Salford Public Health

Late diagnosis of HIV in women in Greater Manchester, by Sheree Powell (MSc Public Health 2021)

When I started the Public Health Masters programme, I knew that I was going to do my dissertation on a sexual health related issue. Working in sexual health for several years I knew there were a few issues that needed research. One such topic that concerned me was the low HIV screening uptake from women had taken priority. The issue seemed small because it had never been discussed during meetings or conferences that I had been to or watched, until I found a document that confirmed that women feel marginalised in HIV related care. The report was named ‘Invisible no longer’ and was authored by the Sophia Forum and Terrance Higgins Trust (2018). It helped me to brainstorm: (1) the aim of my dissertation; (2) how I wanted to collect the data; and (3) who I wanted to interview. During this time, I felt I won a quarter of the battle as I gradually searched for relevant details to eventually discuss with my supervisor.

A few months before any dissertation-related work was required, the lecturers organised a visit from Salford City Council public health to identify: (1) who has a project that may be helpful to them (2) provide a project or idea to those who did not have one. I liked the fact the lecturers were getting the class involved in work that could be used externally, as well as a chance to work with an organisation.

I remember being excited to start my project as I watched my idea develop over the weeks and months before even writing the first line of my literature review! My aim was to identify the barriers and facilitators of women testing for HIV outside of maternity services in the UK, since evidence demonstrated women were not screening for HIV as much as men, nor were they being offered the test as frequently. Witnessing the lack of HIV testing for women first hand, I had a feeling it could be a result of a mixture of things such as the lack of HIV health promotion for women or women having a low perception of HIV risk as well as stigma. I really wanted to collect evidence to understand why women had such a low testing uptake, but to get there I knew I needed to speak to women who were HIV positive and I knew that could be a challenge since women are rarely approached for HIV related research.

Understanding what I wanted to achieve was one thing but putting a project together was another! This is why a supervisor is very important. Your supervisor will help you to structure your project to maximise data collection as well as ideas and providing you with the necessary support you need. Don’t forget the library can help you with using journal databases so you can expand your search terms! I found that service incredibly helpful as I tried to focus on research from western countries.

Writing my dissertation started during COVID-19. Working on the frontline I now attempted to balance university work, home life (what was left of it) and work. It was incredibly hard and my headspace was all over the place. My supervisor and the university were incredibly supportive during this time and I am very thankful. As the first wave passed it was time to collect data and I ended up hitting a few hurdles for a number of reasons, but I had my supervisor to support me during this process and I was keen to understand the complexities of women testing for HIV kept me going.

Finishing the project I could not be more proud of myself, especially completing it in such an uncertain time! I never felt unsupported. Some of my classmates became friends and we supported each other. One thing I was ecstatic about is sending my report to the Sophia Forum and receiving feedback! That is rewarding in itself! In the end my project did not continue with Salford Council as COVID-19 erupted, but It did not stop me from sending my report to organisations who I felt who be interested to read my findings. I gained further feedback from them also, which ended up being submitted to an All Party Parliamentary Group HIV testing inquiry! Mega happy! Coming to the end of my blogging time, I want to say If you already have a project in mind in the early days of the course (1) brain dump as much things as possible (OneNote helped me to organise my brain chaos) and (2) gradually search for relevant things, at this stage you don’t have to worry about narrowing it down; just have an understanding of the topic, find out if it has been researched already and think about what your project could do differently (if it has previously been researched). Later on in the course you can discuss your project with your supervisor, where you can begin to narrow your ideas if necessary. Some things you may keep and others you may not, but what you have may form a framework for your dissertation, which can be half of the battle—well maybe a quarter of the battle! If you do not have a project I would recommend to find something that will keep your interest! There may be times when you do not want to write and it may sound cliché but my passion kept me going!

Introducing our new Public Health Practitioner Apprenticeship Programme

Starting January 2021

We are delighted to offer a new Public Health Practitioner Degree Apprenticeship programme from January 2021. With public health now very much in the public eye, as a result of Covid-19, the new apprenticeship is both timely and a very exciting development. This three-year BSc (Hons) degree apprenticeship has been developed through consultation with Public Health England and employers in a range of public health-related fields. It is underpinned by the Public Health Practitioner Apprenticeship Standard https://bit.ly/2KApZiz. At the time the Apprenticeship Standard was being developed we are sure, no-one thought we would be gripped by a global pandemic just a few months after it was published! Against this background, we anticipate being the first UK University to offer the bespoke Public Health Practitioner Apprenticeship Programme. We are hugely excited to welcome our first Public Health apprentices to the University of Salford in January 2021 (first day of teaching 1^st February). See our course prospectus for more information: https://bit.ly/3foO5s1

With such an imminent start date, we are of course keen to let as many people – employers and potential apprentices – know about this new opportunity as possible. We’re here to support employers in registering interested members of their teams on to our programme. Our apprenticeship team are a great source of support and ready and eager to guide those already working in public health related roles through the admissions process and onto the programme. They can be contacted at apprenticeships@salford.ac.uk and are very much the first point of contact.

