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My name is Kevin Weiss, and I spent my summer as a graduate intern at the U.S. Centers for Disease Control and Prevention (CDC) – Thailand Ministry of Public Health (MOPH) Collaboration (TUC) office in Bangkok, Thailand. I was working as an intern for the HIV/STI Research Program (HSRP) in the CDC’s Division of HIV/AIDS Prevention (DHAP). Acronyms upon acronyms!
My initial project focused on completing a spatial analysis of an HIV voluntary counseling and testing (VCT) dataset from a CDC-backed clinic intended to serve men who have sex with other men (MSM) and transgender women (TGW). This was a fruitful analysis as well, with fresh abstracts to be submitted for an HIV conference.
My summer took an unexpected SORT-like turn when my supervisor asked if I could set aside my practicum for a week to assist in a MERS response. I agreed!
The TUC office was located on the campus of the MOPH, which facilitates collaboration and cooperative work. As such, when an Omani tourist who had traveled to Bangkok for medical reasons tested positive for Middle East Respiratory Syndrome (MERS), we noticed an uptick in activity around campus. I and a few other CDC-ers actually made it into one news channel’s broadcast of a joint World Health Organization-Ministry press conference.
I was asked to serve by the MOPH, with an initial focus on contact tracing for the individuals who had contact with the individual who was isolated at a government infectious disease hospital. Including medical personnel and airplane passengers, this number was estimated at over 175 people. Although I didn’t get involved too much on that end, some of the concepts and ideas used to trace contacts included use of social media platforms. The job of an outbreak-responder or epidemiologist includes thinking outside the box in manners such as these.
As part of a MERS working group, I spearheaded the creation of a rapid respiratory infection control questionnaire for a rapid capacity assessment for 70+ regional and provincial hospitals in Thailand. I drafted an initial list of questions in English using resources from the World Health Organization, CDC, and other previous investigations. After a number of revisions, the assessment was translated into Thai and piloted among infection control nurses at a few Bangkok hospitals as a trial.
Unfortunately this was when my practicum ended. The results of the survey are intended to be used to evaluate response capacity for severe respiratory conditions country-wide and identify areas for improvement or targeting of resources.
On the whole my practicum was an excellent experience, and the MERS experience exposed me to outbreak and response in a professional capacity. Two weeks had passed and no more cases were reported, so while my survey was not used during this summer response, it can serve as a base for future response efforts.
This experience was unparalleled, providing a gratifying and meaningful time for an aspiring student. I am deeply grateful to all who allowed this to happen and for me to participate, and I hope to take these lessons and experiences and apply them in the future.
The culture of Rwanda is rooted in togetherness. Sharing in life. Sharing in progress. Sharing in health.
This summer I worked with the Rwanda-Zambia HIV Research Group (RZHRG) at Project San Francisco in Kigali, Rwanda. RZHRG is a globally renowned force in HIV/AIDS prevention, specifically through Couples Voluntary Counseling and Testing (CVCT). Couples get tested – together. Couples get counseled – together. Couples commit to pursuing better health – together. The results are greater empowerment and greater commitment among couples, both of which have contributed to Rwanda’s decreasing HIV incidence. Due to the success of CVCT, this method of prevention has been adopted by the Ministry of Health and continues to be a healthcare norm across Rwanda.
CVCT also allows researchers to observe HIV transmission events. About 80% of all Rwandan couples have been jointly counseled and tested, and more than 40,000 discordant couples (only one partner has HIV) have been identified since 1988. Although unfortunate, transmission does occur; however, these events can help us better understand contributing factors and the serological aftermath of infection. This is where I come in.
This summer I returned to my natural habitat. As a biochemistry major in undergrad, I spent nearly all my free time in the lab. For three months, my love for laboratory science mingled with epidemiology on the global stage. Let’s just say I will never be the same!
Using the tools of molecular epidemiology, I amplified and sequenced the DNA of seroconverted couples and determined linkage. When HIV infects someone, the DNA integrates into the host genome. Not only does the HIV-specific DNA confirm infection, but it also confirms the source of the infection. If the virus was acquired from the positive partner, the couple is linked; however, if the virus was acquired from an outside source, the couple is unlinked. I look forward to sharing the results of my analyses so that we will better understand factors associated with increased risk of transmission in CVCT enrolled couples.
