The Yemen Field Epidemiology Training Program (Y-FETP) residents continue struggling in deteriorated security and health situations. The conflict in Yemen, which has been raging for the past nine months, has led to a humanitarian catastrophe that has caused more than 6,000 deaths, the displacement of over 2.5 million people, and it caused millions of Yemenis to be in dire need of immediate assistance. The Human Rights Organization has also projected that 2.5 million children are suffering from chronic diarrhea, 1.3 million from pneumonia, and 280,000 from severe malnutrition.  Prior to the war, the Y-FETP was functioning normally and operations were proceeding according to plan for the second Cohort, however plans were not interrupted, at best they were slightly challenged.

 “Of course the war in itself was a shock to us.” says Technical Advisor of the Y-FETP, Dr Abdulwahed Al-Serouri, “It was a shock for our residents and their families who, on their part were concerned about their sons and daughters being away from home. “Dr. Al-Serouri further added that families urged their sons and daughters, the FETP residents, to leave Sana’a and to go back to them.

“Most of our residents have families in the different governorates in Yemen. So, more than half our residents left Sana’a due to the war. This meant that we only had four residents left out of 12 and those were mainly the people living in Sana’a and its surrounding governerates. We tried as much as possible to absorb this shock. We felt that our residents were needed more than ever in these times, so we tried to convince them to come back to Sana’a. We tried telling them that the situation is not as bad as it seems. Some out-brakes were happening here and there and we also needed them to complete their deliverables.   After much convincing some of them did return, others would stay for one or two weeks, only to feel unsafe and then return back to their homes and families under the influence of pressure from their mothers, fathers, and wives, “Says Dr. Al-Serouri.

Pushing Forward with the Third Cohort

This situation did not stop the Y-FETP’s resolve to push forward with the program.  In fact, The Y- FETP team was even thinking to proceed in planning for the third Cohort as scheduled. There were strong debates regarding this issue even within the team.  Some team members were wondering if it was even a good idea. Questions were raised regarding who will come and who will register in such situations, especially given that their main target is from the governorates and not only from the city of Sana’a. The Y-FETP started advertising for the third Cohort just to see what will happen. The first announcements were sent to governorate offices, noting that at the time there was no electricity or faxes even to properly advertise for the program.  The internet was out across the country, and the phones were cut in some areas due to bombarding. Some governorate health offices were not even operational, so it was difficult to communicate with them at times.

“In response to such challenges, we decided to delay the deadline for application for another month and we decided not to go the traditional way,” says Dr. Al-Serouri, “we contacted the people in the health offices by phone and we asked them to nominate some people to be part of the Y- FETP third Cohort”.   Dr. Al-Serouri added that some teams within the health offices were reluctant so they were asked to just nominate and then see what will happen.

The health offices did nominate applicants and eventually people started to apply.  “We ended up with 32 applicants from outside Sana’a and 16 from Sana’a. After the initial screening of all applications we ended up with 16 who fit the criteria for FETP residency, “Dr. Abdulwahed Al-Serouri says. “A training course was conducted for the 16 who were accepted and 12 others as a step towards building epidemiological capacities. Surprisingly enough we had strong pressure from those who didn’t fit the criteria to be part of the program. We promised them to do intermediate courses for them. We even feel guilty for not accepting them, but at the end we have criteria to abide by. However, they opened our eyes to their need for a training. After the initial course, 12 candidates were chosen for the third Cohort, but due to the war and pressure from their families only 10 made up our third Cohort. We ran the introductory course for one month. While continuing plans to graduate the second Cohort “

 Challenges in the Day to Day Running of Operations

In search for further support, the Y-FETP team recently conducted an official visit to EMPHNET‘s offices in January 2016. During this visit the Director General of Disease Control and Surveillance at the Yemen Ministry of Public Health and Population, and Y-FETP Program Director Dr. Abdul–Hakim Al Kohlani and Dr. Al- Serouri met with EMPHNET’s Executive Director Dr. Mohannad Al-Nsour. They discussed the challenges the program is currently facing in-light of the current war situation in Yemen, and they stressed their need for securing financial support for maintaining the program’s sustainability. According to Dr. Al-Serouri, these engagements have been fruitful and the initial response from the entities the Y-FETP had reached out are positive.

For now, some residents are continuing their work on a voluntary bases. In the last three months, they have carried out four outbreak investigations namely in: cases of food poising, Neonatal tetanus, and a confirmed case of bacterial meningitis due to Neisseria Meningitis and Dengue. “Carrying out these investigations isn’t easy, as our residents need to finish their work within a tight timeframe, to offset the risk of bombardments.” He added.

The Y-FETP also works within logistical challenges as well, Dr. Al-Serouri explains that another challenge faced by Y-FETP is that there have had been no electricity for the past six month. “We managed to get solar energy with the support of TEPHINET, “he explains “, this allowed   our residents to come to the program, carry out their work, and this is a key success for us. The availability of solar energy had really solved a problem for our residents, since they do not have electricity in their home. Our residents are now always happy to come to the program office and fully charge their laptops, and in turn continue their work.  We got more rooms from the Ministry of Public Health. We were also able to buy chairs and tables for our program. We can now say we are self-sustained. This makes life easy for us. We also managed to buy a photocopier and to have a better infrastructure. We can even say that we set an example for other programs. Our progress opened the eyes of other programs. This was all three months after the war. Some other programs followed our example and they applied for the WHO and got solar energy as well. “

Empowered by Determination

Al-Serouri ended his talks by stating that “It is the determination of residents and applicants that inspires us to continue as our Third Cohort candidates claimed that they are willing to start the program as volunteers, even if there is no funding. Their appetite is open for such work, and it is this enthusiasm that fuels our determination to continue.”

From his end, Dr. Al Kohlani added that the Ministry of Public Health and Population grasps the importance of the work done by Y-FETP and that this program’s work should be included in the ministries budget. This is something the program will strive for, after the war. He further explains that, “the Ministry of Public Health and Population is fully committed to this important program. H.E the Minister and the Deputy Minister for Primary Health Care attended two activities conducted by the Y-FETP namely; the Advisory Consultation Workshop held in March 2015 and the Mentorship Meeting in October 2015. The last one was also attended by the WHO representative in Yemen. H.E. the Minister himself submitted the award of the 4th EMPHNET Regional Conference for the best oral presentation to Y-FETP resident Dr.Eshraq Al-Falahi. These are just a few signs of recognition for the Y-FETP program and the work it does. This recognition is granted by the higher heath authority in Yemen.”