In keeping with all apprenticeships, there are entry criteria. The entry criteria are:

Two GCSEs at minimum grade C/ grade 4 in English Language and Mathematics. Level 2 equivalents such as functional or key skills can be accepted.
UCAS 120 points
European Baccalaureate Pass in diploma of at least 75%
We also positively welcome applications from students who may not meet the stated entry criteria but who can demonstrate their ability to successfully pursue a programme of study in higher education. Students who do not have the traditional entry requirements may be able to apply through the Salford Alternative Entry Scheme.

How will the apprenticeship run?

Apprentices will spend one day a week (Mondays) on University study (equivalent to 20% off the job training) delivered either digitally or face to face, depending on the ongoing response to Covid-19 by ourselves. They will, over three years, gain a broad level of knowledge, and develop skills and behaviours, in line with the requirements of the Public Health Practitioner Apprenticeship standard. We are looking forward to sharing our expertise to build knowledge and skills across 15 bespoke modules including: Evidence Based Health Promotion; Public Health Intelligence; Designing, development and evaluating Health Improvement Programmes; Commissioning for Health; and, Policy and Strategy in Public Health.

This is a really innovative programme to support the future development of the UK public health workforce. Dr Margaret Coffey, Programme Leader for the programme said:

“We are truly delighted to be at the forefront in relation to offering the Public Health Practitioner Degree Apprenticeship. We see it as a critically important platform for developing the public health talent for the future. We are looking forward to developing strong, positive relationships with employers and line managers to help support the personalised development of each and every apprentice”.

At the end of the three-year degree apprenticeship programme, successful apprentices will be able to register as a Public Health Practitioner. If you’re interested in finding out different types of roles public health practitioners may have, see: https://www.healthcareers.nhs.uk/explore-roles/public-health/roles-public-health/public-health-practitioner. With the breadth of roles that exist across public health, this degree apprenticeship provides an exciting new route for employers to support, develop and retain the future public health workforce.

For more information, see https://findapprenticeshiptraining.apprenticeships.education.gov.uk/courses/507

We welcome general enquiries about the programme. Please contact: m.coffey@salford.ac.uk

The University of Salford’s School of Health and Society is an institutional member of the Association of Schools of Public Health in the European Region (ASPHER).

Managing the emergency response to COVID-19 in Ghana, by PhD student Lawrence Lartey

Lawrence Lartey is an Emergency Room physician and is also a University of Salford PhD student in his second year of studies. He has taken a three-month interruption of studies to be part of the team that is responding to Ghana’s COVID-19 crisis. Below, he writes about his experiences and reflects on how his PhD journey so far has helped equip him to deal with his new role during this crisis:

“I am currently at the headquarters of the Ghana Health Service/Disease Surveillance Department helping with the epidemiology of the COVID-19 in Ghana (since January). I am assisting with THE handling of 1,065 passengers under mandatory quarantine, their follow up and laboratory testing. The team is also doing contact tracing of over 25,000 people and managing the 566 positive cases we have in the country as of 13/04/20. Our focus is on data collection, analysis and interpretation to guide government on public health policy decisions and actions. We are also under partial lockdown but those of us on the frontline still go to work 24/7. So far so good.

“I must confess that these past 18 months studying for my PhD has really shaped my thinking and approach to science and research. I can attest that I have improved with my analysis and appreciation of preparations for going into the field to collect data. I have had several opportunities to sit in the strategic Public Health Emergency Operation Center that contributes information to assist the Inter-Ministerial Coordinating Committee and National Coordinating Committee meeting at various levels of their work. I will share my experience from time to time when we started with the Emergency Preparedness plan for the country and now the Emergency response. I am also privileged to have very active and supportive leaders in the Public Health Division of the Ghana Health Service (Director: Dr Badu Sarkodie) and the Disease Surveillance Department (Head: Dr Asiedu-Bekoe). I am grateful for the opportunity they have given me to work with them.

“Considering that I have been a dyed-in-the-wool clinical practitioner, I have now transitioned into Public Health at the national level. The game changer for me has been my journey on the PhD programme. Your constant guidance and directions have opened my mind to many things including teamwork, working with superiors, doing critical analysis, logical reasoning, human behaviour and interests, crisis management, etc.

“Some years back, I would have hesitated to engage with the health system at that level because of gaps in my knowledge and competencies. But now I don’t feel as deficient as before, and in instances where I am not sure of the subject matter, I have used general principles I have learnt to solve the challenges I have encountered. I want to say a big thank you to you and Debs for everything you have done for me and continue to do.”

