Tuesday, July 28, 2009 – Day 4

**NOTE: NAMES HAVE BEEN CHANGED** (Can you guess where the names came from?)

Day 2 on the job went slightly better in that I had a better understanding of what I had to do… or so I thought. I need to compile influenza data of Cambodia from at least 4 different surveillance systems into a monthly report for the WHO. Trouble is, each system has different parameters, different ways of reporting, gathering, etc. I try to make sense of all the numbers thrown at me – thank goodness I took an intro epidemiology course this summer or else nothing makes sense. It’s great to see what I learned has a real life practicality to it. Specific/sensitive case definitions, case fatality rates, positive rates, incidence rates, etc. It actually all makes sense… until I realize how daunting the task is to put all this raw data into visually appealing and understandable pie, line, and bar charts. Dr. Nemo gave me a template of how to work the data but some requests aren’t possible given the data I’m given. So I pore over this for 2.5 hours with Nigel on GChat.

10 AM meeting with Nemo and he keeps asking me if I’m ok and settling in ok. He remembers that I wanted to find a gym and that I wanted to get a better understanding of how the WHO works. He says that whenever someone seems too enthusiastic, he gets worried. Haha… if only he knew how much energy I had. He begins to explain the WHO organizational structure and how politics is embedded everywhere. I learn that PAHO was established in 1902 before the WHO was established after WWII in 1946. In order to add PAHO, WHO granted PAHO much autonomy within the American region. That led to the formation of more independent regional offices – my office is under the Western Pacific office headquartered in Jakarta, Indonesia. WPRO, the acronym, includes all of SE Asia, East Asia, and the Pacific Islands. The main WHO HQ is in Geneva, Switzerland. Politics are at every level, drafts are written before meetings, and developed countries that provide a lot of funding (like the US) direct a lot of what is being researched. Nima understands that I have no idea what I want to do with my life, whether it’s clinical medicine or public health, but he thinks that the CDC’s Epidemiology Intelligence Service (EIS) or the STOP program would be good experiences. We’ll see… I tell him about my desire to do nonprofit medical mission work in developing countries and he says it’s hard work and very challenging. You need to hit the ground running, just like working at the WHO. Very little training involved. We move on to talking about this monthly report and what to include based on the raw data. Some of it is confusing to him too, trying to make sense of other people’s numbers. After this talk, I feel much better about my task and pick his brain about seasonal flu vaccine production and how vaccines are produced based on educated guesses of the flu strain that coming season.

I go home for lunch (7 minute walk) and meet Ms. Ray, the housekeeper, who cleans my room everyday and neatly places my stuff. This is my first time with a cleaner – it’s kind of nice to not clean for myself. I read a bit more of The Kite Runner, great book btw. After eating the leftover fried rice reheated in a pan, I leave in search of more gyms… hopefully at reasonable prices. After getting lost around the block, I find Goldiana Hotel with a mediocre outdoor gym with old machines. Next is Anise Hotel, which has no gym. I walk back to the office sweating profusely. I could sweat just standing still – it’s so hot and the sun just bores into your skin. I am sure my skin color is shades darker from the past few days.

I spend the afternoon creating charts in Excel and then leave after 5:30. I come home and talk with Bruce a bit. He is Lady’s boyfriend. I’m renting the room from Lady, who is in Lebanon doing work for CARE. Bruce also works for a NGO that helps drug abusers and sex workers in Cambodia. His many tattoos on his arms are reflective of his Californian upbringing. I reheat more of the rice, I think I only have 3 more meals left in it. Belle, the other girl interning for a NGO from Harvard law, joins me for dinner and we chat about our work. She lived in Africa for a year and she knows quite a lot about the frustrations of the bureaucracy and craziness of international organizations. She saw the war crime tribunal today which is pretty interesting. Pol Pot’s era of genocide is finally being recognized in court as some guards and leaders are being tried for crimes they committed decades ago. Pol Pot died in 1998 without ever being tried. She tells me that Hun Sen, the Prime Minister of Cambodia, was a leader in the Khmer Rouge – no wonder the movie only showed 30 seconds of the genocide and killing spree. I talk to her about medicine, health care plans, etc. We wonder if it’s good to raise taxes for those in the $250,000+ income bracket. I’m all for it, even though I will eventually be there (w/ a spouse’s income combined). She is too, except she thinks that there is a large difference between the 250+ and 1 million range. Our conversation is interrupted when Buddha hops in with a flashlight. Where’s Bruce? We don’t know. Buddha eagerly invites us to try his wife, Mei's, bok choy dish outside. We hunch around a single gas burner facing a small 13” TV playing Lady Gaga and Beyonce music videos and try the bok choy with meat and eggs. It is delicious and much better than the “fried rice” I attempted. I try this sauce on the bok choy that Buddha claims is mildly spicy. No – mild is a word for those who are experienced in spicy. This sauce was like five symbols of fire flames.