All this is possible because of the Rwandan sense of togetherness. In Kinyarwanda, the word for this is turikumwe. Not only did I witness this in research but also in my daily life. When I stepped into the research lab, I was part of an active force. Turikumwe. Traveling to places like Lake Kivu, Nyungwe Park, and Volcanoes Park, I connected with people that saved me from jungle mudslides while simultaneously conversing about family life. Turikumwe. After visiting the Genocide Memorial, I debriefed with people who have experienced the worst pain imaginable but have become acquainted with the freedom of forgiveness. Turikumwe.
This summer experience has shown me that public health on the global stage works best when we work together—when we commit ourselves to understanding a culture, when we become partners not stakeholders, and when we open our eyes to learning from our partners.
Greetings from Belize!
My name is Caroline Quinn and I am spending my practicum here in Belmopan, the capital of Belize, working with the Ministry of Health through the CDC’s International Emergency Preparedness Team (IEPT). IEPT is part of the CDC’s Global Health Security agenda. Currently, only about 16% of the world is prepared for a disaster. By working with various countries all over the world, the IEPT is hoping to raise that percentage.
Last summer, SORT alumna Dasha Klebaner spent her practicum developing the Belize Ministry of Health’s first all-hazards plan, meaning a plan that can be adapted to any type of disaster. This summer, fellow SORT member Emily Szwiec and I are tailoring the all-hazards plan to each of the six different districts in Belize. Because different districts have different potential hazards, different staff, and different resources, they each need a plan that works for them. For instance, one district is more at risk for hurricane damage while another is more prone to outbreaks of vector-borne disease. In order to do this, we’ve had the chance to travel to four cities so far and work with health services staff in each to develop their plan. So far we’ve been to the San Ignacio in the west near Guatemala, Belize City on the Caribbean coastline, Corozal in the north of the country near Mexico, and Punta Gorda at the southern-most point of the country. Belize has a tiny population (about 350,000) but is a mix of many different cultures (Caribbean, Latin, Mayan, American, British, etc.) so it has been great to get to see all the different sides of the country.
We have also worked with the main public hospitals in each district on their Hospital Safety Improvement plans, based on guidelines from PAHO. To be able to function before, during, and after a disaster, for example, some hospitals needed to install fire alarms and fire extinguishers while others needed to move their generator so it would not be underwater in a hurricane.
Last week we also had the chance to help members of the IEPT facilitate a country-wide Incident Command System training with 36 individuals from the six different districts. Hopefully, if each district knows their role in a disaster and how to communicate with one another, everyone will be able to work together in a disaster.
It’s been amazing to get to work inside a foreign ministry of health, meet all the public health staff in the different districts, and learn more about disaster preparedness. On the weekends, we’ve also had the chance to explore Belize, from hiking Mayan ruins to snorkeling with sharks and rays to trying (key word here) to learn some Kriol to making traditional Mayan chocolate drinks.
My favorite adventure so far was seeing crocodiles up close on the boat ride to the Mayan ruins of Lamanai (which actually means “submerged crocodile”).
Caving in Actun Tunichil Muchnal to see the thousand-year-old skeletons that first confirmed the practice of Mayan human sacrifice was pretty amazing too. You could say it was un-Belize-able.
*SORT Leadership would like to thank Caroline for penning an awesome account of her summer experience! Thank you so very much!
By: Jamie Schenk
2nd-year MPH student (Environmental Health)
Hi (SORT) World!
My name is Jamie Schenk, and I am a 1st year member in SORT but a 2nd year student at Emory University Rollins School of Public Health. I am from Laguna Niguel, CA and graduated from UCLA in 2013 with a B.S. in Human Biology and Society, an interdisciplinary major that combines the basic science core with bioethics, genetics, law, and public health, among other fantastic academic disciplines! While I was at UCLA, I gained some hands-on public health experience through my involvement in the National Children’s Study, the UCLA Sports Medicine Internship Program and starting a food co-operative called the UCLA Student Food Collective.
Through my undergraduate studies at UCLA, I became fascinated by gene environment interaction. While my education gave me a fantastic foundation on genetics, I was lacking substantial knowledge on the environmental component. I then applied to MPH programs in environmental health. I chose to come to Emory because it is in a public health hub, Atlanta, which is home to the CDC, American Cancer Society, and a regional office of the EPA, among other influential health agencies. I also wanted to work with Dr. Dana Barr, an analytical chemist who is an international expert on biomarkers. It was also time for me to get out of my California bubble for a little bit and experience life in another region of the country.
