In early 2016 I found out about the World Health Organisation (WHO) Internship program and decided to apply on a whim, thinking it was unlikely I would be selected, but filling in the application form was a useful source of procrastination at the time. The World Health Organisation had an exotic appeal, with images of field workers surveying people in rice paddies and emergency Ebola laboratories in West Africa coming to mind. The idea of doing international public health related work in a far off place was a lovely day dream to escape my thesis induced nightmares. However, the dream soon became reality when a few months later, I found out my application had been successful.
My CV was plucked from the thousands of hopefuls and I was offered a position at the WHO Office for the Western Pacific Region (WPRO) in Manila, the Philippines, starting immediately. Suddenly the idealised day dream was becoming a tricky reality. It wasn't great timing for me, as I was in the middle of a major research project and I had numerous other activities to complete relating to my PhD thesis. When I told my PhD supervisors that I had received this offer, their reactions ran the full gamut from amazement to confusion. I distinctly remember one of them saying "well yes you can take the time off... but why do you want to go there?" Fortunately I was able to negotiate with all the parties involved to let me go for 2 months over the Australian summer, which meant I would forfeit our customary long Christmas break, but this way it would cause minimal disruptions. Even more fortunately, earlier in the year I was granted a scholarship from Layne Beachley's Aim For The Stars Foundation, which allowed me to be able to pay for my flights and some other expenses while in Manila, as of course, the WHO doesn't pay interns.
I landed in Manila at the beginning of December and was placed in the Division of Communicable Diseases (DCD) with the Hepatitis, HIV and Sexually Transmitted Infections (HSI) Unit. On my first day in the office, a meeting was held to plan their impending Year End Party (YEP) performance. I soon found out it's a long standing tradition at WPRO that all divisions perform a pantomime style routine in a competition held at the annual YEP, and the theme for 2016 was "throwback to the 90's". Apparently they were having trouble recruiting Spice Girls, and my first act of service to WPRO would be to play Ginger Spice in DCD's YEP performance. Needless to say, I was happy to oblige. Sadly, we didn't win the YEP competition, but it is widely agreed that DCD was robbed this year (as it also was the year before apparently).
From then on, the actual work began. I quickly discovered that the WHO relies heavily on interns and volunteers to complete much of it's work, in large part due to a very restricted budget, but also because of a culture of donor countries supplying many personnel in-kind, through secondments and various other strategies. Interns do a lot of grunt work and are essentially the minions of WPRO. At times, one gets the distinct feeling of being 'another brick in the wall' as an intern at the WHO. My duties were split between working on HIV surveillance data and providing technical support for viral hepatitis related activities. One experience during my internship really highlighted, for me, the way viral hepatitis is often thought of both domestically in Australia and Globally. This experience was when I had lunch with the Regional Director of WPRO at the beginning of my internship. Dr Shin Young-soo, the outgoing WPRO Regional Director, regularly has lunch with visiting interns and volunteers in his (palatial) office. On this particular day, a group of 8 volunteers and interns were joining him for the obligatory lunch date, including myself. At the beginning of lunch, Dr Shin went around the group of interns one by one (with our CVs in front of him) and asked us about the projects we were working on at WPRO, our academic backgrounds and various other quips relating to either our nationality or professional backgrounds. I found this act mildly amusing and wondered what he would have to say when he inevitably came around the table to me.
When my turn arrived, I was stunned to hear him open with "Ah, Sofia, the Australian. Well viral hepatitis is almost over now in our region. We have all the amazing new drugs that cure it. What will you work on next?" I choked on my lunch for a second as my brain scrambled to process what I had heard. I thought, "surely this man knows that WPRO has the largest number of people infected with hepatitis B and C of all WHO regions, and most of these countries don't have universal health coverage, coupled with huge financial inequality and poverty? Surely he can't be serious." He was. I quickly discovered that like many other very senior public health bureaucrats, prevalence of the disease in question is usually the only thing they really pay attention to. Which is quite misleading, especially when considering countries like China.
The prevalence of hepatitis B in China is estimated to be about 5.5%, which puts it below many countries in Africa, with prevalence's above 8% in most countries on that continent. However, the total number of people in the whole of Africa estimated to be infected with hepatitis B is 75,641,609. The total number of people estimated to be infected with hepatitis B in China alone is 74,601,204 (only 1.04 million less then the WHOLE of Africa combined). I pointed this out to Dr Shin, and asked how China would be able to pay for diagnostic tests and LIFETIME therapy for hepatitis B virus for all these people? I also asked how China will implement and pay for diagnostic testing and treatment for the 9,795,000 estimated people infected with hepatitis C virus there. There is very variable quality and availability of diagnostic testing across China for both hepatitis B and hepatitis C virus, and with most people unaware that they are infected, just finding these people will be an enormous challenge. Treating them will be a whole other problem for future China to deal with. I would like to say that Dr Shin is an isolated example of this thinking, but from my experience so far, he isn't. I encounter this as the prevailing attitude among people not directly involved in viral hepatitis research. Very few people are aware of the fact that viral hepatitis kills more people globally than tuberculosis, HIV and malaria, yet this has been the case for several years. It seems viral hepatitis is the global problem everyone wants to ignore. It's just too big. Too expensive. Too difficult. It takes years for people to die from liver cancer or liver failure, unlike HIV/AIDS or tuberculosis, so no one worries now.
Thankfully, there are extremely committed individuals at WPRO, and around the world, who are prepared for the hard tasks ahead and are working tirelessly to try and eliminate viral hepatitis. But unfortunately, many, many more people will die from viral hepatitis before this happens. I don't advocate for diverting resources away from treating diseases like HIV, tuberculosis or malaria. This is a case for additional spending and additional resources. HIV transmission is far from over (case in point: the Philippines, with a 624% increase in the number of new HIV infections between 2005 and 2015!) and multiple drug resistant tuberculosis continuing to spread more and more. We need to encourage both public and private spending on these diseases, or else the chances of achieving elimination will be very low. There are still significant hurdles to clear on the journey to elimination of viral hepatitis as a public health threat by 2030, but hopefully they will get fewer and smaller along the way, thanks in part to the small but important contributions made by interns and volunteers like myself.
This blog is written by Dr. Sofia Bartlett; scientist, ocean lover, and curious human being. Her bio can be viewed here.
© Sofia Bartlett and Rogue Transmissions, 2017. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author is strictly prohibited.