Training health care workers in PNG and Solomon Islands through the Field Epidemiology in Action program

In today’s episode of Contain This, we feature the Field Epidemiology in Action (FEiA) program, which trains field epidemiologists in Papua New Guinea and Solomon Islands to strengthen outbreak detection and response through partnership and workforce development.

The FEiA program, supported by the Indo-Pacific Centre for Health Security, is currently training up to 42 staff in PNG and Solomon Islands to conduct surveillance and implement public health interventions to help health authorities respond more quickly and effectively to disease outbreaks such as COVID-19.

Our guests on this episode: 

• James Flint, an infectious disease epidemiologist and programme manager from the University of Newcastle.
• Adrian Kakayan, a nursing officer based in PNG who has recently completed the FEiA program.

For more information on the FEiA program visit the website, Youtube, and X (formerly Twitter) channels.

We encourage you to join the conversation on X at @AusAmbRHS. 

Transcript

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.

Fiona Mulhearn 00:35

Welcome to Contain This. I'm Fiona Mulhearn, a Director at the Indo-Pacific Centre for Health Security. I'd like to acknowledge the Traditional Owners and Custodians of Country throughout Australia and the region. We recognise the continuing connection to land, waters, and community, and pay our respects to Elders past and present. Today we are featuring the Field Epidemiology in Action Program, which trains field epidemiologists in Papua New Guinea and Solomon Islands. Firstly, we will hear from James Flint, an infectious disease epidemiologist and programme manager from the University of Newcastle, then James will take us into the field to hear nursing officer Adrian Kakayan, based in Papua New Guinea. 

We hope you enjoy the conversation. It's great to have you with us today, James.

James Flint 01:21

Thanks Fiona. It's great to be here.

Fiona Mulhearn 01:24

Can you just start by giving us an overview of the Field Epi in Action project, how it started and what it covers now?

James Flint 01:30

So the Field Epi in Action project or team supports field EPI training and practice in the Pacific. Most of our activities are focused on Papua New Guinea and the Solomon Islands. And field epidemiology includes things such as disease surveillance and outbreak response, but also operational research, which is designed to strengthen the delivery of health services and public health programmes in these countries. So from our perspective, our main role is supporting our national government counterparts to develop sustainable field epi training programmes. And we're there for as long as needed but the goal is eventually for us to completely step back and allow these programmes to run completely by the local teams that we work with to get them up and running. The programmes that we support in Papua New Guinea and Solomon Islands are firmly embedded within the national Ministries of Health and they use these training programmes to train their healthcare workers at all levels of the government service, health service. So from the very front lines, the health centres, up to the districts, to the province and also at the national level. So in addition to the field epi training, we also support rapid response team training programmes. So this is more of a partnership with the province in Papua New Guinea. And the field epi training graduates from the programmes are actually a really key part of these rapid response teams they're often they're the leads in the rapid response team. So the goal of this training is to establish provincial base rapid response teams that are multidisciplinary, that can very quickly mobilise and respond to disease outbreaks or public health emergencies in the country. 

Fiona Mulhearn 03:20

Great to hear that the program is focusing on both establishing the institutional structures which is embedded in the local health system, and also developing the foundational technical skills for health officer across the different provinces where those skills are needed. How has the programme been developed over the last nine years from that foundational level, through to intermediate and advanced training plus rapid response teams?