When the immediate crisis is over, Lawrence plans to return to his PhD research, which is based at Tema General Hospital in Ghana. He is carrying out a study into Emergency Department crowding and its impact on the clinical care and mortality outcomes of stroke patients, and is supervised by Prof Penny Cook and Dr Deborah Robertson.

From one of our Alumni – Chuks Onwunyi

I am Chuks Onwunyi from Nigeria. I bagged a Masters of Public Health degree from the University of Salford in 2017. My interest in public health was born out of a keen desire to understand the dynamics and variations in health of population. I wanted to understand what determines human health and how these factors could be managed in providing optimal population health. Enrolling in the MSc Public Health program was therefore a way to enhance my capacity to contribute positively to improving population/community health

Picking University of Salford was easy: Beyond my love for Manchester, the testimonials of alumni as well as the structured curriculum/programme informed my choice of and attraction to the University of Salford. Moreso, during my time at the university, the support received was immense. The lecturers were open and accessible, and I also had access to experts outside the school which helped me see the wide application of my course of study. The curriculum exposed me to different aspects of public health. I also enjoyed the mentorship program which gave me access to lecturers who had great experience in public health. Also, the lectures were designed to allow engagement with public health experts from different practice areas. This particularly helped me to see the application of theory in practice post graduation. I also networked with some of these experts which was helpful in shaping my next career decision.

Another interesting feature of the public health program at Salford is that it allowed for public health skill acquisition and development. During my program I led an external project which gave me firsthand experience and skills which I honed and have applied over time. Furthermore, after graduation, I have successfully led major international projects. Much of the successes recorded on these projects can be traced to the mentorship program which continues post-study. I have consulted my mentor (that was assigned to me during my study) at different times for references, ideas and direction.

I currently work as a Health Policy Analyst with the Government. I have led and supported several projects including the development of the Suicide Prevention Framework, Opioids harm reduction policy strategy, and design of the Alcohol harm reduction policy options. Before now, I led a Bill and Melinda Gates Foundation funded project in Africa targeted at improving Maternal, Neonatal and Child Health outcomes.

I am grateful for my experience at Salford. The experience laid the foundation for all I have contributed to recently and the improved health outcomes being experienced in several countries. Salford to the World!

My Masters Dissertation on tobacco use in new migrant communities By Nisha Kassam

This is my first time blogging and I hope that this piece helps others in their journeys when starting their dissertation projects. At first, I had no understanding of how big a task writing a dissertation was and how much it would consume my life! From the research methods module, I knew that I wanted to look into my own research area and I wanted to build upon a piece of work that I had worked on from start to finish, so my dissertation journey started from picking a topic area of interest and it ended with a report being presented to Manchester City Council. A couple of weeks after submitting the report to the council, I got an email from the council informing that my work will be used in an upcoming Council guideline. I will be referenced in their work, which I still to this day can’t believe is happening!

From the start of the dissertation module, I buddied with up a course colleague, David Gilbert, and we set out a task schedule and went over all the tasks that we needed to complete for the dissertation. We had the same supervisor so that made it easier for us to bounce ideas off each other and work together, it was also great having someone who was working at the same pace as me. We had a lot of late nights in the library working on our individual projects, with delirium usually happening around 2 am in the morning. We would find ourselves arguing over who our supervisor’s favorite student was and shouting ‘noooooo more!!’ at our computer screens after receiving our feedback, which meant more work for us to do. (Helpful hint: if working in the library take snacks—we always got the munchies around midnight and that helped to fuel us on through the night and also there are food options that can be delivered to the library!!!.)

Onto the practical side of things, it was important for me to collaborate with one of the city councils, as they would help in providing resources and would also help in refining the topic area being researched. I approached Manchester City Council during the research proposal stage of my work and they offered to assist me in the dissertation project. My initial topic area of interest was shisha/waterpipe smoking in Manchester, however, the council had already completed a lot of work on waterpipe/shisha smoking and asked me to look at a new area that was under-researched. So my dissertation project changed direction, looking at tobacco use and smoking in new migrant communities. The council provided me with the resources to complete the research project, insofar as access to migrant communities that could take part in focus groups.

I jumped into the research side of things and started conducting focus groups with different migrant communities. I had given myself a month to collect data and then planned to analyse the data, however, the council asked for more out of the project, they wanted to look at the project from different points of view, so that they could have a complete overview of tobacco use in Manchester. Interviews with primary care professionals were added to the project. I approached primary care professionals that the council recommended, as well as primary care professionals I knew through my work as an Operating Department Practitioner. I used all the contacts available to me in order to make my research project successful. However, adding another aspect to the dissertation project was the greatest challenge as it meant that the project changed from being one dimensional to being a triangulated research project. This meant analysing data from different perspectives and also meant further ethical approval was needed for the interviews, adding more layers to an already complex project.

