AUTHOR NOTE: This is the first part of a three-part series looking back on my six years as an epidemiologist at the Maryland Department of Health and Mental Hygiene. The second part will be HERE on August 9, and the third part will be HERE on August 16, 2013, my last day at DHMH. It goes without saying that what you’re about to read represents my view of things based on my experiences there. In no way should it be construed to be the opinion of my employer, my colleagues, my friends, or my family. Why the big disclaimer? You’ll see…
I remember it as if it was yesterday. Some things you just remember because you look back at them and wonder why you did them, or how you got away with something. This is such a memory. I was driving on the DC Beltway on my way down to Richmond, Virginia. I had applied for a job with the Virginia Department of Health, and they wanted to interview me for their “Lead Toxicity Surveillance Program.” As I was about to leave for Virginia, I received a letter in the mail from the Maryland Department of Health and Mental Hygiene, henceforth to be referred to as “DHMH.” The letter was from the Division of Communicable Disease Surveillance. They also wanted to interview me for a job as an epidemiologist.
As I was driving at high speed on the beltway, I took out my cellphone and called the number on the DHMH letter. A woman answered the phone, and I asked to speak with Dale Rohn, the chief of the division. Dale answered the phone and I introduced myself as the guy that had applied and gotten a letter to schedule an interview. I wanted to schedule the interview with him, and I also wanted to ask him a question. “What are my chances of getting the job?” I asked.
Think about that for a second. Here’s this guy who just graduated from epidemiology school, has no publications or any type of credit in the world of public health, and he cockily calls to see if there is a chance that he’ll get the job… All before interviewing. If I were Dale, I would have ended the call and not scheduled the interview. Or I would have scheduled the interview, but I would have made a note not to hire me. “Well, it depends on who else is interviewing and how they stack up against you,” he answered. I told him I’d like to schedule the interview.
When I arrived in Richmond, the first thing I noticed was how far away it was from my home in Waynesboro. Not only that, but a few months before all this I had started dating a cute, smart, pretty, intelligent woman who would eventually become my wife. I had a good thing going there, and moving to Richmond would have been a mistake. Knowing that, I decided to sink my interview at Virginia. The problem was that I didn’t want to sink it so bad that word got out that I was incompetent as an epidemiologist. So I answered all the questions they gave me to the best of my ability. I sank the interview in saying that I really had a hard time moving down there from Waynesboro, and that it would be better if I could do some of the work from home. They never even called me back.
The Maryland Interview
A few days before I gave my final project presentation at George Washington University, “the girl” (now “my wife”) bought me a tie with an electron microscope picture of the flu virus on it. It’s a great tie, and I still have it. It gets a lot of questions. (Well, I get questions about it. The tie can’t answer questions.) I wore that tie to Baltimore as I went to be interviewed. I remember that the drive down route 140 was much easier, and that I really had no problem driving right to the building and parking. Total commute time, with no traffic because it was later in the day, was about an hour and fifteen minutes. I could do that. It meant staying with “the girl.” So I decided to nail the interview.
Dale Rohn welcomed me and showed me around the office. There were a lot of cubicles and a lot of people doing things in those cubicles. It certainly wasn’t like in the movies, where epidemiologists run out and save the world on a daily basis. But I kind of expected that. Then we went into a meeting room and sat down to talk business.
The first thing that Dale did was show me how much I was going to be paid as an entry-level epidemiologist. Rather, it was how much I was not going to be paid. The job at the lab paid me $28,000 a year more than I would be getting paid as an “Epi.” (That’s what we call ourselves, “Epis.”) I told him it was fine. I wanted to be an epidemiologist. I wanted to move out of the lab and into the world of public health. Chasing diseases would be much more fun that collecting blood and running tests in the middle of the night. (I still intended to stay at a lab occasionally to get some “play money.”) So that was step number one, telling Dale I’d work for peanuts.
Dale and two other people would then interview me a short time later. Stacy (I forget her last name, since she left DHMH shortly after I started working there) and Alvina Chu. Alvina was (and still is) the chief of the Outbreak Investigations Division. They asked me questions about disease surveillance, epidemiology in general, and about outbreak investigations. Apparently, though I was to be working in surveillance, I would be requested/required to help in outbreak investigations. I gave them all the right answers, showing confidence and proudly wearing my flu tie.
I think it was the flu tie that won me the job. They offered me the job a few days later.
