Stories of Empowerment for World Field Epidemiology Day
In honor of World Field Epidemiology Day on September 7, 2022, TEPHINET asked Field Epidemiology Training Program (FETP) fellows and alumni to share stories of how empowering field epidemiologists has directly benefited public health systems in their countries. Below, read the stories of 11 FETP-trained field epidemiologists from China, Germany, India, Indonesia, Liberia, Nigeria, Uganda and Vietnam.
Gamze AktunaField Epidemiologist in TwiNit Project and German FETP (PAE)
Robert Koch Institute, GermanyAn FETP story about cross-continental empowerment initiatives between Namibia and Germany:
This is a story of the Namibia Field Epidemiology and Laboratory Training Program (NamFELTP) and the Germany Field Epidemiology Training Program (Postgraduate Training for Applied Epidemiology, PAE) strengthening fellows and alumni, not only within national boundaries, but also across continents. In 2020, the Namibian Ministry of Health and Social Services (MoHSS) and the Robert Koch Institute (RKI) started a twinning project with the long-term goal of supporting the establishment of a Namibian Institute of Public Health. As one of three technical work areas of this project, the Field Epidemiology and Laboratory Training Programme (FELTP) enabled collaboration and scientific exchange between Germany and Namibia in order to strengthen and consolidate the existing NamFELTP for the development of qualified public health personnel.
In December 2021, three field epidemiologists from the NamFELTP were invited to present and participate in the virtual Outbreak Investigation Module, which was organized by PAE together with the European Centres for Disease Control (ECDC) fellowship programs (EPIET/EUPHEM and MediPIET). This exchange provided an opportunity to start building R programming capacities in Namibia to strengthen outbreak response capacities. Between January and April 2022, PAE and the twinning project team were actively involved in supporting the sixth cohort of NamFELTP through supervision and lecturing. In April 2022, 27 trainees from six regions graduated and returned to their regional duty stations with an increased understanding of public health and advanced basic epidemiology skills to carry out their tasks. Field epidemiology training has the power to connect epidemiologists and scientific knowledge from across the globe, as demonstrated by this study.
Ifeanyichukwu Paul AmaechiSenior Environmental Health Officer/Epidemiologist
Nigeria Centre for Disease Control, Abuja, Nigeria
I graduated from the Master of Public Health (MPH) Epidemiology and Disease Control program of the School of Postgraduate Studies, Federal University of Technology, Owerri, Nigeria. During this program, I was taught by professors of public health, environmental health and epidemiology. The knowledge and skills I gained from the training program prepared me to work in the field of public health and environmental health. The program developed my skills and thinking so that I could deliver lectures to my students as a young lecturer for the course “Introduction to Public Health Practice” at Abia State College of Health Sciences and Management Technology, Aba, Nigeria. After graduating in 2019, the MPH program gave me the opportunity to be an agent of emergency preparedness, environmental health preparedness and health response in Nigeria when I joined the Nigeria Centre for Disease Control (NCDC) in 2020. As a member of NCDC's public health lab department, I was fully involved in detection of infectious diseases such as COVID-19, monkeypox, Lassa fever, cholera, yellow fever, and more. Disease surveillance and laboratory optimization of Nigeria’s public and private health institutions were a part of the NCDC lab network. I believe that empowering more young health lecturers, like me, through career development, training and support will greatly impact public health response in Nigeria.
