An Epidemiology Student’s Journey
Last year I pursued a summer internship at the CDC, because I wanted to learn about how to best operationalize my field epidemiology career aspirations. I knew the CDC would offer extraordinary training opportunities. But I was also drawn there because of its location in Atlanta, in the South, close to my home.
I make no excuses about my upbringing. I am an unabashed Southerner, a second-generation small-town Floridian from a southern outpost of America’s Bible belt. I missed collard greens and corn bread. I missed ‘y’all’s’ and Southern hospitality and waffle houses. I missed home dearly, and the CDC was the nearest large public health entity to that home and my family whom I love deeply. Fortunately for me, the CDC is also home to a center that provides the globe with one of the best, if not the best, emergency response epidemiologic methodology.
Basia Tomczyk DrPH ’99, MPH ’94 was recommended to me in the fall of 2012 as a possible mentor by Dr. Ndola Prata, scientific director (now director) of the School’s Bixby Center for Population, Health and Sustainability. Dr. Prata’s kind e-mail to Dr. Tomczyk facilitated several phone interviews and later an in-person interview, paving the way for an internship position.
The CDC is a massive organization. The imposing skylines of the Clifton and Chamblee campuses dot the horizon from miles in every direction. These beacons of public health were alternately beckoning and repelling me as I drove onto campus that first morning. My fear was not of the CDC or what it represented, but of the prospect of sitting in a cubicle‒a fate I place just above death. The CDC is just that: cubicles. But it is also the nerve center of both U.S. and international public health. There are some of the most eloquent, intelligent people I have ever met. There are courses to be taken, mentorship to be had, and all manner of opportunity to enhance your trade as a public health professional. My favorite, the unanimous love of good science, was tangible. I wanted to stay without payment just to be around the brilliant scientists and the general aura of being around those who were changing the world in very real, measurable ways. I loved the CDC and would be honored to go back at any time for any length of time.
I was very fortunate to have Dr. Tomczyk, one of those brilliant, world-changing epidemiologists, as my preceptor at the CDC and as a mentor throughout the summer. She tasked me with several key emergency response topics specific to reproductive health and sexual and gender-based violence (SGBV). For Dr. Tomczyk, I worked on literature reviews for a reproductive health and SGBV CDC protocol and assisted in the design of SGBV indicators for a large, multinational refugee-centric SGBV guideline. These tasks allowed me to understand more fully just how acute and protracted emergencies are monitored and evaluated at the facility, camp, regional, and national level. I had worked for many years in and around conflict and refugee settings, and I was familiar with the responding agencies, but I was absolutely clueless as to how they were set up, funded, monitored, and evaluated.
In late June 2013, I was approached by a member of the Division of Global Disease Detection and Emergency Response (DGDDER) senior staff regarding an additional project separate from my internship at CDC. This CDC staff member, Dr. Richard Garfield, was informed by Dr. Tomczyk that I had worked internationally in low-resource settings quite extensively. Dr. Garfield had a Syrian refugee project overview in Iraq that he needed designed, implemented, and analyzed. I jumped at the chance to work with Syrian refugees. This project was what I had hoped would be available and precisely the public health specialty I wanted as a career. I spent the duration of the summer designing all materials for what would be known as the Iraq Access to Care Study.
In Atlanta cafés and CDC offices I began to compile materials pertaining to the study. The database template, codebook, training modules for staff, logistics materials, operations materials, and analysis syntax all began to accrue under the guidance of Dr. Garfield and DGDDER staff. Key research questions assessed in the study included how, when, and what type of medical services were needed by Syrian refugees displaced in Iraq. Questions were also designed to assess pediatric vaccination availability, reproductive health service need, and the prevalence of high-risk behaviors.
One Tuesday in late July 2013, I was notified by Dr. Garfield that the Iraq study was ‘a go.’ Five days later I was on an Emirates flight to Iraq, racing over oceans and mountains and icebergs towards to the unknown.
Iraq was hot and dry and foreign in ways unimaginable to most in the West. Burqa-clad women zipped by on the rear of scooters as their cigarette-smoking men sped them to an unknown destination. Market spice shops spilled turmeric and sage and spices foreign to me in kaleidoscopes of color as I walked by with my interpreter, Dr. Mohammed Jassim. Men stared at me around every corner and in every tea shop. I was foreign, and obviously so. The World Health Organization vest and badge adorned my shoulders as I made my way from the villages to the refugee camp and back again.
Days flew by in the Iraqi high country of Duhok province. Those first days were filled with a series of stakeholder meetings, including several with the local government. I met with the Iraqi press; my solemn statements regarding Syrian refugee study specifics interpreted into a wild array of hand gestures, foreign language, photo flashes, and fervent writing. I conducted roughly one week of training for a staff of 40, using the same highly animated translator, Dr. Jassim. Then, to the field, where days and nights passed in a flurry of data collection team supervision. As soon as data entry was complete at our Duhok mobile office, I was rushed by car to Erbil, WHO headquarters, for a debriefing. That same evening, I was on a flight out of Iraq, back to UC Berkeley and back to reality. I returned to SFO via Dubai, rushed via BART to my epidemiologic methods class, and it all became a surreal experience that I have yet to fully analyze.
I remember a little Syrian girl, a spitting image of me at five years old, rushing to play with me one day in Domiz camp. This girl, already a veteran of a brutal war, wanted nothing but to be a child again. But her innocence was lost. The playing was a way to forget, for the moment, she was in a refugee camp in the desert in blazing heat, sharing a tent with at least 10 other refugees, deprived of food, proper health care, and many other essential services.
That girl, and 2 million others just like her, still in those camps surrounding a nation that is fast becoming the greatest humanitarian crisis of our time, are suffering while I sip a $4 coffee and type this from my fancy computer on a campus filled with privileged people doing things that are unimaginable to refugees. My heart pangs when I think about this disparity. I feel responsible for her now, if only a little bit, as I have her family’s health care services information in my possession. My internship may be over, but my job has just begun.
Jesse Berns is a second-year MPH student in the Epidemiology/Biostatistics program.