‘Every Disease Is Its Own Unique Puzzle’.

“‘I’m going to go home finally! It’s going to be great!’” Laurie Ohlstein (’15) remembers thinking as she came to the end of her second year in Senegal with the Peace Corps.

Then she heard about an opening for a Peace Corps national malaria coordinator in Madagascar.

“This opportunity just seemed too interesting,” Ohlstein says. “I mean, when’s the next time I’m going to get to work in Madagascar?”

This spring Ohlstein completed the School of Public Health’s Master’s International (MI) Program, combining the master’s in public health with 27 months of field experience with the Peace Corps.

Her new role in Madagascar is a natural progression from her work with malaria in Kédougou, the capital of the region with the highest malaria burden in Senegal. There, she helped scale up the active surveillance malaria program and piloted a new method in schools in southeastern Senegal.

“It’s a cyclical fever disease,” Ohlstein says. “You get a fever in the evening, you feel really bad, you wake up in the morning and you feel fine so you think it was just a fluke.”

Rather than wait for people to seek care for malaria—and wait too late—the active approach meant sweeping the whole village every week and testing anyone with symptoms. Those who test positive could be immediately given artemisinin-based combination therapy (ACT), or be sent for more intensive care if necessary.

After a year in Senegal, Ohlstein came up with a way to take it a step further.

“I had a meeting completely unrelated to malaria, not even to health,” she says. A high school social worker was giving her a tour, and pointed out a cabinet where medicines were kept.

“And I say, ‘Do you have malaria meds?’ She says, ‘No.’ I say, ‘Do you want them?’ She goes, ‘Yeah, of course.’”

So with the head doctor at the local health center, Ohlstein designed a pilot program to train school administrators in eight schools across the city—two high schools, two middle schools, two elementary schools, and two preschools—to use the active surveillance model, sweeping the classrooms for children showing symptoms each week and providing ACT or sending them to the health center as needed.

The benefits of the system are threefold, Ohlstein says. Some of the schools are far from health facilities, making it difficult for children to come in for testing. Those health facilities are also overburdened by malaria, Ohlstein says, so the additional source of testing and treatment frees up those facilities for other health issues.

It’s also a matter of timing. “The beginning of the school year happens when the rainy season ends,” Ohlstein says. “That’s when people stop taking precautions, they stop sleeping under their bed nets, they think they’re safe, and then there’s a spike in malaria cases.”

The pilot wasn’t able to start until November, but even deep in the dry season Ohlstein says the program found 179 positive cases out of nearly 300 tests by March. The program is being scaled up to include all 130 schools in the city by the 2017–2018 academic year, and every school in the region by 2018.

Ohlstein, meantime, will be 4,600 miles away in Antananarivo, Madagascar’s capital. As national malaria coordinator, she will oversee the rollout of the active surveillance model of village-wide sweeps all around the country.

Although she only arrived at the end of May, Ohlstein can already see that Madagascar poses unique challenges to her work: The country is much larger than Senegal and has less developed transportation infrastructure, and until 2013 the Peace Corps was unable to work directly with the Malagasy government because of diplomatic issues.

These are challenges Ohlstein feels ready to face with the arsenal provided by the MI program: “I have a more complete education because I had the experience working and living in the environment that I did, but I also think that I was able to be a better volunteer because of that education I had beforehand.”

In the latter case, “Peace Corps training felt like a mini grad school review,” she says. “I could hear professors in my head,” especially Associate Professors of Global Health James Wolff, Christopher Gill, and Lora Sabin.

“I really love program design and implementation,” Ohlstein says. “I like to be able to say, ‘Hey, what if we try this?’ and to see what happens.

“Every disease is its own unique puzzle, and that’s what I like about it.”

—Michelle Samuels

Laurie Ohlstein is taking over the SPH Instagram account from Antananarivo, Madagascar, from June 20 through June 24. Follow along at Instagram.com/BUSPH/.