Queen Elizabeth Scholar: Insights from Fanny Cheng

– [James] Welcome everyone to our last QES webinar of the fall term. We’re coming to you from
McMaster Health Forum at McMaster University
in Hamilton, Ontario. I will give you a quick rundown of the McMaster Health Forum,
our scholarship programme and our new scholarship programme and then I’ll turn it over to our two Queen Elizabeth Scholarship
presenters today, Fanny and Mijia, who will tell you about their experiences in Australia and Uganda respectively. The McMaster Health Forum is a aims to be the leading hub
for improving health outcomes through collective problem solving. We harness information,
convene stakeholders and prepare action-oriented leaders to act as an agent of change
by empowering stakeholders. The Queen Elizabeth Scholarship Programme is run by a partnership between
the Rideau Hall Foundation, Community Foundations of
Canada, Universities Canada, and individual Canadian universities. The purpose of the
programme is to activate a dynamic community of
young global leaders across the Commonwealth
to create lasting impacts both at home and abroad through
cross-cultural exchanges, encompassing international education, discovery and inquiry, and
professional experiences. The version of the Queen
Elizabeth Scholarship programme hosted by McMaster Health Forum is called Strengthening Health Systems. Our scholars contribute to
strengthening health systems and become part of our large and growing network of
health system leaders. Our old QES programme is now ending. Mijia and Fanny, who are presenters today both come from that older programme. We now have a new programme. We are one of 20 Canadian institutions to be given a new QES programme that will run from 2018
to the end of 2021. Our new programme is called the Queen Elizabeth Scholarship programme in Strengthening Health
and Social Systems. And because of the slightly new focus there are a few changes
to our new programme. So I’ll just point those out to you now. First of all the location of
the internships has changed. Before we could only send students to Commonwealth countries. That has now been expanded
to include Commonwealth plus low and middle income countries. Because of this our
partners have also changed. So our partners from our old programme are carried over to our new programme, but we now have new partnerships
in Colombia and Lebanon. And the focus of our internships
have changed slightly. We have now added social systems as one of the focus of our internships. And because of that
our eligible programmes have changed slightly
so all of the graduate and undergraduate programmes that were eligible before are still eligible, but we have now added the
undergraduate programme of Arts and Science. And the number of
opportunities has decreased. In our old programme we sent
abroad or hosted 61 scholars. In this new programme we will
send abroad or host 24 scholars. In terms of our old programme they were divided into three cohorts. Our first cohort primarily went
away or visited us in 2016. We had a mix of incoming,
outgoing scholars and interns. In our second cohort primarily visited us or went away in 2017. You’ll see that we had primarily, most of them were made up
of 20 outgoing interns. And our third cohort of which
Fanny and Mijia were a part, primarily visited us or went away in 2018. Here we had a large group
on incoming scholars who visited us in the summer of 2018, and 15 scholars who have
gone abroad during this year. Our first presenter today is Fanny. At the time of her internship she was an undergraduate student here at McMaster in the Bachelor of
Health Sciences programme specialising in Global Health. During her internship Fanny
hoped to gain insights on where, how and why Ontario
and New South Wales differ, and how they address similar
health systems issues. She also wanted to see
kangaroos and learn how to surf. So those are her
aspirations before she left. We’ll see how she successful she was. Fanny is currently a
student in the MD programme at the University of Toronto. So thank you for making
the trip down to Hamilton and Fanny, I’ll turn it over to you. – [Fanny] All right, thanks
James for the introduction. So thank you for coming out. As he mentioned I will be talking about my time in Australia. So specifically I travelled to Sydney, which is located in the
state of New South Wales. Fun fact, the flight time
was 29 hours and 10 minutes. It was a lot of layovers, a lot of planes, a lot of airports. And before I kind of talk about
the sort of work that I did in health system strengthening, I think it’s worth
comparing the health systems of New South Wales and Ontario. So first of all the population. So New South Wales has approximately half the population as Ontario. And in Ontario in terms of
the health system structure, we do something that’s called public financing and private delivery. So if you need any medically necessary or physician provided services, then essentially the government will kind of pay for that. So all of our taxpayer
money kind of goes to that. However, in New South Wales, they actually have a
really interesting system, which is like a two-tier health system, in which they have an entirely
separate private network of hospitals and doctors. So if you do get sick you can either go to a public hospital or to a public doctor and have that be covered
