Community Needs Assessment

For all to enjoy, here's a copy of my community needs assessment, done on the recent health fair in North Miami Elementary School:

COMMUNITY NEEDS ASSESSMENT

Community Health Nursing Fall 2006

1. Location: North Miami Elementary School

Date: November 4, 2006
Instructor: Marie Etienne/Marie Anglin
Activity: North Miami Elementary School Health Fair – Disease Screening
Health Issue(s): Diabetes/Hypertension/Women’s Health

2. What are the demographics of the population in the community that you will be addressing with this activity? (gender, race, ethnicity, age, group, etc.)

City of North Miami[1]:

31.8% of North Miami residents are between 25-44 years of age.
19.6% are between 45-64 years old.
Average age is 32.
The median income for a household in the city was $29,778, and the median income for a family was $31,760.
About 20.7% of families and 23.9% of the population were below the poverty line, including 29.5% of those under age 18 and 17.2% are 65 years old or over.
Ethnic Mix: 34.81% White, 54.89% African American, 0.32% Native American, 1.92% Asian, 0.05% Pacific Islander, 3.16% from other races, and 4.85% from two or more races. Hispanic or Latino were 23.16% of the population.
North Miami is known for its large Haitian-American population. In 2001, voters made Josaphat Celestin the first Haitian American mayor of a large Miami-Dade County community.

3. Prevalence. What are the risk factors facing this population(s)? What is the prevalence of this particular health problem among this population?
South Florida has a large and growing number of Haitians, particularly in North Miami. Unfortunately, Haitians are greatly affected by chronic illnesses that affect many groups of African descent: diabetes, hypertension, breast and cervical cancer. Data on the prevalence of diabetes and hypertension among North American Haitians are difficult to assess because they are categorized under “African American”. From what we do know, cancer, tuberculosis, and HIV are some the most prevalent diseases of Haitians who’ve recently emigrated from Haiti. From 1979-1984, among Haitian women, cervical cancer accounted for 39% of all cancers. Approximately 50% of Haitian women get pap smears compared to 25% of English-speaking Caribbean Americans and 10% of US-born blacks[2].

4. Identify some of the major health problems that this particular community faces.
Haitian Americans are at risk for contracting high-morbidity diseases such as hypertension, diabetes, breast and cervical cancer. This in part due to hereditary influences, as most groups of African descent are at higher risk of having cardiovascular disease from ages 30 and over (and in some cases, children are now having cardiovascular problems). Contracting STDs and HIV/AIDS is also a major problem in this community, as Haitians do not have the resources and the awareness of information that can prevent the spread the STDs. Tuberculosis is a major health problem in most Latin American countries, primarily due to the highly contagious rate of this disease and it’s similarities to other respiratory problems.

5. Why do you think that this community needed this educational program/health screening/other?
There is a lack of health resources available to Haitians, in particular for those who fear losing their residency status. The median income level of North Miami residents is about $29k with about 24% of the population below the poverty line. This population doesn’t have the financial resources to seek out preventative health care from health care professionals. Language barrier is also an issue, as the majority of Haitians speak Haitian Creole – it’s important to have health care professionals who can speak to them in their own language and building trust in the health care system.

6. Could you assess the community’s knowledge of your health issue during the activity? After the activity?
Unfortunately I was unable to obtain objective information through use of a survey. However, I was able to obtain subjective information from the blood pressure screening. The majority of the adults I screened (about 70%) had high blood pressure and didn’t know it. About 90% of the adults were more interested in knowing their blood sugar and cholesterol levels, stating that they could have their blood pressure checked at local supermarkets. Half of the women waiting for blood sugar and cholesterol results were interested in having a mammogram and pap test. Unfortunately, very few women were interested in learning how to do a breast-self examination.

7. How will your activity influence the long-term health of this community?
Our intention is to increase the Haitian community’s awareness of risk factors for common, chronic diseases and to detect certain cancers early for effective treatment. I believe the knowledge that H.A.N.A. and Miami Dade College provided to the community encourage them to reduce their risks by changing poor nutritional habits (high salt and sugar intake) and keeping appointments with local doctors and the Miami Dade County Health Department for routine screenings.