At Emory, I have had phenomenal experiences gaining more public health knowledge inside and outside of the classroom. I worked in the analytical chemistry and exposure lab of Dr. Barr during my first year, working on studies involving gene environment interaction. This summer, I completed my practicum at the US EPA Office of Children’s Health Protection in the Regulatory Support and Science Policy Division in Washington, DC doing risk assessment and translational science work. I currently work at the Division of Reproductive Health at the CDC and as a Teaching Assistant for the introductory environmental course offered at the Rollins School of Public Health.
As a second year student in the Environmental Health department, I felt it was important to be able to apply my knowledge of exposure science beyond what I had experienced in my studies. I wanted to expand my scope of knowledge to be able to apply my interests to outbreak scenarios. Having knowledge of exposure science to help inform epidemiologic efforts in an outbreak response seems to foster important public health collaborations, and I wanted to have that experience before I graduated.
I am very much looking forward to this upcoming year as a SORT member learning from some of the leading authoritarians in outbreak response!
By: Daniella Coker
Through my work-study position at the CDC, I had the opportunity to travel to Accra, Ghana the week of October 6! I went there to attend and help facilitate a portion of a USAID sponsored workshop on strengthening Ghana’s national capacities to detect and respond to Ebola. As many of you have probably already heard, the current Ebola virus disease outbreak in West Africa is the largest in history. As of now Ghana has yet to have a confirmed Ebola case, but there is a growing urgency to assess and update the preparedness plans of currently unaffected countries in West Africa, Ghana being one of them.
The main purpose of the workshop was to facilitate dialogue on country preparedness, especially in the context of the current Ebola outbreak. Most of the workshop’s participants included Ministry of Health officials from Ghana at the district, regional, and national level. There were also representatives from the Ghanaian military, alum from the Nigerian field epidemiology training program who were directly involved in Nigeria’s Ebola response, and a couple of people from Gambia. There were also facilitators and observers from USAID, Public Health England, DTRA, and the CDC who attended.
The workshop was divided up into 3 days. For the first two days, participants and facilitators were divided into small groups to work through a scenario of a single Ebola case introduction into the country. The scenario asked questions, like “Which ministries in your country need to be involved within the first few hours of case identification?” and “In your country, how and where is laboratory testing conducted?”. These questions inspired people at my group to pull out pens and paper to ask each other, “Okay, who would you call after a case is found? What’s their name? What’s their phone number?” Since this scenario seemed to inspire a lot of questions, the second day of the workshop was changed to provide more background on the Incident Management Framework and stories from representatives directly involved in the Nigerian Ebola response.
The last day consisted of breakout sessions sponsored by the CDC, aimed at providing more targeted technical guidance of different aspects of an Ebola response. The CDC held 4 different sessions, where participants could attend one in the morning and a different one in the afternoon. These included sessions on the incident management framework, infection control, risk communications, and contact tracing. As part of my job in Atlanta, I had created a contact tracing scenario that we were to use during the session. Two of my colleagues from Atlanta and I used this contact tracing scenario to walk through the contact tracing process step by step to identify challenges and initiate discussion revolving potential solutions that can be effective in the Ghanaian context. For example, one set of challenges regarding contact tracing in Ghana specifically would be that many homes, especially in rural regions, don’t have addresses, many streets don’t have names, and often times people are called by several different nicknames. Imagine trying to locate 30 to 40 of these types of contacts within the first 24 hours of a detected case!
Overall, the workshop was a successful one! Plans are currently being made to continue the momentum of country preparedness in Ghana. Also, a similar workshop like the one in Ghana is set to be held in Cameroon next week for the French-speaking countries in the area. Since being there I’ve gained a greater appreciation for public health preparedness and the importance of collaboration across a range of organizations to have an effective response.
This was an incredible learning experience and I am greatly appreciative of the opportunity to attend this workshop!
Our members are currently assisting a CDC mapping scientist in the Ebola outbreak response efforts by using an online mapping platform called OpenStreetMap to gather infrastructural spacial data in affected regions — particularly Guinea, Sierra Leone, and Liberia. Because these data (i.e. location of villages, connecting roads, and relative population size) do not exist or are not easily accessible in these regions, OpenStreetMap allows volunteers to provide such information to organizations like MSF (Doctors Without Borders) on the ground that are currently spearheading the response. Since OpenStreetMap is an open-source online platform, our members are able to conveniently map whenever they’re available and have internet connection.
Check out this short video to learn more about how valuable these and similar humanitarian mapping efforts are: https://www.youtube.com/watch?v=C175zW8-6j8