A Matter of Life and Death

Pandemic Lessons: Epidemiologist Anne Rimoin on the importance of listening to community. And how a public health problem anywhere can be a public health problem everywhere.

From a conversation with WorldView editor Steven Boyd Saum

Photo by Peter Israel

 

In epidemiology, you have to look at things holistically. And in the midst of this pandemic, as an epidemiologist whose whole career trajectory was shaped by my experience with the Peace Corps, I find myself asking: What does Peace Corps have to do with how we respond to COVID — and how we need to do more? Peace Corps is all about working in a community; my work, whether related to COVID or not, is really about having your ear to the ground in the community and understanding the community’s perceptions — and understanding how important local community is in terms of being able to effectively run public health interventions. 

A case in point: We’ve learned over and over again with Ebola outbreaks that you have to pay attention to local community leaders and understand their perspective. Having empathy and creating relationships to reach that understanding, and targeting communication to what’s really happening — that’s critical. 

The window that Peace Corps Volunteers have into that — that we have to bring our experiences in working in communities globally back home locally — is so important now. It is going to be critical in terms of being able to get to the other side of this pandemic, whether we’re talking about vaccine hesitancy, wearing masks, social distancing, or basic public health measures. In public health, everything that I do, I lead with listening to community.

This is a matter of life and death. Bringing the world back home has never been more important.

 

This pandemic has shone a light on how we are no different than anywhere else.

 

We always think that this is the “Third Goal,” the last thing out there in the Peace Corps experience. But our country has never been more vulnerable. This pandemic has shone a light on how we are no different than anywhere else. And that an infection anywhere can be an infection everywhere; a public health problem anywhere is a public health problem everywhere. 

The whole idea of “global is local, and local is global” has never been more important. We have not been paying attention to the community here in the same way that we do overseas.


Information and misinformation

Whenever you have lack of information and lack of communication, you open the door for disinformation, misinformation, and misconceptions. We’ve seen this happen over and over again in the United States. 

I served with the Peace Corps in Benin in the 1990s, in the village of Bopa. As a Guinea worm eradication volunteer, my job was disease surveillance and health communication. The lessons I learned there are important today: You must be able to have direct and open conversation and communication with community leaders. Those leaders are not just the politicians; they are people who are key to the community. In a place like Benin, they could be traditional healers. Here, they’re religious leaders, sports figures, celebrities — where people get their information. 

When I was in Benin, there was a Guinea worm song contest: Every village had a contest to come up with the best song about how to avoid getting Guinea worm — which you do by filtering your water and some basic public health steps. That sounds quaint, but it’s really a perfect example of great public health communication stemming from grassroots communities and finding creative ways to get the message out. Beninois culture really embraces music, so it was a genius idea that every community got involved in.

 

The human experience

We in the United States have always felt like we were different. We’ve held ourselves as being so much more sophisticated and that these things don’t apply to us here. But they really do. And isn’t that one of the big lessons of Peace Corps? The hubris that we feel as Americans might be tempered a little; we might be a little more open to learning about other cultures — and what we can learn from them to do better here.

The three goals of Peace Corps are essential. Training people in low-resource settings and helping promote better understanding of Americans — both of those are certainly important. But bringing home the understanding of what’s going on in the world is so critical going forward. “What do countries want and need? How can we be of assistance?” Answering those questions takes a lot of listening. As Americans, we’re really great at talking. We haven’t always been so great at listening. This last year of the pandemic just demonstrates how critical listening is.

 

Public health work in Lomela, Democratic Republic of the Congo. Anne Rimoin, left, is currently stateside, but an entire team of Congolese and UCLA field director Nicole Hoff are there full time. Photo courtesy Anne Rimoin

 

So is community. In the United States, people are not used to public health crises affecting their daily lives. In Africa, people are — and they understand the need to pull together as a community. That definitely has had an impact. Los Angeles County, where I am, is the most populous county in the United States. It’s extremely diverse; you have a lot of frontline workers and multigenerational households; and a lot of pandemic fatigue. Together, that has probably created the perfect storm, possibly in addition to a more contagious strain circulating. And it has created a situation where we have a public health emergency on our hands.

 

How the pieces fit together 

As a professor at UCLA, I have continued to run my research here in Los Angeles: working on asymptomatic infection, immunity, and occupational exposures for healthcare workers and first responders, as well as studies for veterinarians and veterinary clinics. Our team in the Democratic Republic of the Congo has been continuing work as well, which is extremely important: with Ebola survivors from outbreaks in 1976 and 1995 to the recent outbreak, working with healthcare workers and trying to understand exposures. An entire team of Congolese and UCLA field director Nicole Hoff are there full time. So we’re continuing to collect samples and do studies in DRC — where COVID hasn’t hit as hard. That needs to be studied as well. And we’re continuing studies to understand population immunity to vaccine-preventable diseases.

At the Center for Global and Immigrant Health, which I direct, we’ve been continuing to support global health, locally and globally. That includes learning from people working overseas and what their experience with COVID has been. At the same time, we’re trying to reimagine what global health is going to look like in the future, how we’re going to get back to working in partnership overseas; many projects have been grounded. 

 

In public health, having the long game in mind — the essence of Peace Corps — is key.

 

Global public health work is changing profoundly. In the time since I was a Peace Corps Volunteer, a lot of capacity has developed on the ground, as well as the ability to build more capacity. This pandemic has shown how important that is. People in a country should be able to do the work themselves on the ground, so that it really becomes a collaborative partnership — not a situation of people from high-resource settings going to low-resource settings, doing the work, and leaving. Having the long game in mind — the essence of Peace Corps — is key. The pandemic will definitely have an impact in that global health will be reimagined: by growing grassroots capacity, thinking through a new way forward.

When I started as a Volunteer in Benin in the early 1990s, in terms of public health there was very little infrastructure. The internet and cellphones have completely changed the landscape in terms of public health communication. I was in a village where there was one phone that didn’t really work. It’s very difficult to do surveillance in those circumstances. There are now good schools of public health in Africa, and people who have been trained elsewhere and come back and are able to lead public health and scientific work.

In the months ahead, I’m hoping to see vaccines rolling out with equitable distribution globally, since that will be an important way forward. What’s also going to be important is monitoring variants of COVID that are cropping up, and how that may impact vaccine effectiveness and treatment effectiveness. Viral surveillance is going to be critical: being able to collect samples globally and sequence them to see if the virus is continuing to mutate — which it will.


Debt and investment

I feel a debt to Peace Corps; it changed my life and how I think about the world. The experience informs everything that I do. And while I know “the toughest job you’ll ever love” is no longer their tagline, it’s so true! It really was the hardest thing I ever did. Why? Because it’s dealing with culture: listening and understanding and trying to respond to the needs of a local community. That’s really hard.

At Middlebury College I was a history major, focused on Africa — though I didn’t know what I would do with it career-wise. As a musician, I was interested in the music industry; I actually interned at IRS Records and thought I would become a music entertainment lawyer. I was going to take the LSAT while I was in Peace Corps. Because I spoke French, I was offered a position in Benin with this perfect public health program. My dad was a respected medical geneticist and scientist. I didn’t think I would go in that direction; really, I was intimidated. But instead of going to law school, I ended up getting a master’s in public health. My dad used to say I avoided science like the plague — and became a scientist studying plagues. That was all because of my Peace Corps experience. 

In a very real sense, the investment in Peace Corps is an investment globally and an investment locally. It does change how Volunteers view and interact with the world. We need a lot more people who have that perspective.