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A ‘Participatory’ Approach

A ‘Participatory’ ApproachHealth officials in Indonesia have turned to two Tufts-trained veterinarians for their help in implementing a new system to control the spread of avian influenza.

Medford/Somerville, Mass. [01.22.07] While controlling avian influenza remains a concern for most of Asia, experts are particularly alarmed by the situation in Indonesia, where no formal control program exists and the human death toll from the disease stands at 62 —the highest of any nation. Fearing that Indonesia could become a hot spot for the start of a worldwide pandemic, World Health Organization officials have asked two Tufts-trained veterinarians to help set up a program that they believe will be key to battling bird flu in Indonesia and throughout the developing world.

"You simply couldn't get more virus in the environment," Jeffrey Mariner, who earned his D.V.M. from the Cummings School of Veterinary Medicine at Tufts in 1987, told Science magazine about the severity of the avian flu problem in Indonesia.

In 2006, with bird flu running rampant in a country with a population of 220 million, health officials scrambled to find ways to better assess the scope of the problem and get it under control. They settled on participatory epidemiology, a method Mariner developed along with Christine Jost (V’96, F’03), an assistant professor in the Cummings School’s department of environmental and population health. The approach is focused on community engagement—and involves recruiting community members to participate in both disease surveillance and response efforts.

“It sounds simple enough: Train teams of vets to tap into local knowledge of where and when outbreaks are occurring, and then enlist villagers' cooperation in control efforts,” Science reported. “The basic fieldwork provides epidemiological data on how the disease is spreading and kept in circulation, which in turn leads to higher-level strategies for control.”

A New Technique

Jost and Mariner first used participatory epidemiology more than a decade ago in Africa to tackle rinderpest, a highly contagious and deadly viral disease that affects cattle. At the time, Mariner was working for the Food and Agriculture Organization (FAO) of the United Nations’ Global Rinderpest Eradication Program.

"I realized that the farmers knew a lot more about where rinderpest was than the veterinary officials," Mariner told Science. He added that herdsman and community members became key sources of information about cattle deaths and illnesses.

Through participatory epidemiology, rinderpest was eradicated from Sudan. When the disease cropped up in Pakistan, the same technique was used to counter it there, as well, Science reported. International health officials like Peter Roeder, an FAO animal health officer who worked with Mariner on the rinderpest project, have similar hopes for Indonesia.

"Reducing infections in poultry is a critical aspect of reducing the risk to people,” he told Science, citing several challenges that health officials face in dealing with avian flu in Indonesia. Among them are a weak animal health infrastructure and the fact that the country—with 3,000 inhabited islands—is geographically diverse. He told the magazine that there are also many cultural and ethnic differences among the population.

For these reasons, Roeder explained to Science, participatory epidemiology is good fit for Indonesia.

Bringing Participatory Epidemiology to Indonesia

Mariner and Jost began their efforts with a pilot program in Java, Indonesia, early last year. With help from several other Tufts alumni, includingEric Brum, D.V.M. (A'99, V'04),Dale Hogland (N'99, F'99) and Alison Turnbull, D.V.M, M.P.H. (V'06, M'06), they trained pairs of veterinarians to go out into the island’s villages, collect information about bird flu and engage villagers in participatory disease response. Mariner told Science that the results of the early research were surprising.

“[It] turned up much more avian influenza than anyone expected,” Mariner told Science. “Poultry populations were fully saturated."

But people living there already had a strong sense that something powerful was at play, Jost explained to the magazine. She said that villagers began to provide teams with details about outbreaks that had been previously unknown to officials.

According to Science, the initial success of the program has prompted officials in Indonesia to push for its expansion. In the meantime, Jost and Mariner are planning a new pilot program to measure the impact of their control and response programs.

"I don't think we've had any impact on incidence [of outbreaks] so far," Mariner told the magazine. But even without hard data on the impact of the program, many people are optimistic about Jost’s and Mariner’s efforts.

“International and Indonesian animal health officials believe [participatory epidemiology] will be a key component of bringing the [avian flu] crisis under control, both [in Indonesia] and throughout the developing world,” Science reported.

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