James Flint 03:43

So PNG's field epi training programme is really a unique programme. And it's been going as you mentioned, for over nine years, actually, it started in 2013. And there's over 100 FETPs around the world but PNG's is one of the only ones which has a real focus on the public health interventions during the training programme itself. So these trainees, we call them fellows they do field projects. The first field project is focused on understanding a health problem in the area they work. And then they go on to take the evidence that they've generated from that first project and design a public health intervention or improvement project. And then they go ahead and they actually implement this and they monitor and evaluate how effective it was. So that really makes the programme quite unique. And the same model has been adopted in the Solomon Islands with that focus on actually implementing their findings and doing these intervention projects. So it's a really fantastic training model. Like all FETPs, the fellows learn by doing so most of their time is spent in the field applying the skills they learn in the classroom. It's a very intensive programme. The cohorts are fairly small, so we train about 10 to 15, maybe up to 20 fellows every year, there's a lot of very intensive mentoring that goes on through the classroom training as well as while they're in the field. So mentoring is a really, really important part of the training model. There's three different levels of training that we've co-developed for use in the Pacific and PNG and Solomon Islands as a frontline One Health FETP, which goes for three months. There's the intermediate FETP, which goes for nine months. And then there's a more advanced FETP, which goes for 18 months. And it's exciting to see the graduates of the advanced programme now becoming a key part of the faculty or the trainers and mentors for the intermediate and the frontline programmes. And as I mentioned earlier, the graduates of these programmes are also very involved in the rapid response team training. And we've actually just finished so this is a partnership with the National Department of Health and the World Health Organization in Papua New Guinea. And we've just finished the initiation training in all 22 provinces in PNG, there's over 300 members who have been trained to establish these rapid response teams

Fiona Mulhearn 06:26 

What a fantastic outcome, nothing like a global pandemic to highlight the critical importance of developing those surveillance skills within the health workforce. Can you just tell us a little bit about the role of the fellows in the COVID-19 response?

James Flint 06:39

The FETP fellows played a really important part during the COVID-19 response. And not only the COVID-19 response, but the national polio response, which occurred just a few years earlier. And almost every single graduate was involved in both the responses. So for COVID-19, there were about 100 intermediate and advanced graduates across both PNG and Solomon Islands. And many of them held quite senior roles in the response, such as incident managers at the provincial level, so really responsible for the entire COVID response. There were others who were leading their rapid response teams. Others were the surveillance leads or the immunisation coordinators. So a lot of them did step into these really quite influential and important roles during the response, but others that were involved the case investigation, and the contact tracing and a lot of them also were involved in training other healthcare workers during the response, so they really did play an important part of the COVID-19 response. It's worth just noting how incredibly difficult the responses are not only for outbreaks, but how incredibly difficult it is to deliver public health programmes period, in some of the remote areas in Papua New Guinea. A few weeks ago, I was in the field in Papua New Guinea and just wanted to share one story if I can to highlight just how challenging it is delivering routine health services as well and to highlight the value of the kind of the training that's been provided to these health care workers that are on the frontlines. So this graduate was working in one of the poorest performing districts in the province. And he was able to improve every single key performance indicator to become one of the top performing in the province. And these indicators cover things like routine immunisation, or antenatal care, supervised delivery, TB, and the like. And when I was visiting this graduate in the field, he invited six of the managers of the health centres that he oversees to come and meet with me. And they all came with these framed certificates. And they were beaming, they were so proud of these certificates that were presented to them by the provincial health authority where they work. And it was in recognition for their outstanding performance during a recent immunisation campaign. So they had exceeded the 95% coverage target for measles, so an outstanding result. But what was even more remarkable I think, was what it actually took to achieve that target. And I was just blown away at the level of their commitment. And this is what they were telling me these six health care workers that was kind of coordinated by our field epi graduate, they were saying how they had to swim across flooded rivers, with their vaccine eskys on their backs, rivers that we know have crocodiles in them. They had to literally trek up mountains and kind of dodge the deadly snakes, they walked for days. They had to sleep, you know, along the way in villages as they went, not knowing where they're getting their food from, having to avoid at times, angry villagers who were kind of very sceptical or unwilling to receive them. They were doing this with no electricity, no connectivity, is just, just remarkable, and so impressive. The extent that they went to and the commitment that this team showed in being able to deliver a routine public health programme in Papua New Guinea. And it just really hit home, how complicated, how challenging it is to deliver what on paper looks like a fairly simple programme. And the ability of the graduate to mobilise this team and to use his skills and his knowledge and the confidence that he got through the training to be able to take one of the lowest performing districts in the country in the province to one of the best in the country was really encouraging and quite inspiring. 

Fiona Mulhearn 11:15

Absolutely, that's a great story. And it really does put in perspective the context in which the health workers in PNG are required to operate in and the logistical challenges that that brings. We know that the health workforce is predominantly staffed by females, how is the programme encouraging females to apply and participate fully in all training activities?