by the government, or you can go to a private doctor or private hospital and
have that be covered, either by your private insurance or be covered through
out-of-pocket payments. And despite these differences we do share a lot of healthcare challenges. So first of all we do have issues with rural health access. So for instance, Ontario
we do have a lot of people living in the GTA, Hamilton, near the border with the U.S. But we do also have a
substantial population living way, way north where
there aren’t as many facilities or opportunities to access care. And it’s the same thing
with New South Wales. So out of that 7.5 million
there may be five million that are living around Sydney. And so this creates a lot
of challenges in ensuring that the other 2.5 million people get the coverage that they need. Both of these states,
Ontario and New South Wales, we also have a significant
indigenous population and we can see that there are
significant health inequities between the non-indigenous
and the indigenous population. And lastly, we both face a significant chronic disease burden. So I’m talking about
cardiovascular disease, cancer and also obesity. So actually New South Wales, one of their main priorities right now is
to address childhood obesity. So due to the similarities often times we will kind of look
towards New South Wales to see what they’re doing to
address some of these issues, and see whether or not we
can adopt that in Ontario. So while I was there I actually worked with two different organisations in partnership with each other. So three days of the week, on
Tuesday, Thursday and Friday, I was working with Dr. Andrew Milat in the evidence and evaluation branch of the New South Wales Ministry of Health. And then for the other
two days of the work week, I worked with Karen Lee
who is a research officer at the Australian Prevention
and Partnership Centre. So that was actually located
at the University of Sydney. And while I was there I worked
on many different projects, but I’m only going to focus on major ones. So the Scalability Assessment Tool Study, the Scale Up Reporting Tool and some of the training
that I did in public health. So at the Ministry one of
the most fantastic things about my experience there were that there were so many opportunities to learn more about public health. So every single month
they would, you know, give us free breakfast
and invite some speakers to come in to talk about things like the health of the LGBTQ plus population, the homeless population,
we once had a debate about whether or not
legislation is necessary to keep people healthy. Really interesting findings there. And even a conference on e-cigarettes. But probably the highlight
of my internship experience was the rural health training week. And so the Ministry was kind
enough to actually fly me out to a rural city, Ballina. It’s not even a city actually. It’s a population of 25 thousand people. But the point was to spend a week there and kind of learn about
the different challenges that people living in
rural New South Wales face. So we had an opportunity
to visit a hospital in the nearby town of Maclean. Talked to one of the two doctors that work in that hospital, and look at the challenges that they face in terms of trying to provide care for all these people while
having very limited resources and also the bureaucracy that comes with trying to figure out
how to transport patients to facilities that might
have better, I’m sorry, to other hospitals that
might have better facilities and be able to deliver more complex care. We also looked into the
issue of flying fox bats. And that might seem
like a very random topic but I think it’s actually
a perfect example of how health can really
connect to other fields, and how an issue can be
really multi-faceted. So specifically, there are
these flying fox colonies that have set up shop near
a lot of these rural towns. And unfortunately they carry things like the Hendra virus and the Lyssavirus. I think the Lyssavirus is
also known as rabies actually. And these can be deadly to humans. There are also issues with sleep, so if there’s a colony that’s
really close to your house, then you know, they’re nocturnal and they can make a lot of noise at night and prevent you from getting good sleep. There are also issues with
contamination of drinking water and their destructive effects also kind of extend to economic effects. So loss of crops because
they love eating fruits. And loss of horses. So a lot of these people
actually keep horses as pets. But the issue is that we
can’t just cut down the trees and drive them away
because they’re also listed in the endangered species list. So you can’t really disrupt
their habitat at all. And even so, if you wanted to move them to another place, the question is where? Because a lot of their
habitats like the rainforest had actually been cut down. So we actually sat in on a
bit of a town hall meeting where we got to listen
to different people, like an environmental
activist, or a school principal with the school being located near one of the bat colonies try and, like, talk to each other about
how we can move these bats or if there are any other solutions that can both promote the health of humans but also keep these bats safe. So the next thing I wanted to talk about was my involvement in the
Scalability Assessment Tool Study but before I go into that,
