South Africa-Estimating the national burden of severe influenza illness in South Africa
The objective of this proposal is to estimate the annual total number of cases of influenza-related severe acute lower respiratory tract infection (ALRI) in South Africa. Secondary objectives include estimating the annual number of cases of influenza-related severe ALRI that are hospitalized, not hospitalized and occur in children and adults. The target audience for this manual is epidemiologists and policy decision makers in the Ministries of Health of developing countries. There are several principles that apply to the process of data use . A hierarchical approach to data sources will be used, whereby local, in-country data will be used as much as possible. This will be important to promote greater local ownership and confidence in the estimates. National data will be built from sub-national (e.g. provincial) level data so as to maximize the use of all available data in country and to cater for in-country epidemiologic differences that might affect influenza burden. Available, rather than newly-collected, data will be used as much as possible so that the burden estimates can be done relatively rapidly (e.g. within a month) and inexpensively. The methodolgy has been previously piloted in Guatamala and Kenya.
This summer, I had the opportunity to spend two months in South Africa as part of the Center for Global Health’s established field placement program. I was based in Johannesburg in Gauteng province for the duration of my research, but had opportunities to travel around South Africa and to neighboring Mozambique and Swaziland. I had spent a few weeks in Angola a few years ago so this was not my first foray into Africa. I expected to be more prepared because of this, but living and working in a new country with a very different culture is not something you can prepare for: you just need to jump in and get ready for an incredible experience filled with challenges and opportunities.
My project was focused on estimating the burden of influenza in the country. A question that came up quite often when I spoke to people in South Africa about what I was working on was: “Influenza… what about HIV? That’s what people are dying from”. It was easy to get defensive and explain all the reasons why influenza needed to be researched, but I quickly learned that some of my best conversations started off with this question. Having people push back on you and question what you are doing in their country is a valuable experience. Talking about what I was doing helped me reason through why my project was valuable work not only for my learning but also its practical value. I also appreciated that, although I had the support of a great research institution validating my presence in South Africa, I still had to earn the approval of someone I met on the street in South Africa.
Conversations with people I met while living in South Africa were some of my most memorable experiences. Learning about apartheid from a book or the Internet is important, but discussing that era with someone who lived through it gives you a new perspective. Talking to someone who has family and community members that are HIV and TB positive puts a face to the disease and what you are trying to accomplish with your work. One of the most important things you can gain while working in global health is perspective. Learning epidemiology and how to implement interventions will only get you so far if you don’t understand the culture you are working in and what they’ve been through.
My overall experience in South Africa was great and I felt that each opportunity and challenge that presented itself was a learning experience. One of the challenges I faced was safety, since Johannesburg is one of the more dangerous cities to live in. Other challenges were being alone in a new country and adjusting to a different pace of work, but by immersing myself in the work and the new environment in which I lived, I overcame these obstacles.
The challenges, however, were far outweighed by the experiences I gained by living in a new country. One of the best moments I had was the day it snowed while I was in one of the townships doing surveys. It rarely snows in South Africa, let alone in Johannesburg, so it was an incredible moment to be with a huge team of people during a snowstorm in Soweto, some of who were experiencing a snowfall for the first time.
This experience was critical in developing my ideas of where I want to be in the future and how I plan on getting there. I think for globally minded individuals who see themselves in the international public health arena, getting field work experience at the beginning of your career is essential. Working in a developing country can help you push your own boundaries and let you learn about a new country and different cultures. Working in more resource-limited settings also allows you to take on tasks outside of your specific project, wherever help is needed. I definitely plan on working internationally for the next few years and am very grateful for the opportunity to have worked in South Africa.