One Health in the “Land of Smiles”
by Dr. Carling Sitterley
Dr. Carling Sitterley graduated in May of this year with her doctor of veterinary medicine (DVM) degree. She also holds a bachelor’s degree in biology with a minor in religious studies from the College of William and Mary. She is currently finishing up coursework for a master of public health (MPH) degree, as part of a dual DVM/MPH degree program. After graduation from the MPH program in December, she hopes to work in clinical practice for a couple of years before moving on to work in international veterinary medicine and/or public health.
Traveling over 15,000 miles and visiting both Europe and Asia for the first time, I was both excited and nervous about my five-week journey to Italy and Thailand as part of my Master of Public Health practicum experience. I was excited to see amazing things, taste delicious food, and meet remarkable people. I was nervous about traveling so far by myself to new locations where the predominant language was not my own. Ultimately, this trip would become one of the most enriching, impactful, and humbling experiences of my life.
The first thing that struck me during my international travels was just how privileged I am that English is my first language. From Rome to Bangkok, all of the signs in each airport were in the native language, as well as in English. Not only that, but most of the airport personnel I encountered spoke some level of English. Even in Bangkok, where there was only a limited number of Thais who could speak English, I never felt judged for not knowing the language. I was able to pick up a few key phases, such as “Sawasdee Ka” (“Hello”) and “Khob khun ka” (“Thank you”), and I could usually get by with some combination of humorous hand gestures, a smile on my face, and these key phrases.
My journey began with four days in Rome, Italy, where I networked with a number of veterinary and public health professionals at the headquarters of the Food and Agriculture Organization (FAO) of the United Nations. I was impressed by the breadth of work that FAO does, the opportunities associated with this organization, and the people I interviewed. On my day off, I walked across Rome and saw Vatican City, the Pantheon, and Colosseum, and other notable sites.
I was sad to leave Rome but excited to find out what awaited me over the next four weeks in the “Land of Smiles.” This epithet for Thailand could not be truer to the beautiful country. The Thai people were always friendly, smiling, and easy going. Compared to the surrounding countries in Southeast Asia, Thailand is quite advanced. However, it is still developing by Western standards. The food in Thailand from green curry dishes and papaya salad to an entire grilled fish and mango sticky rice, was even more amazing than I had anticipated. Only once was the food too spicy for me, and even though I tried to hide this, my red lips gave me away to my Thai hosts. We all had a good laugh over this. As a predominantly Buddhist country, I was able to visit a number of Buddhist temples, and learn about the religion, how certain people incorporate it into their lives, and the meaning behind certain practices.
My first week in Bangkok coincided with Songkran, the traditional Thai New Year celebrated as a three-day festival of cleansing. Since Songkran also meant time off from work and closed businesses, I spent most of the first week exploring a number of different markets in Bangkok. One of my DVM classmates, Thomas Rogers-Cotrone, who was also in Bangkok for a three-week laboratory research rotation, joined me for this part of the trip. We visited the Chatuchak Weekend Market, the largest market by far with 27 acres; the Pak Khlong Talat Market, which is devoted strictly to flowers; and the Khlong Toei Market, a fresh market offering vegetables, cuts of meat, whole chickens, and live fish. This differs greatly from how I am used to getting my food packaged with precise weight and prices. While the market visits seemed touristy, understanding how a culture gets, transports, and prepares its food can help with disease investigations on the human and animal levels.
“One Health” in action
The main purpose of my practicum was to learn more about “One Health” in a global context, using Thailand as an example. “One Health” has many definitions, but essentially it is an interdisciplinary approach to addressing health issues of humans, animals, and the environment. Because “One Health” is interdisciplinary, much of my time in Thailand involved conducting interviews with a variety of professionals, including medical doctors, veterinarians, research scientists, and public health professionals. One interviewee had even completed both medical and veterinary doctorate programs. Many of these meetings were set up and guided by my preceptor, Lt. Col. Samuel Yingst, a US Army veterinarian and microbiologist who works at the Armed Forces Research Institute of Medical Sciences (AFRIMS). AFRIMS is a unique research facility located in Bangkok, Thailand, that exists as a joint effort between the Royal Thai Army and the United States Army.
As part of my “One Health” investigation, my second week in Thailand was spent with a Thai veterinarian, Pattarin Opaschaitat, and her two technicians, Noi and Bas, in Phitsanulok. There I attended a two-day training session on Coxiella burnetii diagnostics conducted by Dr. Opaschaitat and her team. Coxiella burnetii, the cause of Q fever, is a specific example where the One Health approach is important. Q fever is not particularly common in humans, but it can be quite serious, leading to death in some cases. Ruminants (sheep, goats, cattle) are the reservoir for this bacterium, and these animals can shed the disease agent even when they are asymptomatic. One of the possible interventions for the prevention of human disease is at the animal level, although it does not pose a problem there. Thus, human and animal health professionals must work together to address this issue.
The training was geared toward the employees at the regional animal diagnostic laboratory and therefore, was all in Thai. This is when the language barrier was most apparent to me. Not being able to speak the language did make my understanding of things that much more difficult. However, I observed and could pick up some things from pictures in the slide show and by watching the demonstrations. For the entire week, Dr. Opaschaitat was my translator. When she was busy teaching, I used context clues to figure out what was being discussed, which is much harder to do than it might seem at first. Dr. Opaschaitat was very inclusive and filled me in as to what was going on in English when there was a break in teaching. Aside from the training and getting a tour of the regional laboratory, our time in Phitsanulok also included a visit to a sheep and goat farm, where I assisted in collecting blood samples for routine disease surveillance, and a visit to a Thai water buffalo breed preservation farm.
During my third week in Thailand, I was a facilitator for a multinational risk communication workshop. Attendees included animal and human health representatives from Cambodia, Lao People's Democratic Republic, Myanmar, Thailand, and Vietnam. Each had a wealth of knowledge and I learned about each country's communication network and generalized steps of how information would be shared in the case of a zoonotic outbreak. It was great to see “One Health” being applied in action.
Through my experiences and interviews, I came to realize that despite environment often being included in “One Health” definitions, it is a piece that is often left out or placed low on the priority list. This does not mean that no one in human or animal health cares about the environment. Rather, it is so hard to bring together experts from these two areas that inviting even more experts to the table can be that much more difficult. Funding, emergent problems, politics, policy and leadership have not encouraged or required this to be the case either. I hope I am wrong, but in my experience I have yet to see this happen in actuality. And if it is not happening yet, I hope change toward this being a reality will occur soon and for the better.
Even though the purpose of my practicum was to focus on “One Health,” I learned and experienced so much more. I know getting to know so many key officials in the international veterinary and public health, learning about the Buddhist religion, seeing wet markets and farming practices in another country first hand will forever continue to shape who I am professionally and personally. I am also indebted to all of those who contributed to this experience for me, from my preceptor Lieutenant Colonel Yingst, who provided more hospitality than I could have expected, to all of my interviewees, Dr. Opaschaitat, and my MPH advisor Dr. François Elvinger for sharing their time, expertise, and knowledge with me.