Just Dive Right In...

Many of you have pointed out (repeatedly) that I have been delinquent with this blog.  For that I can only claim swine flu.  No, not that I have it, but that it broke the day after I arrived in Rwanda and for the first few weeks I was working almost constantly on the outbreak investigation. It wasn't until my third week here that I finally got a day off (and on that day, I slept, not blogged).  The U.S. government (henceforth known as USG) certainly doesn't make life easy for its low-level flunkies abroad.

Let's start at the beginning. I arrived here on a Thursday afternoon.  Friday morning I went to the office, attended a few meetings, and had a relatively low-key day.  That was to be the last for a while.  Saturday morning I received a text from my supervisor asking if I wouldn't mind being "on call" for H1N1 for the weekend. Not knowing what that meant and wanting to seem eager, enthusiastic and helpful, I said of course.  The next day I found myself at a "Special H1N1 Outbreak Control Task Force" meeting being charged with coordinating and maintaining surveillance of all suspected and confirmed cases.  Now, I am not an epidemiologist or strategic information specialist.  I've never worked on an outbreak investigation.  Infectious disease isn't my forte. Other than the four CDC folks there, I had never met any of the 12 people in the room. Yet for some reason they decided to give me the task of maintaining the line-listing, which is the official record of who is a confirmed case of H1N1 and all their vital statistics.  On that day there were already 7 cases, but maybe they thought that would be all for a while, and that maintaining the list would be not be particularly time-consuming or important.

They were wrong.

Within a few days the outbreak had exploded, with up to a dozen new cases everyday.  Every morning, starting that Monday, I would attend the four-hour daily task force meeting and gather all the data on the new cases from the lab and people involved in contact tracing.* In a country where information doesn't so much as flow as it does come to a screeching halt at the slightest hurdle, filling in just one cell in an spreadsheet can take hours.  Getting a patient's age or date of diagnosis would eat up half my day.  But because this was such a time-consuming process, no one else wanted to do it, which turned me into "The Holder of All Information."  I was, for a few weeks there, the only person in Rwanda with the complete list of all the confirmed and suspected of H1N1 cases in the country-- a very strange position to be in.

Information really turns out be power, so I (or rather, my spreadsheet) became much in demand.  On that first Monday, my second day on the job, we met with the Minister of Health, who was given a copy of my various graphs, charts and lists tracking the outbreak.  Although he was happy with these pieces, he was unhappy about everything else in our (really, the Ministry's) handling of the outbreak and took the meeting as an opportunity to introduce us to the new task force leader.

And so it went for a while-- endless meetings, spreadsheet mania, and an ever-changing person in command.  Each day we would receive news of people been sacked, "resigning," being brought in as yet another "supervisor."  Task force members dropped like flies, only to be instantly replaced by more obliging minions.  Throughout it all our mini-team of five CDC-ers sat by, jaws agape and brains reeling from all the changes.

To say this experience was a crash course in Rwandan politics, CDC bureaucracy, and public health practice would be an understatement.  But by the time I handed over my spreadsheets to the ministry's new surveillance manager in week 3, I could definitively say that I had learned more than I had expected to in my first 6 months of work.  The learning curve was Everest-steep, but I could not have asked for a better introduction to the key players and major problems in the Rwandan public health system.

However, it was a great relief to be relieved of my duties as surveillance manager.  And of course, I was even more relieved to have escaped the experience without having contracted swine flu myself.

*Contact tracing: the systematic identification and diagnosis of persons who may have come into contact with an infected person.