By Scott Epperson, UGA CVM, class of 2018
Prior to starting vet school at UGA in the fall of 2014, I worked in the Influenza Division of the Centers for Disease Control and Prevention (CDC) tracking the spread of influenza viruses throughout the U.S. each flu season. While I mainly worked on activities in the U.S., I also had the chance to work with several foreign ministries of health on their influenza surveillance programs and this started my interest in international work.
A couple months after starting school I was contacted by a former colleague from CDC who asked if I would be interested in working in the CDC office in Dhaka, the capital and largest city of Bangladesh, over the summer on an evaluation of their avian influenza surveillance system and helping to revise their protocol for investigation of human infections with avian influenza viruses. I knew almost nothing about Bangladesh, but I did know I wanted to work overseas during the summer after my first year of school and the projects they asked me to work on seemed to fit perfectly with my previous influenza experience and my desire to work in veterinary public health after graduation. I accepted the offer and was able to secure the Freeman Asia grant through the UGA Office of International Education which covered the majority of my expenses.
CDC’s Bangladesh office is housed within the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) which is an international health research organization located in Dhaka. While I worked day to day in the CDC office, I was a participant in icddr,b’s student field experience program (http://www.icddrb.org/what-we-do/training/student-field-experiences) which is a program open to students from around the world to come to icddr,b to gain experience in public health research. As a member of both the CDC team and the Zoonotic Diseases Research Group within icddr,b’s Centre for Communicable Disease, I was able to see how both organizations functioned independently and how they worked in close collaboration to design and implement a huge number of research and surveillance projects.
I arrived in Dhaka in mid-May and was met by an icddr,b staff member at the airport and transported to the student apartment where I would be staying for the summer. Once a the apartment I found out that my roommates were not due to arrive in Bangladesh for a couple weeks, so I was left on my own to explore the neighborhood, find the grocery store, get a SIM card, and, most importantly, find the best coffee place (that turned out to be the most difficult goal since Bangladesh has such a strong tea culture). Eventually my roommates arrived, with even more student interns arriving as the summer went on. There were several student apartments scattered throughout the neighborhood, but most everyone was within a short 15 minute walk. By the time I left Bangladesh in late July I made more friends and met more people than I could have possibly imagined when I was planning my trip.
My first days in the office were hectic with meetings and introductions, setting up the structure of my projects, and my first ever visit to a live bird market. In order to perform an evaluation of the avian influenza surveillance system I needed to understand the poultry raising and selling practices in Bangladesh, and so this required visits to a number of live bird markets both inside and outside of Dhaka. During these market visits I learned more about the concern for avian influenza and the potential for human infections with these viruses.
Bangladesh is one of 6 countries in which avian influenza is considered endemic meaning that it can be found every year throughout the country. Also, the infrastructure for selling frozen or refrigerated meat is not widespread meaning that most people purchase their birds from a live bird market where the bird is slaughtered and butchered in front of the customer to take home, or the live animal is purchased, kept at the customer’s home, and slaughtered before eating. The combination of this level of contact between people and animals, the high population density (approx.168 million people living in an area slightly smaller than the size of Iowa) along with the endemic nature of avian influenza in Bangladesh make it a potential hot spot for spread of avian influenza from birds to people and demonstrate why surveillance for avian influenza viruses is critical.
Over the course of the next 2 months I continued my market visits, including visits to several towns and villages in the more rural areas of the country. I met with stakeholders of the avian influenza surveillance system, including representatives of the Food and Agricultural Organization (FAO) and departments within the Government of Bangladesh representing both human and animal health, to get their view on the usefulness and strengths and weaknesses of the system. I was also able to make progress revising the outbreak investigation protocol for detection of avian influenza viruses in humans. There was also a bit of fun mixed in with a lot of work. I was able to go to a Bangladesh national team cricket match and over a long holiday weekend I went to Malaysia with several other icddr,b student interns.
Overall, my experience in Bangladesh was incredible. Not many foreigners make it to Bangladesh and so pretty much everywhere I went I was the only non-Bangladeshi in sight. People were incredibly generous and seemed genuinely interested to find out what I was doing in their town, and, almost always through an interpreter, I was able to talk about my work and find out a little bit about their lives as well. Some of the most memorable experiences from my trip aren’t the ones that involved sightseeing or a weekend getaway, rather the simple moments that gave me a greater insight into people’s daily lives and the Bangladeshi culture: eating mangoes straight from the tree in a mango orchard in Rajshahi, hearing from an elderly woman in Netrokona about her time fighting in the war for Bangladesh’s independence in 1971, and breaking the fast at sundown during Ramadan. While the work was interesting and challenging, and I am grateful for the friends I made, these memories are the things I will take with me and which continue to fuel my interest in international veterinary medicine.