What do disease detectives and murder detectives have in common? When we talk about epidemiology, the core principles revolve around the who (person), what (health event), where (place), when (time), and why/how (causes, risk factors, and modes of transmission). A disease detective, trying to find out what the disease of concern is, resembles a murder detective searching for the perpetrator. Identifying the cause of disease is like looking for the motive for a crime, and establishing how a disease could have developed is reminiscent of following the tracks of the murderer and asking how they used the murder weapon.
In seventh grade, I received the board game Simpsons Clue as a Christmas gift. I didn’t know much about the game but was fascinated as I began to play it with my siblings and friends. The purpose is to investigate a murder by gathering evidence and clues. The winner is the one who can figure out which three cards are hidden within the secret envelope that hold answers to the who, where, and how of the murder. It was fun to act as a detective and use clues to help unravel a mystery. This curiosity and interest for discovery and investigation eventually carried on beyond a hobby and board game. Years later, I became intrigued by the concept of infectious disease outbreak investigations after watching Contagion in my Intro to Epidemiology course during my third year of undergrad at the University of Illinois at Urbana-Champaign. The movie reinvigorated my passion for investigation and how it could be put into play for disease detection in preventing the next epidemic.
GRADUATE SCHOOL AND PURSUING THE FELLOWSHIP
During graduate school (also at the University of Illinois at Urbana-Champaign), when I spoke with one of my professors about his thoughts on going into the infectious disease field, he suggested that I change my focus and consider chronic disease due to there being less opportunities in infectious disease in the United States. With this epidemiological shift occurring, chronic diseases are replacing acute infectious diseases to become the predominant cause of morbidity and mortality in many parts of the world. However, I was adamant that infectious disease epidemiology was more appealing to me and where my passion was.
“…I was adamant that infectious disease epidemiology was more appealing to me and where my passion was.”
An infectious disease is a disease that is caused by the invasion of a host by agents whose activities harm the host’s tissues and can be transmitted to other individuals. The fact that we, as a society, oftentimes have the tools and power within our hands to detect, control, and prevent the spread of disease from one person to another is why I chose to work in infectious diseases. I later spoke to others within my department about opportunities in the field and found out about the PHI/CDC Global Health Fellowship Program. I immediately researched it and knew where my next journey was meant to be.
The following year in 2018, I applied for the fellowship and waited eagerly until April/May for an interview offer. I advanced to the pool of candidates eligible for an interview, but unfortunately was not chosen. It was a huge disappointment as I thought I had a strong chance, but I knew that I couldn’t give up quite yet. I made sure to attend all the info webinars and really put more time into perfecting my personal statement and revamping my CV. With help from my family and former professors, I reapplied again the following year with renewed hope and confidence. This time around, I was sure I’d be offered an interview. Luckily, I did get an interview, but unfortunately once again it didn’t turn into the result I had hoped for.
That second rejection really hit me hard and made me want to give up and reconsider other options to get into the global infectious disease world. In fact, that’s exactly what I did. I applied to be an HIV mitigation volunteer with the Peace Corps in Eswatini. After interviewing, I was offered the position and happily accepted it, set to depart in 2020. After the COVID-19 pandemic hit, everything came to a sudden halt. All Peace Corps volunteers evacuated back to the States, and the program was put on pause indefinitely. While I kept thinking the pandemic would be short-lived, I constantly checked my emails for updates on when the program would restart, and I’d finally be able to deploy. That time never came, and like many others, I began to feel hopeless and confused. My parents advised me not to worry: things would eventually turn around for the better, so do not give up because persistence pays off. In the meantime, I applied for the fellowship one last time at the end of 2020, thinking that the third time had to be the charm.
The PHI/CDC fellowship offered everything I was looking for to further develop my skills and passion for improving the quality of life and health for populations. Before applying, I made sure to connect with several current fellows via LinkedIn to gather tips and suggestions on how best to tailor my application and more importantly how best to prepare for the interviews. I also enrolled in a six-month data science boot camp through Northwestern University, where I was working at the time, which strengthened my technical skills and helped shed light on a career at the intersection of public health and data science.
“The PHI/CDC fellowship offered everything I was looking for to further develop my skills and passion for improving the quality of life and health for populations.”
