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Qualities i see in the people around me!

Time is flying soo fast and my internship has came to an end. It was an amazing experience, from where i can say that i learned a lot. All the good, and less good experiences that i have been through made me more confident, more ready for what will come in the future on all the aspects. Professional and emotional. Of course all of that happened with the help of people around me. Maybe it will sound a bit funny, but living in Denmark for the past 3 years, and coming in Romania, only to visit my family and friends, made me feel like i was a stranger, when i returned in my home country for the internship. Moving into a new city, and taking everything from 0, was a bit difficult. I found Bucharest as being one of the most crowded and noisy cities i have ever seen. Also many, many people with a bad mood. All the time. After three months of living here, i still have the same opinion about everything. I was born in a small and very quiet city, far from Bucharest, where i lived for 19 years. Then i moved to Copenhagen. So i am not used at all with grumpy people. As i said in a previous post, people are always in a hurry, stressed, and angry almost all the time.

BUT, i had the chance to meet some extraordinary people along the way. During my internship i met soo many people ready to help and explain everything step by step. And i am very thankful to all of them. I met some people during the internship, people we worked with for the articles, who are willing to help us in the future, with our thesis and anything we will face in our career. 

Now, i also have a place in this article where i would like to talk about some qualities that i found in “my partner in crime” and friend, Georgiana. Even if we know each other for three years, we truly got to know each other during this three months. I got to the conclusion that we changed a lot since we arrived in Romania. Let’s say that life is not the easiest here, and you really need a friend next to you. And a true friend is there for you in your worst moments. And so she was. I met a new Georgiana since i came here. More serious, ready for a future career, and more responsible of her own actions. We are different, and some time this leads to some misunderstandings, but she is still amazing. One of the qualities i appreciate the most is that she was capable to be a friend in our free time, when we laughed about something weird that happened on our way to the office, we joked, we were mad, we tried to help each other with advises on our emotional life,but from the moment we were in our office doing our work, then she was just my co-worker. Any problem we had 5 minutes ago is left at the door. In that way, every task that we had, was finished in time, with good feedback. I know she will be one of those people who are ready to face everything that will come in the future, and she will be a winner. And i am thankful for that because i learned so much from her strong personality.

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Hello my dear friend! :D

Of course that i will reblog this, as i consider it one of the most interesting post that i read on Tumbler. I am very happy that you found a part-time job at our internship place. I also know that you will have a lot of fun there, and i will come to visit you so you can tell me the last gossip.

I want to say that i admire you for sharing your feelings about some “problems” with the blog where we write about our activity during the internship. I have read some post similar to yours on this subject, and i can’t agree with many of them. But this one is written in a proper and decent manner, with very good explanations. Also i think we can choose what we want to share, without hurting anyone, only by writing a few words of what we have done, and not go into details, when it is not the case or when it is not ethical. I am sure we all can do this without making a big drama of it. I have also encountered some difficulties with the blog, but most of them were technical.

But most important, i found your words about the BA thesis very motivating for me. Choosing the topic for my thesis was the easiest for me, and i consider challenging other parts from the thesis. But as you said i know it will go really well, and i love to see that you spread so much positivity, nice thoughts, and determination to everyone who is working on it, in the following months.

Three months more experienced

So, our internship is coming to an end. As you can recall, I started my internship at WHO Bucharest, and from there we were send to Totem, to help them with their research on Refusal to Measles Vaccination. I had been a bit sad to leave all my wonderful colleagues at Totem, but fortunately I got a part time job there, so I will actually be able to afford food while writing my thesis, so I have that going for me, yeeeeey!!!

