Epidemiologists without borders—one step closer!

What exactly am I doing here in Malawi? Let me tell you!

One of the major roles played by MSF in this emergency mission is to help establish a viable system of complete data collection for the measles outbreak (in addition to all of that medical stuff, I mean). All health facilities and hospitals are visited at least once per week. At each site, the data are copied from the patient register books on to a special reporting sheet for epidemics (this one is measles, next one cholera?). At some health facilities this is standard practice, at others people have never been trained so we showed them how. So far, so good.

The next step is to collect the data and bring it back to a central location for data entry. Easier said than done. Do you know how much fuel costs here?? Yes, yes mighty expensive! As long as MSF is out in the field doing case management of the measles cases, we collect the line lists as well. MSF then hires data entry people to enter the line lists of measles cases in order to be able to document the extent of the outbreak and to be able to effectively evaluate the impact of our vaccination campaigns—at least in the districts where MSF is working: 12 of 28 districts.

Paul Ndhlovu, District Health Officer

Near the beginning of the epidemic it was decided that it would be useful to the Ministry of Health if MSF would collect data even in the districts where we were not directly working as well. Although there have been some ummm shall we say challenges, it’s nothing that a little visit to the District Health Offices (DHO) can’t clear up. This turns out to be a doubly good move, because as I may have mentioned in the past, internet access and connectivity is not yet state of the art here in Malawi. Therefore, a major challenge is getting the data all in one place in a timely fashion.

(I know, I know, control your excitement, epidemiology is just so gripping!) Actually I have to say that I am having a wonderful time criss crossing the central and southern part of the country with my fearless driver, Clifford (in the yellow shirt), spreading epidemiology cheer wherever we go! I have to confess that it wasn’t always like this. It turns out that some people are not totally enamored with data. Can you believe it?!? They don’t love to collect the data from the field and they really don’t love entering data into an excel spreadsheet. The saddest thing of all is that this is where the whole thing ends (for the most part). Come on! Now is when it gets exciting!! No wonder they didn’t love data until I came along!!

With a simple flip of the autofilter switch amazing things can happen with the data! At every DHO, I do a little presentation with data, charts and tables—their data, their charts, their tables—and people are amazed at the things they can do once they have the knowledge and the technology. Often at the end of the bumpiest, dustiest roads is a person yearning to learn the joys of data analysis, (though many are unaware of this yearning until the end of my presentation). A most popular use of data that is intuitive to most DHO personal is the fact that they can now document their need for additional resources. Knowledge really IS power! To be fair, almost everyone has mentioned that the basic template that I have provided them for the measles outbreak can easily be altered for other epidemics that will sadly come along and keep the people at the DHOs perpetually busy throughout their careers.

Paul Ndhlovu on his motorcycle
To my never ending delight, after my trainings, I have had several requests for additional epidemiology training. To that end I have developed an epidemiology toolkit that I will distribute (along with free antivirus shareware!!) on my next round of visits to the DHOs.

What do we want?
When do we want it?
Why do we want it?
To get more money!
What?! Really, why do we want it?
To improve the public’s health!

Long live epidemiology.

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