Hello again! Last month, I wrote a primer on my experiences working in the realms of public health while in medical school. I am proud to have an active role in leading some Zika virus-related research and outreach while here in the country of Sint Maarten.
I left off last time with a photo of our most current successful partnership with local government and the local Red Cross where we organized student volunteers to do home inspections and contribute to vector control efforts. Our contributions were praised and are ongoing as more students volunteer for tangible public health working experience in the field. Concurrent with another research project happening on campus regarding Zika seroprevalence, the school community is excited and engaged in all of these efforts. Though it is early now, by the next phase of that project I will be sharing how immunologic work aimed at Zika detection is done here and how labs—everywhere—are absolutely vital.
Relying on epidemiologic and laboratory data has shaped the way we look at Zika virus in this area. A vast spike in reported cases to public health offices matched with an equal increase in laboratory confirmed cases has raised alarm for local officials. While the increased ability to detect and report Zika within the community is growing due to advancing research, the measures taken to mitigate the risks of infection and transmission have not changed despite public health efforts already. With the history of Arbovirus being a routine part of life in the region, behavioral change seems to be a significant hurdle with respect to social determinants of health.
Figure 1. Distribution of cases on Sint Maarten per epidemiologic year 2015-2016, per the Ministry of Health, Social Development, and Labor – Collective Prevention Services Department.
For now, working partnerships have grown in the last month and have brought on exciting developments. Incorporating the public health outreach within the oversight of a service-learning course at AUC School of Medicine, ongoing works related to Zika education and prevention are supported by local government. The Sint Maarten Ministry of Health, Social Development, and Labour as well as their office of Collective Prevention Services were impressed with my team’s initiative and so enthusiastic about our first public health effort that they wanted to be a involved with our work. Having such prominent sponsors is lending both credibility and attention. The relationship that has developed between the mobilized student volunteers has fostered an attitude of inclusivity and collaboration.
Figure 2. Representative meeting of student volunteers, Sint Maarten Red Cross, and others at a briefing of the Collective Prevention Services training session, October 2016.
One of the more recent and successes involved a program aimed at school children from various parts of the island. Local churches here have a program called “Healthy Me” where by school-aged children between 4 – 16 from various regions within the Sint Maarten community come to one school or community center to learn about their own health. Often times, my medical school’s pediatric interest group will send a large number of volunteers to talk to the children about metrics of health including conducting eye exams, measuring height and weight, blood pressure, pulse, and discussing diet. This time, my team proposed we collaborate with this event and hold Zika related presentations in one of the classrooms adjacent to those other screening rooms. We were approved and held nearly ten sessions with a total of almost 400 children!
Having a youth-tailored presentation along with coloring-activity books, we were able to impart a strong message to the children regarding source reduction and vector control. Writing an age appropriate presentation, engaging the children with active participation, and distributing activity booklets modeled after CDC education materials received positive feedback. Our community partners with Collective Prevention Services at the Ministry of Health supplied their overwhelming support and truly enjoyed being a part of the project. They have since requested to use our presentation materials and activity books at schools throughout Sint Maarten with the hopes of contributing positive public health outcomes from children to their parents and families.
Figure 3. Me delivering one of the Healthy Me presentations to children, October 2016.
Figure 4. Healthy Me Zika Presentation.
Figure 5. Pamphlets for Children.
Citing the CDC’s approach to similar Arbovirus threats in the past, it became clear to my team and I that behavioral change is a significant part of improving public health outcomes within a community. A grassroots, or “bottom up” approach, both involves the community and positively influences behavioral changes to reduce risk and transmission. While the region here is fraught with historical exposure to Arbovirus threats, awareness and risk reduction are still critical for a population’s overall health.
Recently, the WHO released a statement calling for Zika to no longer be considered an epidemiologic emergency. This news has been met with both relief and criticism. Despite the virus receiving this downgrade, they still assert that it will continue to pose a threat as an ongoing infectious agent with complications that must be monitored by public health officials. While cases continue to increase over time, the management and reduction of risk is something both laboratories and public health officials will continue to address. Regardless of its status as an emergent epidemic or not, laboratories will still conduct studies to confirm reported cases, local government will continue to address the residents of this island to reduce risk, and I will continue to report about the state of progress between them. Labs, public health, and media are all part of the mechanism which translates data into results—and I am happy to be a part of that process.
Thanks for reading!
1. Vlaun, N., & Davelaar, G. (2016). ZIKA Virus on Sint Maarten . Philipsburg, Sint Maarten: Ministry of Public Health Social Development and Labour, Collective Prevention Services.
2. Davelaar, G. (2016). Results of the Pilot project “Cull de Sac,” a Mosquito Surveillance Plan for Sint Maarten . Philipsburg, Sint Maarten: Ministry of Health Social Development and Labor, Collective Prevention Services.
3. Gubler, D. J. (1988, December 7). Aedes Aegypti and Aedes Aegypti-borne Disease Control in the 1990s: Top Down or Bottom Up. Washington, DC: Centers for Disease Control and Prevention.
4. WHO (2016). “Fifth meeting of the Emergency Committee under the International Health Regulations (2005) regarding microcephaly, other neurological disorders and Zika virus” Statement, 18 November 2016. http://www.who.int/mediacentre/news/statements/2016/zika-fifth-ec/en/
-Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.