Photo: Dr Ximena Tolosa (front row, first from the right) with Cambodian public health authorities, infectious disease control personnel and colleagues from the World Health Organization in Phnom Phen, Cambodia, May 2017

Dr Ximena Tolosa is a microbiologist with qualifications in international public health. In February 2017 she joined the Australian Field Epidemiology Training Program (FETP) run by the National Centre for Epidemiology and Population Health at the Australian National University. The FETP is a two-year program that prepares Australian public health professionals to address a wide range of public health problems, from tackling the emergence of zoonotic diseases to setting up public health surveillance systems and responding to outbreaks of disease. A key goal for the field epidemiologist is to improve population health by preventing and responding to health threats. Of course, disseminating lessons learned is critical to epidemiology as it ensures that for each health problem addressed there is a shared understanding regarding best practice. FETPs currently exist in 61 countries and form a network called Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET). While placed in state health departments and research institutes, FETP scholars provide a public health service to their countries and regions while strengthening international public health capacity.

“I am one of 16 field epidemiology scholars in the 2017 Australian cohort. Professional backgrounds in the 2017 cohort range from medicine, nursing, microbiology, anthropology, Indigenous health, environmental health and public health,” says Dr Tolosa.

“My field placement is at the World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza located at the Peter Doherty Institute for Infection and Immunity. My first project involved a one month trip to Cambodia to better understand the impact of influenza virus infections in Cambodian children. This is part of a larger study that aims to estimate the burden of influenza in the entire population. Currently, the burden of influenza in Cambodia and other developing countries in the region is not well understood. If the scale of a health problem is unknown it is unlikely that action will be taken to prevent it, leaving subpopulations vulnerable to severe disease and at further disadvantage. In practical terms, understanding the burden of influenza infections in Cambodia is important so public health officials can design evidence-based public health policies, and conduct prevention and control activities to limit the spread of disease. Armed with knowledge of seasonal influenza activity and a more robust public health system, Cambodia will also be better prepared to protect its population against the threat of pandemic influenza.

In May 2017 I travelled to Cambodia to work with a team from the Ministry of Health and the WHO Cambodia country office to estimate the influenza burden of disease. For this we visited several healthcare facilities in the north west of Cambodia and reviewed hospital admission registries for 2016 to identify cases of severe acute respiratory infection. Importantly, the methodology we used accounted for specific challenges that developing countries face when trying to calculate the incidence rates of diseases.

Besides assisting public health officials in Cambodia in conducting an epidemiological study I co-delivered two training courses to enhance the skills of local epidemiologists in data management and data analysis. It is energising to participate in building public health capacity in our region. More important than assisting a country to perform a specific task is ensuring that technical knowledge is transmitted to relevant individuals so that they can carry on working independently. This is how I understand international solidarity. As the recent Ebola epidemic has taught us, a swift and collaborative response is needed to halt disease transmission and further spread, but what is needed to prevent another large-scale humanitarian emergency is strengthening public health systems in low-income countries. When dealing with the threat of infectious diseases in a highly interconnected world, this approach becomes critical.
I would like to acknowledge the support of my supervisors Dr Sheena Sullivan and Dr Tambri Housen for facilitating my participation in this project. This work was supported by an Australian Government Research Training Program (RTP) Scholarship”.

If you are interested in a career as a disease detective you can learn more about the Australian FETP program.