8. In your opinion, what are the specific needs of the populations as a community?
The Haitian community’s main obstacles to healthcare would be communication. It is essential that the Haitian community has health care professionals who not only speak Creole, but are knowledgeable about the culture and beliefs of Haitians, especially when it comes to potential conflicts between Haitian folk medicine and western allopathic medicine. This population also needs resources that are affordable, making access to screenings and treatments easier – thereby improving healthcare compliance.

9. In terms of your health issue, what type of resources do you believe that this community could utilize to help alleviate the health problem at hand?
This community needs more local health fairs in the community, local health centers for affordable treatment, and health promotion information pamphlets in Creole.

10. Identify one agency/organization/facility in this community that the population could refer to if they had to deal with this health problem.

Fanm Ayisyen Nan Miyami, Inc. (FANM)
[Haitian Women of Miami]
7900 NE 2nd Ave
Miami, FL 33138
(305) 756-8050

Miami Dade County Health Department
Project Screen
Jennifer M. Prince-RN, NPS
8600 NW 17 ST Suite# 200
Miami, FL 33126 (305) 470-5634
(305) 470-5635

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[1] Taken from URL: http://en.wikipedia.org/wiki/North_Miami,_Florida#Demographics

[2] Holcomb, L.O. (1996). Haitian Americans: Implications for Nursing Care

Journal of Community Health Nursing, Vol. 13, No. 4. (1996), pp. 249-260.

Miami Children's Museum -- Last Visit

Today was my last visit to Miami Children 's Museum, completing my community service hours and observation hours at the same time. There were only 2 nursing students there, including myself. "Business" was slow until about noon when 3 different party groups came in to see the gallery. We were kept busy until 4 pm, teaching the kids about anatomy, exercise, and dental care. By 4 pm, I was alone, helping kids earn stickers and smiles for being good "doctors", fixing our doll "Tooter" with his ailments. Some children really enjoyed playing with the crutches -- so much so that one kids suffered a nosebleed from playing too rough with one of the other kiddies. At around 5 pm, I stayed in the Parent/Teacher Resource center and read a few books with kids until my time was over at the museum.

I learned a lot from the museum -- I'm a lot more comfortable around children than I was before doing hours there, and I feel good about teaching kids the importance of maintaining good healthy habits. I would recommend this community service activity to any nursing student who's interested in completing their hours. Maybe, by teaching this kids about the importance of healthy habits now, it can help them become more aware of ways to reduce the risk of receiving chronic illnesses such as diabetes and hypertension. Health promotion and primary prevention are some of the initiatives listed in Healthy People 2010.

Today's vocabulary word: Environment. The environment (pg. 38) is all that is external to the human host; physical, biological, social, cultural, etc. Environment plays a big role in what we learn, how we behave and think, and how healthy we are. The children at the museum, many of them from minority families, may be at risk to diseases such as hypertension. You can see the environmental influences of poor food choices when the kids choose pizza, burgers, and ice cream at the fake "Publix" as their food choices for the day. One child stocked his shopping basket with CHEESE, lots and lots of CHEESE!

North Miami Elementary School Health Fair

Today I (along with another student) assisted with a local health fair at North Miami Elementary School. It was my first health fair and a good change of pace from volunteering at the Miami Children's Museum. Surprisingly there were only two students who went to the fair, and a Barry University student who was part of the Haitian American Nurses Association (H.A.N.A.). We had project boards showing information on child safety, poison/burn prevention, breast self-examination, and preventing infections (handwashing). We had a children's corner where nursing student ("G") taught kids about germs, handwashing, safety, and entertained them with arts and crafts while the adult were screened for diabetes, high cholesterol, and hypertension.

The H.A.N.A. nurses screened the adults for blood sugar and cholesterol levels while I screened them for high blood pressures. Quite a few, in fact the majority, of the adults at the health fair had high blood pressure. Many of them were also in shock that their blood pressure was so high -- one man, on blood pressure medication (took one that morning), had a blood pressure of 170/110. Clearly his medication was ineffective, and Prof. "A" explained to him in Creole what to do to alleviate the problem (my Creole is a little rusty). About 80% of the adults who attended the health fair were Haitian, most living near the elementary school. What was great about the health fair was that there were other resources they can use after medical screening (making appointments with Miami Dade County Health and F.A.N.M. association, even a make-shift hospital with beds in the auditorium for routine mammograms and pap exams).

Most of the adults responded well to the fair and were interested in what we had to teach them. For example, many of the women at the fair responded favorably to the breast self-examination table, eager to learn methods to identify early signs of breast cancer.