Back at WHO, we were asked to go through some reports. The reports on the qualitative part of the study we had conducted while at Totem. It’s been such a useful experience, to actually get the interviews done for a real job, knowing that we were working for a respected organization and there was no possibility for shortcuts or for doing a poor job, as sometimes we did in college. 😃😁

What we did since we left Totem? Well, we got there for one more day, as our supervisor from Totem has arranged for us to meet the person in charge of analyzing the quantitative data we have previously collected, so that she can explain to us all the processes she was doing. That was an extremely interesting and difficult lesson in quantitative methods!!!! I cannot really say that: “hey, I’ve learnt so much after those two hours, I’m like a pro now in quantitative data.”, I probably didn’t really learn much, although I was truly paying attention, but those were some really difficult stuff. But what I can say is that for the first time in my life, I have found quantitative data interesting. And, also, the lady gave us her contact details, so we can contact here anytime we need some information, so that’s nice too.

Back at WHO, we worked on the interview guide for the TB patient who came from Montegro to get treatment in Romania. We received really got feedback on the interview guide from our supervisor at WHO but, unfortunately, the interview won’t happen. (The social and political implications would be too high.) Sometimes, I feel like I cannot share much information on this blog because it is kind of confidential, and, I mean, please don’t take any offense in this, my really nice Metropol teachers, but I really can’t see how sharing confidential information with just few people (as it would happen if my blog was private) is in any way better than sharing it with everyone. That’s why going for a private blog was never an option, to begin with. With the risk of failing this module (although, I really don’t see how that would happen, since I have really been working hard for three full months), I cannot share on this blog more than I already did - public or private. I simply don’t see how. Mostly, I handled confidential information during my internship. I told people: “hey, you can tell me, no one except myself will know what you told me.”, and then just go writing on my blog about it. And this is NOT me complaing about the blog. If anything, I am trying to explain myself. Everyone is like “oh I hate the blog because I hate it that everyone can read it.”, I really don’t have that problem - I’ve been having different blogs for the past 10 years, writing is what I do. But many of the requirements of this blog ask of me things that I cannot do - tell others what I was told in confidence. We actually did sign a five years confidentiality agreement at Totem, not that this has anything to do with the way I see things - we all value ethics more than anything!

So, I really hope this blog will suffice.

It was a shame that the TB article won’t happen - WHO people will try again, but they aren’t really hopeful. Anyway, we did tell them we are really willing to work on it, so they can contact us, even though our internship is almost over.

Ps: we wanted to do a video of our supervisor, but she is on holiday this week. Maybe we’ll post it in three weeks or so. (We also have holidays soon. 😍)

And yeeey, I started working on my BA thesis and I really really really think it’s going unbelievably well!!! As I suspected, deciding on a single topic was the hardest thing about this thesis - I went back and forth from Cannabis, Alcohol, Tobbaco, Mental Illness, TB, and PCOS. Once I have settled on PCOS, things are going smoothly. (Still, working on my theories and the literature review, once I get to actually collecting my own data, things will probably become more difficult. :D)

Peace, people. I hope all of you got awesome internships and I hope all of you love writing as much as I do. My thesis will be the most beautiful thing there ever was! (Actually, my writings are on my computer in a folder called “my beautiful awesome incredible babies, so yeah.) Come on, we can do this!!!! ❤️❤️❤️

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Published or not published?

