Yellow fever outbreak in Africa: feelings of an epidemiologist in a rapid response team

By Enny Cruz, PhD student in the Faculty of Epidemiology and Population Health

I IMG_5806came to the School from Brazil in 2015 to do a PhD in epidemiology. While I have been very much enjoying my studies, my PhD project does not require field work and as a PhD student I spend many hours alone in my own bubble just looking at numbers. This summer I had the opportunity to join a GOARN (Global Outbreak Alert and Response Network) team as a field epidemiologist in Angola during an ongoing yellow fever outbreak. I immediately grasped the chance as I saw it would be a great opportunity to develop new skills while experiencing working in an international organization. Before leaving for Angola, I read about yellow fever and outbreak control and also tried to get to know a little bit about the country’s culture and history. This was my first mission with WHO, and I tried to be as prepared as I could.

When I first arrived in Angola I remember thinking: this is very similar to Brazil (the country I come from). In fact, it really is! The weather is reasonably hot all the time, and the people are friendly and loud. The food is savoury and varied. The capital, Luanda, had the very wealthy living in luxury buildings, while many poor people live just outside on the street. All these elements are quite similar with Brazil. However, there was something fairly different: they had deep roots with the native cultural aspects, for example although Portuguese is the official language, children learn from their parents a tribal language before they learn Portuguese. They have a very recent history of war against the Portuguese colonialists and also even more recent civil war. These are situations that leave a scar on society in some ways that I cannot explain, but I have not experienced in Brazil.

Working alongside the community

Working alongside the community

 

My days in Angola were out of the ordinary. I was part of a rapid response team, and I was working alongside international staff deployed by UNICEF, CDC and MSF and also national staff from Angola. They had different backgrounds, language, priorities and ways to get things done but we all had the same mission: to help the country face the yellow fever outbreak and other major concerns. It was very interesting to observe how we all used different tools from our own backgrounds to achieve this goal.

My main role in the rapid response team was to investigate yellow fever suspect cases in hospitals and community. While doing this it was impossible not to be involved with other concerns, such as malaria, rabies, respiratory infections and with the sub-optimal hospital and community living conditions. I noticed the vaccination coverage for others diseases such as polio and measles were below acceptable levels even in the capital; they had had no rabies vaccine for months. All these factors fuelled each other and made the population highly vulnerable to easily preventable infectious diseases, including yellow fever, the disease outbreak that I was assigned to work with.

Meeting with partners from MSF, UNICEF and OMS/GOARN in ‘Shock Room’

Meeting with partners from MSF, UNICEF and OMS/GOARN in ‘Shock Room’

 

I had thought found that by going to a distant country, getting to know and interact with people from different cultures, working by mixing medical skills and my numerical skills would made me feel lucky to be an epidemiologist. However, when arrived I realized that the distant country with a different culture had more in common with my own people than I had imagined, and the medical cases and statistics and numbers became not just numbers but real people with real stories that I would remember vividly at the end of every day. So in fact I felt more than lucky, I felt grateful for the choices that led me here, for the choices that led me to choose epidemiology (a profession I had never even heard of before graduation).

I cannot deny that there were a lot of problems. The work was tough and I believe that the rapid response could have been more effective, however I had the opportunity to see close up the challenges faced organizing a massive vaccination campaign, and I had the experience to investigate a disease of unknown aetiology, to prepare a questionnaire to be used in the whole country by different levels of health care workers and also to see how difficult it is to classify a suspect case in a meeting with ten people in the course of an outbreak. These are all tasks that, before this experience, I thought would be much easier. I really learnt what it is to do field epidemiology.

Looking for Aedes aegypti larvae in wells during field work

Looking for Aedes aegypti larvae in wells during field work

 

This experience made me grow as an epidemiologist and also as a person, and I really appreciate the opportunity that I had. So I recommend to epidemiology students to try to prioritize this kind of experience as part of their program. I felt that these two months added a specific kind of knowledge that I would not have acquired in any other way, doing only my lonely PhD analyses, and it will help me leave the School more prepared to face the challenges posed by global public health.

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