In terms of findings from the research, I found that alternative tobacco products were popular in new migrant communities, many migrants were using different tobacco products including shisha/waterpipes, and heated tobacco units. These products were becoming more popular due to the flavours on offer and also their price points. However, the research indicated that cigarettes were still the most prominent form of tobacco being used within new migrant communities, although migrants were finding ways to get cheaper cigarettes, thus were importing cigarettes from their home countries or were buying cheaper/counterfeit cigarettes from certain supermarkets or corner shops.

There were no services specifically for new migrants, and a lack of data collection on new migrants makes it difficult to track their needs. Gaps in the research were presented clearly and I also included recommendations and conclusions in the report, which the council could implement in the future.

Photo by Ander Burdain on Unsplash

So I still can’t believe that this was the outcome of my work, to be referenced in an important guideline for the council that I was collaborating with. Getting the email to say that my work was being used was completely unexpected, but this meant that all the late nights and library visits were totally worth it…

The one thing that I would recommend to future students is to work systematically, plan everything from data collection to data analysis, timetable your plans and make lists. (Lists are super important in detailing everyday details, the guys on my course used to make fun of my list making, but they do work!)

As cliché as it sounds, doing a dissertation is a real journey, and it presents a lot of challenges along the way, but the key is perseverance and hard work. I enjoyed every aspect of it, from the data collection to the analysis to write up. Even if it meant sleepless nights and no social life for a few months, it is totally worth it! Even now, as I’m writing this, I am now thinking I want to do more and work on other research areas.

(As a side note, I also want to publicly thank the lecturers on this course, as without them none what I have achieved would have been possible without them and their input.)

Nisha

Public Health Field Trip to the Village of Eyam

By Lee Houghton

Tuesday 8^th October saw our newly bonded MSc Public Health students set forth for the wilds of Derbyshire, on a field trip as part of the Evidence Based Public Health Module. The aim of this field trip was to give us all an understanding of real-world public health in action, to show the development of public health through the ages, and to spend some time together as a group to get to know each other better.

I had never heard of this village and indeed began the trip by repeatedly pronouncing its name wrongly (think Eeeeeem—to rhyme with steam—rather than the two syllables you brain will probably go to initially). A quick Google search identified it as ‘The Plague Village’, which sounded intriguing but I avoided reading much more as I didn’t want to have too many preconceptions.

On the way to the village we stopped at the glorious Chatsworth House to see how the other half lived! I had always wanted to visit here and it did not disappoint, a perfectly grand National Trust property set in the most beautiful gardens and wider landscape, just walking round I got a real feel for how incredible it must have been to live here and the impact an estate like would have on the wider communities in terms of providing work/opportunities to sell/buy produce.

Chatsworth House — as you can see we are a little windswept and rained on here!

We continued on to Eyam to find a more realistic representation of how the majority of people would have lived in the 1600’s (whilst all secretly still wishing we lived at Chatsworth!). As a group we toured the village with tutors pointing out areas of interest. The village suffered terribly when the plague hit and as a community took positive action (potentially to their detriment) to avoid onward passage of the disease.

We saw the homes of those who had passed away and the innovative methods of intervention that the villagers put into place to avoid passing the disease on.

The sad tale of the residents of Rose Cottage

A definite improvement in the weather here! Students at the Boundary Stone

We visited the church and graveyard where a beautiful window has been installed commemorating the sacrifices made by the people of Eyam, and also displays showing some interesting facts and anecdotal stories of individuals…needless to say we were impressed with Margaret Blackwell’s accidental cure!

We were impressed with Margaret Blackwell’s accidental cure!

The beautiful window in the church in Eyam, commemorating the sacrifices made by the villagers

The afternoon of this first day was spent doing group work in the classrooms at the hostel, this involved research and working together to create presentations telling the story of the plague and exploring the implications of the villager’s choices. It was a great opportunity to work together in a relaxed environment, fortified by many cups of tea and the beautiful views from the classroom windows!

Beautiful views from the classroom windows

After dinner in the hostel it was onto the evening activity, which consisted of a rousing game of Pandemic! I had never played this boardgame before and after we were all initially confused by the YouTube video of instructions that never seemed to end, we decided to get on and have a go. Turns out we weren’t too bad and were soon working together to save the world (Disclaimer: we probably need another couple of practice games before we could actually save the world!).

Day 2 saw us back in the classroom working in groups to look at the modern-day issues around Plague, we were really surprised to find out that there are still significant pockets of it about, and to look at government and health agencies approach to tackling this. It was great way of looking at global inequalities and their impact on population health.

After lunch there was just time for look round Eyam’s museum which has so many interesting displays and resources on plague in the village. It was a useful way of consolidating what we had learned and seeing some effective visual representations of the spread and reach of disease, including really personal stories.

