The Military, SARS, and 30 Screaming Children

“Anna says you were lying this morning.”

Grace’s accusation gets merely a blink from me. At barely five foot and clad in the XL paper lab coat that I pulled out of the storage room this morning, she hardly cuts an imposing figure. I’ve reached the point in my teaching career that accusations about my character rank so far down on the list of things that keep me awake at night that I can dignify her anger with a humming noise.

No one is mishandling 6 molar HCL, and no one is about to flood the lab. We’re fine.

Grace, of course, does not have the same perspective and my non-answer barely registers as she barrels right into the rant she has apparently been building ever since Anna told her whatever Anna told her this morning.

“Anna-says-that-you-were-lying-and-that-actually-everythingis-fine-and-that-couldn’t-be-truebecause-you-TOLD-me-that-allthat-stuff-was-happening-but- Anna-seems-SO-sure-and-I-justdon’t-”

We used up all the Advil last week when we had the 5th graders in the lab, so I interrupt before she can get any shriller. Of all the things I don’t expect to have to explain to high school science students, the fact I have to clarify this makes me a little disheartened for the state of STEM in our nation.

“Grace. The activity this morning? That was make believe. I’m not actually from the CDC and you certainly aren’t dying this week from SARS.”

The Gains in the Education of Math and Science (GEMS) program represents one of these experiences you stumble across in your life that you simultaneously can’t believe was real and couldn’t have been more impactful. Organized by the Army Educational Outreach Program and funded by the US Department of Defense, GEMS has two related goals:

1) Ensure that students from low-income neighborhoods and schools with underfunded science programs have access to a summer experience that can spark an excitement for a future in STEM careers, and

2) Offer them college-aged mentors (called near-peer mentors) who exemplify how minorities and first-generation college students can succeed after high school.

What this means in practice is each week during the summer, certain Army laboratories open their doors to a new group of 30 to 40 middle or high school students and 10 frazzled undergraduate students who have been tasked with the care, keeping, and edification of the next generation of brilliance. For three summers, I watched the Walter Reed Army Institute of Research (WRAIR), the seat of the world’s developments on malaria, Ebola (and at one point, HIV) vaccines, switch from military readiness operations to experiments on glowing slime, worm dissections, and something that vaguely passed for engineering but really seemed more of a chance to clear out the extra supplies in the storage closet.

Despite my exasperation from the constantly rotating cast of gremlins with sticky fingers and lost lab coats, undergraduates like myself who worked at GEMS were more than glorified babysitters – we drove the curriculum, wrote the lesson plans, cobbled together supplies from the mosquito hatchery and Wal-Mart, and operated under a semi-autonomy that seemed like benign neglect but really represented an understanding of how to leverage a sense of ownership and pride. It was our lab for the summer, and we earned or lost the smiles and approval of the kids. These rewards, our sense of deservedness of them because everything in this lab was under our control, were strong enough to keep us motivated no matter what we encountered. So every June, before the DC schools let out for the summer, the other interns and I scrambled to come up with lessons we thought would be engaging and could be described in the shortest write-up imaginable.

That final year at GEMS led to my greatest work to date: a SARS outbreak.

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A quick aside that I have learned to include, post-Grace’s comments, post-meetings with military supervisors:

I do not possess and have never possessed any pathogens or strains of bacteria, viruses, or fungi that could pose a risk to national interests, student health, or my personal safety. I do not have SARS samples, inside knowledge about the SARS outbreak in 2004, or promotions about the next one that may occur. I certainly do not have the power to orchestrate outbreaks.

I do have, however, a healthy concern about the state of public health education in the United States. In an age where local Ebola outbreaks become global catastrophes, Zika becomes front-page news, and a host of anti-vaxxers spark childhood diseases we had imagined extinct, the case for a strong public health workforce writes itself into the media and public panic. But in reality, the field of public health is vastly under-staffed with few education-to-career pipelines to boost employment. The latest data on public health staffing vs. need estimated that the field currently lacks at least a quarter of a million people, though the analysis acknowledged that the numbers in the next decade were likely to become even more dire as the workforce generally was highly biased toward individuals nearing or past the age of retirement (1). Other research shows little focus on public health education before the university level with the existing curriculum lengthy and “hands-off,” lacking the lab work and interactiveness to engage children (2)(3).

Our way of solving these problems in GEMS? A 90-minute, immersive simulation in which we told our students that five deaths in DC-area hospitals had created concern at the CDC that the city could be ground zero for a new outbreak. Students then had 90 minutes to gather clues to “solve” the problem by identifying the specific pathogen which had killed the patients. Throughout the lab, stations staffed by other interns in the program provided not just hints about the infection spreading throughout DC but potential careers in public health.

Students sorted through patient records and personal effects (receipts, emails, notes) to figure out who could possibly be “patient 0” (the first case of a disease) and how it had spread through the area. Students also centrifuged fake blood to conduct a mock complete blood count to determine if the disease could be attributed to a virus or bacterium, and modeled antibody-antigen tests to confirm that all patients had died of the same pathogen. The end of the simulation featured a mad, 60-second dash to sort through disease information to identify the most likely culprit.

– ·•· –

There’s a certain attraction to being the person that gets to run in the room declaring an outbreak scenario, sprinting down the hall to drag the head of the infectious disease residency program into the lab to talk to *your* kiddos, dashing around in a general level of excitement to make sure that none of the fake blood will end up painted by one child onto another’s lab coat.

But as weird and wonderful as the general pandemonium was, something about the lesson got through to the kids. As part of my residence at GEMS, I was researching non-traditional forms of education to see what could be adapted effectively into the academic year (which sounds much more impressive than saying I was the survey monkey). The comments we received from students on their post-simulation surveys were an unparalleled thrill to anything else that summer.

“I learned about different careers in public health and what they do. I felt like I'm the person who actually works at the field (professional)”

“I enjoyed that we got to look at a real case and really get to know the patients and how they contracted the disease, made me feel like a real doctor… but one who didn't let the patients die because that part was sad.”

“I really liked the lesson because I thought it was real, especially the blood and the patient files. It was like being a detective or spy to solve a mystery or puzzle”

The students at GEMS are the ones we write off when it comes to science careers. They are more likely to come back to our program than they are to graduate from high school, and their ingrained belief that they are “not good enough” because of parents, teachers, peer trajectories, and other influences that weave their way through the program are a constant hum of melancholy against the science experiments. But the logic the students were able to deploy throughout the simulation and the curiosity they exhibited throughout their week in the program is evidence that the gaps we have in the science pipeline – whether in computer science or public health – are gaps of our own making, not a dearth of students who hunger to excel in these areas. The US is no closer to resolving that gap than we were when I left GEMS three years ago, primarily because we refuse to invest in programs that do not see children as burdens.

There’s little room for optimism in public health – we couch successes in failures and deaths, and embrace the idea that if we are too happy about our achievements, we will see them unravel.

And I understand that pragmatism. But I also know that once upon a time there was a lab where I got to be a part of students embracing the excitement and possibility of public health with extended arms, and to me, that seems like more of the way we will solve problems than anything else I have seen.