Epidemiologists are key members of many teams at Doctors Without Borders/Medecins Sans Frontieres (MSF), using their analytical skills to understand how diseases are spreading and where medical interventions can make the greatest difference. Louis Bahina Essengue takes us behind the scenes in Sierra Leone.
For the past four years, I have been working as an epidemiologist with MSF. I come from Yaoundé, Cameroon, but I have not spent much time at home since I began my career with MSF. Instead, I’ve been working in Niger, Bangladesh, and Guinea.
It had barely been four weeks since I had greeted my family in Cameroon after returning from Guinea, and I was already preparing to say goodbyes again as I was offered the position as project epidemiologist in Sierra Leone.
I started thinking about the new challenges I would face, the new people I would meet and work alongside, and began to imagine what my new home would be like.
Hangha hospital, Kenema
In Sierra Leone, I am based in the Kenema project, where I have now been working for more than one year. Kenema is home to Hangha hospital, a large pediatric hospital with around 100 beds, incorporating an Inpatient Therapeutic Feeding Center (ITFC), Intensive Care Unit (ICU), Inpatient Department (IPD), an Emergency Room, and Isolation unit.
There are two main MSF components in place: the hospital and the outreach program.
Every day, the hospital staff care for patients in need of urgent medical care, mainly related to malaria, pneumonia, and severe malnutrition cases. The nurses and medical staff provide each patient with a high standard of care and treatment, delivered according to MSF standards. Meanwhile, the outreach team works with local communities, meeting them where they are to share important information about health and services.
But to make the right decisions—about things like where we need to concentrate our efforts, changes we need to make, or how we can prepare for new medical needs—the teams need reliable data.
The importance of epidemiology
As the epidemiologist here, I support the entire hospital and outreach team with data management and analysis. I calculate health indicators like mortality rate, bed occupancy rate, length of stay of patients admitted in our hospital, and more.
I analyze data from the different strands of our work, so we know if we are achieving our targets or not, helping management to spot any problems or to celebrate successes.
I also do surveys and assessments, which help to identify areas of attention and contribute to decision-making at the project level. Surveillance of diseases is central to my work—analyzing the data to spot changes or outbreaks. It’s also crucial to the team, allowing them to receive punctual alerts and to organize a timely response if required. That could mean anything from a vaccination campaign, a new treatment facility, or health promotion teams working with the community to reduce transmission of a disease.
While I often work “behind the scenes”, improving patient care and outcomes is at the heart of everything that I do.
One of MSF’s goals in Kenema is to build capacity among local health care staff, so part of my role involves transferring skills and knowledge. I provide training on how to properly complete registers and forms to ensure that patient information is recorded accurately.
Data management can be a challenge. When caring for critically ill patients, the staff are not always able to properly complete patient registers, which are the primary source of data collection in the hospital.
Alongside my team, composed of a data supervisor and four data encoders, I closely monitor and support the hospital staff to ensure the quality of data recorded and to see that patient confidentiality is maintained.
Being meticulous and vigilant is key to ensure data is analyzed accurately: even small errors have the potential to affect decisions made at the project level. My skills with office software and computer sciences help me daily to improve the quality of reporting.
I create templates for reporting and data collection, and on a monthly and quarterly basis, I work with the hospital and outreach managers to review activity indicators. Together we compare the target originally set with what has been achieved and agree on recommendations for the next quarter.
Disease surveillance is an important part of what I do, including diseases like measles and meningococcal meningitis. These diseases can spread quickly and are particularly dangerous for young, unvaccinated children, so spotting outbreaks early is key to saving lives.
Kenema is also an endemic area for Lassa Fever, a viral hemorrhagic disease spread by rats. I support the hospital team with reporting cases to the Ministry of Health and Sanitation (MoHS)—contact tracing people that suspected Lassa fever patients have been in touch with so they can also be tested—and the shipment of test samples, which is not always a simple task.
It’s vital to maintain a positive collaboration with the authorities and to ensure they are well informed of our activities, particularly for priority diseases. This helps to improve the quality of the partnership between MSF and the MoHS.
I have a good relationship with the surveillance officer with whom I meet weekly for updates.
I am always using the data collected to monitor what’s happening in local communities. For example, I follow the number of diarrhea and malaria cases to flag where environmental health activities need strengthening.
I’m always looking for ways in which MSF can increase support to the community to improve the health of local people.
Working under pressure
Ensuring high data quality and reporting is the essence of what I do, working under pressure to meet strict deadlines. One of the really rewarding aspects of this is getting to reflect the hard work of the MSF team here.
Through our reporting we highlight the support we are providing to the MoHS and the difference we are making to the lives of those in Kenema district, Sierra Leone.
Simply feeling that you are doing a good job may be nice but having the data to prove it is much better.
How you can help
Not everyone can treat patients in the field. But everyone can do something.
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