What was surprising was the shear amount of resources available to the adults at the health fair. Doctors, nurses, and social workers were available to prescribe medication, consult, and screen for diseases. I wish more people in the community knew about the fair so they can benefit from it. This health fair, definitely helps meet some of the goals of Healthy People 2010, reducing health disparities in targeted minority populations, such as the Haitian community. It felt good to be a part of a proactive movement to assist local residents in getting the health care they need but otherwise cannot afford.

Today's vocabulary word: epidemiology. Epidemiology (pg. 33) is the study of the distribution and determinants of health-related states or events in a specified population and the application of this study to control the health problem. Epidemiology studies the similarities of people or populations that develop an illness. Knowing the prevalence of certain diseases in a population gives incite on how pervasive an illness is and what methods we can implement to reduce it. For example, at this health fair, many Haitians had high blood pressure, also true for most groups of African descent. We can use this information to find biological and environmental reasons for hypertension (such as greasy foods) and reduce this disease among Haitians.

Reflection Hours #4: Furthering Your Education

Today's reflection hours started a little later than usual. We'd just finish taking our OB ATI exam, and the students were trickling in one-by-one until an hour after our exam. We had the pleasure of speaking to Prof. "A" about our service hours and the need to further our education. Many of the students in class voiced their concerns about completing a bachelors: Should we wait until MDC have the BSN available or should we complete the RN-BSN program at FIU? What field of nursing are we interested in? Have we thought about the academic skills we need for the BSN (which has more "theory" classes than the ADN)?

It seems overwhelming for us to think about the BSN, since we're still trying to complete the ADN and being bogged down with reading assignments and examinations. However, for those of us who believe the salary difference between ADN and BSN are minimal, we can use the BSN as a "stepping stone" to an MSN. Some of us may want to remain a bedside staff nurse, and that's a very respectable position. Without staff nurses, hospitals cannot effectively provide patients holistic care. Maybe one day, after working on the floor for so many odd years, we would want a change, something less physically demanding yet still be involved in nursing. Maybe nursing management, insurance consulting, home health, and more. The great part of nursing, is that the opportunities are endless.

Today's vocabulary word: managed care (completely off-topic, I know). Managed care is an insurance-based approach that includes a collection of strategies such as prepayment arrangements and preadmission authorizations to control costs. With managed care, patients are being treated minimally and discharged early in order to reduce the costs to insurance agencies for medical treatments. This is a major ethical dilemma -- on the one hand, the costs of medical treatments have become very expensive and it's hard to manage effective treatment and keeping the costs to the hospital down. On the other hand, these patients are human beings and are being reduced to liability costs when they should be treated -- regardless of how they became sick (by not practicing disease prevention).

Miami Children's Museum -- Third Visit

Today I spent over 4 hours at the museum today. I did more of the usual stuff- showing children the anatomy of the human body by using a doll; playing with medical equipment toys (they like to use the fake stethoscopes on each other); and teaching them the importance of exercise, choosing nutritious foods at Publix, and dental care. As usual the kids love playing "pretend", dressing up as doctors and nurses, and showing their parents how much they know of the human body. Parents are often eager to express their conviction that their children will be in the medical field someday.

Today I learned that being involved in the community includes being comfortable in the community you're serving. If you don't feel confident in or have the desire to serve the community, you can't put 100% effort in community health activities. There were times where I felt winded, tired, and unmotivated to do community service hours. The hardest part of completing community service hours, at least to me, is initiating, or gathering the energy to attend the meetings, and health fairs to complete our hours.

Today's vocabulary word: community-based nursing. Community-based nursing includes the setting and the practice of the community health nursing. Community health nursing, according to our ATI book (pg. 1), refers to "nursing activities specific to the health promotion and prevention of disease that affect a community's general health status". To expand the definition of community health nursing, community health nurses (CHNs) are accountable to the public. CHNs also possess a greater sense of intimacy with their patients than in others areas of nursing. Since we are experiencing some of the responsibilities of CHNs, it's natural to feel a closeness, even awkwardness, with serving the community. It's a very involved, personal experience that we commit ourselves to, and I'm much more appreciative to the CHNs that serve the community on a full-time basis.

Reflection Hours: #4 -- RELAX, RELATE, RELEASE!!!

