Finding Purpose in Chaos: Reflection In and Beyond the Public Health Classroom

In February 2020, I began teaching a new course designed specifically for undergraduate public health majors: “Professionalism in Public Health Practice.” The course aimed to prepare students for internships, jobs, and graduate programs in our field. The course’s original goal was practice-based: What knowledge and skills do students need to take the next step in their careers? The syllabus was packed with résumé and cover letter workshops, how to read a job posting, and how to network with professionals in the workforce. Recent alumni visited to answer questions about how they studied for the GRE, what internships they completed, and how they decided whether to work right away or go to graduate school first. Students brainstormed ways to market themselves at career fairs and how to sit for interviews. It was an extremely informative but, admittedly, also rather prescriptive, focusing on the how of professional preparation.

“If there was ever a time to be a public health student, this was it.”

Six weeks into the semester, the coronavirus pandemic hit the United States. By March, I sat before a classroom full of public health almost-grads who were asking if they would be sent home in order to keep everyone safe. Some reported up-to-the-minute news regarding the virus’s spread, government responses (or lack thereof), and regional school closures. Others shared concern about family members on the medical front lines who weren’t allowed to leave work after viral exposure. One student worried about where she would live if we went to distance learning because her parents were immunocompromised. The tension in the room was thick, but there was also an edge of hope. If there was ever a time to be a public health student, this was it.

Our college announced an early spring break the next day. Students quickly packed (most of them, only for a few weeks away), and then scattered to their hometowns. We didn’t know what was about to happen, or how long it would last. We didn’t get to say a proper goodbye, or even, “see you on Zoom.” There was no closure, only chaos, soon followed by confusion.

This was my first pandemic as both a public health professional and a faculty member. While students were tasked with adjusting to their new normal of virtual learning, I was confronted with the reality that this professionalism course was simultaneously urgent and already outdated. What changes would I need to make for it to be as meaningful as it was useful?

“In focusing on the how of professional preparation, I hadn’t asked them to pause and direct their attention to why they wanted to pursue public health in the first place.”

Throughout my previous eleven years of teaching, I’d come to realize how prescriptive public health education as a whole can be. Considering the rigorous standards set forth by accrediting bodies and students’ growing demand for pre-professional training (especially in the health sciences), my public health courses had fallen into a rhythm (or rut?)—one that addressed competencies and outcomes that students would need for their post-baccalaureate path. Students were eager to complete their required courses and internships, graduate, and move on to the next adventure. In focusing on the how of professional preparation, I hadn’t asked them to pause and direct their attention to why they wanted to pursue public health in the first place.

Still, our alumni regularly write to me and reflect on how their Augustana experience helped them navigate their vocational path. Many trace that path backwards to identify those “a-ha” moments that changed the trajectory of their lives. It was these alumni who, over the course of more than 25 years, had found their way into public health even before Augustana formalized a public health major and pre-professional workshops. Those students were called to public health through some special experience or moment, a moment of asking why, one that helped a nebulous jumble of ideas and desires solidify into a calling.

Of course, this is one of the ultimate goals of a residential, Lutheran liberal arts college where students live, learn, work, and serve together. These alumni stories, combined with an Education-for-Vocation faculty seminar at Augustana College that NetVUE funded and in which I participated, led me to recalibrate the second half of my professionalism course. I asked students to reflect on their goals in public health: What originally brought them to public health? What were their interests before the pandemic? Where did they feel they were being called now? And why?

One business and public health student, Tracey, was in the middle of an internship with the local American Red Cross when the pandemic hit, and she had to move home to Connecticut. She felt called to continue helping others, and so signed up to work at a nursing home. Knowing that she was putting herself in harm’s way, she said she would rather try to help the vulnerable than sit home and worry.

Hannah, double majoring in political science and public health, shifted her plans of pursuing health policy work in order to join a service organization and help in disaster areas. She immediately deployed from Illinois to California to help provide shelter to people evacuating the wildfires.

