In this episode of Plugged In to Public Health, Lauren sits down with former podcast host and recent University of Iowa MPH graduate Prithvi Raj Daliboyina (“Raj”) to reflect on his time in the College of Public Health.

Before coming to Iowa, Raj completed physician training in India. During his MPH in Epidemiology, he expanded that clinical perspective through coursework and projects in epidemiology, biostatistics, qualitative research, data analysis, and healthcare quality improvement.

Raj discusses the transition from thinking about health at the individual patient level to examining the broader systems and population-level factors that shape health outcomes. He also shares how projects involving medication adherence and hospital length of stay helped him see the importance of issues such as transportation, communication, health literacy, care coordination, and access.

The views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors, and do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Lauren Lavin:

Hello everybody, and welcome back to Plugged in to Public Health. Today’s episode is a little bit different because our guest is someone who has spent the past two years on the other side of the microphone with us. Raj recently graduated from the University of Iowa with his master of public health in epidemiology. And during his time here, he also served as one of the student hosts of Plugged in to Public Health. Raj came to Iowa after completing his position training in India, and in this episode we talked about what it was like to move from a clinical patient by patient perspective into the broader world of population health. We reflect on the parts of graduate school that surprised him, challenged him, the projects that helped shaped his interest in data and healthcare analysis, and what he learned about combining clinical knowledge with epidemiology, biostatistics, and public health practice.

We also talk about adjusting to graduate school in a new country, finding your place within a field as broad as public health, and Raj shares some advice for students who may be starting in MPH without exactly knowing where they wanted to take them. I’m Lauren, and if it’s your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they’re relevant to anyone both in and outside the field of public health. So let’s get plugged in to public health. Plugged in to Public Health is produced and edited by the students at the University of Iowa College of Public Health.

The views and opinions expressed in this podcast are solely those of the student host, guests, and contributors. They do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health. Thank you, Raj, so much for being on the podcast, or at least the other side of it today as a guest. To start, could you just introduce yourself, where you’re from, why you ended up at Iowa? Just give us the background so that listeners can re-familiarize themselves.

Raj Daliboyina:

First of all, thank you so much for inviting me onto the podcast. I really appreciate that. My name is Prithvi Raj Daliboyina. I go by Raj. I finished my physician training in India. I used to work as a physician before deciding to pursue my master’s in public health. And that’s how I ended up at University of Iowa because I was interested in doing a concentration in epidemiology. So that’s how I ended up here. And it’s been two years since and it’s been a great journey. I’ve been able to work that and gain different kinds of skills over the few years. But yeah, that’s how I ended up here.

Lauren Lavin:

Yeah, I can imagine it’s very different than physician training in India.

Raj Daliboyina:

Yes.

Lauren Lavin:

So now that you’re officially graduated from the MPH program, how does it feel to be on the other side of it?

Raj Daliboyina:

I think the main things would be relief and a little bit of pride, and also relief that you set out to start a goal in new country and public health since in the last two years has been a domainian in debate, is what I would go with. That created a kind of spaces where you were always questioning what it’s going to be like. So it’s great that I could finish my journey. I have been able to gain the skills I set out to get from the college, from the program, and that fills me up with pride that I was able to achieve what I set out to achieve and I was able to walk that graduation walk and my parents, my mom was able to visit me and-

Lauren Lavin:

Oh, great.

Raj Daliboyina:

… watch that whole ceremony. And I think looking forward, it’s the anticipation of trying to put these skills to use and contribute and grow as an individual in the sphere.

Lauren Lavin:

Yeah. Grad school is hard enough. I can’t imagine trying to do grad school in another country. You have to adjust to another country and then on top of it, a new type of schooling and all of that. So you should definitely be proud that you ended up on the other side. When you first started the MPH program, what did you think it was going to be like and how did the reality of it compare?

Raj Daliboyina:

I didn’t think it would be hard. And I was humbled over the last two years, is how I would say that. Because I was like, “Hey, I went to med school. I have done one of the most rigorous programs in that context, so how hard can this be?” And I was very quickly humbled by the various things that I was able to learn.

Lauren Lavin:

I love that.

Raj Daliboyina:

Yes. And that’s it. But the expectations first, basically it’s going to be very theoretical. And I anticipated a little bit of maybe data and working with the technology programs such as SAS and R. But as I explored the programs and the opportunities available within the College of Public Health, I was able to do much more field-based projects. I was able to do a qualitative project, I was able to do a quantitative project. I was able to do certifications in biostatistics and infectious epidemiology at the same time. These are the things that I didn’t plan for, which I was able to do once I was here, once I was able to talk to my program, my coordinators, my professors, and it opened up a lot of different spheres.

