Fighting outbreaks and health emergencies on the frontlines

The theme for World Field Epidemiology Day 2022 (on 7 September) is Empowering Field Epidemiologists for Stronger Health Systems. As we wrote in our last blog, to celebrate, we are sharing stories from Pacific field epidemiologists on the frontlines in our programs for each of the Day’s sub-themes.

First up is Health Extension Officer, John Landime. John is a Field Epidemiology Training in Papua New Guinea (FETPNG) graduate, Advanced FETPNG fellow, FETPNG junior faculty and Rapid Response Team lead in Nawaeb District, Morobe Province, Papua New Guinea.

Here, John shares his journey as a field epidemiologist, speaking to the first sub-theme for World Field Epidemiology Day 2022: fighting outbreaks and health emergencies, including COVID-19, on the frontlines.

My journey as a field epidemiologist

It all started in 2009 in the heat of the cholera outbreak.

As a young Officer in Charge of Boana Health Centre and the only Clinical Health Extension officer in the District the burden on me to respond to this outbreak was enormous. With no experience in outbreak response and investigation I relied on my clinical knowledge to respond.

I had constant and regular contacts with Edwin Benny, the Provincial Disease Control Officer during these responses. I faced my biggest challenge yet when I was ordered by the Provincial Health Office to manage a cholera centre established by the Médecins Sans Frontières along the Bukawa coastline.

*John conducting risk communication activities during an outbreak*

‘Somebody in the District should be taking over now’ that was the message to the Health Technical Officer. The Health Manager was called up and eventually the call ended on me. I packed my bags, took a Community Health Worker to accompany me and off we went. I spent an hour in the Provincial Health Office reading through a thick manual on cholera of which nothing made sense to me at that time. We boarded a boat and took an hour boat ride to Bukawa. I managed the centre for 30 days. In all this time Edwin Benny was the one that I seek advice and of course a name Berry Ropa kept popping up in my conversation with Edwin. I only know of Berry as the Boss of Surveillance at that time.

I had a laptop that time but had no idea about using Excel. I have no idea that it was an application for data collection and analysis. I use Word to draw tables and enter simple linelist of cases during my response in the District.

Anyway, cholera came and went and I built an interest in respond to outbreaks in the District. I attend small pockets of outbreaks under the guidance of Edwin and collect data using simple linelist in Word.

In 2017 I received a call from Berry Ropa the Surveillance Boss who is the Director of Field Epidemiology Training in Papua New Guinea (FETPNG). I was to attend FETPNG.

*John (right) about to board a chopper with colleagues to respond to a diarrhoea cluster*

After the training it had open up so much for me in terms of data collection and analysis, I leant to use Excel and was trained by some of the best in the likes of Tony Merritt and James Flint (from Field Epidemiology in Action/Hunter New England Health in Australia). Storing data into Excel was just awesome. I literally entered every data in my facility into Excel.

In early 2018 I set up my child health register in my health centre to track my children under 5. All the children were entered into the Excel linelist and monitored over time to ensure they received their vaccine. I used this to create simple graphs to do in-house review meetings with my staff at the health centre.

I attended several outbreaks in the district and wrote reports to Authorities with recommendations. I even wrote an Abstract on my project on unsupervised and supervised delivery and was selected to attend the TEPHINET conference in Laos PDR the following year, 2018.

*John providing health education to community during an outbreak*

In early 2020, the pandemic hit – COVID-19. I led the first National lockdown in Mutzing station road block with fellow FETP graduate Brian Manari. All entries of vehicle passing were registered and entered into linelist. Person of interest were identified, interviewed and tested.

I provided weekly report to the Markham District Administration on the COVID-19 response. While in Markham I was also Coordinating Nawaeb District COVID-19 response.

From observation of the nature of presentation of COVID-19 I immediately set up 4 respiratory clinics in 4 major health centres in Nawaeb District. I created the cough algorithm for use in Morobe Province and was used in respiratory clinics for the easy diagnosis and differentiating cough cases. I spent all year 2020 setting up my respiratory clinics and responding to cases of COVID-19.

“I attended all those outbreaks and COVID-19 while working with a broken hand. I did not let that get in my way… I had a plate inserted in my hand… but I responded with courage and determination to work as a field epidemiologist” - John

In February 2021 Morobe reported its 10th case of COVID-19 from a village under my catchment. This detection led to the 2nd wave experience in the country and Morobe. With the experience in outbreak response I was again called up to manage the outbreak in that village close to the highlands highway. With a rapid activity plan and prudent contact tracing, 7 more cases were identified and immediately isolated. With my knowledge on linelisting and contact tracing I successfully manage the 8 cases of COVID-19 under home isolation with no new transmission. I went on to manage other pockets of cases in the District and led in the front on contact tracing and other rapid response activities.

The 4 respiratory clinic was an idea developed and tried out by me and was the subject of my Advanced Field Epidemiology Training in Papua New Guinea (aFETPNG) project. Operations around its establishment will be subject to continuous operational research to improve knowledge and practices in its used in the public health domain.

*John and colleagues conducting a COVID-19 investigation*

My training in field epidemiology has given me the confidence to tutor and mentor training students from Pacific Adventist University in 2022 where data in my facility regarding practices were reviewed with literature reviews and recommendations being done to improve practices around maternal child health and other operations in the health centre. Field epidemiology training enable me to assist development partners like Clinton Health Access initiative (CHAI) and Care International on some current operational research being carried out in Nawaeb District. With knowledge and skills on data collection and analysis I felt confident engaging with them.

*John conducting interviews as part of an outbreak investigation*

Thank you, John, for sharing your field epi journey with us!

Next week’s World Field Epidemiology Day blog will be on sub-theme 2: Strengthening health surveillance systems to detect public health threats early.

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