Heroes without capes

Thailand’s vast experience in dealing with epidemics and natural disasters is a key pillar of the country’s sturdy public health system, and field epidemiologists or “Disease Detectives” play a crucial role in it.

When there’s a disease outbreak or when health-related threats emerge, epidemiologists are often one of the first people on the scene to investigate. Also known as “Disease Detectives” or “nak rabaad witayaa” in Thai, these experts — most often physicians, veterinarians, scientists or health-related professionals trained to locate the source and root cause of disease, identifying people at risk and determining how to control or stop its spread — are an indispensable part of the epidemiological equation.

“What’s unique about the program is its ‘learning by doing’ approach,” Dr. Kamnuan Ungchusak, an alumni of the Field Epidemiology Program (FETP) explains. “These are skills you can never acquire from university. The FETP crafts you to be like stone, not a glass marble. You see, marble is used for decoration but stone is used as a weapon. Like David when he beat Goliath, you need to be like stone.”

From visiting patients at hospitals or inside their village homes and learning about their way of life, to understanding their lifestyle and surroundings in order to come up with both short-term and long-term solutions, epidemiologists like Dr. Ungchusak are the disease detectives that complete the comprehensive, multi-dimensional machinery that is Thailand’s public health system.

Thailand’s FETP has its roots in the epidemiology unit, established in Bangkok in 1970. When the World Health Organization (WHO) began to promote the use of data to inform disease control efforts, Thailand’s Ministry of Public Health (MoPH) realized the importance of this approach and sent staff abroad for overseas university-level epidemiology training. However, the lack of manpower and skills required remained a problem. With support from WHO and the US CDC (Centers for Disease Control and Prevention), the FETP in Thailand was established in 1980. After much success in capacity building for the country, training for international fellows from the region was introduced to the program in 1989. This very same program became a WHO-designated collaborating center in 2001. Since then, 250 professionals have been trained (178 are working in the system) and posted at various provinces in Thailand as well as working in health organizations throughout Southeast Asia.

“Through a variety of courses spanning between one-week to two years, students are equipped with the necessary skills with which to approach and analyze a situation and come up with effective solutions,” explains FETP Director, Dr. Panithee Thammawijaya. “Our program has been compared to military training and that’s partly true. We’re results-driven so we train hard, but we also keep up with state-of-the-art biomedical technology. On top of that, we take a preventive, multi-disciplinary approach by conducting our own investigations and factor in social problems - so in that sense, we’re also known as disease intelligence officers.”

Through years of training, the FETP has produced an army of healthcare workers ready to be dispatched at troublespots nationwide. When the first cases of COVID-19 were reported in the new wave (December 2020) in Samut Sakhon, for example, a team of FETP epidemiologists was immediately deployed to come up with an extensive “battle” plan to deal with the outbreak. In the same way that they had been able to contain diseases such the bird flu and MERS, the operational synergy between the FETP and other organizations were pivotal in helping Thailand come to grips with the first COVID-19 outbreak in December 2019 and largely halting local transmission in the new wave in 2020.

“We have a strong public health system,” says Dr. Ungchusak. “It’s a well-organized system comprising hospitals and medical staff down to sub-district health-promoting hospitals (Ror Por Sor Tor) and village health volunteers (Or Sor Mor). This system works hand-in-hand with Thailand’s vast experience in dealing with epidemics and natural disasters and are the true forces behind our ability to handle these problems so systematically.”  

With the latest COVID-19 curve gradually flattening, there are no major celebrations in store and it’s business as usual at the FETP, the “military camp” that relentlessly churns out experts from the assembly line in preparation for the next battle against “Goliath”.

“If Dr. Ungchusak compares FETP training to hardening him into stone,” says Dr. Thammawijaya, “I’d say that in general, we’re also like water, for a good field epidemiologist should be malleable. When poured into a vessel, water will completely adjust its shape to fit into that vessel. Like water, an epidemiologist should be cool, as we’re constantly fighting against “hot” objects like epidemics. And like water, once an epidemic is over, an epidemiologist will simply evaporate and disappear into the horizon. There’s no need for any recognition because our job is already done.

Original article published on WHO Thailand.