Delea Prevention Transcript

DELEA: [M]y personal opinion is that's why we had success. People don't really talk about the success in Bissau, but I would say for the Global Health Security high-risk countries, Bissau has probably been the most successful. Our successes, my true personal opinion is our successes are based truly in the fact that we change people's perception of what they were able to do. Placido had some big ideas, but a lot of the staff under him did not think that it was possible. I think, again, this comes back to you don't need to give a country a lot of money. Luckily, because Bissau was small and nobody was paying attention--let me just tell you in general what happened.

Q: Sure, sorry. [laughs]

DELEA: I came in on a two-month detail. I came in as the support for the first month, for the first three weeks. Then I was a team lead after that. But there were two of us in-country at that point. We had an FETP [Field Epidemiology Training Program] program, the STEP [Surveillance Training for Ebola Preparedness] program, which was the surveillance--oh gosh, I can't even remember these names. It was an Ebola program, basically a very basic field training epi program that was done specifically for Ebola. We had enormous success with that, our STEP program, and we brought in mentors from Portugal, or from Brazil. The Brazilian FETP program sponsored, and one girl was from Argentina, and one girl was from Colombia. Basically, South America's FETP program sponsored Bissau. We worked with TEPHINET [Training Programs in Epidemiology and Public Health Intervention Network], which is a regional co-ag [cooperative agreement] we have in South and Central America. We worked with them to bring these people into country for a ten-week training program. We were able to train sixty people, I think. We had enormous success. These people were trained very well. Our going out into the field, our training exercises, and their projects, what they brought back. We actually identified chikungunya, which they said didn't exist, and we identified that. We actually did have chikungunya in Bissau. And there were a couple other things. We identified some outbreaks that were going on and tried to think about how the country needed to deal with some of those that the country apparently knew were going on, and was ignoring. But it came to light and we're like, how do we deal with these? That was one of the big things.

I spent a lot of time, aside from just these, being the technical lead and meeting endlessly in all of these different work group meetings about how we prepare the country, we did this training. And then I did a lot of training. I spent a lot of time with Placido. He was my basic person, so sometimes I would just go sit in his office and be like, what do we need? I did very, very basic training on [Microsoft] Excel. A lot of their surveillance was based on Excel, and they didn't even know what a cell was. A lot of these people were not computer literate at all. They were scared to be computer literate. So I did a lot of training. Then of course, there's people who want to do pivot tables in Excel. It was kind of like, I had to do training for, what is a cell in Excel? And how do you add two cells together, and how do you put a word versus a number? All sorts of stuff like that, all the way to how do you develop pivot tables that we can do some pretty--more advanced analysis than they were able to do before they understood that technology. So, stuff like that.

We were trying, and then they wanted some evaluations, so I spent a lot of time working with two of their people. In the time that I was there, Placido actually made an evaluation group. He identified and hired three people that would be in charge of evaluation for the agency as a whole. Which meant we went back and we looked at their strategic plan and some of the plans, and we started selecting evaluation indicators. We went back to IHR, what they had to do with the International Health Regulations, and started looking at, how could the countries start evaluating what they were able to do and not do? And how could we use that data to improve their system? These were the kind of things and the conversations.

Because there were only two of us, sometimes only me, in that first kind of sixty-day period, and I actually closed the program. I went in January and I closed it on April 1st. Then I came home, and at that point I was still working at NCEH, and I came home and went back to NCEH. While I was in-country, I was offered a job in global health in the Global Health Security Agenda program, running the Bissau country program. We would, of course, never have a country director, we would never have a program in-country, but it was, how can we work with this country? We've got eight million dollars, seven-point-some million dollars that we can spend. What can we do?