I conducted my field studies from to July to September of 2007 with the Community Based Avian Influenza Control (CBAIC) project in Jakarta, Indonesia. My preceptor for the project worked for USAID, which is the funding agency for the CBAIC project. The CBAIC Project team is led by Development Alternatives Inc. (DAI) in partnership with the Johns Hopkins Bloomberg School of Public Health, Center for Communications Programs (CCP), Winrock International, Training Resources Group (TRG), and local partners.

Avian influenza (AI) is reaching a crisis level in Indonesia. The virus is approaching endemic levels in small and medium sized poultry establishments throughout the country, and Java is especially hard hit. Indonesia leads the world in the number of H5N1 human cases and deaths (113 cases to date, with 93 deaths). The Indonesia AI situation is complicated due to the geography, the decentralized government, the unpredictable nature of the virus, a culture deeply tied to poultry-rearing, and the host of stakeholders already involved. Accordingly, the CBAIC project attempts to strike a balance between rapid emergency deployment and a more sustainable development approach. In addition to working with the Government of Indonesia in AI planning and pandemic preparedness, one of CBAIC’s major goals is to strengthen community-level surveillance and response to AI outbreaks.

CBAIC works in collaboration with two local partners, Muhammadiyah and Indonesian Red Cross (PMI), to identify one volunteer coordinator from villages in numerous provinces throughout Java, Bali, and Sumatra. The Village AI Coordinator (VAIC) is trained to recognize signs and symptoms of AI in animals and humans. VAICs aim to raise AI awareness in the community, and promote the adoption of practices to prevent the transmission of the virus, as well as active and sustained surveillance of animal and human infections.

To asses VAIC knowledge and activity level within their villages, I conducted an independent survey in provinces in West, Central, and East Java. After an extensive literature review, I designed a structured face-to-face questionnaire as well as focus group and semi-structured interview guidelines to use in my field work. Specifically, questions addressed general AI knowledge, level of activity with regard to follow-up of assigned duties, frequency of visiting households in village, and frequency of reporting potential AI outbreaks. Focus groups were designed to assess if VAICs were recognized in community and if activities were successful in raising community AI awareness. I traveled to twelve villages in six provinces throughout Java and conducted a total of 45 face-to-face interviews with VAICs and five focus group discussions at the community-level. After coding and analyzing the quantitative and qualitative data, I compiled major themes and trends along with recommendations for future evaluation of the project into a report for the CBAIC team. This report will be used to strengthen future monitoring and evaluation of this project.

This experience has gone beyond just allowing me to utilize the skills I acquired in my first year of study in the MPH program. It has given me given me invaluable experience in hands-on fieldwork and provided me the opportunity to interact with a complex and beautiful culture.

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In the past five years, the EBPP has worked with the community to help solve immediate needs, such as access to food and clean water and an improved road. The EBPP's next goal was to identify possible causes and solutions for another problem identified by the community: extremely high rates of maternal and infant mortality. This is the project in which I was asked to participate.

I helped to conduct a needs assessment with several components. We began by designing a qualitative study on pregnancy and childbirth to help identify possible causes of high rates of maternal mortality and poor birth outcomes. We decided to focus on traditional beliefs and practices that may be contributing factors to problems in pregnancy and childbirth. I worked directly with the health program manager in conducting three focus groups and interviews with 18 other key informants, including midwives and doctors from the local health center, as well as traditional healers and mothers from the villages. Some of the interviews were conducted in Indonesian, which allowed me to improve my language skills, but most were conducted in the local language (Balinese).

To try to determine actual rates of mortality, we conducted an audit of records from the local health center. I was also able to observe a number of community health clinics for women and children that took place once a month in each of the villages. I was also asked to present our initial findings to the medical students of the Udayana University in the capital of Bali. In addition to sharing information about the study, I advocated for the creation of an internship program and I helped form a partnership between the medical school and the EBPP.

Based on our initial findings, the EBPP has decided to create a program that will help to address some of the important issues identified in our assessment. I intend to continue to work with them to analyze data from surveys that were done with women in the villages, as well as to create a proposal for funding a future program to address issues of reproductive health in this community. I plan to return to assist in this project and to use the information and experience that I have gained in my dissertation.

This internship was invaluable to me. It gave me a deeper appreciation of some of the most complicated issues in working with international communities-such as problems with translations, forming partnerships with local organizations with competing interests and different agendas, cultural sensitivity and how to avoid insulting village leaders and local health care staff, and the importance of incorporating the community into needs assessments and programs.

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