17th Century Plague doctor with protective suit (waxed fabric overcoat, a mask with glass eye openings and a beak shaped nose, typically stuffed with herbs, straw, and spices)

The trip was a great success and we found it so useful to see public health in action through history. It was a great opportunity to spend some quality time together and definitely helped to bond us as a group, which will hopefully stand us in good stead for our next assignment where group work is vital.

The combined effects of prenatal alcohol exposure and childhood trauma: findings from a four-year research project at the University of Salford.

By Alan Price, PhD

Foetal alcohol spectrum disorder (FASD) is the range of conditions that can be caused by prenatal alcohol exposure (PAE). People with FASD can have a wide range of physical and mental difficulties, especially with planning, attention, impulsivity, coordination, social communication, emotional arousal, and memory. These difficulties can impact daily living, school, work, social relationships, and long-term health and wellbeing. In the UK, it is estimated that at least 3%, and possibly up to 17% of the population would qualify for a diagnosis on the foetal alcohol spectrum, although the majority will never be diagnosed. FASD has been known about for several decades but does not yet receive appropriate attention in schools and universities, meaning that many doctors, teachers, social workers and other professionals are not trained to spot the signs of FASD. This can leave children and adults with FASD struggling with the academic and social demands of everyday life without the support they need. Unsupported, people with FASD are more likely to be excluded from school, lose their job, struggle with addictions, and be convicted of a crime. FASD is thought to be especially common in looked after and adopted children and care leavers. Many of these individuals also have histories of traumatic experiences such as abuse or neglect in early childhood, which are also known to lead to developmental difficulties similar to those seen in FASD.

I came to the University of Salford in 2015 to conduct research on the combined effects of PAE and childhood trauma. The project was offered as a funded PhD in partnership with the National FASD clinic in Surrey. I had just completed my degree in psychology and already had some experience in alcohol research, but like many others I had never heard of FASD. The first stage of the project was a thorough review of the published literature on FASD and trauma. I was surprised to see that very little research had been published on the combined effects of both exposures, only five studies in fact, but there did seem to be an interesting pattern of results emerging. Taken together, the studies suggested that children with both PAE and trauma were functionally similar to children with just PAE but tended to have more difficulties than children with just trauma. This suggests that, where children have both exposures, PAE is more likely to be the primary driving force behind those children’s difficulties. The published studies had tended to focus on speech, language and communication, but other areas of functioning still needed to be addressed. Therefore, during the next stage of the project I conducted studies into brain functioning, intelligence, working memory (the ability to hold and manipulate information in the short-term), inhibitory control (the ability to stop oneself from performing an action that feels natural), empathy (an understanding of the perspective and emotional state of other people) and behavioural difficulties in children with PAE, about half of whom also had a history of trauma. I was interested to see whether the children with both exposures had similar or more severe difficulties than the children with just PAE.

Using a brain-imaging technology, functional near infra-red spectroscopy (fnirs), to look at brain activity

Since FASD is largely a hidden condition, I suspected that recruitment of participants would be challenging. Most of my participants were recruited via social media, especially online FASD support groups, which had been set up by families affected by FASD to provide mutual support and information. In order to access as many participants as possible, I used an anonymous online questionnaire to ask parents and carers about their children’s PAE, trauma, empathy and behavioural problems. The strategy worked, and 245 parents or carers completed the questionnaire, many more than I had expected. As well as UK respondents, many were from the United States and Canada, which reflected the populations of the online support groups. To make as much use as possible out of the participants, I invited the UK respondents to bring their children in for some further assessments. Many of the families lived outside of the Greater Manchester area where we are based, and I only had funding to offer £10 for travel expenses, but an amazing 25 families affected by FASD came into the university, some travelling hundreds of miles at their own expense to get here. In the lab, I used a brain-imaging technology called functional near infra-red spectroscopy (fnirs) to look at brain activity, a standard IQ test to measure intelligence, and puzzles to assess working memory and inhibitory control. Finally, I also conducted interviews with 12 parents and caregivers, to explore their experiences of raising a child or children with FASD.

The results of the questionnaire and lab studies between them supported the findings of the literature review. Children with both PAE and trauma had similar brain activity, intelligence, empathy, inhibitory control, and working memory to children with just PAE. In terms of behavioural difficulties, children with both exposures had a slight tendency to have more severe conduct problems than children with just PAE, but their emotional functioning was similar. The studies also showed that children with PAE have high levels of childhood trauma, severe behavioural difficulties and poor empathy compared to typically developing children, although intelligence, working memory and inhibitory control were within the average range. In the interviews, parents’ experiences were fairly consistent, and there was little difference between the experiences of parents of children with and without trauma. I asked parents about their children’s behavioural difficulties, which I expected would be described as stress inducing. This was the case, although parents also described many positive experiences. However, even though I didn’t specifically ask, every family described some level of stress caused by dealing with service providers. Doctors and other healthcare workers often didn’t understand and were unable or reluctant to diagnose FASD. Adoption agencies and social workers were accused of playing down the impact of PAE in order to secure a placement, then leaving families to deal with FASD with no specific support or training. Parents and children were offered services designed for trauma and attachment issues, even when children had no history of trauma. There was a widespread lack of understanding and lack of services designed to deal with FASD, and this seemed to be the most stressful part of their experiences.