During the summer of 2021, I interviewed for a PHI/CDC fellowship position in Pretoria, South Africa and while I thought that the interview went amazingly well, the role was given to someone else. It felt like previous years and that nothing had changed. A month later, I interviewed for a PHI/CDC fellowship position in Yaoundé, Cameroon, and while that interview also went well, once again, I wasn’t offered the position. At this point, I started to lose all hope and figured that perhaps it was time to just move on from this dream and pursue other opportunities. In fact, I started a job with Blue Cross Blue Shield of Michigan (BCBSM) as an Epidemiologist and was very satisfied and happy with my new role. It offered great pay, great benefits (including a pension), and fulfilling work. I was set to move to Detroit, Michigan for the position, but due to COVID-19 and the spread of Omicron, we remained remote, so I postponed the move.
BECOMING A FELLOW IN MALAWI
Two months into the new role at BCBSM, I received an email from the PHI/CDC program saying that there was a rare mid-year opening for a Surveillance fellow in Lilongwe, Malawi. I was content with my current role, but I figured it wouldn’t hurt to interview for practice and see what happened. Just 10 minutes before my interview was set to begin, the internet cut out at my apartment. I started to panic and immediately called an Uber to take me to the nearest Starbucks. I got there with a minute to spare, all frantic and nervous, and then connected to the WIFI and plugged in my headphones given the loud background noise from all the customers. The interview went alright in my opinion, but I actually felt the least confident about how it went compared to my other interviews. To my surprise, a week later I was offered the Global Surveillance Fellow role in Lilongwe, Malawi. I was absolutely ecstatic, while also conflicted; I now had a major dilemma to solve with only two days to decide. Do I stay with the good job that I only started two months prior or finally pursue my dream opportunity? After many calls with family and friends and differences of opinions, I realized that I would completely regret my decision down the line if I didn’t take this once in a lifetime opportunity now. Plus, it would open countless doors to further develop and expand my career. With that being said, I formally accepted the offer and spent the next two months exploring everything Malawi had to offer before arriving here in February 2022. The lesson was clear- when things aren’t going your way or the way you had hoped, don’t give up because persistence pays off.
“The lesson was clear- when things aren’t going your way or the way you had hoped, don’t give up because persistence pays off.”
After becoming a fellow, I’ve learned that you don’t have to have all the prior global health experience in the world or have graduated from the top public health programs in the country to be a PHI/CDC fellow. Instead, it comes down to your passion and drive for helping others, as well as your curiosity to continuously learn and adapt and illustrate and explain that to others. You’ll need to put in the hard work and network with people who are experts in their field, but if you want something, stick with it and don’t let others try to stop you from achieving what you’re passionate about.
OPPORTUNITIES AS A FELLOW
I have been a fellow for under a year at this point, but the opportunities and experiences thus far have been more rewarding than I could have ever imagined. While Malawi is considered one of the poorest countries in the world, it is rich in the smiles and drive that people possess in making do with what little they have. I’ve met some of the friendliest people I’ve ever encountered, which comes as no surprise given Malawi is regarded as the ‘Warm Heart of Africa’.
“…the opportunities and experiences thus far have been more rewarding than I could have ever imagined. “
The learning opportunities are plentiful. In less than a year, I’ve attended several site visits across the country for recent HIV infection surveillance (RHIS) hotspot investigations, I spent a week in Addis Ababa, Ethiopia for site supervisions and two weeks attending an infectious disease modelling course at Imperial College London, and now, I’m participating in a month-long detail assignment with the Global Mpox Response Team at CDC headquarters. My responsibilities as a fellow are dynamic based on current needs, but my main responsibility revolves around RHIS. RHIS helps determine whether newly diagnosed people living with HIV were likely recently infected (<12 months) to identify potential geographic area or subpopulations experiencing ongoing HIV transmission. While my role started out supporting recency efforts in Malawi, I am transitioning to support the program efforts in other countries in southern and eastern Africa. I’m very grateful and humbled for the chance to serve as a Global Surveillance Fellow with CDC Malawi and look forward to what the future has in store.
P.S. To learn more about my adventures in Malawi and abroad during the fellowship experience, feel free to check out my personal blog.
-Reno Stephens, MPH
Read more about CDC’s global health impact in Malawi here.