EpiCentre

Interview with Vincent Brown. By Jeremy Shoham

Vincent Brown is the co-ordinator for the MSF PSP (populations in precarious situations) residential training course for MSF field staff which is held twice yearly. He works for EPICENTRE the agency responsible for running the course. As a regular participant of the panel discussion on emergency food aid needs assessments and interventions which forms a component of the course, the ENN thought it time to find out a little more about EPICENTRE on behalf of Field Exchange. I therefore set up an interview with Vincent at the most recent PSP course in Lacanau which is about 45 minutes drive from Bordeaux in France. A delayed flight meant that I arrived quite late in Lacanau. Vincent looked tired (it was near the end of the two week PSP course) so I felt a little guilty interviewing him in the late evening when I imagine he would have much preferred to unwind with a drink. Nonetheless, Vincent was typically energetic, enthusiastic and warm in answering my questions.

EPICENTRE was set up in 1986 by an epidemiologist called Alain Moren who had been working for MSF France for several years. Alan was very interested in public health epidemiology and after studying in Johns Hopkins University and a two year stint as an epidemiological information officer in CDC was asked by MSF France to create an applied epidemiology unit in Paris. This unit (EPICENTRE) was to undertake three main activities - training, applied research and 'consultations'. Although initial funding was entirely from MSF France, it was understood that within approximately 5 years EPICENTRE should become roughly 50% selffinanced. EPICENTRE is located in the same building as MSF France and now boasts a staff of 15 people in Paris comprising medical epidemiologists, computer specialists and administrative support. EPICENTRE also has three field posts headed by senior medical epidemiologists in Kampala, Kinshasa and Abidjan.

EPICENTRE activities include the following:

Research and Consulting: EPICENTRE develops applied research projects aimed at improving health programmes while a team of public health and epidemiology experts are available to requesting agencies and countries. EPICENTRE are routinely involved in disease outbreak investigations, epidemiological studies (prevalence studies, clinical trials, risk measures), setting up and evaluating health information systems, computerising these systems, evaluation of health programmes and rapid epidemiological assessments. This work may be done for any branch of MSF on demand, or outside contracting agencies.

EPICENTRE are also involved in up to 22 weeks training for MSF staff each year. There are two weeks of training specifically in nutrition and vaccination each year while nutrition also forms a module of the biannual PSP course.

Vincent described how research ideas and proposals are usually jointly conceived by MSF France and EPICENTRE but that on-going operational demands on EPICENTRE, i.e. evaluations, assessments, etc , do limit time to press ahead with research ideas. He also explained how some research takes a long time to set up, especially clinical trials, and that these may involve lengthy discussions with ethical committees at national or international level.

Nevertheless, applied research comprises one third of Epicentre activities with over 20 research projects planned for the year 2000. Examples of Epicentre research activities include:

• a review of epidemic thresholds of meningitis during outbreaks in Sahelian Africa
• an assessment of the impact of routine antibiotic regimens on acutely malnourished children admitted to therapeutic feeding centres.
• assessing admission criteria for adults in supplementary feeding programmes
• an evaluation of the efficacy of different drug combinations in the treatment of malaria.

I asked Vincent what he believed EPICENTRE's greatest achievement had been to date. He said that it had to be the development and use of applied epidemiology as a tool to assess/evaluate ongoing programmes. He then started to explain how this tool was now being developed by EPICENTRE to document violence and advocate for its cessation. Recently, EPICENTRE had carried out representative epidemiological surveys on Kosovar refugees in Montenegro and Albania on the extent of violence committed against the individual. This information was then shared 'at international level'.

The following morning at breakfast, Vincent provided a few more details about the PSP course. He explained that MSF staff needed to have had 12-18 months field experience before they could be accepted on the course and that applicants only had to pay for subsistence. He also said that given how each course of 36 students usually had between 15-20 nationalities with huge variations in length of field experience, it was remarkable how well they got on.

The atmosphere on the PSP course always seems to me to be uniquely multi-cultural and vibrant. It also struck me how the creation of a semi-autonomous research/technical support group by an emergency humanitarian agency is a fairly unique initiative. Operational emergency aid agencies generate so much experience and data in the course of their work, yet undertake very little research during the course of these activities. This is mainly due to competing and higher priority operational demands on agency staff. Those of us who are more research minded often reflect on the wasted opportunity to conduct vital research. EPICENTRE appear to have found a mechanism whereby emergency programmes can be utilised as project sites for important research. It is therefore perhaps surprising that there are not more examples of this kind of institutional arrangement between an operational emergency agency and research/technical support unit.