Sarah GaoProgram Officer
China FETP, ChinaOn October 11, 2020, six confirmed cases and six asymptomatic cases of COVID-19 were reported in Qingdao city, Shandong province, China, erasing the record of zero-report of COVID-19 cases for 56 consecutive days throughout the country. The sudden increase in cases attracted public attention and posed the question "Where did the virus come from?". The National Health Commission (NHC) of China immediately dispatched an expert group to Qingdao to guide local prevention and control. Ms. Huilai Ma, director of the Chinese Field Epidemiology Training Program (CFETP) of the Chinese Center for Disease Control and Prevention (China CDC), was a member of the group. As a senior field epidemiologist, Ms. Ma led the epidemiological investigation team in carrying out the tracing of the origins of the virus, leaving no stone unturned during the investigation. After 72 hours of continuous investigation, patient zero was found---two dock workers of the Qingdao Dagang company who had unloaded a batch of cold chain foods (frozen cod) imported from abroad during their night shift on September 19, 2021. Through “two-stage mixed sampling” testing of the outer packaging of thousands of tons of frozen cod stored in cold storage, experts from the Institute for Viral Disease Control and Prevention (IVDCP) of China CDC isolated live SARS-CoV-2 virus from the same batch of imported frozen cod unloaded by the workers. This marked the first time in the world that live SARS-CoV-2 virus was isolated from the outer packaging of cold chain foods. For the first time, it was confirmed outside the laboratory that under the condition of cold chain transportation, SARS-CoV-2 virus can survive for a long time on the outer packaging of items. It suggested the possibility that the SARS-CoV-2 virus could be imported from a long distance, crossing borders, with cold chain items as its carrier. Based on the findings of the investigation, Ms. Ma suggested that in addition to enhancing the prevention and control of importation of the virus by travelers, attention should also be paid to cold chain items, implementing preventive measures for importation from both people and goods simultaneously. The Ministry of Transport of China subsequently took the suggestions of Ms. Ma and other epidemiologists into account and issued multiple versions of the “Guidelines for prevention and control of SARS-CoV-2 virus transmission by imported cold chain foods from roads and waterways and disinfection protocol,” which safeguards cold chain foods under the global pandemic. With the increasing frequency and complexity of global public health events, the importance of field epidemiologists in health institutions is becoming more and more prominent. As the director of China FETP, Ms. Huilai Ma has led her team in battle with COVID-19 since the beginning of the pandemic and is dedicated to providing professional advice and suggestions to decision-makers. Each of the trainees and mentors of the China FETP have played an indispensable role in pandemic control and prevention. They have completed assigned tasks excellently and won public recognization. This could be the best explanation for how empowering field epidemiologists may lead to a stronger health system.
Hoang Quoc Cuong, MD, Ph.D.
Graduate (2016), Vietnam Field Epidemiology Training Program
Pasteur Institute in Ho Chi Minh City, Vietnam
Dr. Hoang Quoc Cuong graduated from Vietnam's two-year advanced Field Epidemiology Training Program (FETP) in 2016. Since then, his career has progressed fruitfully, and he currently serves as deputy director for the Pasteur Institute in Ho Chi Minh City. In his role during the COVID-19 pandemic, he was responsible for guiding COVID-19 nosocomial outbreak responses at Long An General Hospital and for advising provincial leaders and the Long An Provincial Centers for Disease Control and Prevention (CDC) on COVID-19 surveillance and response in the community. The knowledge and experience he gained during his FETP training had a direct impact on his success in this role. Part of Dr. Cuong’s work included overseeing Long An General Hospital’s technical response to COVID-19. Under his leadership, the hospital conducted daily investigation and monitoring of virus transmission, improved methods for treating patients and improving biosafety protocol, and better managed medical waste to ensure hygiene and transmission prevention. In his capacity supporting provincial leaders, the depth of expertise Dr. Cuong developed in his FETP training allowed him to better support Long An Province’s capacity to share data more effectively.
With his guidance, Long An established a more responsive reporting system for the accurate assessment of the epidemic situation at each level; they introduced surveillance teams to support collaboration across health and other sectors and they devised strategies to guide local decision-making in controlling the spread of infection. Dr. Cuong’s contributions to Long An Province’s COVID-19 response were well-informed by the knowledge he gained as an FETP participant and had a direct effect on the strength of Long An Province’s response in controlling COVID-19. His leadership is just one example of the impact and critical role field epidemiologists play in managing emerging diseases and threats.
Darius B. LehyenGraduate (2018), Liberia Field Epidemiology Training Program Epidemiologist
Ministry of Health, Liberia
I am delighted to have been part of the Liberia Field Epidemiology Training Program (FETP). In February 2022, I was involved in outbreak investigations of, and responses to, pertussis in Jamestown, Jo-River district, Rivercess County. I was interested in learning more and having field experience in outbreak investigation as a field epidemiologist through the Liberia FETP. With the district health team, we investigated pertussis outbreaks and conducted active case finding to collect information. The purpose of the investigation was to confirm the existence of the disease affecting the population and to verify the diagnosis. I was delighted to carry out this investigation as the lead for the epi-surveillance team for this pertussis outbreak. I was not just happy to contain the outbreak and enhance vaccination activities but also grateful for my skills and efforts applied in responding to the outbreak. We saved the lives of people in hard-to-reach terrain in my country. I am jubilant. For the first time in my career, I see the fruitful impact of the work we do in Rivercess County, Liberia as a surveillance team.
Stella Martha MigambaFellow, Uganda Public Health Fellowship Program Field Epidemiologist
Uganda National Institute of Public Health, Uganda
The role that field epidemiologists play in ensuring resilient health systems is vital to human survival. Field epidemiologists collaborate with the Ministry of Health and partner organizations to implement disease control programs. They are public health service professionals who fill a critical gap in human resources for health, bringing together various professionals, including clinicians, social workers, veterinarians, security agencies, and politicians, for the purpose of One Health. They are critical thinkers who conduct deep analysis so that public health actions are guided by sound scientific evidence.