I think it’s important to define a few terms. So implementation science
was basically the field that this whole study was in, and that refers to the study of methods that promote the systematic
uptake of research findings and other evidence-based
practises into routine practise with the hope that this
will improve the quality and effectiveness of health services. So it’s really practical of a field because what’s the point of
generating all this research if it’s not being
implemented or used properly. And specifically within
implementation science, I was looking at scaling up. And scaling up refers to efforts
to expand an intervention that was shown to be
efficacious on a small scale to a greater proportion of the population. Once again, very important
because we need to figure out, first of all, which
interventions are worth expanding and how do we maintain the
same level of effectiveness that was seen on a smaller scale when we expand it to a greater
proportion of the population? Because often times when
we do that expansion, we don’t have the same resources, resource intensity as before. And we also have to start
factoring in things like is there political support for this? Are there, you know, capacity
for training, et cetera? So when it comes to developing
an intervention all the way to disseminating it to the population, first of all, there is four steps. So you know, the
development of the programme through either research or looking at what other jurisdictions have done to address this issue in
similar interventions. Then you usually test it in a pilot phase under some tightly
controlled circumstances, like maybe only at one or two sites. Then you do a real-world trial if the efficacy testing
has proven good results. And usually this is across more sites and in less controlled settings. And then finally, if that
also produces good results, then you start disseminating
that at the population level. And this seems really neat and logical, but unfortunately in the real world, that’s not always the case. So yes, sometimes population
health interventions are, do go through all four of these steps. But sometimes they skip
the efficacy testing. Or sometimes they skip
the real-world trial and go straight into dissemination. And there are actually
quite a few interventions that go straight from the development to implementing it population-wide. So that’s called at scale dissemination. But no matter what stage or process that this intervention goes through, at some point during this
process people are going to ask, “Should we scale up?” So, “Should we put more resources “and should we expand this intervention “to a greater proportion
of the population?” So our tool was basically
this study was trying to devise a tool that
would help policy makers make this decision in
a more systematic way. So what kind of factors should we look at when we look at scaling up? And how can we make sure that
when we make this decision that it is evidence-based
and we’re considering all of the factors that we should? So a previous QE scholar, Paddy Sreeram, actually began this project
in the previous summer before I went in 2017. And so when she was
involved with the project, they were at the beginning stages and they first consulted
a few people who worked in the field of scaling up or in population health interventions. And they asked questions like “What kind of factors do you consider “when you decide whether
or not to scale up?” And, “What should be included “in a scalability assessment tool “that will potentially help people decide “whether or not to scale up?” And from there they decided to… Sorry, they drafted a tool. So this was a draught tool
and they looked at things like for example evidence
or resources available. This obviously is a very, very rough and abbreviated version of it. And then that was when I began getting involved with the studies. So we used this draught tool and we gave it to about 20 other people who also worked in the field. And we asked them questions like, “What kind of changes should
we make to the draught tool?” And we also asked them a
lot about interventions that they were involved in, and we asked them how
their project was approved, who was it approved by, the process. And I have to say, I was involved in sitting in at the interviews and cleaning up the transcripts and doing some qualitative analysis, but it was really, really valuable just even being able to
be in the interviews. Because these people, they kind of have the insider perspective on things. So often times, you know,
as a citizen of Ontario, I do question why the government decided to design a programme in this way, why they decided to drop this
programme versus another one. So to get their perspectives
was definitely a privilege. And as well I got to learn about many different interventions
that New South Wales was pursuing to address issues that are also seen in Ontario. So for instance childhood obesity or adult obesity, or indigenous health. So that was also very valuable and it did give me quite a few ideas in terms of what we could
implement here in Ontario. Then the last project
that I want to talk about is a Scale-Up Case Reporting Toolkit. So I don’t know if you’ve ever heard of the consort reporting guidelines, but the idea there is
that the consort tool was made so that we can systematically, how do you say, standardise the reporting of randomised control trials to ensure that they are