Today we talked about the different community health projects that our peers our involved in: the Miami Children's Museum, YMCA (interesting story about a volunteer football coach being too "touchy" with the abs of overweight kids), and the benefits of health fairs. We had finished our Peds rotation the week prior, and we're all feeling the stress of taking an exam (almost) every week until the end of this semester. So, our instructor asked us to stand up from our chairs, turn to the person in front of us, and massage their shoulders! When we were done, everyone felt a bit awkward, but more open to communicating. The theme of the day, we must remember to talk care of ourselves too, otherwise we are no help to the community or to our patients.

This leads me to today's vocabulary word: Ethics. Ethics can be defined as the values, practices, standards, and code of principles. Ethics guide the distinction between right and wrong based on the moral consequences of actions. As health care professionals, we must clarify our own values when taking care of patients whose beliefs are different from ours. In the case of the volunteer football coach, he may believe it is appropriate to touch the children's stomachs after they've exercised. However, these children had different beliefs about what is appropriate vs. inappropriate touch, and he was removed from the coaching position.

We will be faced with tough, ethical dilemmas in the community as well as the hospital (access to health care, child/sexual abuse, abortions, etc.). That's why we need to look at ourselves introspectively before we can help our patients.

...And it doesn't hurt to treat ourselves first to shoulder masage or two.

Miami Children's Museum -- Second Visit

Today I spent my first visit, aside from orientation, with the kids at Miami Children's. I was there for only 5 hours, but I was very exhausted when I was done! I love kids, but they can wear you out!!! I can't count how many times I've explained the human body and it's body parts -- I think I've memorized my "anatomy speech" to the kids by heart now. At the museum, there's a Baptist Health "ER Room" where kids can learn about the human body from a doll stuffed with fake organs, and x-ray machine with cool x-ray films of different body parts, and a video on what kids experience in the "ER".

It helped to have other nursing students there, as I was not comfortable approaching the kids until I've watch their techniques on teaching the kids about health care. I felt more comfortable by the 3rd hour, when I was trying to explain to two sisters how the spine looks on x-ray film. The older sister was VERY competitive, answering all of my questions before her little sister can get a word in! It's nice that they know a lot about the body, but it's important to give others the opportunity to learn as well.

Today's vocabulary word: Culture. According to the ATI book (pg. 18), culture incorporates the learned, shared, and transmitted values, beliefs, norms, and practices of a particular group that guide thinking, decisions, and actions in patterned ways.

• Culture is learned.
• Culture is taught.
• Culture is social.
• Culture exists at many levels.

The girls I encountered at the museum were very competitive, as well as their parents, who were encouraging each girl to top her sister. Some individuals are culturally raised to be competitive people, as evidenced by many individuals in the U.S. who pride themselves on individuality and succeeding in the workforce, school, or even their social lives.

It's interesting to note how powerful cultural influence is, from or moral, ethical values down to our personality.

Reflection Hours: #3 -- Child Abuse

Today we talked about child and sexual abuse, and our duties as future nurses to patients who approach us with these problems. We talked about the signs of child abuse, as defined by the ATI book of Community Health Nursing: physical evidence of abuse; conflicting stories about the "accident" or injury from parents or others; inappropriate response of caregiver: exaggerated or absent emotional response; refusal to sign for additional test or treatment, etc.

According to our ATI book, one million children are abused each year, and these numbers are expected to increase. Abusive caregivers usually single out only one child to abuse, and the long-term effects on the child's mental, intellectual, social, physical and sexual health are detrimental. Sexual abuse often involves a person known to the child and is often incestuous in nature.

Several people in class today talked about their experiences with children and child abuse. "J", a male nursing student in our class, has been having trouble finding a community health site that accepts him. He talked about his experiences with KidCo, how he didn't want to help a male child use the bathroom for fear of being labeled a sex offender. Unfortunately, the actions of others in our community that commit these crimes makes it difficult for men who legitimately want to help children, especially in nursing. "J" also talked about the BACA group (see image above), or Bikers Against Child Abuse. He finally found a group he identifies with that also protects children from individuals who would harm them.

Today's vocabulary word: Primary Prevention. Primary Prevention is the prevention of the initial occurrence of disease or injury. Primary prevention is directed toward well people. As faras preventing child abuse, we need to equip parents with information on support networks for parents who are overwhelmed with the responsibility with raising children, among other things. In Florida, the Department of Children and Families has a child abuse prevention plan that has been implement for the years 2005 to 2010.

