This week our guest is Dr. Nafissa Cisse Egbuonye, director of the Black Hawk County Health Department in eastern Iowa. She joins Steve and Alexis to talk about working in public health at the local level and the keys to communicating important messages during the pandemic.

In 2019, the UI College of Public Health honored Dr. Cisse Egbuonye with the Iowa Public Health Heroes Award. You can read more about her career and achievements here. 

Alexis Clark:

Hello everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Alexis Clark and I am joined today by Steve Sonnier. If this is your first time with us; welcome. We’re a student run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health.

Alexis Clark:

Today, we’re excited to chat with Dr. Nafissa Cisse Egbuonye, who is the Public Health Director at Black Hawk County Health Department, a role she’s held since 2016. Dr. Egbuonye obtained her master’s degree in health promotion and behavioral sciences from San Diego State University in 2011 and her PhD in public health education and promotion from Texas A&M in 2016.

Alexis Clark:

Welcome to the show.

Nafissa Cisse Egbuonye:

Thank you. Thank you for having me.

Steve Sonnier:

If you want to start us out Nafissa, tell us a bit about your path into public health, how you ended up in the current role. I saw San Diego on there. I’m from California. How did you end up in Iowa? Why Iowa?

Nafissa Cisse Egbuonye:

Well, I think for me, it stems from my childhood. It’s not the physical location that makes a place a home for me. I came here in 1989. I was put on a plane and I was five years old and I land in JFK. Actually my first state in the US was in Illinois. I’ve lived in the Midwest. I’ve lived in the East coast, Vermont, and the South and the West coast. So I feel like I’m coming back to my American roots being here in the Midwest. When I was looking into getting to the administrative side of public health, I just wanted a place that was welcoming. I have two little children. [inaudible 00:02:00] is actually born here in Waterloo. I just wanted a place that was very family oriented and in a place that would welcome me and that’s what Black Hawk County has done.

Steve Sonnier:

That’s wonderful to hear. With your current role, you’ve got the public health director side of things, you’ve got this tremendous education behind you. What made you consider the administrative side of public health?

Nafissa Cisse Egbuonye:

Yeah. I’ve always believed that as researchers it’s also important to understand practice. My undergrad degree is in public administration and in public policy. I’ve always felt that public policy really has an impact on people’s lives, the decisions that our lawmakers make. So very early on, I was really interested in public policy. And then I took a course called Confronting AIDS. What I really appreciated about the professor is that he didn’t give his perspective; he just gave us scenarios and asked us how would we approach this situation. Whether it was a policy regarding HIV or AIDS, or whether it was implementing programs, he was just very open to hearing from us students. That’s what really motivated me to going into public health, and I loved the course.

Nafissa Cisse Egbuonye:

I also minored in community health and I pursued my MPH. During my MPH, I was trained as a quantitative researcher. In quantitative research, one of the things that you know is that the voices of the people also are not theirs. People are not just numbers. They have stories, very robust stories in terms of their journey. The field of practice just kept calling me.

Nafissa Cisse Egbuonye:

I’ve always believed that as students, it’s always important to balance your studies with also practice, like field experience. I was always that student that volunteered. I was always that student that was looking for any internship. So I interned with a lot of nonprofit organizations in San Diego. Did a lot of volunteer work. Actually, most of my volunteer work was around HIV testing, so I got a sense. I learned how to do that very, very earlier on. And then because San Diego was so close to Tijuana, I was able to go there and see how the border relationships between the US and Mexico impact the health of the San Diego County, and what are some of the initiatives that are being implemented there as well.

Nafissa Cisse Egbuonye:

It was just always about making sure that whether you’re a researcher to really get an understanding of how things are happening at the local level. So that’s really why I’m here.

Alexis Clark:

So when you talk about acting as the director, how do you intertwine that practice plus the research component because sometimes you get folks that aren’t understanding one aspect of it? What’s your approach to blending that?

Nafissa Cisse Egbuonye:

I think that’s why the PhD comes into place, so reading studies and seeing P values and understanding what those P values mean. And especially right now with COVID, there’s so much misinformation out there and people are just sending links of studies that maybe debunk the vaccine. And so being able to have that research expertise, you can actually read the study and explain to individuals why this is not accurate. Even here at the Health Department, we have alumni from the University of Iowa, we have Josh Pikora, who’s our Disease Surveillance and Manager, who I work very closely with. He did his MPH in epidemiology. Aaron Reinke, who’s our epidemiologist. They’re very, well-trained in the field of public health. We look at data, we look at trends and then we ask ourselves, “Okay, what does that mean for the general public? How do we share this information in which it’s understood?”

Nafissa Cisse Egbuonye:

That’s how it is with also all our other fields. In environmental health, there’s a lot of research behind mental health issues, but it has to resonate with people. So really using terminology and communicating in an effective matter and really working also with the different audiences. Oftentimes I think the public health field is very much like, “Here’s the information,” but now within this agency, we’re looking at partnering with the different populations and saying, “Okay, here’s the information that we have. How will this resonate, or what can we change, so we’re doing this collaboratively so that our messaging resonates with people?”