Alan presenting his research at EUFASD 2016

Taken together, the results of the published studies, questionnaires, lab studies and interviews show that children with both PAE and a history of trauma appear to function similarly to children with just PAE and tend to have more severe difficulties than children with just trauma. Therefore, the difficulties seen in children with both of these exposures seem to be primarily caused by PAE rather than childhood trauma. Based on these findings, my recommendation would be that children seen in care, school, or in a medical setting, who have both PAE and a history of trauma, should be thought of more as a child with FASD than a child with a history of trauma. The trauma absolutely should not be overlooked, as it will definitely have had an impact, but in terms of interventions, therapies and strategies, those designed specifically for FASD may be more effective than those designed for trauma. These conclusions have led to a new project; my colleagues and I are currently developing a parent training programme designed specifically for FASD issues, something which is currently missing in the UK. The full thesis is available in the University of Salford institutional repository.

Twitter: @alandavidprice1

Email: A.D.Price2@salford.ac.uk

My PhD Journey, by Dr Faye Prior

My PhD journey started when I joined the University of Salford in 2015. Before this I had completed a BSc in Sport & Exercise Science and an MSc in Clinical Exercise Physiology, followed by several years working as a researcher in the health technology industry. Along the way I had also completed qualifications in gym instruction and exercise referral instruction. Therefore, the planets aligned well when an opportunity arose to complete a PhD about exercise referral schemes, combining research experience with personal interests.

Exercise referral schemes are one of the most common approaches to increasing physical activity levels in people with long term conditions, providing access to individualised exercise programmes and support from qualified exercise professionals. There are hundreds of these schemes operating across the UK, illustrating their popularity as a method of physical activity promotion. However, the evidence base underpinning the effectiveness of these schemes to-date has been poor. The aim of my PhD was to contribute to this evidence base, by evaluating Tameside’s “Live Active” exercise referral scheme.

Fortunately, the scope of my PhD was quite broad, meaning that I could develop and practice a wide range of research skills. The majority of my data was quantitative, some of which was secondary data collected by the scheme, and some of which I collected using accelerometers. With so many different types of data, I found myself conducting several types of statistical analyses, from simple to complex statistical tests, several of which I was trying for the first time! Fortunately, I was able to take a break from all of this quantitative data, by conducting a qualitative study. This was the most enjoyable chapter for me, and in the end, turned out to be a very important chapter, revealing findings that were central to my final conclusions.

Margaret and Faye — Dr Faye Prior with supervisor Dr Margaret Coffey at graduation

In March 2019 my PhD journey came to an end, when I successfully defended my thesis at the viva. Following this, I was fortunate enough to be offered a position as a senior research associate at the Equality and Human Rights Commission. Health inequalities were an important consideration in my thesis, and have always been an area of interest and motivation, so this is a fantastic opportunity to explore equality and human rights more broadly. I have no doubt that I would not be in this position, if it were not for the research and transferable skills that I developed throughout my PhD, with the help of my fantastic supervisors, Dr Margaret Coffey, Dr Anna Robins, and Prof Penny Cook. By the end of your PhD, you will have developed more skills than you may realise, some of which will be quite broad and highly valuable, and you must not forget this when planning your next steps after the PhD!

Of course, for myself, and many other students, the PhD journey provided an opportunity to experience and practice more than just the intricate details of research study. Throughout the three years I attended several conferences, both home and abroad, sharing the findings of my research through posters and oral presentations. I also met several other researchers at these conferences, with the same research interests as myself. It has been great to stay in touch with these people, to discuss our research, provide each other with feedback, and some have been kind enough to invite me to collaborate on their work in the future. It was also great to complete this PhD with a partner organisation, Live Active, where I got to develop my stakeholder engagement skills, and attempt to influence practice with my research findings!

Improving sanitation in Ugandan schools

Teams4U is a charity that brings volunteers from the UK to make a difference in children’s lives in countries including Bosnia, Belarus, Romania, Sierra Leone and Uganda. This was my third visit with Teams4U to the Mukongoro district of Kumi Region, Uganda, to participate in their work with schools to improve public health. In recent months Teams4U’s attention has focused on reducing the days missed from school due to sickness and diarrhoea. An intervention to improve hygiene and sanitation has been developed.

Basic sanitation

There is no water supply or electricity supply to the public schools, although there is typically a hand pump installed at the perimeter of the school grounds, which is shared resource for the school and the local public. There are usually three or four pit latrines for the children to use. The latrines often have no doors for privacy and used by around 1000 children, making the smell and flies unbearable. There is no source of water nearby for hand washing.

