In a world where record numbers of people need humanitarian assistance and disease outbreaks are a continual global threat, the systems needed to respond are under unprecedented strain. And the resources in shortest supply are field response staff – specialists who volunteer to take their skills to some of the world’s most threatening locations.
"Before the Ebola outbreak in West Africa in 2015, we deployed about 100 people a year, but for the Ebola outbreak alone we sent more than 1,000. It became clear that we did not have enough adequately prepared people," explains Renee Christensen, Training Co-ordinator for the WHO’s Global Outbreak Alert and Response Network (GOARN).
GOARN brings together more than 200 technical institutions and networks worldwide to coordinate and provide staff and resources in response to acute public health events.
In response to this growing need, WHO created the GOARN Outbreak Response Scenario Training, a tailor-made programme designed to prepare specialists by simulating the conditions of a real emergency deployment. Participants on the 6-day course can expect as little as 3-4 hours of sleep a night, erratic meals, stressful conditions and artificially chaotic circumstances.
"The purpose is to prepare people from some of the world’s top hospitals, universities, public health institutions and NGOs to work in a difficult, fragile, stressful field setting," said Ms Christensen. "We test their skills, core competencies, including communication, teamwork, and security awareness, as well as their ability to adapt to different and changing environments, to work with national responders and local communities, and to fit seamlessly into a larger response."
All those applying are already experienced specialists in their fields – which include epidemiology, case management, infection control, laboratory sciences, communications, and logistics – usually with some experience of emergency work. Nominations are made by the GOARN partner institutions, which are expected to release programme graduates for up to 6 weeks of deployment during the following 2 years.
The training is built around a rapidly developing disease outbreak scenario in a fictitious South East Asian country, Gornali, which faces a range of security, developmental and public health challenges. The scenario is so realistic that participants have been known to Google the country for extra background.
The training is intensive. Up to 15 trainers are needed to run simultaneous simulations for 3 teams of 8 people. The simulation may require work in as many as 5 fictitious locations – including Gornali’s capital city, at the Ministry of Health, local hospitals and clinics, and with local communities at other field sites.
"The teams comprise a mix of different nationalities, genders, languages, and profiles. We usually assign 3 epidemiologists per team, each trained in different approaches to data collection and case management, but they have to agree on a common approach," said Ms Christensen. "They are deliberately put under intense pressure to see how they will cope. The trainers control the scenario and drive the developing outbreak with phone calls in the middle of the night, news media, and radio calls that the team must respond to immediately. We watch and assess both individual and group performance. Sometimes the teams go into meltdown, but then pick themselves up again."
Most trainees enjoy the challenge. "The experience was incredible and will serve as a foundation for navigating uncertainty in the field," says Aiden*, who recently attended a GOARN training course in Australia.
Maya* attended the same course. "I loved every moment of it – even the stressful ones. I got some really positive feedback. I feel like I've been on a deployment and now all I really want to do is go on an actual deployment."
Occasionally, a trainee may realize that this kind of work is not for them, or they want to restrict themselves to deployments in more developed countries, or in capital cities. But, Renee Christensen says, this is also part of the process.
"They usually feel it before we do, which is a perfectly acceptable outcome. They still leave the training with more knowledge about how GOARN and WHO operate in outbreak response, the realities of working in the field, and their personal limits for deployment. It is better to find out from the training, to help them be prepared and ready, and not be surprised on mission."
Five courses have been held since the training programme was revised just over a year ago – in Australia, Jordan, Mexico, the Philippines and Portugal. In total, about 120 public health experts from 80 GOARN partner institutions and 45 countries have completed the course.
The course is constantly evolving, to stay up-to-date with shifting challenges. Animal health experts are now included in teams, in line with the ‘One Health’ approach. In 2018 a new, advanced level will be developed to train team leaders. More online training is in the pipeline – using self-directed modules, gaming and virtual reality technology.
*Names of participants have been changed.