I think I would never imagine myself as a qualitative data analyst or a clinical data analyst when I started the program, but I ended up working very close to that. And right now I’m looking out for jobs or positions because I’ve been able to train for it over the two years. So that would be the difference between the expectations and reality that I ended up.

Lauren Lavin:

Yeah. So you were humbled in the beginning. What did you think was most difficult?

Raj Daliboyina:

I think one thing was, it’s a very country specific thing. You have to pick your classes, you have to structure your whole two-year program based on what you need and how you are going to plan. Some classes are only available during some semesters and things like that, which is very different from where I come from. Where I come from, everyone in the class in the year goes through the same classes, same programs, everything is already decided and fixed for you. And USA in that context, grad school in that context gives you that opportunity to design it to suit your requirements, but that means that it’s your responsibility to plan it out and make sure that you are invested fully in it. So getting used to that system took a little bit of time. And the other thing was the sheer amount of theory. While I was familiar with public health through my physician training, with epidemiology as such, or with biostats basics, it still was much more in depth.

And I would say there was a lot of fine print that you only see once you’re in the grad school, once you’re actually reading those materials while you’re interacting with the projects and things like that. That’s what humbled me. I was like, “Okay, yes, this is going to take more than a glance. This is serious business.” And I was able to get through it. I had targets and the GPAs and all of that. I was able to get it.

Lauren Lavin:

Yeah, absolutely. I agree that it’s just navigating a different academic system and a lot of theory and all of that stuff definitely in a MPH program. What were some of the biggest things that you learned during your program? And these can be academically or personally.

Raj Daliboyina:

I think with regard to AP, I was able to learn specifically much more critically about the relation between population and health and how we have to invest on it on both short-term basis and a long-term basis to achieve the definition, the WHO definition of health, which is basically a well-rounded, which is basically, it’s called wellbeing on a personal scale and on different levels. So that was something I learned in AP specifically. And the other things was basically data based. I was able to gain very good skills in SAS, in R, how to look at big data sets and come out with fine details on it, how to present the data that has been given to you, how to clean it up. Because one of the things that I’ve really been able to understand the gravity of is that the fact that public health personnel have to present the data, which is quite complicated many times, is the fact that you are presenting to people who are not into public health.

It could be legislators, it could be public, it could be someone with a different language, a different set of skills or understanding. And it is your responsibility as the person who’s trained in public health that you convey the importance or the facts that you have figured out from the data in a convincing way to the public, to the people you are talking to. It’s basically an amalgamation of all departments in the College of Public Health. It’s the multidisciplinary aspect of MPH, is what I would say is what really I learned over the course.

Lauren Lavin:

Yeah. You don’t realize how much you need all of these different facets of public health until you see it all come together and you’re like, “Oh yeah, I do need that from biostats.” Or “I need to think about the epidemiological side of something.” And then you see the health management side, which is it in practice. So absolutely, there’s definitely a big multidisciplinary aspect to it. And you don’t see that until you have to start doing your own projects and interacting with people across all of the different departments. Was there a class or a project, internship or mentor that ended up having a really big impact on you during your time here?

Raj Daliboyina:

I must say to say the cliche thing, I always loved data, but I never got an opportunity to explore that aspect as a physician. But in College of Public Health, data has been my thing. All the three certifications that I took in biostat, everything is based on the fact that just give me a computer and I can have a field day with that kind of thing. But other than that, I would really say my work with Dr. Deshpande and Dr. Martha Carvour in both of the qualitative and quantitative projects I’ve been able to do were amazing in the sense that the qualitative project was about basically making sure that what are the factors that are affecting people from taking their diabetic and hypertension medications over the whole state of Iowa? So we partnered with the Iowa Primary Care Association and we were taking in factors from both the population of the patients themselves and also from the various practitioners and other coordinators in the IPHA.

And it was beautiful because I was able to do fishbone diagrams and the way it all comes together as to you wouldn’t trust that the main reason was transportation or the main reason was access to medication or not being able to understand the literacy that was being provided to them because they come from a different linguistic background. And things like these would not be factored in if you were just looking at it from the point of view or the physician’s point of view. You would be like, “Yes, the medication has been given, it’s been advised, you’ve already given the counseling. Why isn’t the patient taking any medication?” And they could be, at least we came up with about six to seven factors that were affecting-

Lauren Lavin:

Really?

Raj Daliboyina:

There were multiple factors. There was transportation, there was communication, and all of these were specific to different geographical areas of Iowa. So each center has its own problems, and then we had to come up with a report that summarizes everything. And that was the beauty of that project. And the other one was the practicum where I worked with length of stay. And length of stay itself as a physician seems like that’s just the basic metric, but we were able to identify eight diagnostic groups that were getting affected by common factors, which were like 14 factors, which again, we got distilled to 10 different things. And then we came up with toolkits, and when we spoke with the coding team and all, one of the biggest factors that came through was the fact that even after a patient is well to be discharged, the communication between aftercare and the hospital is not getting entered into the system.