In the first days of our internship we started to work on a project about a patient from Montenegro who suffered from multi-drug resistant Tuberculosis and was transported to Romania for treatment. We started this project by interviewing a doctor from Marius Nasta, Pneumoftiziology Institute. I must say that we learned more than we thought in the beginning, at the end of the interview. Apart from hearing many new things,the interesting story on how the patient was treated in the hospital, and the fact that she came for treatment in Romania as her country has not the necessary resources for her treatment, we also had some difficulties. Because we are not used with all the medical terms, it was a bit challenging to follow the discussion, to pay attention to all the details and make notes in the same time. But somehow, we managed this. After we return to our office, we discussed with our supervisor what we found out, and she gave us many articles from where we can inspire in writing the article. All the articles were very helpful for us, for the article, and also for our profession, especially the ones about nutrition. So we started to work on it, by writing about the health system in Romania and Montenegro, some words about the patient, the reason why she came to Romania, how she was transported to Romania, and, about the period when she was in the hospital based on what her doctor told us in the interview. Unfortunately we postponed the article as we were asked to participate in the project about immunisation at Totem. Now, that we finished our work at Totem we are back WHO. During the first day, our supervisor told us that a new patient form Montenegro came for treatment in Romania, and we have the possibility to participate to an interview with him. We were both more than excited to hear that, as it is interesting to hear more than one opinion about this experience. The patient didn’t speak English or Romanian, he knew only Serbian, so we chose not to participate to the interview together with our supervisor. None of us know the language, and we were thinking that it make no sense to be there, as we wouldn’t understand the conversation, and we would’t be able to ask questions. In a way we could say that we participated, because we succeed in doing a good interview guide, that was used, with a very good feedback. But in this time we continued to write on the project we started before leaving at Totem. Unfortunately, we were told that the patient did not feel very comfortable on talking on this subject, also he was not sure if he agrees with the fact that his case will be published. The interview with the first patient was also impossible to happen, as she left back to Montenegro, and it was very difficult to find a way to get in touch with her for the interview. We were told by our supervisor, that the project has to be postponed again. Because our internship will soon come to an end, there is almost no chance that something will change during this last days. But we said that we wish to participate in writing the article, because we found it extremely interesting, and we want to take part in it, even after the end of our internship.

In our last days of the internship we were doing some WHO certified courses send by our supervisor with the following titles: 

- Pandemic and epidemic-prone diseases

- Writing for the web

- Risk communication essentials 

- Public health interventions in pandemics and epidemics

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I have to say that i am so happy that i can share this amazing and interesting photos with all of you. This was one of my favourite day during my internship. After many days of office work this day was like coming up for fresh air.

A delegation from WHO (Denmark and Germany), came to evaluate the medical emergency system from fire departments, the emergency aviation system, and SMURD. We joined this delegation, and we were going to all of the mentioned institutions and we took notes, and we used them to write a report on the discussed subjects. Read Arafat, the founder of Mobile Emergency Service for Resuscitation and Extrication (SMURD), was our “host” for a period of two days. He presented us the current situation of the emergency health system in Romania. Read Arafat was for a while the Minister of Health, in 2012, and for many years the Under- Secretary of State for Health in the Romanian Government. He was nominated as the State Secretary at the Ministry of Health until January 2014. After that, he accepted to move as Secretary of State at the Ministry of Internal Affairs to head the newly created Department for Emergency Situations under which all emergency services are coordinated including fire and rescue, civil protection, prehospital medical emergency response, air rescue and emergency departments.

Unfortunately, as the final product of our work is not published yet, with the necessary changes i am not able to share details from the meeting. But i am able to say that it was more than interesting for me to learn more about the medical emergency system form my country, Romania, as i never had the chance to talk with specialist about it, and be in person in all the institutions mentioned above!!! 

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Another day, another week in review!

As i mentioned in my last post, we were working on the qualitative part of the study.  

First i will describe you more this part.

It is expected that the questionnaire survey will provide overall insights into barriers and drivers to vaccination in susceptible population groups. To further explore these insights and obtain a deeper understanding of the reasons behind these factors, qualitative studies in the form of individual interviews were conducted by me and Georgiana, after completion of the questionnaire survey.

The scope and purpose of these qualitative studies will be guided by the questionnaire survey outcomes. The target group were again parents or caregivers of confirmed measles cases in the current outbreak, aged 13 months or older at the time of the onset of measles, and doctors. The discussion guide will further explore the insights from the survey - barriers and drivers to vaccination in susceptible population groups- and obtain a deeper understanding of the reasons behind these factors. It should go deeper into and explore issues related to the three defined assumptions as to the reasons for suboptimal uptake: possible access issues, issues related to traveling and migration and hesitancy related to safety concerns and growing anti-vaccination communication, also online presence.

The discussion guide was developed by the two of us, based on the outcome of the questionnaire survey. It was shared with all stakeholders for review before finalisation. In-depth interviews were organised in Bucharest, Arad, and Timisoara, cities with a high burden of measles cases. Participants, both patients and doctors were selected from those cases included in the survey. All the discussion was recorded.