James Flint 11:34

Many of the health programmes being tackled by the fellows and graduates of our programmes disproportionately affect women and girls. So we've always made an effort to ensure that there's good representation by women in our programmes. However, we also understand there's more to it than just ensuring that there's gender balance amongst our trainees. We appreciate that the training experience itself is different, and often more difficult for female health care workers. So one of our team is actually conducting research to really dig into and understand the experience of women in not only the FETP programmes in Papua New Guinea and the Solomon Islands, but FETP programmes around the world. And she's conducting a gender analysis of FETPs to help inform how training can be better designed and better delivered, and also how fellows can be better supported during and following their training, especially when it comes to women who entered the programme. So that's a very exciting piece of work that has been started by one of our team and, and over the next year or two, we'll be drawing on those learnings. And not only using them to change the way we deliver health programmes but advocating for change across the global FETP community.

Fiona Mulhearn 13:41

You've been listening to James Flint, the coordinator of the Field Epidemiology in Action Program. On a recent trip to PNG, James also spoke to nursing officer Adrian Kakayan, a participant in one of the training programmes about how he used his skills to conduct an investigation. We'll play you a little bit of that interview now.

James Flint 13:36

Adrian, you've been involved in a recent investigation outbreak investigation, which was one of the projects that you did as part of your training. Can you just share with us your experience with this investigation and a bit of some details around it?

Adrian Kakayan 13:53

It was very interesting and very challenging. Because I was still a student, and I was involved in that investigation. The tools that I was taught that the training was very helpful to collect our datas which were raw datas, it helped me to analyse those datas and also establish the case definition for those mysterious deaths. So, we we managed to establish a case definition for the mysterious deaths. The case definition was anyone in Nemnem village who were in contact with the deceased over handling the diseases in the period of March till now up until now that the signs and symptoms similar to those cases, that cases in the live cases that we managed to determine investigation. Out of the first six cases form, we got the blood samples, which came out positive for the O antigen and A antigen. So we, we suspect that it was typhoid involved in these deaths, that also TB out of those six, we interviewed, we investigated and found out that two is pretty positive to drug sensitive TB and three were clinical TB case that we confirm and started them on anti TB treatment. Also, malaria testing, we did a RDT rapid diagnostic testing on site, which all of them came out negative, including the COVID and ILI in suspect swabs. So, in conclusion of the mysteries that we said that it was typhoid and TB.  

James Flint 16:07

So can you tell me how many cases there are and how many of those cases have passed away? 

Adrian Kakayan 16:14

We the main findings were 19 of those typhoid cases were males. And 15 were females. The most of those cases were clinically diagnosed with that typhoid they fit in retreated on site with the recommend for on-site clinic. They said that village Namnam village so we had a local team there l team, going there and doing the syndromic management for typhoid. And for TB they did a sputum collection. So, we had the age range was from two to 70 years, the median age was 35 years, number of deaths so far was nine, which amounted to 26.4%. Number of admitted was to 5.8%. And case fatality rate at that time was 26.4%. 

James Flint 17:17

And from a One Health perspective, have you involved other sectors in this investigation? Or are there plans to involve like a One Health team to investigate? 

Adrian Kakayan 17:32

Yes, when we went there, we went with two environmental health officers. They did their part in investigating the waters, latrine, sanitation. And we recommend for One Health approach after this training, so we can all go there so we cannot only say that it's TB and typhoid for this yet because we have to establish the real cost now. Still people are dying. Even though we said TB and typhoid. People are getting treatment, but they're still dying. So it's planned to involve the One Health.

Fiona Mulhearn 18:13

You’ve been listening to James Flint, an infectious disease epidemiologist and program manager from the University of Newcastle and nursing officer Adrian Kakayan, based in Papua New Guinea. You can learn more about the Field Epidemiology in Action program at the Field Epi in Action website plus via the program’s Youtube and Twitter channels. Thanks for your company, I’m Fiona Mulhearn, a Director from Australia’s Indo-Pacific Centre for Health Security. Join us in another fortnight for the next episode of Contain This.