So the patient is ready to leave the hospital, but the aftercare is not ready to take them, which is increasing the length of stay and throwing the whole system into the wrench. Those were very different perspectives for me as a physician to look at healthcare as such.

Lauren Lavin:

Yeah. How do you think that your training as a physician has impacted both the way that I think you approached the MPH, but even more specifically that project you were just talking about?

Raj Daliboyina:

I think even when I was doing the project, my training has always been about patient specific. That’s how you are as a physician. Each patient has their own problems, has their own presentation. You’re very specific and microscopic in your outlook. But as a public health official, when you’re looking at things, you’re looking macroscopically more than microscopically. So that was the overlap of both POVs. That was what I really would say was where my training as a physician and public health has been helpful. I was able to see, for example, when I was presenting the data, once I decided that the key indicators and the DOJs, the diagnostic groups were decided, I classified them based on how many DOJs, how many key factors as a common factor.

So you could go based on how microscopic you want to go. Do you want to be specific DOJs? What are the specific key factors affecting them? Or do you want to go in a much more wider range where okay, you identified the maximum affecting key factors and then work on those to make sure that you have a more wider output from your whatever recommendations that you want to implement. So both of these were the things, I think, how I would look at projects as a physician who’s trained in public health.

Lauren Lavin:

It makes you uniquely qualified to be a different voice on a lot of these types of projects, and I’m sure in the classroom as well. So you were part of the Plugged in to Public Health Podcast over your time here. Is there anything that you enjoyed most about being involved with the podcast or did it change the way you though about communicating public health?

Raj Daliboyina:

It was a great experience to be a part of it. I got opportunity to talk to really eminent personnel, especially Dr. Mukherjee, Professor Hannah that I did interviews with. It was really big opportunity. And I think the best part about the podcast has been that it has been a voice where you could be yourself the most in these days as an immigrant, as in a sphere of public health there are so many things that you are cautious about, the way you approach, the way you want to talk.

But the podcast was a place where you were able to question or ask or share or gain knowledge or be a dissenting voice if you wanted to be and still come out with a better communication of the problem that you’re discussing about. A better idea or a source of information for the listeners where they can look at all perspectives. And I think that was the best thing about the podcast, and I really enjoyed being part of that aspect of the podcast too.

Lauren Lavin:

I think you raise a good point about being able to dive deeper and not necessarily just accept the narrative, whether that’s the news is giving or what everyone else talks about something, you can challenge that and this allows for that there’s conversation dialogue around those ideas. So totally agree. Looking back, what was one challenge during graduate school that taught you something important or changed how you approached your work?

Raj Daliboyina:

There were different challenges as an immigrant student that I faced while I was doing grad school. There were immigration challenges. There were moving to a new city, a new geographical area challenges. I’m going towards the weather first. I think nothing has been a bigger challenge for me than to move to Iowa City than the weather itself. It really made my health a complication for me in the initial months, which affected my academics in the first semester. It took me a couple of months to understand how I am reacting to the weather, that led for me to have some kinds of setbacks in my schooling, in my academics. Just in the sense of academics, the biggest challenge has been able to find my way, why departments of these areas of work that public health was happening. Because I come from clinical experience, there were so many avenues that I could have explored and it was overwhelming to decide where should I specialize, what should I pick?

Especially as a generalist, I’ve been able to work in different kinds of departments. I have been able to work with the community-based health departments. I’ve been able to work with biostat. So it was hard because everything seemed like, yes, I can do this, I can do that. But that also means that you get overwhelmed and also you become very, “Oh, I’m not a specialist of anything. I can do a bit of everything.” So initially that was my biggest challenge, but I was able to overcome that as the program progressed. As the second semester ended, I was pretty clear about what I really wanted because I followed the advised plan for MPH, which is finishing most of your course programs in the first year. And because I finished almost all of my core programs in the first year, I was able to do programs, classes with almost every department and by the end of the first year of MPH.

And that made me quite aware of where I see myself, what my strengths were, weaknesses were, which kind of work excited me or made sure that my output would be best. So most of my second year I was able to curate my decisions or the classes I pick or the electives I picked were based on that thing. So that was my biggest challenge. And I was lucky enough with the support of the college, I was able to fulfill that.

Lauren Lavin:

I’m sorry that you had to go through that, but it sounds like you learned and it was able to help make the, I don’t know, the second year even better.