Oh, My God! Oh, My God! Oh, My God!
One of the first things that happened when I started working at DHMH was a situation with a case of Legionnaires’ disease (LD). The disease is a pneumonia caused by the Legionella species of bacteria. Apparently, a woman working at a big office building that was somehow tied to the state government had caught LD, and she told her friends at the building that it was the building that gave her the disease. The word spread around that the building was making people sick. Yes, “people,” though the case count remained at one throughout the whole thing.
During my first week of work, I was sitting next to the State Epidemiologist, Dr. David Blythe, and other eminent people from the health department, talking to people at the governor’s office and other agencies about the situation. I think they may even have asked for my opinion on something because I remember telling myself, “Oh, my God! Oh, my God! Oh, my God!”
The rest of the first few weeks were spent trying to figure out what was going with influenza surveillance in Maryland. From my perspective, it was in shambles. The person running flu surveillance was one of the physicians who had a ton of administrative work to do, meaning that he did a lot of grant writing. So he didn’t have time to give flu surveillance the love that it required. I did. My final project at George Washington was about influenza surveillance in a rural setting, and I was going to implement a similar system to whatever was going on in Maryland.
Remember, this is the summer of 2007.
The first year was spent bringing flu surveillance into the 21 century, helping out with outbreak investigations, and getting to know the people I worked with. Maryland is interesting in that the 24 jurisdictions (23 counties and the City of Baltimore) all have independent health departments. It is the people at those health departments who interview cases and are the front line of outbreak investigations. We just provided guidance and support. So I had to learn the names, telephone numbers, fax numbers, and emails of a ton of people.
The other thing I did was to being doing weekly influenza surveillance reports during the flu season. Little did I know that interest for those things would be high when they started going out. They went from one page a week with the most basic information to six page, full-on reports with detailed information. The media also became interested in flu surveillance, and I was interviewed a few times about the “flu situation” in the state. That was the winter of 2007 into 2008.
Let Me Blog about It
I decided early on that I was going to blog about my experiences as an epidemiologist as much as I could. Like with my job at the lab, my job at the health department had to do with a lot of confidential information. So I didn’t write about stuff until it became public knowledge. Even then, I didn’t write about details of our outbreaks. I’d just take what was known and expand on it. For example, if there was an outbreak of rabies in feral cats, I’d write about rabies, the rabies vaccine, and what public health does to combat those things. That blog was called “The Epi Times,” and I would write in it about once a week. The rest of the time, I was blogging about my personal life at “Ren Returns.”
I asked a few people to join me at “The Epi Times,” but many were apprehensive about it. This was something that was pervasive throughout the culture at the health department, the fear of social media. Facebook was in its infancy and Twitter was around the corner. Blogs were all the rage. The iPhone had just been released. But our computers running windows XP and Office 2000 were indicators that technology was not something wholly adopted by the bosses. That reflected on my colleagues. No one wanted to blog with me.
From Australia, With Love
I consider the “Maryland Resident Influenza Tracking Survey” (MRITS) my greatest achievement at DHMH. It is a weekly survey of Maryland households, asking the participants if they or anyone in their household was sick with flu-like illness in the previous week. It wasn’t all my idea. I had been corresponding with some epidemiologists in Australia. They were running a similar program with great success, and I wanted to do some social media integration into the practice of disease surveillance. The term “participatory epidemiology” would be coined a few years later.
In fact, in 2012, I was invited by the Skoll Foundation to go to San Francisco and discuss participatory epidemiology with some of the greatest minds in the field. People from all over the world came to the meeting, and I had a blast meeting them. I got to meet in person with the folks from Australia. I even joked that my reason for being in San Francisco was them, but then I had to clarify that I didn’t intend to make it sound like they procreated me.
MRITS launched in Maryland in October of 2008. Week after week, people signed in and told us if they had any flu-like symptoms. At first, the survey was run through an online survey provider. Later, the information technology folks at DHMH would create a server and site for the survey. Actually, the reason why they did it was because the H1N1 pandemic occurred in the spring of 2009. Wanting to show the public that the state government was doing something about the pandemic, the governor and secretary of health paraded the MRITS system to the media. I got to go in front of a lot of cameras for a press conference.
I stood in the limelight, and I didn’t really like it much.
Atlanta, Here I Come!
