A Typical Day As A Field Epidemiologist In A Disease Surveillance Program

Surveillance is a word related to policing or intelligence gathering and refers to a close watch or scrutiny of anything. An epidemiologist is a physician who is employed to study, prevent, and control the epidemics or disease outbreaks.



Surveillance
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MBBS/MD Epidemiologists can work with different types of health organizations and in various capacities.

The field-based epidemiologist works at the periphery, generally at the office of the district chief medical/health officer, where the epidemiologist investigates suspected disease outbreaks and epidemics and suggests remedial measures for their prevention and control in the district. A district is the fundamental administrative unit in India.

Obtaining information for disease surveillance is one of the core responsibilities of the field epidemiologist. The surveillance is carried out by the epidemiologist for both the pre-defined and known health problems, such as Malaria, Typhoid, Dengue and Diarrhea as well as for the unforeseen problems leading to a sudden spurt of deaths or disability in his area of jurisdiction, such as Ebola, Encephalitis and Swine Flu. The surveillance program could be an integrated program focusing on multiple diseases or a specialized one, for example, only focusing on Flood, Polio, or Cancer.  


Six honest men
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The epidemiologist usually heads a small team of 10 to 30 health workers/surveyors and their 2 to 3 supervisors. These numbers may vary from district to district but one fact remains the same throughout that these people are the eyes and ears of the epidemiologist when it comes to actively receiving and verifying information related to suspected cases and outbreaks. The epidemiologist also receives periodic passive information reports from the designated reporting units, who are the formal and informal healthcare providers in the territory.

The epidemiologist also unevenly obtains information from local media outlets and the newspapers/periodicals published in the territory. Sometimes epidemiologists may receive medical information from political leaders, NGOs, school teachers, postmen, or any layperson from the society. These sources may often provide more rumors but rarely these are the only and the first source of an outbreak. 

The epidemiologist doesn't only obtain information from these sources. He is also the trusted source of disseminating information, who is looked upon by everybody during an outbreak. 


Information
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He supplies the information about the status of spread and containment of the outbreak and the availability of remedial measures. He coordinates the information with those higher-ups in the hierarchy of health departments as well as the district administration. The epidemiologist may be the most sought after person in the district during an outbreak. The epidemiologist may also be trusted to oversee health education activities during the outbreak, although it is the responsibility of the communication department. Be it a global pandemic of swine flu or a local food poisoning or the monsoon related higher frequencies of diseases, the epidemiologist is always on his toes coordinating with other health officials to the relief of people.


Outbreak
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The epidemiologist spends lots of time in field-based activities like investigating reported outbreaks, taking specimen samples of water, food, mosquito larvae, etc. from the environment and blood, throat swab, stool samples, etc. from the patient, surveying households for active case hunt, meeting public representatives, inspecting health center and their readiness for managing outbreaks, inspecting mosquito control spray, distributing chlorine tablets, fever tablets, ORS supplies, etc. 

So, he/she may usually be provided a utility vehicle with the services of a driver and an administrative secretariat in his office with a control room. This also acts as the epidemiologist's meeting room for his daily and weekly meetings with executives or as the training center while he is conducting a workshop for health officers from his jurisdiction. This also serves as the data center which houses documented reports received from reporting units and the rumor registry.


Other positions where the epidemiologists could work are:
  • The office of State/National level health officers, where they supervise the work of district-level epidemiologists and help in the formulation of policies and programs.
  • Multilateral organizations or NGOs, where they work as consultants and help in monitoring, and evaluating health programs, and tracking the progress of government initiatives.
  • Teaching and training institutions, where they do academic, research work, and conduct training for the workforce.
  • Hospitals, where they take care of infection control programs etc. and support the research team.
  • Consulting companies, which advise governments on health programs as an interdisciplinary team member. They may sometimes also practice as independent healthcare consultants.
Working as a field-based epidemiologist brings with itself a few unique challenges that may not be seen in the above positions. These unique challenges may even cause burnout among the epidemiologist. 


stress
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  • Helplessness: This is a result of many operating factors, i.e. being alone in the field, not receiving support from the other departments, a hostile community, and vested interests, lack of guidelines or delay in their availability, stretched finances and other resources.
  • Thanklessness: Prevention is better than cure, but the one who cures people gets all the credit and the one who prevents may never even be thanked; he/she may be just seen as doing his/her job. One would in the least probability receive a big award or honor for service to public health as compared to a cardiologist. On the other hand, one error in managing the epidemic could land you in problems.
  • Job Insecurity: Many times surveillance programs are temporary and funded by donor agencies. In such cases, the contractual nature of the job may cause the build-up of insecurity about the career. Will my job stay? Will I get relocated? Will the project funding continue? Will the support staff be laid off? These kinds of questions would be raised many times to the epidemiologist by the team members. 

Epidemiology is in large part a collection of methods for finding things out on the basis of scant evidence, and this by its nature is difficult. -Alex Broadbent


Did you get a pulse of the work profile of a field-based epidemiologist? Feel free to share your views.



Views expressed are personal

Last Updated On 08/22/2019 07:30 PM


Author Profile: Dr. Naval Asija is a New Delhi based non-clinical doctor having health administration postgraduate training. Since 2018, he has been writing/blogging full time on health issues. In the past, he has worked for a decade in healthcare, in different organizations, namely Innodata India Pvt. Ltd., Win-Medicare Pvt. Ltd., National Institute of Health and Family Welfare, Integrated Disease Surveillance Project and the National Polio Surveillance Project.
The author can be contacted through https://www.linkedin.com/in/navalasija/
journey of a non clinical doctor

 

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