Raj Daliboyina:

And now I think I can’t live anywhere where the weather doesn’t change in 10 minutes. I can surely assure you if it’s cold and if I’m somewhere else, I was in Dayton, Ohio the other day and I was like, “Why is it so cold? Why isn’t the sun showing up?” And I’m like, “No, that’s not what happens. You walk into Walmart and then you walk out. It might rain when you walk in, but when you walk out, it’s going to be cloudy, it’s going to be sun outside.” Things change in Iowa City, so I’m used to it right now.

Lauren Lavin:

What’s your ideal weather situation? And does that factor into what your next job will be?

Raj Daliboyina:

Not anymore. I think I used to be like, “Yeah, I want to live in the snowing places because I come from a seaside town.” I was like, “Yeah.” Even when I was moving to Iowa, a lot of people were like, “You’re going to Iowa, you should be careful about the weather.” And I was like, “I’ve lived in New York. That’s fine.” And then again, the weather of Iowa has humbled me.

Lauren Lavin:

Yeah, it’ll do that. Yeah.

Raj Daliboyina:

Yeah.

Lauren Lavin:

Absolutely. You’re now exploring opportunities after graduation. What kind of roles or areas in public health are most interested to you as you think about what’s going to come next?

Raj Daliboyina:

Currently, I’ve been lucky to be a part of a project that I’m doing with Professor Tammi in our department. We are working on cleaning material and the efficiency on it and on its protocols in the hospital. But other than that, I have been looking for mostly clinical analyst or epidemiological jobs which have a strong analytical basis. My practicum has also been on basically qualitative analysis or quality management or improving… Basically, I’m trying to see a Venn diagram of a job where I’ll be able to base my skills as a public health official over my skills as a physician and a clinical aspect that I’ve learned. The best positions I’ve been looking for are clinical analyst positions for different healthcare opportunities out there. Yeah.

Lauren Lavin:

What advice would you give to students who are just starting out an MPH program school just starts this week, especially those who will still be figuring out what they want to do with it in the end?

Raj Daliboyina:

My biggest advice is don’t be afraid, be cautious. In the sense that if you are starting and you don’t know what you’re trying to do like me, you don’t know what your specialty is, do not get overwhelmed by it. Be cautious about just understand the program, see what opportunities are there, see the certifications. Just explore the classes, especially the first semester where you take all the basics, introduction to epi, introduction to biostats, all of those classes when you’re taking in different departments, they’re all introductory classes. So just explore your program in the first semester, in the first couple of months.

And as the opportunities present themselves to you to work with the professor, to work as a podcaster, to be a graduate ambassador, to work as a student body, just talk to your seniors. You will see or there will be opportunities that will just present to you and then you can grab them and that will shape or let you know what you like or what you don’t like. So that would be my advice.

Lauren Lavin:

I think that is great advice. What a great way to end the podcast. Someone gave me this advice when I was starting was like, “Say yes to as much as you can.” And not in a way that’s completely overwhelming to you, but say yes before you say no, just because that’s how you’re going to meet people. That’s how you find out what you’re interested in. You get connected to other faculty and advisors and it will really shape however long you’re here, whether it’s two or five years. So I agree with that. Thank you, Raj, so much for being on the podcast, both as a host and a guest today as we close out this chapter. I really enjoyed chatting with you, and I’m so grateful for your work with us over your time here at Iowa.

Raj Daliboyina:

Thank you so much for the opportunity, especially Lauren, for doing all the editing and all the coordinating for all of our podcasters, for holding up the podcast for the last two years. It’s been amazing work that you do and thank you for interviewing me today.

Lauren Lavin:

Thank you so much. That’s it for episode this week. A big thank you to Raj for joining me today and for everything he has contributed to the public health podcast over the past two years. One of the themes that came through in our conversation is that graduate school does not always take you exactly where you expect to. One of the themes that came through in our conversation for me is that graduate school does not always take you exactly where you expect it to. Raj entered the MPH program with a background as a physician and an interest in epidemiology, but along the way he discovered new interests in data analysis, qualitative research, healthcare operations, and the system level factors that influence patient care.

His experience is also a good reminder that public health requires us to move between perspectives. Sometimes that means looking closely at an individual patient and other times it means stepping back to understand the policies, systems, and data shaping health across an entire population. And for students who are just beginning their own graduate school experience at the beginning of this new year, Raj’s advice is worth remembering. Explore what is available to you, talk to people, take opportunities as they come, and give yourself some time to figure out what kind of work you actually enjoy. You do not have to have the entire plan figured out on day one.

This episode was hosted and written by Lauren Lavin and edited and produced by Lauren Lavin. You can learn more at the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at cph-gradambassador@uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.