When children are at home, there are also often no hand washing facilities. Each day water is carried from the nearest hand pump and stored in water containers for cooking and washing, but many homesteads lack a drum with a tap for easy hand washing. Some families are not aware of the importance of hand washing to prevent disease.

Sanitation solutions

A ‘Tippy tap’ is a contraption that is simple to make with a small water container, rope and wooden supports. A child can easily tip the drum to let the water out by using the foot operated lever. They are suitable for use at a homestead. Some schools have been using them, although a single tippy tap is inadequate for the typical school which has over 1000 children.

With support from the Welsh Government, Teams4U have begun to install simple hand washing facilities, comprising a large tank with two taps and bars of soap on string. These tanks can store sufficient hand washing water for a whole school. They still require filling by hand, but schools arrange teams of children to carry water from the pump to the tank as part of their daily chores. The tanks can be drained during holidays to allow them to be cleaned. Some schools fill their tanks with soapy water to get over the problem of soap bars going missing.

Hand washing using a new tank supplied and installed by Teams4U

The Teams4U installation also includes ‘toilet flappers’ fitted to each of the long drop latrines and signage about hand washing on the walls. The toilet flappers are simple devices that remain closed to seal off the odours and stop flies from entering the long drop. They function similarly to the flaps in the portable toilets that are used in festivals in the UK.

Volunteers get involved

The whole school also watched as Teams4U volunteers acted out a hand washing story about a Ugandan boy who does not wash his hands and becomes ill. In the story he then learns about hand washing and when to wash hands. The story features the family’s naughty goat, who causes great hilarity amongst the children when he runs amok. The use of the tippy tap is demonstrated, and the boy learns how and when to wash his hands properly. He learns to wash his hands after handling animals, after using the toilet and before meals. He finds in the future he is no longer ill.

Volunteers performing the play for the whole school

As in previous trips, the Teams4U volunteers visit a school each day for seven days. The morning activity is a physical activity intervention where all 1000 or so children take part in simple team games. In the afternoon, there are sessions for the older children that focus on puberty, development and respect for women. These have been the subjects of my previous blogs. There is also an opportunity for volunteers to play with the children. The challenge is to think of activities that overcome the language barrier and can be done with hundreds of children at a time! Successful activities include simple face painting, balloons and bubbles.

Teams4U volunteer face painting to entertain the school children

Click here to see a film of a volunteer entertaining the children with bubbles

https://www.facebook.com/penny.cook.75436/videos/10156365190389821/?t=1

The interventions with the children are supported by an education programme for the key church leaders, health care workers and senior women teachers. This is supported by funding from the Department for International Development (DFID). The training aims to provide a legacy for the ongoing education of the children in hygiene and disease prevention, dignity and respect, puberty, menstruation and sexual health.

Volunteers supporting the training of the teachers

How do we know it works?

The onus is on the charity sector to deliver an intervention that has a lasting impact. At schools we visited, there is evidence of previous well-meaning interventions that have had no impact. I asked why the schools needed Teams4U’s water drums when some had evidence of large water storage drums. I was told that the drums had been designed to collect rain water, but no one had ever installed the guttering to harvest the water. Boxes containing computers sit unopened in schools that have never had an electricity supply.

In addition to the work to educate local leaders on how to sustain the benefits of the interventions, Teams4U will be collating data on school attendance in the coming weeks in order to determine whether the hygiene interventions have had an impact on absence due to diarrhoea. The aim will be to provide the intervention to all 150 primary/junior schools in the Mukongoro district. The charity has already demonstrated that its puberty and development sessions (‘Develop with Dignity’) are effective: knowledge of menstruation increased after the education sessions, and fewer girls miss school because of their periods.

Girls receiving washable sanitary ware as part of the Teams4U intervention

Get involved

You can join in and help run the sports, ‘Develop with Dignity’ and sanitation programmes. Read more about volunteering opportunities on the Teams4U website. If you come as part of the University of Salford’s BSc Public Health and Health Promotion, you can also help us do research to evaluate the programme during a heavily subsidised 10 day trip (the students pay £200 towards the cost of the trip).

A powerful experience for the volunteers

It is difficult to describe the pure pleasure that these children get from a little attention from the visitors. The impact on the volunteers is also profound as we experience the simple joy that children get from a hand shake or a stream of bubbles. It is also humbling to think how we take our children’s education for granted. In Kumi, there are no staff to clean the school. The sweeping of the classrooms, the fetching of the water and the cleaning of the toilets is all done by the children. Some of the forward thinking schools grow their own vegetables, and the children also tend to these. In several of the schools we are greeted with songs of welcome. The children also sing songs that describe how seriously they take their learning in order to better their lives. We found this truly humbling.

