A interesting challenge to the notion of field epideimiology, drawing heavily on the lessons from a case in Ghana in 2011. The “field” is often seen as a frontier into which experts are parachuted:
Despite the mounting evidence suggesting it was not a zoonotic outbreak, more likely explanations for the outbreak, specifically that it had a toxic aetiology, went unexplored. After 2 years, all of the investigations into the outbreak had petered out. No meaningful public health interventions had taken place nor a compelling explanation for the event developed. However, if you read the draft and published manuscripts describing the outbreak authored by the investigators during that time, you would be left with the opposite impression…
Early on in the BAR outbreak response, a district disease control officer had raised concerns about introducing elite foreign and national outsiders into the investigation, warning: ‘They will come in, sit down and they will take this one, and this, and then they will come out with a nice story of a nice thing’. In an email to his fellow local outbreak responders, he explained that the outsiders will ‘want to publish because it is an emerging disease, however, there is the need for deeper investigation’ and that instead, they themselves should ‘work as hard as possible to answer all the possible questions, irrespective of the years or months that it will take’. Regardless of the image of transnational outbreak responders might have cultivated among themselves and the upper echelons of the larger epistemic community, to have such a reputation on the ground with those who witness work directly, is a damning indictment of these practices and their effectiveness.
The lessons from the editorial are that local workers get there faster and have the contextual expertise that is required for useful hypothesis generation.
It’s worth considering what other aspects of public health practice need to learn these lessons too.
Stuck in ‘the field’: why applied epidemiology needs to go home - BMJ Global Health editorial
More on the Brong-Ahafo case in this 2023 article by the same author.