Steve Sonnier:

When you’re talking about the message resonating with people, that’s a continual challenge, and we talked about this briefly with Aaron about the idea of there’s this information overload that we’re all experiencing underneath the pandemic right now, when you’re trying to communicate something very tenuous at times like vaccine adoption or the rollout as a whole, or COVID-19 testing, what’s your role in creating this message to make sure that it reaches all sorts of folks? We’ve got to account for folks who may not have internet access or English might not be their first language. Where do you play a role in making sure it’s an effective message for all?

Nafissa Cisse Egbuonye:

I think for us, what has been exciting is how Black Hawk County we’ve taken on a health equity approach prior to the pandemic. We also did a communication assessment. So getting a sense of what people know about the Health Department and what we do. All those things were important for us to do prior to the pandemics.

Nafissa Cisse Egbuonye:

With the COVID-19 pandemic, it’s important to have a health equity lens to how you approach things. Whether it’s disease investigation and surveillance, whether it’s vaccination, you always want to ask yourself who’s missing at the table. That has been something very key to how we have been able to reach key populations. And even if we haven’t reached them at this moment, especially with vaccination, they’re still part of the conversation.

Nafissa Cisse Egbuonye:

We have bi-weekly meetings with community leaders from different populations, ethnic groups. They inform us what’s going on in their communities, what their concerns are, so that we work together to be able to inform everybody in an equitable matter. Just last night, I was with the Black pastors, we were on a Zoom meeting and they’re expressing to me some of their concerns, some of their needs. We’re working together in a very collaborative manner.

Nafissa Cisse Egbuonye:

Even for us, with our different sectors, like the business sector, the healthcare system, the nonprofit organizations coming together prior to the pandemic has been key so that you have those relationships already established. It’s not during the pandemic you want to start building relationships, that’s not going to work. It has to always be done prior. There has to be a component of preparedness that we don’t often talk about, but it needs to be there.

Alexis Clark:

I think that’s a great point. Working collaboratively with those different entities in those different communities is a crucial part of planning. How do you consistently bring the energy and creativity to your role as the director and where do you ground yourself during difficult times such as these?

Nafissa Cisse Egbuonye:

Wow, that’s a great question. I’m a naturally positive person. I believe in positivity. I believe in hope. They’re very difficult days. We’ve had days where we’ve all been exhausted and cried, but I think that public health … you can’t lose hope. If you make a difference in one person’s life, that’s a huge thing, but we’re talking about population health, so we have to have that momentum. We have to have that hope that things can be better because that’s what our field is about; looking at problems and deep rooted problems and how we can implement solutions.

Nafissa Cisse Egbuonye:

I think our field has learned that transactional approaches don’t work anymore because that doesn’t fix the problem, but transformational ones do. But we also have to give us that grace, that it might not be tomorrow or the day after. We might not even see the change, but we’ve tried our best and hopefully we’re leaving this world a much better place for the next generation.

Steve Sonnier:

It really resonates with me because I remember coming into the College of Public Health and within the first couple of months of just being in the public health setting, it was very encouraging. Everyone is trying to do better for the community. Even if you have different ideas or different views of how to get there, the focus is we want to make this world a better place. And being part of that community and part of that push is really powerful and motivating. I can see how that’s a very good place to ground yourself. Being a naturally positive person too, helps as well.

Steve Sonnier:

When you’re thinking about your transition as a student, you go from a master’s to a PhD, for the folks who are either finishing their master’s right now, or starting it out and they’re considering the many pathways before them, what do you think was the selling point for the PhD side of things? Was it great? I get to have more experiences with the awesome people in public health, or was there something else driving you within there?

Nafissa Cisse Egbuonye:

One of the things that I would say to students that are listening is that I’ve always had practical experience throughout my undergrad, to my master’s, to my PhD. That practical experience is important. I was able to jump from my master’s to my PhD because I did take two years between my bachelor’s and my MPH to work. I think something that’s very important is to find a balance between the different degrees that you pursue and getting that practical experience, because it helps solidify what you want to do.

Nafissa Cisse Egbuonye:

My MPH, for example, was funded by the National Institute of Health, but that was also because it seen also some of the experiences I had as an undergrad, the willingness to just try out the different internships and whatnot. And even during my master’s in public health, I was very intentional about different experiences, whether it’s domestically or internationally, to really solidify the direction in which I wanted to go into. So by the time I got to my PhD … it was also because I didn’t want to go back to school. I just said, “Let me just get this over with,” because I knew that once I started really my career in public health, I just didn’t want school to be another barrier.

