“Prevention is always better than cure” is a lesson we have learnt the hard way by facing the wrath of the Covid epidemic in the last 2 years.

Aritra Das (PhD), our next pathbreaker, Epidemiologist at CARE India, conducts various epidemiological studies to assess the current status of different Reproductive, Maternal, Neonatal and Child Health (RMNCH) services, in order to guide different policy decisions in the domain of public health.

Aritra talks to Shyam Krishnamurthy from The Interview Portal about initially starting out as a doctor, and transitioning to a career in Public Health to focus on preventive healthcare rather than curative healthcare.

For students, in a country like ours, where income and healthcare access serve as critical barriers, relying only on curative health cannot be an ideal solution. Take up a career in public health for the overall betterment and health of the community !

Aritra, can you take us through your background?

Way back in 2001, I had written in the school farewell magazine that it was my dream to contribute to the field of medical sciences and help restore smiles in the faces of the unfortunate. It was because of this objective that I joined medical school. However, during my years in medical school, I realized the futility of spending huge resources for treating a handful of patients in big hospitals. These resources could have been much better utilized in preventing diseases in a larger population, eliminating the need for a hospital visit for a large proportion of patients. This realization led to many questions in my mind regarding the prevalent health policies. And what better way to seek answers than to find them yourself? This is what motivated me to take up a career in research in the field of Public Health.

What did you do for graduation/post graduation?

I did MBBS from the University of Calcutta, India and then did Masters and PhD in Epidemiology from the University of California, Los Angeles (UCLA).

How did you end up in such an offbeat, unconventional and uncommon career?

After my graduation as a medical doctor from R G Kar Medical College, University of Calcutta, I joined as a Senior Research Fellow cum Medical Supervisor, Phase-III of a randomized controlled trial of Bivalent Killed Whole-Cell Oral Cholera Vaccine [A collaborative project of the National Institute of Cholera and Enteric Diseases, Kolkata and the International Vaccine Institute, Seoul, Korea]. Subsequently, I was fortunate for the vital transition in my public health career through this fellowship. The excitement of contributing towards the eradication of a public health nuisance like Cholera inspired me. Over the next three years, my field experience in several cholera endemic zones shaped my understanding of the public health situation prevalent in Kolkata and, in general, India. In this role, I successfully led the efforts of community-based active surveillance for acute diarrhoeal episodes and supervised the vaccination of the study participants according to randomization protocol. After successfully achieving my job responsibilities, I made a momentous decision to pursue a career in epidemiological research. 

I was accepted into the Masters in Science and subsequently into the doctoral program in Epidemiology at the University of California Los Angeles (UCLA). I was fortunate to have Professor Roger Detels as my advisor, an internationally acclaimed epidemiologist, who transformed the rest of my career through the considerate mentorship he provided over five years. My academic and research pursuits were facilitated by a graduate student scholarship and NIH Fogarty fellowship for doctoral studies. At UCLA, I worked as Teaching Assistant, which involved teaching epidemiology to graduate students, and was rated highly by the professors whom I assisted. I also worked as a research associate in the Multicenter AIDS cohort study (MACS), the world’s longest-running cohort study on HIV patients. After successfully completing my Master’s and PhD, I decided to return to India to contribute to the cause of public health in India. 

How did you plan the steps to get into the career you wanted? Or how did you make a transition to a new career? Tell us about your career path

The Phase-III randomized controlled trial of Whole-Cell Oral Cholera Vaccine was the project that helped me realize my true leadership potential. As a medical supervisor, it was my responsibility to plan and organize the activity at the field level with a very clear vision. Through regular meetings with the community health workers regarding field activity, I got to know about the problems arising at the field level and take necessary action for resolving them. I learnt to take personal responsibility for failures and spread the credit for success widely as I believe this sort of magnanimity goes a long way in improving the work atmosphere and team-feeling among the staff. With a constructive spirit of discontent, I tried to organize hands-on training of field staff to develop the weaker ones and thus improve the quality of work and data fidelity.