Older alumni, too, have reached out to me to reflect on where their public health journeys have led since leaving Augustana and as the pandemic hit. Sara, who studied religion and public health, started working at a regional food bank in Ohio only two weeks before her state lockdown made the demand for their services skyrocket. She shared, “Augustana taught me how intertwined our community and individual health is, and how important it is to ask deeper questions when coordinating an effort. How will this affect someone different from me? In what ways can we honor and respect someone’s humanity even during this time of emergency?”

“In what ways can we honor and respect someone’s humanity even during this time of emergency?”

Alyssa, an alumnus with majors in public health and communication studies, now researches the impact of postpartum depression on Latinx communities for her doctoral program in Seattle. Her team explores how Covid-19 and the increasing impacts of institutional racism may exacerbate this already serious issue for underrepresented mothers.

Darielle, a Masters in Public Health (MPH) candidate in Chicago, described how her time at Augustana prepared her to be flexible, especially during unpredictable situations: “Augie pushed me to persevere, to be resilient and humble...which has helped me remain optimistic during the pandemic and social injustices.” She plans to use this optimism and resilience in her new role researching opioid use disorder and treatment therapies.

Nikki, who pursued her Bachelor in Science of Nursing (BSN) and became a registered nurse, reflects deeply on how her nursing and public health backgrounds blended to make sense of the chaos during the early days of the pandemic:

2020 was “The Year of the Nurse,” celebrating the 200th anniversary of the birth of Florence Nightingale, the founder of modern nursing. At the beginning of the year, nurses hoped for recognition via safer staffing ratios, better pay, and more independence in our practice. Covid-19 shook the entire healthcare system to its core and we are just now beginning to pick up the pieces. It was easy to get lost in the horror of it all; no one had any answers and we were working with limited supplies. [But} our experiences and reliance on one another made us stronger.

Reflecting on her Augustana education, Nikki said the liberal arts helped her understand not only the how of nursing, but also the why:

When I started as a nurse, I always assumed “helping” patients meant improving their health. I have learned, unfortunately, that this is not always possible. Helping patients in palliative or hospice situations can mean helping them accept their illness or death. Some patients are managing their illness fine physically but have a hard time grasping the mental and emotional side of being ill, like being scared and secluded from their family. Talking to these patients, making them laugh, or holding their tablet during a Zoom call is as important as monitoring their oxygen saturation. I’ve come to understand that in order to help someone you have to understand their perception of health. I learned this in medical anthropology, and through my experiences, I was able to apply it in real life.

These alumni stories show us that public health can and should be rooted deeply in the Lutheran approach to the liberal arts, with its institutional commitment to vocational reflection. Combining skills-based public health courses (the “how”) with opportunities for introspection and exploration (the “why”) allows students to examine their role in serving others and make meaning as health practitioners. The liberal arts curriculum provides even more opportunities to connect other areas of study with their public health goals. This is demonstrated in the fact that the alumni I’ve here quoted majored in the diverse fields of business, communication studies, nursing, political science, and religion.

The pandemic is far from over, but hearing testimonies from public health students and alumni who have shifted their plans in order to serve others in new ways has strengthened my resolve to include more deliberate reflection in all of my courses. Augustana’s mission calls us to offer a “challenging education that develops the qualities of mind, spirit, and body necessary for students to discern their life’s calling of leadership and service in a diverse and changing world.” This year has shown us exactly how important it is to find purpose in chaos, and I look forward to seeing our next generation of Augustana public health graduates find their calling in our ever-diverse and changing world.¹

Endnote

1. I want to acknowledge and thank the many Augustana College public health alumni who have shared their vocational journeys with me, especially Alyssa Hernandez, MS; Sara Hovren, BA; Tracey Keane, BA; Nikki Montgomery, BA, BSN-RN; Hannah Norris, BA; and Darielle Sherrod, MPH(c).