Fellowship provides students with opportunity to do summer practicums that focus on building relationships and collaborating with local communities.
September 6, 2024 – For several weeks this summer, primary care doctor Meena Hasan worked at Creative Minds Academy, a nonprofit in Clarksdale, Mississippi, that runs a program aimed at tackling chronic disease at the grassroots level by offering older residents a community-based health and nutrition curriculum, dance fitness classes, and cooking classes. Every morning she’d meet with the same 25-30 women, and they’d talk about nutrition, disease prevention, and whatever health concerns were on their minds, from understanding disease diagnoses to improving diet. After their discussion, the group would take a dance fitness class together.
“I was there chopping vegetables, cooking, and eating with them during our healthy cooking sessions. And I was there every day learning the dance moves with them,” Hasan said. “I worked to build trust over time, wanting to ensure that they felt comfortable learning from me as a health care provider.”
Hasan, MPH ’25, was working on a practicum project in Mississippi as part of the Herbert S. Winokur, Jr. Fellowship in Public Health for the Mississippi Delta at Harvard T.H. Chan School of Public Health, established through a generous gift from Herbert “Pug” and Dee Winokur. Said Hasan, “This practicum really helped me understand who the people in the Delta are and the challenges that they’re experiencing—the legacy of slavery and racism, and how it manifests now in health inequities between racial groups.” Working with the community, she said, has been “a life highlight.”
Other 2024 Winokur fellows doing summer practicums in Mississippi included Rediet Bayou, MPH ’25; Meghana Iragavarapu, MPH ’24; and Brynn Macaulay, MPH ’25.
Harvard Chan School is a member of the Delta Directions Consortium, an interdisciplinary network of individuals, community-based organizations, academic institutions, and foundations all working together to enable positive change in the multistate Mississippi Delta Region. Through the Winokur fellowship, started in 2020, students spend 8-10 weeks in Mississippi working with community organizations that are addressing health, economic, and social inequities. The program focuses on the rural Delta region—one of the poorest areas in the U.S., with some of the poorest health outcomes.
“For public health professionals, the experience of working in the Delta offers more than what statistics tell us about poverty and need in the region,” said Jocelyn Chu, instructor and director of community engaged learning in the Office of Educational Programs. “In Mississippi, our students can see for themselves the realities of what they’ve read about or learned in lectures, as well as have the opportunity to work with and learn from amazing people who, despite difficult odds, are making a difference.”
Chu added, “The goal of the fellowship is for students to learn about building trust and collaborating with communities. They have technical skills and expertise that they’re equipped with in the classroom, but those are really not going to be valuable if the students don’t have equitable and authentic relationships.”
Supporting foster youth
Bayou, who focuses on child health policy, spent her fellowship at the Jackson-based Children’s Foundation of Mississippi. There, she worked on a strategic research and development plan for youth transitioning and aging out of foster care in the state.
“When you’re 18, you’re still trying to figure out life. For youth transitioning out of foster care, if they don’t have enough support, it creates instability as they move into adulthood. Having adequate support in areas such as mental health, housing, financial literacy, and education is essential,” Bayou said.
During her work, Bayou interviewed a wide range of stakeholders involved in the child welfare system, including the commissioner of the Mississippi Department of Child Protection Services (MDCPS), social workers, therapists, judges, and directors of community organizations. She identified a need for more mental health services and for improved collaboration among stakeholders to avoid gaps in youth resources. In the fall, Bayou will have the opportunity to present her findings to leaders at MDCPS.
“In classes, we’ve learned about policy work, but often not about how long it can take, its ups and downs, and its failures,” Bayou said. “What I have gotten from this fellowship experience is if you’re passionate about helping people, it may take years, but you have to continue to advocate for those that you believe should be helped, in order to bring equity in health.”
Training new community health workers
Iragavarapu, who is specializing in nutrition policy, worked during her fellowship at the Delta Health Center in Mound Bayou to improve maternal health care.
To tackle Mississippi’s high rates of infant and maternal mortality, made worse by a shortage of health care providers, the center began training local women without formal health care backgrounds to become maternal health workers, who could support people during their pregnancies. Iragavarapu helped design and teach the training curriculum, which includes medical concepts as well as information on resources such as free childcare and transportation to health appointments.
The curriculum also includes information on how to improve nutrition during pregnancy—one of Iragavarapu’s favorite parts. After she arrived in the Delta, she experienced first-hand the challenges of living in a food desert, as the town where she worked had just one grocery store and mostly fast-food chains nearby. One recommendation she made was to use healthier cooking methods, for example baking catfish instead of frying it.
In her health policy classes at Harvard Chan School, Iragavarapu learned how rural places like Mound Bayou tend to be viewed negatively, in part because of their poor health outcomes. But she hopes to become a doctor in an underserved area, in spite of the challenges.
“We don’t need any more research about how bad rural health is, how bad provider shortages are, how bad the impacts are,” she said. “We need people who will pick themselves up and put themselves in these situations. We need manpower—more doctors, nurses, and advocates invested in uplifting communities.”
Improving maternal and infant health
In her work as a nurse over the past 13 years in a wide range of settings—including in a rural community in Peru, at a major hospital in Oregon, and at Boston Medical Center—Macaulay has seen how social determinants such as financial insecurity can contribute to health problems for her patients. That’s what spurred her to pursue an MPH in global health, so that she could “go upstream … and try to stop these problems before they happen.”
Her fellowship was at the Aaron E. Henry Community Health Services Center in Clarksdale, where she worked on a grant application for a program aimed at streamlining and coordinating care for people who are pregnant or have given birth, as well as their infants. The program would not only connect people with providers for prenatal, postpartum, and pediatric health care, but also address social determinants of health, such as by helping people find jobs and become financially stable.
Macaulay’s supervisor Will Carter, III, a clinical medicine services coordinator at the health center who conceived the program, said, “Brynn took ownership of the project once she understood what the vision was. She helped that to materialize beautifully.”
He added, “It is crucial that Harvard and other universities continue to send fellows and students to the Mississippi Delta, so they can see the lived experience [of the community]. There’s only so much you can read.”
Said Macaulay, “There’s all the professional learning that this fellowship and being in Clarksdale has brought me, but I also feel like I will never be able to repay the personal growth that I’ve been able to do in being here. One thing I really love about this community is the emphasis people place on relationships. Community, togetherness, friendship, and connection are values here.”
– Jay Lau
Photos courtesy Brynn Macaulay, Meghana Iragavarapu