Internship Projects

Addressing Our Biggest Public Health Challenges

The internship gives students in Dartmouth's on-campus MPH program an opportunity to gain meaningful field experience, focus on areas of particular interest to them, and work on finding solutions to some of our biggest public health challenges, such as homelessness, PTSD, and inequity in health care access and delivery. The internship experience also allows students to continue building a network of healthcare colleagues.

Internship sites can range from hospitals to community health centers, government agencies, nonprofit organizations, and international corporations. While many internship experiences take place close to “home” in New Hampshire or throughout New England, others have taken place as far away as Dar es Salaam, Tanzania. Here are a few of the internship experiences (and public health challenges) undertaken by recent graduates.

Homelessness

Eric Giles, MPH ’16 and Sumithra Nair, MPH ’16, both took a data-driven approach to examining and finding sustainable solutions to the problem of homelessness in the United States.

Giles worked near Dartmouth’s campus, with the Upper Valley Haven in White River Junction, Vermont. The Haven, as it is known locally, offers wraparound services, including a food shelf, short- and long-term shelter, free medical care, educational programming, and life coaching. The goal is for each person in the shelter to move into permanent housing and earn a sustainable wage.

However, many nonprofit organizations across the country are unable to track the outcome of their interventions aimed at helping homeless people overcome obstacles to housing and employment. Such a lack of data can create confusion around resource allocation.

For his internship, Giles collected data around resident demographics and program outcomes to better understand which programming is most effective. A final presentation to the Haven’s leadership team included recommendations for program modification and suggestions for stronger data collection in the future.

The site of Sumithra Nair’s internship was over 500 miles away in Washington, D.C., where she worked on a project aimed at assessing the impact of the Affordable Care Act (ACA) on health insurance coverage for the homeless.

In 2014, the ACA allowed for a state option to expand Medicaid coverage to cover non-disabled adults below 138% of the federal poverty limit. Since the ACA’s implementation, there has been a need for appropriate metrics to measure its impact.

Nair worked with HealthLandscape, a division of the American Academy of Family Physicians, which develops, administers, and markets geospatial analysis software tools and professional services. The group creates interactive maps that make federal- and state-level data available to the public in a meaningful way. At HealthLandscape, Nair undertook a secondary data analysis of a large database generated by a data-tracking system for the homeless population in Cincinnati, Ohio, from 2012-2015. Through the use of descriptive and survival analyses, the propensity of an individual to hold insurance for a year was compared before and after the implementation of the ACA. Final deliverables included a poster submission to a national conference, an infographic for the Interact for Health website detailing the findings of the analysis, and a presentation to staff from HealthLandscape and The Robert Graham Center in Washington, D.C.

Patient Engagement

Allison Comick, MPH’15, completed her internship at Boston Children’s Hospital Department of Plastic and Oral Surgery. As one of the largest pediatric-specific plastic and oral surgery centers in the world, the department sees upwards of 17,000 patients each year. Comick worked with an interdisciplinary team to create an engaging educational video for adolescent patients undergoing wisdom tooth extraction.

A young adolescent brain can hold only seven items of information in working memory and often has difficulty discerning the information that is important to retain. Regardless of age, all patients must comply with the pre-and post-operative instructions when undergoing any medical procedure, and unique strategies need to be identified to reach this patient population. Since adolescents absorb more information visually than through any other means, video interventions appear to be more effective for treatment adherence and compliance. Comick and the team conducted a literature search to identify evidence-based methods, as well as clinic shadowing and staff interviews, to derive video content. They then drafted an age-appropriate script with input from the clinical and marketing teams. The end result was an engaging, easy-to-follow video for adolescents undergoing wisdom tooth extraction that included pre-op instructions, procedure expectations, and follow-up.

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According to the U.S. National Health Statistics, 49% of pregnancies in 2006 were unintended, with 95% occurring among women who use contraception inconsistently or not at all. Of the women in this category, 46% had discontinued at least one method of contraception because they were unsatisfied with it.