Overall, this experience was helpfuil in providing us the tools with helping the most vulnerable in our society.

Miami Children's Museum -- Orientation

Today I visited the Miami Children's Museum in hopes of volunteering their Wellness Center exhibit. I also saw a few of my nursing buddies there (Hi, Latoya!). We toured the museum's different exhibits for kids (alot of hand-on learning activities from infants to school-aged). The hospital room looks impressive -- a giant set of teeth where kids can learn about oral care and emergency room where kids can learn different parts of the body. Alot of different people from MDC and high school student came to the orientation. Most, if not all, are there for the community service hours. That's not a bad thing, at least, you get to choose where you get to complete your hours.

The volunteer coordinator did say something "interesting" in the orientation that gave off mixed messages about the volunteering experience. She emphasized treating kids from "poor" neighborhoods who come to the museum "free days" as well as "rich kids" who pay more than $300 for galas at the museum. This suggests some of the problems of favoring private philanthropy (such as catering to big donors) over the public who may not have the funds to support the museum, but would benefit from the education tools that abound there. The problem with non-profit organizations in the US that public interests are usually funded by private donors who make up the majority of the funding. If the money came from a public source, the way that nonprofits work might be more democratic.

Reflection Hour #2

We're really falling behind in community service hours (at least I am)! We talked about health fairs, blood pressure screeing and blood glucose checks. We also talked about rape, rapists, and what rapists look for in a potential victim.

For one thing, I didn't know that rapists look for women with long hair and rarely attacked women with short hair! It makes sense, as it is easier to grab a woman's hair and catch her off-guard, especially in the back where it's harder for her to fight off her attacker.

Speaking of being caught off-guard, the tip I was most surprised about was encouraging women to intitate conversation to their would-be attacker. I understand the rationale: rapists aren't expecting women to confront them first with a benign conversation starter, such as "What time is it?" These are individuals who plan their crime ahead of time, making every detail, including time, place, and victim, under their control.

Another surprise is that one of the top 3 locations where rapists violate their victims is in the public restroom! Using the restroom is such a private and vulnerable experience, but we often don't think about this when we use public restrooms. Sometimes, we're even fooled by the false security of a bathroom stall lock! From then on, I make sure to use the bathroom with a friend or wait to use the bathroom at home.

These tips were eye-opening for me, as well as everyone else in class. It's disturbing to hear how methodical rapists are in committing these crimes.

Reflection Hour #1

Today we had our first reflection session. Not many people have done community service hours, but the ones that have had interesting stories to tell. There were a few health fairs where students checked the blood pressures and blood sugar levels for local Haitian residents. Some people who were found to have high blood pressure were in denial and did not want to hear anything on reducing the possible complications of hypertension. Some children were also found to have hypertension, with one boy fainting in the process (thank goodness the nursing students were there to aid him!).
We also had a guest speaker from the injury-free mobile of the Miami Dade County Health Department. She passed out a survey on injury prevention in the home, litting things parents fail to notice until their children are hurt. For example, I didn't know that placing a crib near a window with blinders can lead to a tragic hanging if the child puts his/her head through the cords that raise/lower the blinds! It was also good to hear about car safety, as there's alot of misinformation going around as to when we should switched children from rear seats to front-facing seats.
We also learned about choking hazards, how we can tell if a toy is safe if it doesn't fit into an empty toilet paper roll (fancy that!).

I would've loved to hear more about the injury-free mobile and volunteering opportunities, but sadly, we ran out of time. I did learn a few things that I can implement in my own home to keep my 11-month-old safe from burns, posionings, drownings, and choking hazards.

Ethics in Health Care

Not everyone knows what ethics mean in health care. Alot of people have strong ethical and moral values, especially in Miami, but don't know what to do when those values come into conflict with the health care needs of the patient.

One of the biggest controversial issues in health care is abortion. We talked a bit about the morning-after pill, the myths surrounding it and what we should do as health care professionals if someone asks for it. Some pharmacists have even refused to fill out prescriptions for the pill, stating that it is a form of abortion, not giving the women who seek them information on other professionals who can help them.

If we ever find ourselves at odds with our patient, it's best to redirect them to someone who can help them, not just refusing to give them care. We must approach all patients with an open mind, although that easier to say than do. I understand not assisting a patient with an abortion should the situation arise, but refusing to care for a patient after she's had the abortion is not just a statement but an act of medical negligence -- at least, in my opinion.

