" You could literally walk into entire villages that would be permeated with the smell of death just because of the extent of the destruction," says David Bradt (pictured left), a disaster epidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, recalling his visit to Gujarat, India, where in 2001 an earthquake killed thousands. But he might just as well be describing what he witnessed this year in Indonesia and Sri Lanka after the tsunami battered the coastal regions of Southeast Asia, or several other disaster sites he has visited in recent years.
Bradt, epidemiologist and physician board-certified in emergency medicine and public health, has made his career mitigating the impact of disasters. His work has involved man-made disasters like the genocide in Rwanda and the collapse of the World Trade Center, and natural disasters like the earthquake and subsequent tsunami in Southeast Asia.
Bradt's job is to assess the health needs of people in disaster-stricken areas and to advise authorities on how to respond. He then uses what he learns from each experience to refine his approach to managing future disasters, focusing on strategies for rapid epidemiological assessment, environmental health, epidemic preparedness, disease surveillance, and interagency coordination.
Disaster epidemiology--the field Bradt calls home--crosses many disciplines and sectors and offers other scientists a career with an international public health aspect that many are likely to find rewarding.
The Untraditional Pathway
Bradt couldn't stand biology when he was young, so when he went to college at Northwestern University in Evanston, Illinois, and the University of Paris in Sorbonne he majored in French and linguistics. But he had always wanted to become a doctor, so he attended the University of Illinois College of Medicine in Chicago and broadened his clinical experience via several residencies (see box).
It was all part of the plan from the outset. "I didn't change," he says. "I always knew what I wanted. I simply didn't want the conventional pathway."
Bradt's Residency Training
Wearing Many Hats
Bradt's career has two main components. First is his academic work--research and teaching--at the Johns Hopkins School of Medicine and School of Public Health, as well as the Royal Melbourne Hospital. From that academic platform, Bradt takes on disaster consultancies with governmental and non-governmental organizations like the Red Cross, and United Nations organizations such as USAID, International Rescue Committee, and the World Health Organization (WHO).
Because disasters can strike anywhere and anytime, Bradt has to be ready to lend a hand when duty calls. He was deployed to the genocides in Rwanda and Sudan with 1 week's warning; for the Indonesian earthquake and tsunami his notice was only 1 hour. "The phone rings, and I answer the call," Bradt explains. "Preparedness is on-going, repetitive, and mundane." But there's more to being ready than having your suitcase packed. "People who do this work, and there a lot them, accept some personal responsibility for their preparedness--physical and mental fitness, shots, travel documents, technical references, supplies and equipment."
Once in the field, Bradt uses the techniques of epidemiological assessment--review of primary source documents, site visits, transect walks, key informant interviews, focus groups, limited surveys, and sometimes ongoing disease surveillance--to rapidly evaluate emergency preparedness plans, response activities, and recovery programs. It is demanding and challenging work that requires skill in dealing with the logistical challenges posed not only by the disasters themselves, but also by the large and often bureaucratic organizations he works with. "In the field, you're either working directly for beneficiaries or you're working as a consulting entity for an organization," says Bradt. "It's very important to understand the bureaucratic challenges of the interagency process.
Decisions related to disaster management have to be made quickly; the time for synthesis and careful analysis comes later. It is only "when you return to the bench, [that] you have a chance to sit back and work on lessons learned," says Bradt. Once back at Hopkins, Bradt takes what he has learned and uses it to refine approaches to managing disasters. For example, his work at the World Trade Center Disaster after 9/11 led him to examine the role of medical teams deployed under the U.S. Federal Response Plan as well as triage practices at the scene. Bradt publishes what learns from his experiences in journals such as Prehospital and Disaster Medicine and Academic Emergency Medicine.
Bradt also teaches public health students, medical students, and medical residents at Johns Hopkins. He does clinical teaching rounds for people in the emergency medicine residency program, and teaches courses in the School of Public Health. In the mid-1990s, Bradt switched to a part-time position at Johns Hopkins when he traveled to Zaire to help with the humanitarian crisis in neighboring Rwanda. He's been part-time at Hopkins ever since.
Bradt says there are several common routes to training for a career in disaster management. Some people enter the field from conventional medical school residencies; others are biomedical researchers with interest in epidemiology and biostatistics. Still others may enter the field by doing a specialized degree in public health or taking coursework in disaster management, for instance at the Federal Emergency Management Agency's (FEMA's) Emergency Management Institute.
Bradt's clinical work and training is ideal preparation for one of his job responsibilities: case management. "Standardized case management deals with an established best-practice way to deal with recurring clinical issues such as cholera," Bradt explains. "Being a physician allows me to understand and speak credibly about [those issues]."
Disaster epidemiology is quantitative research. Some math skills are required, says Bradt, but the level and the extent to which it's used varies with the hazard being studied. The mathematics underlying the prediction of hurricanes, storm surge strength, and mortality rates is quite advanced. But his own research uses basic arithmetic and software that is readily available. He also utilizes the expertise of others. "You have to be a little humble and realize there are many experts around you that have more hazard-specific competence, so knowing how to borrow their brain is part of the bigger picture."
Bradt has traveled all over the world and has seen devastation first hand. After 9/11, he provided technical assistance at ground zero for the American Red Cross. Although it wasn't the first disaster he has witnessed in his professional life, it had a big impact on him. "It's not so much the destruction of the buildings, because you can see destruction of buildings in other places. [But] in downtown Manhattan, I couldn't believe what I was seeing," he recalls.
An Eye on the Future
Trying to avert a future catastrophe, like an outbreak of avian influenza, Bradt says, is "like holding a beach ball under water." We know it's going to pop up sometime; we just don't know when. When the ball does pop up, Bradt's role would be driven by the agency he is working for. "If it was a research entity, I'd probably be looking at best-practice issues and operational research. If it was a service entity, such as the Red Cross, I'd deal with mass-care issues for disaster-affected populations needing shelter and ongoing community care. If it were a U.N. agency, I'd probably serve a lead role in medical coordination. Or, if it was for a donor government, I'd work to bring resources online to help take care of it."
Effective disaster management, says Bradt, is a hallmark of good governance. He considers himself privileged to be connected to a discipline that helps societies recover when the unimaginable happens. "There's a lot at stake."
Bradt encourages students, whether they specialize in medicine, public health, or disaster management, "to think about ways to incorporate public health knowledge into the work. Public health knowledge leads to high-leverage interventions. In disasters, that is key."
Robin Arnette is editor of MiSciNet and may be reached at firstname.lastname@example.org.