Uganda was lauded for its spirited fight against HIV in the 1990s. Prior to that, the country was burdened with high HIV infection rates, according to epidemiological analysis. HIV/AIDS care organizations such as The AIDS Support Organisation (TASO) were formed to improve the care of HIV-infected persons. Epidemiologists also conducted HIV/AIDS research which led to innovations in HIV/AIDS care and reduced infections. Epidemiologists effectively communicate findings of evaluations and field investigations to stakeholders in ways that build trust; when people trust the health system, they utilize it. When the COVID-19 vaccine was introduced in Uganda, people were reluctant to get vaccinated. However, through continuous and effective communication led by epidemiologists, vaccination uptake increased. They also identify disease alerts early and bring them to the attention of public health authorities. Teams are immediately deployed to manage the threat. Among other areas, the capacity-building of district and health facility staff by epidemiologists on infection prevention and control, case management, surveillance, and risk communication has enabled Uganda to overcome several outbreaks, including the deadly Ebola virus disease (EVD).
One notable response is that to EVD, which registered a high case fatality rate the first time it occurred in Uganda in 2000 but was brought under control during subsequent outbreaks. Uganda has managed to evade EVD on several occasions where it has been reported in bordering regions in neighboring countries. The expertise of epidemiologists in Uganda has benefited the country and its neighbors. During the EVD epidemic in West Africa from 2014 to 2016, Ugandan health workers supported response efforts in West Africa. Similar efforts were employed to control COVID-19, whereby Uganda resisted it for a long time until March 2020, when the first case was registered. These successes were in part due to experienced field epidemiologists, some of whom were deployed at entry points of the country to conduct COVID-19 screening and offer technical advice. By this time, other countries had recorded high case fatality rates and were facing a public health crisis. Later, during the COVID-19 upsurge in Uganda, epidemiologists continuously provided health information to the public, hence managing expectations. This was important for mental health, as there was much anxiety because of the loss of lives due to COVID-19 and the lockdown that affected livelihoods. Epidemiologists influenced decisions that ensured the population was protected and that the health system was not overwhelmed with COVID-19 cases in our resource-limited setting.
Environmental Public Health Officer
Nigerian Air Force, Nigeria
I work with the Nigerian Air Force (NAF) Public Health Directorate as an Environmental Public Health Officer. Since my deployment to the NAF Hospital in Makurdi, I have had a strong interest in the trend of diseases and the importance of public health within my area of jurisdiction. We use the World Health Organization (WHO) Integrated Disease Surveillance and Response (ISDR) platform. The spike in the cases of gastroenteritis in recent months made me ask myself why I moved into a role doing epidemic investigations. During the investigation, I sampled a segment of my community (i.e., food handlers/vendors, restaurants, food hawkers, bread and confectioneries, and drinking water vendors). In conclusion, I was able to link the transmission to people in the aforementioned population. I was able to achieve all this with the residual knowledge of epidemiology during my college experience. I have a special interest in field epidemiology and I know I can do better with capacity building in this noble pillar of public health.
Dr. Hariet Nakigozi
Performance Improvement Officer
National Health Laboratory and Diagnostic Services, Ministry of Health, Uganda
Field epidemiologists have directly benefited public health in Uganda and improved disease surveillance. This has led to improved diagnosis of communicable, noncommunicable, and zoonotic diseases, and viral hemorrhagic fevers. Uganda is known and has been identified as a hotspot for various diseases due to its location in the Congo Basin and favorable climate for diseases ranging from malaria and cholera to Ebola and Rift Valley fever. Public health is improving in Uganda, and policies and guidelines are being put in place to respond to emerging and re-emerging diseases. More technologies are being procured and utilized for testing and diagnostic purposes. Epidemiologists have strengthened research and innovation aimed at developing science in Uganda. More training programs are now on board that enhance practical and public health approaches, including medical journalism for quality reporting in the media in order to strengthen field investigations during outbreaks.
