Global health rotation gives public health student an “up close and personal” look at health disparities

Kenzie Teno’s recent public health internship in Belize, a Caribbean country on the northeastern coast of Central America, gave her a new opportunity – to be part of a interprofessional health team of students and professionals in public health, physical therapy, pharmacy, physician assistant studies and medicine. A student in DMU’s master of public health program, she worked with Hillside Health Care International, a nonprofit organization focused on disease prevention that provides medical care and health education in the Toledo District.

“My time at Hillside was multifaceted, and I was able to participate in a handful of different projects,” she says. “At the beginning of my rotation, I spent some time in the clinic to gain a better understanding of common illnesses and cultures within Belize.”

Kenzie Teno, second from left, with two other public health students and Matthew Nicasio, Hillside’s public health director

During her internship, which fulfilled the Applied Practice Experience required for her M.P.H. degree, she also assisted with Hillside’s ongoing health education initiatives. “I partnered with two other public health students to design presentations for elementary schools covering the topics of nutrition and physical activity and dental health,” she says. “We also applied fluoride treatments as the water in Belize has not been fluoridated and dental caries are a major issue.”

In her final week in Belize, Kenzie attended meetings with local school administrators and Hillside’s public health director and clinical director to kick off a new water, sanitation and hygiene (WASH) initiative, giving her insights into what program planning and management look like in the country. She also worked closely with the two other public health students and Hillside’s public health director, Matthew Nicasio, to initiate a program evaluation of Hillside’s mobile clinic processes.

“I participated in survey design and trial run in country and am working closely with the two other public health students still in Belize to identify the best methods for data entry and analysis,” she says. “Overall, my time in Belize was spent working with people of all ages and backgrounds and on various projects that gave a broad overview of what public health in Belize can look like.”

Kenzie had participated in a non-health-related service trip to Haiti in 2016, which sparked her interest in public health. “That experience gave me a glimpse of health inequities across the globe and made me look for a way in which I could contribute to diminish inequities and encourage equal opportunity for health in any way that I could,” she says. She began researching public health programs and opportunities for health-related service experiences.

“I was incredibly excited to learn about DMU’s international internship opportunities, and Belize specifically because of the curriculum Hillside had listed on their website,” she says.

The Toledo District is the southernmost, poorest district of Belize, with approximately 80 percent of residents living below the poverty line. It is a very rural area, with many rough, unpaved roads.

“One of the mobile sites we visited for clinic and school presentations was approximately 20 miles away from where we were staying, but it took us one hour and 45 minutes to reach the site due to the roughness of the roads,” Kenzie says.

Some of the most common illnesses seen in the clinic are gastrointestinal illnesses, respiratory illnesses and skin-related issues; the most common chronic illness is diabetes.

In Belize, Kenzie enjoyed multidisciplinary interactions with other students and Hillside staff.

“We students and Hillside staff had many different discussions surrounding diabetes in Belize because it is such a wide, systemic issue,” she says. “Many families live on subsistence farming of rice, beans and corn and have limited access to healthy fruits and vegetables. Many people also walk as their main form of transportation but have little exercise outside of necessary travel.

“It was hard to find a balance when educating the patients on their illnesses because simply telling them to modify their diet and to eat more vegetables and fewer carbohydrates was ineffective since they unfortunately do not have the access or the means to make that change,” she adds. “It was an up-close-and-personal look at how the social determinants of health shape health outcomes in different communities across the globe… Full understanding of the obstacles people face to good health was critical to effective education and was an ongoing process throughout the internship.”

In addition to pursuing her M.P.H. degree, Kenzie juggles two jobs, in a medical sales position and as an outbreak and interview response intern at the Iowa Department of Public Health.

“In addition to conducting routine patient interviews for reportable infectious diseases and any additional clusters or outbreaks, I also counsel patients on disease prevention strategies,” she says. “Moving forward, I’m hoping to continue along a similar path and build a career in infectious disease surveillance and prevention.

“My time in Belize allowed me to practice technical skills, such as problem solving and program evaluation, but also gave me insight into the unique challenges of health care and health improvement initiatives in resource-limited, multi-cultural communities,” she notes. “While my time there only strengthened my passion for working with infectious diseases, it caused me to broaden my scope and seriously consider a career in global health. Regardless of where I end up, Belize was a time of both extreme professional and personal growth and is an experience that I will not soon forget.”

That personal growth included resolving her initial nervousness about traveling on her own to a place she hadn’t been before. Her fears “were instantly put to rest” upon landing at the airport in Punta Gorda, a city of just over 5,000 people. Jamie, the Hillside staff member who picked up her and other students, “set the tone for the rest of the trip” with his friendly introduction.

“I felt incredibly welcomed in every village and school that we visited, and it amazed me at how open locals were to answering our questions and discussing their lives in Belize,” Kenzie says. “Everyone was so friendly, greeting us whenever our paths crossed, and I never felt unsafe. Belize is breathtaking, a mix of rainforest, mountains and ocean, with hidden gems such as waterfalls and Mayan ruins found if you decide to wander far enough into the rainforest. The beaches are stunning and the water incredibly clear. However, it is the beautiful people of Belize, not the landscape, that are at the forefront of my mind as I reflect on my experience with nothing but fond memories and a wish to return again.”

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