Battling the Flu

Prague-based epidemiologist Naomi Boxall talks to Jennifer Little.

There you are, chatting to a bunch of suspected bird flu carriers in remotest Azerbaijan – surely a nightmare scenario?

Not for 29-year-old New Zealand epidemiologist and former Massey student Naomi Boxall. Interviewing families last year in the impoverished rural backblocks of the little-known Caucasian state about a mysterious disease that had claimed a life and put others in hospital was for her a career highlight.

During a mission to Azerbaijan to assess whether the nation could handle an outbreak of avian flu, she was on hand when a dead swan tested positive for H5NI (avian flu).

“We interviewed the most affected family,” says Boxall, from Prague where she is spending two years with the European Programme for Intervention Epidemiology Training (EPIET) – a scheme which places an epidemiologist from one EU country into another for field work experience.

“All the sick members of the family were, by then, in hospital under the care of the clinicians.”

Aided by a translator, she set out to determine the relationships within the family, where everyone usually slept, and what they’d done in the days before becoming sick.

“I also had to try to convince everyone to give throat and blood samples. Some did, some didn’t. If someone coughed, I had to be extra persuasive.”

One woman had lost a daughter already, with another severely ill in hospital and thought to be close to death. The woman at first refused to be tested, but was heartened when she learned that her hospitalised daughter was still alive.

“By the end of the day, she was making sure that all the 25 children in the village lined up for their test. The sweets in my purse were handy, as I had something to give the children who were crying after their blood sample withdrawal,” Boxall recalls.

Her last visit was to a neighbouring family who had lost their 17-year-old daughter. She was the first person in the area to have died of avian flu, so it was imperative to collect information on her history, Boxall explains.

The father related details of the daughter’s illness and hospital visits, while the mother “sat on her chair sobbing her heart out”.

Boxall, at the time, wondered “how on earth I could sit there passively writing down notes”.

During the heart-wrenching interview, Boxall sat next to, and comforted, the distraught woman; they hugged tightly when it was over.

Afterwards she found herself in tears. “It was emotionally exhausting, but that day was the best day of my mission,” she concludes.

So just how risky was it?

Before going, Boxall had updated a couple of vaccinations and been vaccinated against seasonal influenza. In her baggage she carried a kit of personal protective equipment.

“You’re at little risk of exposure when you interview people outside in the wind and sun,” she says reassuringly.

Vigilant hand-washing is also a very effective safeguard against infection, she adds.

Back in her Prague office, where she works for the Czech government under the EPIET scheme, it’s business as usual: there is an outbreak of mumps in Moravia in the eastern part of the Czech Republic, which must be investigated (6000 people have fallen ill), and a project investigating side effects attributable to a mass vaccination campaign of Czech Republic newborns is under way. The infants are vaccinated with the BCG vaccine to protect against tuberculosis (TB). Boxall collects data on the extent of adverse effects and where in the country they are occurring.

“We’d ideally like to change the vaccination schedule to only vaccinate babies in high risk groups: those born into families with a TB history, the Roma (gypsy) population and those with HIV exposure. We’ll lend strength to this proposal by measuring and creating a baseline of adverse events.”

Boxall comes across as feisty, fearless and funny – qualities that stand her in good stead. She is, after all, the first EPIET fellow to be sent this far into central Europe. What’s more, she understands she’s the first New Zealander to land a job with the Czech government.

Getting into the EPIET programme in the first place was no mean feat. She had completed her doctorate, having gained a Bachelor of Science, majoring in Biochemistry and Genetics, followed by a Master’s in Veterinary Studies at the Palmerston North campus, and was working for the Institute of Environmental Science and Research in Wellington, dreaming of being a field epidemiologist studying Ebola outbreaks in deepest Africa.

A colleague in the United States mentioned the EPIET programme, which she was eligible for, thanks to her British passport.

After a rigorous application process and several nail-biting telephone interviews – one of them conducted in high-speed French – she was granted a face-to-face interview. Abandoning a role in the Porirua stage show of Les Miserables, she flew to Stockholm to compete with 21 other hopefuls for one of eight EPIET positions. A month later, back in New Zealand, she learned she was in.

Now into her second year of the programme, Boxall is challenged by some aspects of life in Prague and charmed by others. The intricacies of the Czech language are a daily struggle. “It’s one of the most difficult languages to learn, ever,” she says. She has found that her Czech colleagues are less familiar with the team approach to sharing scientific knowledge, and she observes that many more people smoke.

The compensations? One is the city itself, with architectural splendours that span a thousand years. The blog she maintains to stay in touch with family and friends records a lively social life. She performs in an ex-pat jazz a cappella group around the city, and manages the occasional weekend trip to London for shopping and catching up with friends.

But it is easy to imagine Boxall taking her leave of cosmopolitan Prague to head to the disease hot zones of Africa.

She wants to do good. For her, the practice of epidemiology is above all a humanitarian enterprise.

“I want to feel like I’ve made a difference and helped people. That’s all I want to do.”