By Rachel Brown
Over the last century the focus of medicine has been changing. Focus is now on the prevention of medical conditions developing. Prevention can take many forms from encouraging early behaviour change to vaccination. One of the main organisations in this aspect of health care is the Health Protection Agency (HPA). The HPA provides support on public health matters to local health authorities, health care professionals and also advices on government policy. My elective was spent in the gastrointestinal emerging and zoonotic infections (Gezi) department at the HPA’s centre for infection (CFI). CFI is involved in all aspects of public health and epidemiology related to infectious disease.
Before I started me elective I met with my supervisor and set out some learning objectives that I hoped to achieve while at CFI.
To establish what the role of a public health doctor within the HPA and the wider medical community involved.
To observe how the different members of the multidisciplinary team within the GEZI department work together.
To develop a greater understanding of how disease surveillance and outbreak response take place within CFI.
Think about how public health information is delivered to the general population
Meeting my learning objectives:
During my elective I was able to gain a greater understanding of what a doctor specialising in public health does. I spent time with the duty registrar who is responsible for answering queries regarding infections and vaccinations. Many of the queries were regarding rabies exposure and I now feel that I have a good understanding of the criteria for vaccination and when to give immunoglobulin.
I took part in the investigation of a Salmonella Agona outbreak. This involved phoning up patients and asking them set questions. This presented a different set of challenges to seeing a patient in a clinical setting. Often I was phoning a number of weeks after their symptoms had passed and people generally seemed suspicious and reluctant to answer potentially embarrassing questions. Without having the patient in front of me I had to develop a different set of communication skills to enable the interview to progress.
Image 1: Microscope image of Salmonella Agona 
During my time at CFI I had a number of small projects. The first of these was an investigation into the HPA’s international rabies risk classification. The research which was used the classify countries is now a number of years old. My task was to study each country and using information I obtained from the centre for disease control in the USA, Nathnacand a database called rabnet flag up countries which may need their statuses reviewing. I found this very interesting as it enabled me to expand my knowledge of where rabies is more prominent but also made me realise how important it is information to be updated on a regular basis.
Image 2: A map to show the presence/absence of rabies worldwide in 2006 
Another project I had to was try to establish who other than CFI were testing samples of fish following cases of scromboid fish poisoning (caused by the build up of histamine). This required me to phone and email private laboratories in the UK and establish if they tested and if so how many samples. I found this difficult because I had to gather commercially sensitive information. I feel that this has improved my understanding of the difficulties associated with some of the research carried out at CFI.
The Press Department
I spent a number of days with the press department at. I was able to observe how they interacted with journalists and answered queries. I saw some press releases and how they were worded. I was also able to discuss how they released information about major infectious disease stories such as the norovirus outbreak of last year and how careful they had to be with wording to prevent panic. I now realise just how much work goes into making sure that journalists understand and correctly report health related stories.
What I have learnt
During my time at CFI I feel I have learnt a lot about what actually happens at the HPA and what the role of a doctor specialising in public health is. However I feel the most important issue I now understand is how important it is for doctors in all areas of medicine to be aware of surveillance and outbreak investigation. One of the main problems associated with surveillance of gastrointestinal disease is that samples aren’t sent off when the patient presents so many cases are missed. Greater understanding amongst medical professionals can lead to more accurate data collection and also earlier identification of outbreaks.
 birminghamscrutiny.org [homepage on the internet]. Health Protection Agency and Infectious disease. Published by Wordpress. [updated 15/11/2008]. Accessed 20/11/08. Available from http://www.birminghamscrutiny.org/media/hpa_logo.jpg
 allamericanpatriots,.com [homepage on the internet]. Minnesota Officials Investigate Salmonella Infections Linked To Recalled Cereal. Published by allamericanpatriots.com [updated 14/04/2008]. Accessed 20/11/08. Available from http://www.allamericanpatriots.com/news_topics/food_safety
World Health Organisation [homepage on the internet]. Essential Rabies maps . Published by the World Health organisation. [updated 01/2008] Accessed 19/11/08. Available from http://www.who.int/rabies/rabies_maps/en/index.html
 Soxfirst.com [homepage on the internet]. What’s killing newspapers. Published by soxfirst.com. [updated 08/08.2008]. Accessed 19/11/08. Available from http://www.soxfirst.com/50226711/newspapers.jpg