The qualitative data analysis involved the identification, examination, and interpretation of patterns and themes in textual data. The scope was to determine how these patterns and themes help answer the research questions. After the data was structured, the information, keyword and main ideas were interpreted and classified using different presentation methods such as tables or visual schemes.

On the other hand, i am also very interested to tell you more about the experience that we had during this process.

We start doing our interviews in Arad. We woke up in a morning, ready to spend another day at the office, as we knew that we will leave the city in the weekend for doing interviews. But it was not exactly like that. We were told to go home, because in the evening we will take the train to Arad. So that was the moment when all the hurry and stress begun. Don’t get me wrong, we were more than excited to leave all the noise and stress from Bucharest, but we had nothing prepared. So, very fast, we start looking for a hotel room, for both cities Arad and Timisoara, and out of nowhere we are in train, leaving Bucharest.

After a very, very long night in the train, with around 30 minutes of sleeping we are in the train station, around 7 o’clock in the morning. In a short time we were supposed to start our first interview. We planned at least to go in the hotel room to take a shower, to change our clothes, and then leave together. The interview with the first doctor and the two patients of him was in the country side. Trying to be very positive, we were looking for transportation for going in the rural area. What a surprise?! It was not possible to find a bus going there. After Georgiana spent more than an hour in the telephone trying to find a solution with no positive result, we concluded that the only option was to get a taxi. Which was a very expensive option. In all of that time we were sitting on a bench in the train station. Because i don’t what to bore you with all the details, i will get directly to the part when we finished our first 3 interviews in the rural area. At 6 o’clock in the afternoon we had our second interview, in the urban area. Let me point out that our first meal, was at 9 o’clock in the evening. No meal, no break, no sleep for almost 24 hours. :D. Next day, we woke up at 6 in the morning to catch the train for going in the next city, Timisoara. The experience from there was almost the same, but a bit better. We decided to split, Georgiana left immediately with a car in the rural area to do the interviews, and i stayed in the city to do the rest of interviews. The good part is that we finish early so we had the rest of the day for ourselves. So Georgiana slept until the evening and i went out to meet some of my friends from high school. By the end of the day, we were both felt better. We had a nice evening in one of my favourite cities from Romania.

Some thoughts about the interviews. 

Doing the qualitative part is very exciting for me, as this is my favourite part from a research. For me, a challenging part was the duration of the interview, with both the doctors and patients. We had a target of 1 and a half hour with patients and 40 minutes more or less, with the doctors. In the rural area, the parents we talked to had a limited level of education. They found most of our questions, difficult to answer even if we tried to do them as simple as possible, and easy to respond. They had a hard time in expressing themselves. They seemed to be scared of our presence and of our questions and some of them even asked us at the end of the interview if they will have problems because of their answers and if the police will come to their home. It was very hard to maintain the conversation, and the total time of the interview was a bit too short compared with the given one. I have to say, that i was a bit frustrated because i consider that organisation was not good at all. We had to hurry every second, we had no time to get to know those families better, and also they had no time to get to know us, so they can feel more comfortable in talking to us. Some of the doctors, also, gave us very short answers, didn’t elaborate on anything, and were in hurry all the time, especially in Bucharest. 

All in all, it was a very interesting experience for me, and i consider that i have learned many important things and aspects and i feel more prepared for future tasks on this subject.

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What an experience!

As i mentioned in my last post, i will tell you about the work that i did at Totem Communications in the last month. 

But first let me tell you more about this place. 

Totem was founded in 2003, by a team of professionals bringing on local market an unique concept, integrating market research, marketing and communication services. Its current management team has expanded the firm’s expertise to include multichannel marketing, management consulting services and patients programs. The programs, aimed to contribute in improving quality of life for patients, help patients and families better understand the disease and its progression in order to plan and prepare for the future and psychological support for better acceptance of disease and treatment based on prescription issued by a physician. Using proven health behavior change tools and techniques, people build programs that allows a better diseases management.