Children playing team ball games as part of the Teams4U intervention

Studying a Master of Public Health at Salford University through a Chevening Scholarship program: a life-changing adventure by Dr Dimby Sambatra Ismael Rabejaona

At the Chevening official award ceremony in London

My Salford adventure started on August 2017 when I got awarded of the Chevening Scholarship that permitted me to pursue a post-graduate study of Public Health in the United Kingdom. The Chevening Scholarship is the UK government’s global scholarship program, funded by the Foreign and Commonwealth Office (FCO) and partner organisation that aimed to provide opportunities to leader, scholar, researcher and influencer from 144 countries worldwide to fulfil their dream to study in the UK. The application process for this life-changing opportunity was very demanding and competitive but I was driven and strengthened by my desire to experience the best that the UK has to offer in terms of academic life, career opportunities, culture, history, and leisure activities. Therefore, I challenged myself to fulfil all the requirements that was necessary in order to be awarded of such honour to study in the UK, where so many researchers, influencers, scholars, and leaders have shaped our modern world through their astonishing achievement – for example Sir Isaac Newton, Alexander Fleming, Sir Charles Darwin, Sir Alex Ferguson, or John Lennon.

Through my Chevening application process, I had to choose the UK universities that could provide me with the platform to achieve my lifetime project. I, therefore, conducted a thorough search of all UK Universities to find the one that could help me to fulfil my academic and professional goal. My search for the most appropriate university was based on my professional and academic background of public health and occupational medicine. In addition, I was looking for a University that could provide me with the skills and knowledge to strengthen the health system in my country Madagascar, particularly in terms of health at work and well-being, disease surveillance, epidemiology, data monitoring and statistics.

The University of Salford, particularly the Department of Public Health, stood among all UK universities as my first choice. Indeed, during my search for the best university, I discovered that the Salford Department of Public Health delivered a specific module about Health at Work and Well-being led by Dr Margaret Coffey – a well-known and respected researcher in the field of public health. Therefore, I contacted the University of Salford about this module that interested me. The public health team at Salford were keen to enlighten me with additional information through the module leader Dr Margaret Coffey and the programme leader Dr Anna Cooper-Ryan. I was surprised to discover that the module Health at Work and Well-being had been integrated into a particular module called 21^st Century Global public health challenge. This module, led by Dr Anna Cooper-Ryan and Dr Margaret Coffey looked at the challenges of public health on a global scale. Because the Chevening Award represents a global initiative to promote tolerance, excellence in research, leadership and diversity, the choice of the Department of Public Health of the University of Salford became obvious to me as it promotes this global vision of public health by giving opportunities to international students, such as myself, to gather skills and knowledge, and to share my experience of public health among my peers. Definitely, the University of Salford was the place to be to achieve my master’s degree of public health.

With Prof Richard Stephenson the University Deputy Vice-Chancellor at the International Student Scholarship ceremony held at the University of Salford

When I first arrived in Manchester, and I met the public health team, my choice of the University of Salford was reinforced by the level of expertise of the lecturers, the university’s cutting-edge facilities, the amazing students Union, and the International Society activities. In addition, the city of Manchester appeared a vibrant city for the average student, which promoted diversity and tolerance, and provided a wide range of entertainment and leisure. This had a positive impact on my well-being as a student when the master’s study became more demanding. The high level of academic support and the workshops provided by the University of Salford helped me also to achieve a successful academic life.

One of the memorable periods of my academic life in Salford, was our field trip in Eyam when all the teaching staff and the students went on a public health field trip. Not only did the field trip help me to understand in a practical way the “nitty-gritty” of public health and epidemiology, but also permitted me to develop warm relationships with my lecturers and classmates, which strongly contributed to my academic success and well-being later. Apart from the field trip in Eyam, the dissertation project at the end of the academic year was also one of the best moments of my academic life at the University of Salford. During this dissertation project, I had the privilege to work with and to take advantage of the expertise of my supervisor, Dr Margaret Coffey, about the experience of part-time employment in the UK in respect of health and well-being. This project provided me with an in-depth understanding of the challenges that part-time workers might face in terms of health and well-being at work, and the drivers that might explain the level of commitment and satisfaction of the workers for their chosen career. Through this thesis project, I have gathered all the knowledge and skills I needed to go any further in the career of public health with a particular focus on health at work and well-being. In addition, it permitted me to reinforce my research skills and to learn to tackle efficiently all the issues that may occur during a research project that involves a systematic review methodology. I was also astonished by the high level of supportmy supervisor and all the teaching staff provided to me to achieve this memorable success in academic research.

In a nutshell, my academic year at Salford was full of success and was one of the best moments of my life so far. It permitted me to work and to learn from the experience of well-known researchers in public health. It taught me to think outside the box when a public health issue occurs and prepared me to address serenely any public health challenge. This experience helped me to grow, to be more confident, to be bold and to get ready to fight against all form of inequities, inequalities and injustices.