One of the perks of my position as influenza surveillance coordinator was that I got to go to Atlanta the first year that I worked at DHMH. It was a short trip, three days. But I got to go around town and also meet a lot of people who worked at CDC and at other health departments in the nation. The annual conferences would continue up until last year. This year (2013), I was not allowed to go by the bosses because I had announced that I was leaving DHMH. More on that later.
My trip to Atlanta that first year was interesting not only because I got to meet a lot of people. I also managed to get myself lost in the city during a torrential downpour. I had planned to tour downtown and then head down to watch the Braves play the Pirates, but the game was rained-out. So I walked back toward the metro station and managed to lose it. I ended up all the way at the headquarters of CNN and then onto the park they built for the 1996 Olympics.
On my way there, I came across a man who had a big, huge umbrella. The tiny umbrella that I had with me was too small for the rain that was coming down. He offered me his umbrella in exchange for mine and “a few bucks.” I gave him $20 and my tiny umbrella. We then chatted about Atlanta. Unknown to me, the city had all sorts of problems with crime and poverty. He was one of the unfortunate many who lived on the streets of the city, getting by on peddling and, as he admitted to me, stealing stuff to support a habit. It was very sad. At the same time, he was very welcoming of me and didn’t take me for a ride. He just took my tiny umbrella and the money and walked away.
I have a picture of that moment somewhere.
H1N1 and the Rise of the Antivaxxers
I knew that anti-vaccine people could run. I just didn’t know they could fly, so to speak. All that work and public exposure during the pandemic painted a target on my back for the anti-vaccine people in Maryland and beyond. In September and October of 2009, a young lady from Virginia claimed that she got dystonia (a neurological condition) from the H1N1 vaccine. The funny thing was the H1N1 vaccine didn’t hit the public until October. Of course, the story changed to her dystonia coming from the seasonal flu shot.
I decided to write about it one night when I got to “the girl’s” apartment. I stayed up late into the night gather all the information I could about her from public sources. When I was done, I had pretty much summed up her case and explained that it would be highly unlikely, if not downright impossible, that she got the dystonia from the vaccine. Even later that night, after I published the piece, I decided to visit an anti-vaccine blog and read the comments in the blog post about her. I couldn’t believe my eyes.
Everyone in the comments section kept saying that the government, the pharmaceutical companies, and people in public health all were conspiring to either get everyone sick, kill everyone, or enslave the human race. They blamed everything from autism to cancer on vaccines, and they were relentless in their hate of one Dr. Paul A. Offit. I got angry at their comments and made a comment myself. A few minutes later, the editor of the blog had googled my name and told me that I was not to be allowed to comment anymore because I was a “vaccine injury denialist.”
I was on their radar.
I was even more on their radar because Orac picked up on my follow-up blog post about the dystonia case. See, the people from “Generation Rescue,” an anti-vaccine organization that claims that vaccines cause autism, put out a press release that they were helping the young lady get medical care from a controversial physician who practiced some “alternative” treatments. Generation Rescue invited the public and press to look at reports of adverse events from influenza vaccine on a national database available to the public. So I did just that. Only one case in that database matched the case of the young lady, so I wrote about it. In that case report, the physician attending that case wrote that there was a strong psychogenic component to the case’s condition. When Orac wrote that, my blog took on a lot of visitors and a ton of attention.
I was busy enough at work with the pandemic to pay attention to all the evil and hateful comments being made about me here and there in anti-vaccine fora and blogs. It would have been fine if all that stayed there. It didn’t. The young lady’s attorneys filed a complaint with the DHMH inspector general, claiming that I had accessed her private medical information. It took a few weeks of explaining to them how I had gotten access to the public database and just put two and two together. Lucky for me, they saw that and didn’t pursue the case any further.
Unlucky for me that my blogging was now under the microscope from the bosses as well. I swear, some of them must have thought that I was writing up every case I saw, disclosing all sorts of confidential information. But I took extra steps to make sure that wasn’t the case. For a few months after that fiasco, I walked on eggshells at work. I did my work and stayed under the radar, getting by with the bare minimum. This was a strategy that would work for me until 2011. That summer, everything changed.
Part Two is due out on August 9, 2013. Part Three is due out on August 16, 2013, my last day at DHMH.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
About Epidemiological: I am the sole contributor to Epidemiological, my personal blog to discuss all sorts of issues. It also has an About page you should check out.