Q&A: MPH student Julia Kizis shares importance of maternal and child health amidst war and conflict

In areas affected by war and conflict, maternal and child health is often compromised due to the destruction of health infrastructure, displacement of health workers, and the inability of populations to access services. 

That has been the case in Yemen, where 46% of all health facilities are only partially functioning or out of service due to shortages of staff, funds, electricity, medicines and equipment, according to the World Health Organization. 

University of Washington Master’s of Public Health student Julia Kizis was one of several students who worked to help support maternal and child health in Yemen through their practicum experience at MedGlobal. 

MedGlobal is a humanitarian charitable non-governmental organization that provides emergency response and health programs to build resilience among vulnerable communities around the world. In Yemen, they operate mobile clinics and health care centers. 

Through the practicum experience, Kizis worked with colleagues to develop a survey for MedGlobal’s health care sites in Yemen to understand the needs of its facilities. In this Q&A, Kizis describes her experiences at the practicum site and the importance of health care supports for populations living amidst conflict. 

Do you remember when you first became interested in public health? 

I took Global Health 101 here at the UW. I knew I wanted to do something in the sciences. My undergraduate advisor recommended that class, and I just loved it because I thought it was so fascinating. I got to learn about things that weren't commonly talked about in other spaces. Now those topics feel so obvious, but at the time, hearing about diseases and how they’re inequitably distributed across the world was mind opening to me. 

From that point on, I decided to pursue public health. 

Why did you decide to pursue an MPH degree at the UW School of Public Health? 

I went to the UW for my undergrad in public health, so I continued straight on. My undergraduate degree provided me with broad, foundational knowledge but I knew at some point in my life I wanted to get an MPH to become more specialized.   

Why did you choose to work with your specific practicum site? 

I took my practicum through (Professor Emeritus) Amy Hagopian’s class. I wasn't originally planning to take it through the class, but she sent out a list of all the projects she had lined up, and I saw some of the projects that MedGlobal was doing. I thought they were fascinating because they were focused on some of the most vulnerable populations around the world. 

Give us an overview of the work you did at your practicum. 

We worked in MedGlobal’s Yemen branch where they were doing maternal and child health. We ended up doing a quality improvement project where we conducted surveys among health care providers that were working in health facilities, and then wrote a report with recommendations for how to improve the delivery of emergency, maternal and newborn care. 

We had very specific questions about access to certain types of medical equipment, supply availability, and staffing levels. These questions were identified through a literature review focused on the delivery of reproductive health services in war settings and through the guidance of our faculty supervisor, Dr. Maryanne Mercer. 

We also spent a lot of time developing the survey to be mindful of cultural differences and get the survey translated. 

What were some survey findings? 

Staff shortages are the biggest one, as well as access to medicines, blood products and oxygen. Survey respondents also talked about staff training. Most staff wanted additional training because they were sometimes pulled from one unit to work on another and then they felt like they didn't have the appropriate training and skills to work on that unit. In general, there was a lot of health facility infrastructure damaged by the war. 

Was there anything you learned that surprised you from the experience?  

I'm in the Department of Health Systems and Population Health, so this was my first global health project. I was surprised by how difficult communication can be; our site supervisor was located here in the U.S., and every time we had a question that she couldn't answer, she had to forward that along to someone that was on the ground in Yemen, so every question took twice the amount of time to hear back. So, that was frustrating for someone who had never experienced that before.  

For our survey, we had to consider that survey respondents might not have reliable access to the Internet. We used a data collection software that didn't require that. The survey was distributed using the software called Kovo toolbox, so while you have to have access to the Internet to open the survey and submit it, you don't need to have continued access or continued connection to fill it out. It was exciting to learn that such software existed. 

Also, there was just the general shock of how few basic resources were available to the health facilities, coming from someone in the American context. 

Why is it important to understand the impacts of conflict on public health? 

Conflicts can impact public health in many ways, and I think knowledge of those intricacies is important. For this project, there were several additional aspects we had to take into consideration than I had previously experienced as a student studying health services. For instance, there was no system for transporting patients to a higher level of care if basic emergency interventions didn't work. On a larger scale, such as across an entire country in conflict, this can impact public health. 

What impact do you hope this type of work will have on maternal and newborn health? 

I think that maternal and newborn health is something that's often overlooked when it comes to emergency situations or ongoing war conflicts. I think that other areas of health care are prioritized, such as the control of infectious disease or treating trauma, and maybe rightfully so, but it’s important to not forget about the maternal and child health needs in these areas. The surveys we created can help MedGlobal when deciding how to distribute its resources as well as seek funding to meet the identified needs. 

What do you hope to do with your degree after graduating? 

I don't think I'm going to continue in global health, but I would probably look at something U.S.-based. I would like to continue doing some type of quality improvement projects or safety within health care systems or at a governmental level. 

Are there any public health questions you're curious about pursuing in the future? 

Although there are myriad differences between the Yemen and U.S. healthcare context, one commonality is that health worker shortages are one the most pressing issues. I am curious about finding a solution to the health worker shortage that satisfies all stakeholders, in the future.