For her internship, Daniela Agusti, MPH ’16, worked with a Dartmouth Institute research team dedicated to addressing this public health challenge. Right For Me is a study that aims to improve the conversations people and health care providers have about birth control—and specifically to evaluate the effectiveness of two interventions to improve decision-making about contraceptive methods. Agusti’s internship project involved the translation and refinement of Spanish-translated study materials. She also worked on the development of a pilot study to collect users’ perspectives on the Spanish version of a survey. The final deliverable included a report summarizing the methods used to translate and refine Spanish-translated study materials, as well as best practice recommendations for future work.

International

Even though Jeremy Chou’s MPH’15 internship site was at Dartmouth-Hitchcock Medical Center, the project focused on helping the people of Haiti. Devastated by the 2010 earthquake, Haiti has a growing need for a comprehensive trauma care system, especially in its more rural regions. The Haiti Trauma Project at D-H’s Section of International Health and Infectious Disease focuses on the provision of safe, effective, and accessible care to address some of Haiti’s unmet healthcare needs.

Hampered by the lack of a national registry in Haiti, D-H researchers were considering using a validated, cluster-based survey tool to gain a better sense of Haiti’s trauma care needs.

Chou’s internship project consisted of a design strategy to provide a rigorous assessment of the burden of illness that will be addressed by the proposed trauma system—one that provides a random sample that is representative of the Haitian population the trauma system will serve. Results from the study itself informed the needed capacity of the system and also provided a baseline for measuring improvement and the system’s progress. A final deliverable came in the form of a research proposal detailing the design and methods for the project moving forward. It outlined the process through which sampling would take place and gave an estimate of the project timeline and budgeting.  

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Furaha Kyesi’s MPH ’17 internship took her to Dar es Salaam, Tanzania. There, she worked with a research clinic affiliated with Dartmouth, the Dar-Dar Clinic, which focuses on HIV and TB research and treatment. Tanzania has considerable rates of both, and Kyesi’s internship focused on implementing a new World Health Organization (WHO) guideline for the delivery of TB treatment for HIV-infected children.

As part of the internship, Kyesi completed three unique ethical review board applications for committees at Dartmouth and in Tanzania in both English and Swahili.

Kyesi also developed operational plans to implement the project and developed and completed extensive training with the Dar-Dar clinical and research staff in Tanzania.

Underserved Populations

There are over five million surviving U.S. veterans of foreign wars. According to a report from the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 18.5% of service members returning from Iraq or Afghanistan have post-traumatic stress disorder (PTSD) or depression.

Yet, only approximately 50% of returning service members who need treatment for mental health conditions seek it, and only slightly more than half who receive treatment receive adequate care.

The National Center for PTSD in White River Junction, Vermont — where Jennifer Bales, MPH ’16, completed her internship — is dedicated to the development of evidence-based treatments and the dissemination of up-to-date best practices in order in order to support veterans and clinicians. For her internship, Bales created three platforms to communicate current PTSD research and programs to the appropriate audiences nationwide: an infographic that communicates the risks of polypharmacy and offers an easy-to-understand recommended action plan targeted at the younger veteran population currently prescribed three or more medications for PTSD, traumatic brain injury and/or pain; a letter marketing the PTSD Consult Program to providers that treat student-veterans in college health and wellness centers, and a mailing list of New England schools providing behavioral health services; a 12-month Facebook marketing plan for distribution to over 170 Veterans Affairs Medical Centers nationwide, with weekly pre-scripted posts consisting of videos, apps, and/or informational links related to PTSD.

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During his internship, Eric Jepeal, MPH ’17, worked with Indian Health Services (IHS) in Rockville, Maryland. IHS, an agency within the Department of Health and Human Services, is responsible for providing federal health services to Native Americans and Alaska Natives.

The agency provides a comprehensive health service delivery system for approximately 2.2 million American Indians and Alaska Natives who belong to 567 federally recognized tribes in 36 states, with a goal of “raising their health status to the highest possible level.”

Jepeal spent his time at IHS researching and developing a comprehensive program evaluation plan for the rollout of the agency’s national Behavioral Health Aide Program. The new program aims to deliver vital behavioral and mental health services to Native American and Alaskan Native populations through the use of locally based community health specialists – with a complementary effect of increasing workforce opportunities within tribal areas. The program evaluation plan Jepeal developed will be used as part of a larger national initiative to expand IHS’s Community Health Aide Program to tribal areas in the lower 48 states.