us and our Executive director Rick met and discussed what we though would be appropriate for an HIV/AIDS curriculum. We also had a request from Transform to also cover topics of: Drugs, Alcohol, and Domestic Violence. Since Brit and I had already taught two classroom sessions and we were comfortable with our HIV/AIDS curriculum, we felt the additional topics would be easy to incorporate in our lesson plan.

After doing some research, we decided to go with a similar healthy lifestyle model from a peace corps manual. We decided to teach 5 values that make up a healthy lifestyle. We would base the topics of: HIV, Drugs, and domestic violence around how they affect the 5 values.

When we came up with the 5 values curriculum,  we were worried about some topics we couldn’t talk about because Transform is a Christian organization.  In a Monday morning meeting with Transform, we asked how much liberty do we have when addressing certain topics because Transform’s Christian affiliation. We were given the OK that any topic can be talked about from Emily, Tansform’s in-country coordinator. That took some pressure off of us so we felt good with our initial curriculum and prepared to pitch it to Emily and and the various centre managers on Tuesday. Before the Tuesday meeting, that was probably the last time we saw the 5 values curriculum. By the end of the week, we had a whole new one in place.

Tuesday morning comes and we pitch our curriculum to Transform. After some discussion, the managers felt that their students don’t know enough of sexual education. Well, there goes our plan. The simple ogic goes like this, you can’t talk about HIV/AIDS if you don’t know what sex is. I’m looking at Brit thinking, “oh God how bad is it out here?” We left the meeting with no curriculum and we had to redesign our whole curriculum and make it less philosophical and more straight lecture based, which we did not like.

We ended up coming up with a curriculum focused on the lecture topics of: Sexual Education, HIV/AIDS facts, HIV/AIDS stigma, Drug and Alcohol abuse and finally healthy decision making. We decided to cut domestic violence out because of time constraints and our lack of knowledge besides don’t hit your partner.

We met with various other NGOs during the first week to help build our curriculum, but I will save that for the next blog post because I have a lot to say about NGOs here in Cambodia. And my thumbs are tired.