Forum on Civic Responsibility

Today we discussed citizenship: what we define as civic responsibility and the qualities we look for in model citizens. We also talked about the differences between social justice and charity work, two ideas people often have trouble distinguishing from each other. While justice deals with the substance and rules for guiding ordinary, everyday human interactions, charity deals with the spirit of human interactions. Charity is the act of serving people to alleviate an immediate need (such as feeding the homeless), whereas justice is acting to prevent social problems from happening at all (such as lobbying for increased funding to homeless shelters and back-to-work programs).

We also talked about what we thought would make up an ideal society, such as free/affordable health care and housing, cleaner environment, and improved education in public schools. Affordable healthcare was a big concern for most people in the class, as it was number one in every group that spoke of what their ideal society comprised of.

Our last topic was to choose a citizen we thought embodied the qualities of a good citizens. Unsurprisingly, most people chose Oprah Winfrey, as she promotes literacy programs through her "Book of the Month Club". She also supports impoverished communities in poor neighborhoods and in suppressed communities in economically-depressed countries in sub-saharan Africa. One of the biggest surprises was the response of one group: they named our recent Med-Surg teacher as a model citizen.

The lecture was interesting, as it got us thinking how we can serve our community in a manner that suits us. We also saw a very touching slideshow on nursing students helping people in the Dominican Republic with health issues. It's sad that this class will not have the opportunity to visit the Dominican Republic, but I hope we hear about the experience when the next class goes.

Community Health Lecture

Today we talked about what community services means to us personally and professionally. We talked about the different roles nurses have in the community such as: case manager, legal consultant, counselor and educator. The main goals for a community health nurse is health promotion in the community, to reduce the number of hospital visits and prevent long-term illnesses such as coronary artery diseaseand hypertension, goals mirrored in Healthy People 2010.

Healthy People 2010 (originally Healthy People 2000) are goals outlined by our government to improve health and reduce health disparaties among minorities. The goals are targeted towards populations at risk for certain illnesses, such as African Americans and hypertension. The majority demographic in Miami-Dade County are Hispanics, which make up 56% of Miami-Dade's population. Non-Hispanic Blacks make up 18%, making minorities the majority in Miami-Dade -- 74% of the population! Consequently, the number one leading cause of death in Miami-Dade County is heart disease, which is why alot of health promotional teaching is focuses on nutrition and exercise.

I admire the good intentions of Healthy People 2010, but I think it's an unrealistic goal to set for this country. Some studies have shown the health disparities have not decreased but increased since the initiation of Healthy People 2010.

...The report, which surveyed Baltimore City and all but two of the state's 23 counties, found that affluent Talbot County on the Eastern Shore has the largest gap between the death rates for non-Hispanic whites and blacks. The death rate for backs was nearly 70 percent higher than that for non-Hispanic whites in Talbot County, the state's third-wealthiest by per capita income. The gap was narrowest - less than 5 percent - in rapidly suburbanizing
Charles County...Experts pointed to a number of reasons to explain the difference in death
rates between whites and blacks: availability of health insurance, differences in diet and
exercise patterns, and even availability of transportation to health care providers.

These problems are happening all over the country. Healthy People have met some of its goals -- getting the public aware of health problems and getting regular screenings for early disease prevention, but this is not enough. Many Americans already have chronic diseases that we often screen for. It's the ineffective and unaffordable health care system that discourages the public from seeking health care in the first place.

Community Health Nursing -- First Day!

On Thursday, Aug. 24th, we had our first day of NUR2680L, Community Health Nursing. Our instructor (Prof. E), has a very impressive list of master degrees and is working on a PhD in Nursing. Can you imagine, being a "Dr." in Nursing?? Congrats, Prof. E.!
Anyway, she talked to us about the benefits of serving the community. Essentially, part of a nurse's duty is to serve his/her community. We were given community T-shirts (WHITE -- as if we don't suffer enough from wearing it to clinicals!).
I'm trying to find a community project that is family-based and relates to microbiology (as I can have credit for both since I am taking MCB2010). I thought about teaching mothers/children about acute asthma attack prevention or methods to reduce air pollutants in the home.

I still have some time to think about this, but it would be nice to know where I would best serve Miami.