One of the requirements for the MD/MPH program at OHSU is a public health internship. So after a few months of communicating with Profesora Mirna, the epidemiologist whom I am working with in Venezuela, applying for various grants, and going through the necessary steps, the first day of my internship officially began.
My main project is to evaluate the current epidemiologic surveillance system for dengue (See my explanation of dengue at the end of this blog entry) in Naguanagua, the Venezuelan county I live in. Also, to analyze a database from 2010 to assess risk factors and measure incidence of dengue in Naguanagua. Surveillance, though it may spark thoughts of cops with video cameras parked out in abandoned warehouses, essentially entails the reporting and monitoring of cases of dengue, which are reported by physicians, clinics, hospitals, and other health centers.
I work at the county public health department with Olgita, Dra. Tibisay, and Dra. Carmen — who are showing me the ropes. The first few days, I received an overview of how surveillance works. I learned about the la información para la acción (information for action) model of using data to develop prevention programs as well as vector control. I learned how we receive the reports, how we process them and compile them into weekly and monthly reports to send to the state health department who then sends them onto the national level.
It’s cool to focus on dengue because, although there are variations in aspects of surveillance systems, there is a similar system for most other diseases. I feel like I’m learning a lot through the experience and definitely applying concepts that we’ve learned in the classroom, and I’m not just saying that because it’s the goal of the internship. Everybody has been super nice and great to explain everything. It’s definitely a good thing that my Spanish came back pretty quick because it sure is a lot information and a lot to process in any language.
Here is how my week went:
Monday was actually a pretty crazy first day because we received a call about 9:00 am that a young military officer had died on the previous Friday and dengue was the likely culprit due to the suspicious pulmonary hemorrhage. Tragic, as dengue has a less than 1% case fatality rate with proper treatment here, however, it was cool to see an activation of the public health forces to piece together what happened and prevent any further cases from developing or, if there are, ensure that proper medical treatment is sought.
On Tuesday, I heard a little of the aftermath after Dra. Tibisay went to Maracay to investigate, however, the case left our jurisdiction and it was passed to another county and the state. I felt like Sherlock Holmes or, as Profesora Mirna commented at our afternoon meeting, a bit like Indiana Jones on another case. My schedule for the most part is working at the public health office in the morning from 8-12 and then a meeting with Profesora Mirna in the afternoon. Next week, I will be working with epidemiologist, Dr. Graffe, at the Hospital Carabobo and helping out more with surveillance on the hospital level.
Wednesday afternoon was also a day for meeting people as I met Dr. Pedro, the head epidemiologist for the state, and spent the afternoon meeting the officials at the Hospital Carabobo, from the Directora of the entire hospital to other physicians and people in the HR department. The hospital was a little overwhelming, but Dr. Graffe gave us a nice tour and everybody was muy amable (very nice just doesn’t sound the same in English).
On Thursday, it was scheduled for me to sit in on a big meeting with all the epidemiologists in the state, however, as I navigated my way through the centro and was just about to arrive at el teatro, Profesora Mirna gave me a call and said that it was canceled because something else had come up. Nevertheless, I was able to meet with Dr. Pedro Romero. We exchanged numbers, and he repeated several times “que ahora somos amigos” (now we’re friends) and was too kind to assure me that I could come to him with any questions and that we would be able to reschedule for another time. I made fairly good time getting back to my regular office, though both of the epidemiologists were out the field doing work with a case of H1N1 and I don’t remember what else. Nevertheless, Oglita helped me locate la base de datos (database) and I started familiarizing myself with all of the data, a process that continues to progress.
Friday, though, was quite exciting as I went to one of the clinics and worked with a public health nurse, Leonaris Gonzalez, who gave me an overview of the vaccination programs and how all of that works, which is fairly similar to the system for dengue surveillance. It was cool to see the commonalities. There is also a lot of talk about some promising dengue vaccines on the horizon so, consequently, learning about the immunization program definitely peaked my interest. I also got to talk with one of the physicians who explained, wanting to practice her English, how they fill out the charts of which I have seen so many in the county health office. I also talked with a social worker about the prevention and education programs that they do in the communities and schools. Afterward, I got to ride in the ambulance. It was actually the first time for me to ride in an ambulance, which was funny that it would be in Venezuela. There wasn’t an emergency, other than that we needed to go to the regional laboratory to pick up more vaccines. I won’t lie, I did have a good time riding in the back and we even put the siren on a couple of times. Overall, a very enjoyable Friday, albeit I was very exhausted after a long week.
The vector, or carrier, of dengue is the Aedes aegypti and Aedes albopictus mosquitoes. Dengue itself is a flavivirus, single stranded, positive sense RNA virus that manifests as a fever and a broad spectrum of other presentations such as retroocular pain, a characteristics rash, and myalgias. I won’t drone on with the particulars of the four serotypes and the risk for the more grave dengue hemorrhagic feve; you are free to read my end of the internship report for those of you who feel so inclined.