Reminiscing About the Coming Plague

I recently attended a meeting at the Maricopa County Department of Public Health – ostensibly to review health status data and offer my opinion about the most pressing health issues confronting Maricopa County residents. However, within the course of discussion, I was surprised to learn that dengue fever and malaria are moving northward through Mexico, and both diseases will eventually be taking a toll on Arizona residents. The mere mention of these diseases brought back fond memories and youthful dreams.

As a callow graduate student in public health at UCLA, I had yearned for a career overseas investigating vector-borne diseases like dengue fever and malaria. My professors peppered their epidemiology lectures with stories of their own exploits in exotic foreign lands (one professor, Dr. Telford Work, helped discover West Nile Virus back in the late 1950s), and I imagined myself following in their footsteps.

Indeed, while working in the CDC STD Program, I had the opportunity to interview for a dengue fever epidemiology position in Puerto Rico. I was just certain that this position would jumpstart my brilliant career in global health, and that I would spend a good bit of the rest of my life finding adventure in foreign lands. Unfortunately, I was not selected for the position. I therefore find it ironic that while I never did make it overseas, exotic infectious diseases like dengue fever and malaria are – after all these years – making their way to me.

However, from my perch at APCA, I don’t anticipate playing any role in the fight against either dengue fever or malaria. So, sadly, it would seem that I never will achieve my dream of global health work. Well, not so fast.

The vast majority of people that our agency serves are in fact foreign born and bring to this country a health profile with diverse, global risks. Infectious diseases like tuberculosis and chronic hepatitis B infection are relatively common among new immigrants. So, too, are nutritional deficiencies such as rickets. Immigrants also bring to this country their indigenous conceptions of health. Our understanding of their disease risks, beliefs and behaviors is critical towards effectively working with them on health improvement strategies. As such, our work is partially ethnographic in nature, and we are in a sense cultural brokers of good health. To this end, we often find ourselves thinking globally and acting locally.

So, I’ve come to realize that my dream of global health work is being fulfilled right here in the Phoenix area, and I’m grateful every day for the opportunity to perform this work. And who knows, some day I might just dust off my barely used passport and spend a few weeks volunteering with an international health organization in some far off country. You never know, they might just learn a thing or two from an old global health hand like me.

-Doug Hirano, MPH, APCA Executive Director