Nguyen Dinh Luong, MD, MSGraduate (2018), Vietnam Field Epidemiology Training Program (FETP) Surveillance Officer, Department for Infectious Disease Control and Prevention
Pasteur Institute of Nha Trang, Vietnam
Dr. Luong graduated from the CDC Vietnam's two-year advanced Field Epidemiology Training Program (FETP) in 2018. Since his graduation, Dr. Luong has served as a surveillance officer in the Department for Infectious Disease Control and Prevention at the Pasteur Institute in Nha Trang. When COVID-19 began, the skills Dr. Luong gained during his FETP participation became immediately applicable to his work. He deployed on numerous occasions to investigate COVID-19 outbreaks in Vietnam, and the resulting work supported Vietnam’s efforts to contain COVID-19. From January to February 2020, Dr. Luong participated as an interviewer and data collector in Vietnam’s very first community outbreak among factory workers who had returned to Vietnam’s Vinh Phuc Province from Wuhan, China. Together with FETP Vietnam and the National Institute of Hygiene and Epidemiology, Dr. Luong and the team mobilized 20 FETP fellows and surveillance staff.
The resulting investigation identified 12 COVID-19 cases and 300+ close contacts. During Vietnam’s second wave of COVID-19, Dr. Luong led the Pasteur Institute in Nha Trang’s rapid response team to an outbreak among seven hospitals in the Da Nang Province. In addition, Dr. Luong provided technical assistance to Lao PDR for epidemic control and deployed to Lao PDR as part of a team of surveillance staff and institutions providing support to the neighboring country. Dr. Luong also aided in the development of a COVID-19 disease development strategy in numerous provinces in Vietnam, including Phu Yen, Dong Thap, An Giang, and Vinh Long. Dr. Luong’s capacity to support Vietnam’s COVID-19 outbreaks was greatly informed by his experiences as an FETP fellow. His work investigating and reporting on infection spread is one example of how field epidemiologists can have a direct impact on a country’s successful disease response. In this case, Vietnam successfully contained the spread of the virus for the first fourteen months of the COVID-19 pandemic, and the work of field epidemiologists like Dr. Luong played a critical role in that effort.
Graduate (2011), Indonesia Field Epidemiology Training Program
Head of Health Planning Division
District Health Office, Barru District, South Sulawesi Province, Indonesia
Story text submitted in Indonesian:
TAMAT FETP 2011, SY BUAT TIM YANG BERTUJUAN UNTUK MEMBANGUN SEBUAH SISTEM KETERPADUAN PROGRAM KESEHATAN TERTENTU MELALUI KERJA-KERJA SURVEILANS DAN BERFOKUS PADA PEMBERDAYAAN MASYARAKAT. KAMI MEMBANGUN SISTEM SURVEILANS TERPADU BERBASIS MASYARAKAT DENGAN FOKUS MASALAH KESEHATAN : PD3I, KUSTA,DIARE,KERACUNAN PANGAN,MALARIA DAN RABIES DAN RUMOR.KEGIATAN INI MELIBATKAN PENGELOLA LINTAS PROGRAM BAIK DI DINAS KESEHATAN MAUPUN DI PUSKESMAS. UJI COBA DILAKUKAN PADA TAHUN 2020 PADA 2 WILAYAH PUSKESMAS DAN 7 DESA. SEJAK TAHUN 2018 HINGGA SAAT INI, SURVEILANS TERPADU BERBASIS MASYARAKAT SUDAH DIIMPLEMETASIKAN DISELURUH PUSKESMAS DAN DESA YANG ADA DI KABUPATEN BARRU. JUMLAH KADER TERLATIH MINIMAL 5 ORANG PER DESA, JUMLAH ANGGOTA TIM PUSKESMAS SEBANYAK 60 ORANG. KADER SURVEILANS TERUTAMA MELAKSANAKAN TUGAS DETEKSI DINI MASALAH KESEHATAN DI DAERAHNYA SERTA MELAPORKAN KE PUSKESMAS LAPORAN 1 X 2 4 JAM ATAU LAPORAN BULANAN SESUAI FORMULIR UNTUK DITINDAKLANJUTI OLEH TIM SURVEILANS TERPADU PUSKESMAS. UNTUK KEBERLANJUTAN KEGIATAN SURVEILANS TERPADU BERBASIS MASYARAKAT, MAKA DI MASUKKAN SEBAGAI SALAH SATU INDIKATOR KINERJA DALAM RENCANA STRATEGIS DINAS KESEHATAN KABUPATEN BARRU YANG DISUSUN SETIAP 5 TAHUN. INOVASI LAIN, TAHUN 2019, SAYA MEMBENTUK TIM SURVEILANS KEMATIAN KABUPATEN DENGAN TUJUAN MEMANTAU SEMUA KEJADIAN KEMATIAN DALAM WILAYAH KABUPATEN BARRU UNTUK MENGIDENTIFIKASI PENYEBAB UTAMA KEMATIAN, SISTEM SURVEILANS KEMATIAN EFEKTIF BERJALAN PADA TAHUN 2020 SAMPAI SAAT INI DENGAN MELIBATKAN