The jobs that I worked post-2015 allowed me to apply my training as an Epidemiologist at UCLA, one of the premier universities in Public Health in the USA and the world. The job that I joined immediately after completing my PhD – State MLE Manager (I later assumed the role of Expert Epidemiologist) with CARE India, an international NGO, helped me learn the nuances of working with a large team. I feel fortunate (and proud) that our work could bring a tangible impact on the lives of millions of people in a resource-poor state (Bihar) in India. 

How did you get your first break?

After returning to India, I did some freelancing work for a while. One of such freelancing projects was with CARE India, the Indian subsidiary of an international NGO, that was implementing a large-scale public health program for the Bill and Melinda Gates Foundation (BMGF). My work for that project impressed the stakeholders and they requested me to contribute to their cause on a more permanent basis and offered me a payroll position.

What were some of the challenges you faced in your career? How did you address them?

My tenure as a Senior Research Fellow at the National Institute of Cholera and Enteric Disease (NICED) made me realize that, in a developing country like ours, tertiary (or specialized) health care is a luxury that only few could afford. Further, I felt that the only way to achieve “Health for All” is to control diseases or health problems, i.e. by applying the principles of Epidemiology. However, I faced challenges both on the personal as well as professional fronts. Shifting from a secure (or one may say, with high earning potential) career to a relatively novel domain (and, financially less rewarding) required lots of convincing of my family members and friends. Nevertheless, my parents and some of my close friends were quite supportive of this journey and made this transition possible. 

My initial professional challenges were not significantly different from many other public health professionals working in India. In our country, the primary focus of the policy-makers is on curative health e.g. building major hospitals which have major political implications. However, the impact of public health strengthening measures are often not felt directly by the masses and the policy-makers alike as the goal is to prevent the diseases from occurring rather than playing the role of ‘saviour’ by curing diseases. Such outlook of the policy-makers frequently made it difficult for me to secure funding for our projects and studies and I had to work doubly hard to persuade the stakeholders (donors and the Government functionaries) to support our projects. The archaic mindset prevailing in our socio-political system often served as a professional barrier that my public health colleagues and I had to overcome (and we continue to face the challenges).

Where do you work now? Tell us about your role as Epidemiologist

The current Covid-19 pandemic has explicitly demonstrated the importance of robust public health infrastructure and epidemiological surveillance networks. Relying only on curative health cannot be an ideal solution for epidemic management in a country like ours, where income and healthcare access disparities serve as critical barriers. As epidemiologists, our job is not only to find out the determinants of disease spread and disease outcomes but also to provide guidance on equitable distribution of health resources. As a doctor, I might have successfully treated/cured a few patients but my efforts would have been insufficient in minimizing the risk of transmission among the uninfected/unexposed population. In the context of the Covid-19 pandemic, my epidemiologist colleagues and I have been making a valuable contribution by addressing the knowledge gap regarding the transmission dynamics of Covid-19 and informing the policy-makers about the effectiveness of potential preventive measures mechanisms like vaccination, social distancing etc.

How does your work benefit society? 

I currently lead a team of around 400 people who conduct various epidemiological studies across the state of Bihar. These studies, conducted to assess the current status of different Reproductive, Maternal, Neonatal and Child Health (RMNCH) services and behaviour, churn out findings that are highly relevant to the entire public health system and for the betterment of the health of common, impoverished people who rely on the Government health infrastructure. We share our findings with the Government’s health department and various other stakeholders and guide different policy decisions in the domain of public health.

Tell us an example of a specific memorable work you did that is very close to you!

One of our studies revealed that almost 50% of neonatal mortality (death during the 1st month of life) happens among newborns with a birthweight of 2000 grams or less. Based on our study findings, the State Government has implemented a dedicated “Weak Newborn Tracking” program via which newborns having low birth weight are identified in the community and their mothers are given specific advice on essential newborn care. This simple intervention has managed to save (estimated) 90,000 newborn lives during the last five years. It makes me and my team proud that we could bring a positive change in the lives of such a large number of mothers, newborns and their families!