Nafissa Cisse Egbuonye:

I think just making sure that one has a sense of what they want to do long-term before pursuing their PhD, because sometimes you pursue your PhD, but then you don’t utilize your PhD and that’s not good. You want to really make sure that you understand what you want to do long-term.

Alexis Clark:

Just to build on there; a lot of students do listen to this podcast, what piece of advice can you give to us students navigating the early career, or even if we’re debating going back to school?

Nafissa Cisse Egbuonye:

I would say do something that you’re passionate about. I don’t go to work every day. Even on days I’m tired, it’s very easy for me to get up and come to work because I am doing something I’m passionate about, so this is not a job for me. It gives me great reward to be in my position and help. I say that define what you’re truly passionate about and you will have a career and it will not be one of those that you’re dreading every day to go to, but it will give you reward. It just helps with your overall quality of life

Steve Sonnier:

Within that, we know that the COVID-19 pandemic really dominates a lot of public health right now, it seems to be the only thing on the airwaves, but we know that there’s a bunch of other things happening in public health right now. I imagine even before the pandemic, you were interested in other parts of public health too besides COVID-19. What really for you stuck out in the field of public health that you said, “I really want to make my mark here? I really want to get involved in this era. This is what drives me towards the field.” Is there a specific topic or theme?

Nafissa Cisse Egbuonye:

Being public policy oriented, for me has been public health infrastructure from day one. That’s why I applied for this job. The Board of Health was looking for someone that would help to restructure the Health Department, and I thought, “Wow. What a great opportunity to actually be able to implement your vision of what a local health department can do.” It’s been exciting because you look at our infrastructure, you look at strategies to implement sustainable funding for public health, so what does that mean when there’s barriers to federal and national funding or at the state level funding. How can we build momentum so that there’s funding sustainability for local public health?

Nafissa Cisse Egbuonye:

Right now we engage our community foundations. They love the work we do. They recognize the importance of the Health Department. So we’ve had sustainable funding from them in terms of the grants. Looking at workforce development, the field of public health has drastically changed over the years. But we have long-term employees that do also need the training and the necessary tools to equip themselves to what’s coming ahead.

Nafissa Cisse Egbuonye:

I think those are the kinds of things that really get to me, being able to listen to the community and hear what their concerns are. Again, it’s not just about data. Data can say one thing, but you have to also listen. For example, here we have three robust health care systems. We have a federally qualified healthcare system, we have People’s Community Clinic and then UnityPoint and MercyOne. But you’ll see our data shows that some of the barriers is access to healthcare. So you’re wondering with these three great entities, why is access to healthcare an issue? So we have to do more research to understand what is the barrier to this access. Is it navigation? Is it that people don’t understand the healthcare system? It’s a very complex system.

Nafissa Cisse Egbuonye:

Those are the things that motivate me. And really behind me are geniuses. I just have the opportunity to lead, but honestly we have a very great staff here, and so it makes my life easier.

Alexis Clark:

Looking at your journey, whether it’s in relation to public health or not, what is one thing you thought you knew but were later wrong about?

Nafissa Cisse Egbuonye:

I thought I knew that if I explained the problem and that people understand the problem and get on board with the solution, so I have been very surprised at how public health has been politicized. We’re tied in behavioral health, like just educate, just inform, just give people the tools, hearing how masking became such a big issue. So I think that for me, it’s just human beings are very complex. I’ve learned a lot about the complexities of us as a society. Those are the things that have been very difficult. I think that’s my positive nature, that a little bit naive in a sense that I’m just hoping we all get along and it doesn’t naturally happen that way. Those have been the lessons learned and difficult moments for me.

Steve Sonnier:

I think you go in with different expectations. We were talking about the [inaudible 00:19:25] earlier. The tabletop simulation idea of if I’m going into a tabletop simulation, let me put down everything that I think about for an influenza pandemic and what it can look like. And then COVID came along and changed everything. It’s been very similar in the sense of communication. When you have a novel coronavirus virus versus something that we’re all familiar with, traditional influenza or measles or stuff like that, it’s just different, and the response has really been different across those pathways. So public health as communicators, it’s really been our job to navigate how best we reach folks, regardless of where their stance is or their equity or anything along those lines. Making those bridges is really what our field is about.

Steve Sonnier:

I do really want to thank you for coming on today, Nafissa. It was fantastic to talk with you. I really enjoyed all of your insights. We wish you luck in the coming months battling the coronavirus and enjoying your role.

Nafissa Cisse Egbuonye:

Thank you. Thank you very much. Thank you. Have a great day.

Steve Sonnier:

That’s it for this episode of From the Front Row. Big thanks to our guest, Dr. Nafissa Cisse Egbuonye for coming on today.

Steve Sonnier:

This episode was written and hosted by Alexis Clark and Stevland Sonnier. This episode was edited and produced by Stevland Sonnier. You can find more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud as the University of Iowa College of Public Health. If you enjoyed this episode, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health.

Steve Sonnier:

Keep on keeping on out there.