Since the end of June we work on a research project about suboptimal vaccination, in order to investigate the reasons for the current Measles outbreak and to find out why parents refuse vaccination for their children. The most recent measles outbreak, starting in 2016, has so far caused more than  3,500 measles cases and 18 deaths. There are many assumptions but very little knowledge on the reasons behind the sub-optimal vaccination coverage in the country. Our first assumptions included access issues related to low health access, poverty and lack of integration with the society, including lack of registration for the vulnerable groups. Another assumption included also hesitancy related to safety concerns influenced by the online presence mainly affecting well educated and high income groups. Through this research we wanted to gain more information in order to understand who is affected, the reasons why they are sub-optimally vaccinated and which barriers and drivers affect their vaccination intentions and actions. So the aim is to identify the factors related to sub-optimal measles vaccination uptake in Romania in order to inform a long term strategy to increase vaccination uptake and avoid future outbreak. The entire approach was developed based on consultation with a range of stakeholders in Romania including The Ministry of Health, National Institute of Public Health, The National Society of Family Medicine, UNICEF, WHO, and National Regulatory Authorities.

We worked with a questionnaire survey, targeting representative sample of measles cases to obtain insights into barriers and drivers to vaccination in representative population samples. So we started by doing phone surveys, targeting a representative sample of confirmed measles cases in the current outbreak aged 13 month or older. The questionnaires were applied on the members of the family, persons able to provide the most relevant information regarding the case. Families form bot rural and urban areas, all genders and age were included in the sample. The cases were asked if they agree to give their phone number in order to be contacted for a short interview. We had to conduct 500 questionnaires which was a challenge for us, especially in the beginning. It was for the first time we did this with people we have never met, people who were strangers for us. We did this in a call centre, full of new colleagues, and as me and Georgiana are two very shy girls it was a bit hard to do it. But after a few calls, we started to get used with it. We met all kind of people thorough the phone. Some of them gave us short answers and did not seem to be to comfortable to talk to us about the experience they had, and about their opinions on vaccination, others had a low level of education and it was pretty hard to conduct the interview with them, but we met a lot of people who wanted to share many stories with us. 

The next thing on or list were qualitative studies, in depth interviews for a deeper understanding on the reasons behind the factors we found out through questionnaires. We did 2/3 of them until now, with doctors and patients from two cities; Arad and Timisoara. The interviews were conducted with parents in low-income settings and high income settings, exploring barriers to vaccination, vaccine hesitancy and access to health services, and doctors, exploring their attitudes to vaccination, relations with parents and the way services are provide. 

Next time, i will let you know more about the experience that we had in Arad and Timisoara, some great memories and also many challenges that we faced.

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Learning objectives

Time is running so fast! Almost 6 weeks have passed since i started my internship and i am doing great! Georgiana and i, were assigned to many tasks but we are very happy about it. The time is limited as we spend most of the day at the office but i would like to share my learning objectives and some of the beautiful work that we did during the last week.

Leaning objective 1

Gain experience in doing qualitative data collection to obtain trustworthy information about health conditions of the affected population groups.

Key strategies 

- practice data collection, planning and doing qualitative interviews and observation 

- include a small questionnaire to outline and understand the background of the population and retrieve descriptive data about attitudes and reactions to measles.

- practice data entry and data analysis 

Learning objective 2 

Gain knowledge of conditions of measles and measles outbreak.

Key strategies 

- study the outbreak surveillance data 

- define geographic, demographic and other characteristics of the affected people.

Leaning objective 3 

Gain insights into the individual, social and institutional barriers, and drivers to vaccination among population affected by the measles outbreak.

Key strategies 

- find out the characteristics of children such as vaccination status, education and location. 

- plan a discussion guide to explore the insights from the survey and obtain a deeper understanding of the reasons behind the factors about health access, poverty, lack of integration with society.

Learning objective 4

Develop understanding and skills to improve the accessibility to the most hard to reach and vulnerable population groups.