reporting the things that needed to be reported. So we wanted to do something similar with scale-up case reportings. So unfortunately there are a lot of issues when it comes to reporting on
scaling up of interventions. So for instance, they’re
not really indexed with the keywords
associated with scale-up. So if someone were to go into PubMed and try and look for articles, they’re not going to find those articles because they don’t use the right keywords. Or they focus on describing
the characteristics of scaled up interventions, but they don’t really
talk about the process of scaling up itself, which
can be very, very key. And because when you are looking at scaling up interventions
in another jurisdiction, one intervention might work really well in New South Wales but we
can’t exactly implement it in Ontario just as it was implemented in New South Wales because
there are differences between the population. And looking at the process
of how they scaled up can really help us make sure that if we were to implement it that
it is going to be effective. So ultimately there, of
course from these deficits in the literature, there are issues with finding the right evidence and replicating the
successful interventions. So I kind of did a little bit of literature research
and looked up very similar or existing tools. So those lists of acronyms, et cetera, those were the tools I found. I only found one or two tools that actually addressed
what we were looking for. So as a matter of really pulling out the relevant information
from the other tools, and creating a tool that
would help people writing up these case reports, include
the right information. So we actually sent this
tool to other people working in several population
health interventions. We’re writing up the results and they’re going to take a look at it. Hopefully they will find it useful and maybe we’ll publish it in the future. So that was all the academic work I did. I also kind of want to talk
about the fun things I did. So one thing I had loved doing was documenting all the differences between Canadian culture
and Australian culture. Now Sierra Leone is probably one of the most similar
countries to Canada. But there are a lot of
different things that I found. So for instance they drive on the left. So I had to stop jaywalking
because there were many times in which there was a very near miss because a car would be driving on the left and I would be looking
towards the left to see… Anyway it was really complicated. They also call mosquitoes ‘mozzies,’ they called McDonald’s ‘Mackers.’ Their calendar started on a
Monday instead of a Sunday. So all of these small little differences I found really interesting. And I also took a few photos;
I got into photography. So for example, this is the
view outside of my bedroom. I was very lucky to be able to live in a place that overlooked the river. And that’s the night skyline as seen from my kitchen balcony. And there was also this
winter festival called Vivid. So every day after about 6:00 p.m. all of these different art
installations come to life. And it was all about creating
this light night show. So that is actually
the Sydney Opera House, absolutely gorgeous. And those are fireworks
on a random Monday night as part of the light festival. It was actually quite a scare because we weren’t quite sure what the bangs were at first. And they didn’t really have
squirrels or pigeons there, but they had these beautiful birds. And I’ll be honest, I
would take these birds over squirrels and pigeons any time. This is actually taken
outside of my work place. And I also did quite a bit of travelling. So Andrew and Karen were kind
enough to give me days off so that I could go explore Australia. I went down to Melbourne
and the Great Ocean Road and also went up to the Gold Coast to watch Chloe, another QE scholar, run her marathon, her
half-marathon, sorry. And she did it in a fantastically
record-setting time. Anyway, it was great opportunities to see the southeast coast. And some more photos. So that’s actually the Blue Mountains. I know that when people picture Australia, they think about deserts, but
there are quite a few ranges in terms of wildlife and
what nature looks like. So this is a mountain range near Sydney. And this is Chloe, the QE scholar and me at the Blue Mountains once again. My friend also came over
and we visited Melbourne, we took a lot of great photos, and we also decided to go skydiving, because why not? You’re in Australia, once
in a lifetime opportunity, six thousand dollars,
might as well spend it in a way that is pretty fun. And lastly, of course, as James mentioned, one of my aspirations
was to see a kangaroo. So I did see many, many
kangaroos actually. Here is one photo of me
approaching a kangaroo. It was crazy because
there were these parks, or kangaroos are so common in Australia that you could just walk
through a park and see a bunch grazing around or fighting each other. And one of my friends actually went onto a golf course to play some golf, and found kangaroos just lying everywhere and disrupting their game. So that was also a pleasant surprise. So that is it for my presentation. If anyone wants to contact me with regards to my experience, I have
included my email on this slide. Thank you for listening. (applause)

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