As many of know, the Field Epidemiology Training Program was modelled after a training approach created at the US Centers for Disease Control and Prevention (CDC) over 50 years ago, known as the Epidemic Intelligence Service, or EIS. The impetus for the EIS program was to meet the ever growing and changing needs of an increasingly complex public health environment. It was recognized that doctors, nurses, laboratorians, and other health professionals would need a new set of skills to meet the changing needs and disease threats. More specifically, what the EIS program brought was an on the job learning environment that emphasized what we at CDC called field epidemiology. The idea is simple but profound – to detect and respond to public health emergencies, one cannot sit in an office.
Epidemiologic investigation requires what we often refer to as “shoe-leather epidemiology” — this philosophy is why the EIS logo is not of a disease but that of a shoe on a map – meaning that to be a true disease detective, you need to skills to get out into to field and get your hands dirty. It reminds of me of a phrase that one of my mentors would often say – all public health is local – and therefore, the most important work is in the field.
Over the decades, based upon the success of the EIS program, CDC responded to hundreds of requests to provide support and training to other countries, and these relationships blossomed into fruitful collaborations that helped address the worldwide shortage of skilled public health responders. In 1980, the first FETP program outside of North America was piloted in Thailand – with a goal of allowing host governments to train their own workforce of disease detectives. Over the past 42 years, through FETP, CDC, in collaboration with host governments, has helped train more than 18,000 disease detectives in over 80 countries.
With that background in mind, now is the time for me to admit my own personal connection to the FETP program. Many years ago, at the start of my public health career, I too served as an Epidemic Intelligence Service or EIS Officer at CDC. I travelled all over the United States, and the world, investigating and responding to disease outbreaks of every kind. I learned the basic skills of shoeleather epidemiology and followed the same path as others before and after me.
I can honestly say that the skills and experience I gained during that training has shaped the public health leader I am today. I still think and talk like a disease detective, always trying to figure out how we can apply principles of epidemiology to improve the health of Namibians.
I have also had the privilege of mentoring and teaching FETP trainees while working in other CDC offices, and you can imagine my excitement to see such a strong and robust FELTP program in Namibia. I am very much looking forward to opportunities to engage with you, FELTP alumni, and future cohorts, to support the training program to continue its longstanding success.
As we together mark the occasion of your graduation from the program, please be assured that this is the beginning of your true training, not the end. As you return to your positions and bring your disease detective skills to the forefront to best lead your organizations, your workplaces, and your colleagues, please remember that you are all now ambassadors of not only the Namibia FELTP program, but a much larger cohort, tens of thousands strong, of worldwide leaders in public health response.
The past 2 years have been a stark reminder of how critical it is to have a robust workforce of field epidemiologists. The COVID-19 pandemic has stretched every public institution across the world, and has reminded us of how fragile our public health achievements remain. Worldwide, governments and communities have relied on field epidemiologist to help us navigate a way through the pandemic. We have leaned on their skills to monitor the different waves, to identify measures that work to prevent the spread of disease, such as vaccination. While we do not know that the coming months will bring, we can say with confidence that COVID-19 will remain a public health challenge for the foreseeable future, and moving forward, you will be among the ones that we look to advice on response actions. You have the skills and are ready to apply them. To be successful, we need to continue to build our public health workforce with more people like you to continue to strengthen Namibia’s frontline response.
So, what next?
Today you celebrate. That is certain. You have committed hours, days and weeks to this course, and today you are rewarded for that hard work. Congratulations. This celebration is well-deserved.
Tomorrow, the work starts. A disease detective is always on duty. You see things differently now. You listen, look, learn and assess. Whether it is a report of hepatitis, typhoid, or scabies, to name a few diseases, we will be looking to you to have your ears to the ground and your eyes on the data. You will need to establish yourselves as focal persons, working with your colleagues, teams and supervisors on how to do that and how to successfully take on these additional responsibilities while still fulfilling your regular functions. I am confident that you will find the balance you need.
The work you are doing is vital. In many of your roles on the frontline, you are the face of public health. We need you to help build the confidence of the public that the scientific investigation process behind a disease outbreak is reliable; that the scientific methods used to understand a disease outbreak are trustworthy; and that the science-based responses to a disease outbreak are effective.
You are the cornerstone of Namibia’s contribution to global health security. By rapidly detecting an outbreak in your district or region, and helping to implement measures to address the problem, you will have the potential to prevent the spread of disease to what could become a national or international outbreak. You have an important responsibility on your shoulders. COVID-19 has shown us in no uncertain terms how fast the spread of disease can be, and how much it can damage us physically, emotionally, economically, and socially. Each one of you has the opportunity to do your part to stop new outbreaks in their tracks.
But more tangibly, the role you can play in addressing a disease outbreak will help those affected. I am also a medical doctor and caring for people is my priority. When people ask me what it means to work in public health and epidemiology, I often answer that it is similar to being a doctor, the only difference is that my patient is the general public instead of an individual. The examples of the recent detection of typhoid and scabies are good examples of how we as public health providers care for the general public.
Firstly, I want to commend the Ministry on detecting and reporting these cases. These reports are evidence of Namibia’s exemplary approach to not only detecting possible disease outbreaks, but also following up with clear and consistent communication to the public. As a result, we are seeing that these
situations can be quickly controlled. Your work as disease detectives is often one step amidst a larger public health response, and although it might not always be apparent, please remember that your actions have to potential to directly improve the lives of fellow Namibians. While this impact might not be as visible as that of health providers to patients, the work of a field epidemiologist is no less important.
In conclusion, please let me congratulate you once again, and to welcome you to a proud and long tradition. While we cannot predict the future, knowing that we have a strong workforce of FELTP graduates makes me confident that we will be able to respond to whatever may come.
Congratulations again and thank you for the opportunity to be here today.