LINTAS PROGRAM DAN LINTAS SEKTOR. SURVEILANS KEMATIAN MENGGUNAKAN METODE AUTOPSI VERBAL TELAH DIIMPLEMENTASIKAN DI SELURUH PUSKESMAS DENGAN JUMLAH TENAGA TERLATIH MINIAL 2 ORANG PER PUSKESMAS DAN RUMAH SAKIT. PEMERINTAH DAERAH SANGAT MENDUKUNG KEGIATAN INI KARENA BISA DINTEGRASIKAN DENGAN PROGRAM LAIN MISALNYA PROGRAM JAMINAN KESEHATAN DAN KEMATIAN. SISTEM SURVEILANS INI JUGA SUDAH DIINTEGRASIKAN DENGAN KEGATAN SURVEILANS TERPADU BERBASIS MASYARAKAT DIAMANA JEJARING SURVEILANS DARI KADER DI TINGKAT DUSUN ATAU DESA MELAPORKAN SETIAP KEJADIAN KEMATIAN DI WILAYAHNYA KEPADA TIM SURVEILANS KEMATIAN PUSKESMAS. UNTUK PENGUATAN SISTEM SURVEILANS KEMATIAN TAHUN INI, TELAH DIBUAT APLIKASI SEDERHANA YANG DIHARAPKAN AKAN TERINTEGRASI DENGAN DINAS KEPENDUDUKAN. DATA KEMATIAN DILAPORKAN SECARA HARIAN ATAUPUN BULANAN DAN APABILA ADA INDIKASI KEJADIAN LUAR BIASA, MAKA TIM PUSKESMAS AKAN MELAKUKAN PENYELIDIKAN EPIDEMIOLOGI. UNTUK MENJAMIN KEBERLANJUTAN SISTEM SURVEILANS KEMATIAN, MAKA KEGIATAN TERSEBUT DIAKOMODIR SEBAGAI SALAH SATU INDIKATOR KINERJA DALAM DOKUMEN RENCANA STRATEGIS DINAS KESEHATAN TAHUN 2021-2026. INTINYA . BANYAK MANFAAT YANG BISA KITE BERIKAN KEPADA MASYARAKAT DENGAN MEMBUAT SEBUAH SISTEM SEDERHANA SESUAI KONDISI DAERAH MASING-MASING, TERGANTUNG KEPEDULIAN KITA DAN TANGGUNGJAWAB KITA SEBAGAI TENAGA EPIDEMIOLOGI.
Dr. Purvi PatelGraduate (2021), India Epidemic Intelligence Service (EIS) Senior Consultant
National Center for Disease Control, India
Heat-related illness (HRI) surveillance was an unheard-of surveillance system when I joined the India-Epidemic Intelligence Service (EIS) training program in 2019. I joined the training to learn about health surveillance in my country by witnessing it first-hand from within the government. However, I had never imagined that evaluating HRI surveillance as an India-EIS officer would change the direction of my career. Today, many parts of India are experiencing heat waves. For many north-western and northern regions of the country, this is their third heatwave of summer 2022. As people experience extreme heat, the demand to know its health impact in terms of morbidity and mortality has become paramount for stakeholders. As an officer under the National Programme on Climate Change and Human Health (NPCCHH) at National Centre for Disease Control, Ministry of Health and Family Welfare, I am assigned to oversee nationwide HRI surveillance.
As a senior consultant in charge of the heat-health aspect of climate change impact, I have conducted training-of-trainers of health officers to sensitize them to scientific aspects of climate change impacts, various physiological pathway and scenarios of heat stress development, and trained them for surveillance reporting. I have provided surveillance feedback reports to the states to strengthen their reporting and submitted analysis reports to national-level coordinating agencies to assess state-level preparedness. I am also working towards upgrading and integrating the surveillance with environmental monitoring with support from India Meteorological Department. Learning about ambient heat’s health impact opened my eyes to a whole new domain of climate change and its cascading impacts on our health.
Today, I am more aware of environmental damage that is being done through human activities and its devasting consequences if we fail to keep global temperature rise below 1.5 degrees Celsius. This knowledge has empowered me to be an effective communicator for general awareness (one of the key objectives of NPCCHH) and to work passionately to advocate for climate change mitigation and health sector adaptation. I was one of the recipients of the TEPHINET cardiovascular disease small grant in 2021 and served as the field mentor for the oral presenter who received the William Foege award this year (acute neurological illness in Eluru, Andhra Pradesh). These are definitely going to enrich my career. I thank TEPHINET, CDC, and NCDC for such opportunities to learn and grow.