Key strategies 

- learn from specialists.

- observe different techniques used to motivate people.

- teach people about the ability of the vaccines, social support, health worker support, access to information. 

- learn about the safety of immunisation and injections.

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FIRST IMPRESSIONS 

First week passed and i am soo happy and impressed at the moment about what i am going to do in the next 3 months. I was always exited about the idea of going in an internship because i consider it an opportunity to apply the theory in practice, to meet new people, to learn from them and why not, to make new friends. I have chosen for the second time to do my internship in my home country as i know there are still problems when it comes to education about health among population. I am interested to find more about these barriers to health, and dig more into the problem. Is it about the level of education, or about the money? What are the other factors? I started my first week by participating to 2 conferences. First one was about smocking and i find out so many interesting aspects about it. Why passive smoking is actually more harmful and how dangerous is for the person who inhale the smoke. Why is so difficult to give up smoking and why the person who succeed in that, should never try again a cigarette. Is smoking a genetic factor? Are we predisposed to smoking since we are babies because of the people who are smoking next to us? Wha is happening in the moment when nicotine arrives to the brain and why nicotine causes addiction?These are just a few of the subjects we have talked about during the conference.  

 The second conference was about vaccination against poliomyelitis.The virus lives in digestive system, and often stays there for a long period without any clinic manifestations.Transmision is happening by an indirect way - usually by swallowing contaminated food or water, and in a very easy way in bad hygienic conditions. The virus is very smart and dangerous. In present, 3 countries are still affected by this virus ( Afghanistan with 3 cases in 2017, Pakistan with 2 cases in 2017 and Nigeria with 0 cases in 2017, but 4 in 2016).   

 However, a big progress has been reported. While in 1988 there were 350000 cases of poliomyelitis and 125 endemic countries, in 2016, 37 cases have been reported with 3 endemic countries.

 During the first week, Georgiana and I, were introduced in the project about tuberculosis. We will write an article about the patient from Montenegro who suffered of tuberculosis. The patient was treated in Romania because the hospital from Montenegro did not have the necessary treatment at that moment. In order to get more information before writing the article we had to do some interviews, so we started by going to “Marius Nasta" Pneumoftiziology hospital, where we had the first interview with the doctor who treated the patient. We will take it step by step by collecting all the needed informations in order to write about her “journey” starting with the reason on why she was treated in Romania, the way she was treated in Romania until the moment she was able to leave back to Montenegro.

However, we will postpone the article for a while as we had the opportunity to participate in another project, about suboptimal immunization so we will work for the next month in another institution called Totem Communications. 

So far, this was our first week, and i am very impressed about all the work that we are doing at the moment and i can’t wait to start the new project about immunization as this is my main interest in this internship.  

I will keep you updated with more information about our work at Totem Communications and i will let you know in the next post what are my main 4 objectives that i want to accomplish during the next 3 months.

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Hello Bucharest!

Finally it is  time for my second internship! So that means it is time to fly back to Romania. I chose to do the second internship in my home country again, but this time in Bucharest, the capital of Romania. This time i have started from an early stage to look after the perfect place where to do my last internship. For the second internship we have to  I got in touch with my supervisor, with the help of an older student who performed her internship at WHO office Romania. As this time we have to do a link between our internship and bachelor thesis, i looked after an internship that has to do with the children’s health. It was a long process with a lot of papers to read and sign but no problems appeared. So my internship supervisor is the head of the WHO Office in Romania. She presented me, since the begging, all the projects that we will do, and all the necessary aspects that i had to know. For the next 3 months i will take part in a project about tuberculosis - a patient from Montenegro who suffered form tuberculosis. Me and Georgiana will follow the whole process since she came in Romania for treatment until she left back to her country. We will also take part in a project about measles vaccination - we will try to find out why parents to not vaccinate their children through questionnaires and interviews. So far everything sounds more than interesting! I will write in the next post about my internship objectives and about my impression after the first week! :)