Field Course in Public Health, Kingston Jamaica
Infectious Diseases Surveillance and Control

Submitted by: Stephanie Brodine, Division of Epidemiology and Biostatistics, Graduate School of Public Health

Course dates: August 7 – 17, 2005

Overview:
This grant enabled me to participate as faculty, and supervise 8 SDSU GSPH graduate students, in an 8 day intensive field experience in Kingston, Jamaica, which emphasized disease control in a developing country. This was hosted on the University of West Indies (UWI) campus by the Department of Community Health and Psychiatry, with faculty from not only UWI, but also the University of Alabama Sparkman Center for Global Health and Rice University. Graduate students (34) were from UWI, UAB, and SDSU. The course was structured with core lectures, primarily from Jamaican faculty from UWI and the local Ministry of Health, but also from the U.S. faculty; daily field trips; and cultural experiences. Jamaican graduate students were integrated across all of the student teams to maximize the benefit of a multi-national experience, and to facilitate the visiting students’ grasp of the Jamaican context. Students were required to prepare and present as a team, a terminal project based on their fieldwork and data collected. There was also an exam, which covered lectures and readings, a field journal to maintain and turn in, and a student driven debate on Ethics in International Research.

The SDSU students who participated had extremely positive feedback, gave a strong endorsement to continued SDSU involvement, and the majority (if not all), have actively sought out additional international experiences upon return to SDSU. As a faculty member it was an enriching (albeit demanding!) experience. There is high interest from UWI and the Sparkman Center for Global Health to have a continued SDSU presence, and to potentially expand this from an educational program, to include joint research and grant opportunities. Importantly, the content and setting (e.g., clean water, sanitation, vector borne disease) are relevant to disaster response, such as was required in the Tsunami and Hurricane Katrina. Thus this international course addresses a growing demand for Schools of Public Health (and the GSPH) to strengthen curriculum that addresses the application of basic public health skills, required in disaster mitigation and response.

Faculty:
The other faculty included: Dr Sten Vermund (Director, Sparkman Center now at University of Vanderbilt School of Medicine), a premier infectious diseases pediatrician and epidemiologist with over 20 years research in multiple international sites; Dr. Richard Nisbett, a biological anthropologist and epidemiologist at Rice University, with extensive research in emerging diseases in Costa Rica and Liberia; Professor Brendan Bain, director of the UWI MPH program and Department Head for Community Health and Psychiatry at UWI, with a Caribbean wide reputation in infectious diseases; Dr. Peter Figueroa, a senior physician who is primarily responsible for defining the HIV epidemic in Jamaica and is Chief of Epidemiology and HIV/AIDS for the country; and Mr. Henroy Scarlett, an environmental public health practitioner with extensive experience in Jamaica and currently completing his dissertation in International Health.

Participating Students:
The 9 SDSU students included 1 doctoral student in Epidemiology and 8 MPH students (7 in Epidemiology and 1 in Environmental Health). The additional 25 students in the course were from the UWI (public health graduate students and working public health professionals from Jamaica and the neighboring Caribbean countries) and MPH students from UAB. In the future this course would be suitable for a variety of students interested in international health, including medicine, nursing, or other allied graduate programs. Advanced upper-division undergraduate students with a strong background in biology or ecology could also be considered.

Course Content:
The integration and application of classroom, laboratory, and field experiences are utilized to foster problem solving skills for infectious diseases ecology, surveillance, and control. The 3 primary field projects were Arthropod-borne Disease; Water & Sanitation; and HIV and Sexually Transmitted Infections (STI) Control. Field work included mosquito trappings and larvae surveys, water and sewage treatment plant evaluations, assessment of rodent control, and analysis of Jamaican MOH surveillance data. Teams used field techniques to generate and analyze data. Site visits to STI and HIV clinics and service centers, laboratories, rodent control sites, rural zones, water and sewage treatment facilities, and the Jamaican MOH provided an in -depth look at applications of multi-factorial approaches to disease control in resource limited settings. A syllabus and reader was prepared for the students, and is available. Cultural immersion and team building were encouraged by having all students and visiting faculty live on the UWI campus, the full time participation of Jamaican students and public health practitioners, and cultural enrichment activities.

Logistics:
Students paid $2000 in expenses to cover air flights, room and board, local transportation, and field trips. Lodging was provided in the UWI dormitories in single and double rooms, with the majority of meals served on campus. Days were typically 8 – 12 hours in duration with lectures and site visits. Cultural activities were also included, and 1 day was set aside for a visit to Ochos Rios. Students were awarded 3 units of graduate level field practice.

Assessment:
This is an extraordinary opportunity for SDSU faculty and students, with an interest in International Health, to participate in a multi-university, multi-national compressed didactic and field experience in a developing country context. The quality and prestige of the other US faculty and the Jamaican faculty and lecturers is extremely impressive.

The overall experience, although very demanding for faculty and students alike, was extremely unique and valuable. I broadened my own primary area of expertise in HIV/AIDS, to now include a Caribbean perspective and have developed professional relationships with the faculty team that I expect to bring future cross-university collaborations. I also developed closer ties with my graduate students, which has had benefits back on the SDSU campus. The student feedback emphasized a high interest in course content and topics that were perceived to have great relevance to international health and disaster response, the opportunity to learn public health in a developing country context with local faculty and student peers, and the emphasis on field experiences that would not otherwise be possible in the U.S. The major recommendations from students were to extend the duration of the time in Kingston (to de-compress the course and provide more leisure time), and to consider an on-line pre-test which would shift some of the course work also.