context as Bermuda's only Epidemiology/Surveillance team. For nurse epidemiologist, Rhonda Daniels and surveillance officer, Brenda Vanderpool, it describes their efforts to limit the spread of communicable diseases throughout Bermuda. Explained Mrs. Daniels: "Epidemiology is the study of health and population and our surveillance involves an on-going monitoring of diseases in the population.'' Their department does more surveillance than epidemiology work, she added, with doctors regularly contacted to discover what, if any, communicable diseases are affecting the local population.

"Under the Public Health Act of 1949, they are required to report all communicable diseases; anything that can be transmitted form one person to another. "And what we do is we surveil (them). If say, a doctor calls up and reports having seen a baby with salmonella, I then talk with the parents to try and determine how the baby became infected to get some idea of the prevalence of (it) in our community. And if necessary, we implement control measures so that it doesn't spread.'' Although outbreaks are not common, they do occur, Mrs. Daniels said, with the majority of problems stemming from foodbourne illness. "It's sort of like being a health detective. A few years back we had 17 people call both us and the Environmental Health Officer up, saying they were suffering from various symptoms -- primarily diarrhoea, vomiting and nausea, within two hours of eating a particular food. "We contacted the Environmental Health Officer who was also trying to contact us and then set about trying to determine what the cause was. We found they had all eaten at a particular establishment between 2 p.m. and 10 p.m. We then had to identify what the food was that they had eaten, and then what the organism was.'' The department falls under, and is directly accountable to John Cann, the Chief Medical Officer, who, in this instance bears the title of Chief Epidemiologist. And, in addition to regular disease reports made to the Health Department, monthly, quarterly and annual statistics on the incidence of communicable diseases in Bermuda must be submitted to private physicians, the Caribbean Epidemiology Centre in Trinidad, the Pan American Health Organisation and the World Health Organisation. "I also provide health education to individuals and the public-at-large either via the radio, the newspaper or the television and I also must, at times, give talks to different organisations as well as members of the general public. I think this little unit is an important part of public health because we're talking about the wellness of the country. And so for us, doing this surveillance gives us an idea where to target our preventative measures, our control measures.'' Also responsible for administering health interviews to food handlers, Mrs. Daniels accompanies Environmental Food Health Officers to restaurants as they educate employees on proper food care, ensuring that those who have been recently sick will not transmit those germs to the public. She works closely with the Infection Control practitioner at King Edward VII Memorial Hospital and its microbiology unit and is also in constant contact with health officers, helping ensure that children are properly immunised; a duty she follows up by conducting workshops with nurses. According to Mrs. Daniels, the study of epidemiology dates back to 1854 with an English doctor, John Snow. Faced with an outbreak of cholera in London, the physician was able to determine that those who were affected all obtained their water from a particular pump in the city. "Epidemiology is very interesting. It's particularly fascinating to think that even then, in 1854, he was able to determine what the cause of the disease was.'' Both Mrs. Daniels and her co-worker described their jobs as fascinating. "Doing surveillance is routine,'' said Mrs. Vanderpool, "but there are problems we think only Bermuda is facing and when we do our workshops in Trinidad, we find that all the Islands are dealing with those same problems. We need to know that everybody's up against the same thing.'' She added that her real enjoyment. is coding the causes of death in Bermuda -- a task not recommended for those who are easily depressed. "What I code is the underlying cause of death, what started the event, what led to the heart attack. It could be diabetes, it could be high blood pressure, it could be suffocation or an overdose of drugs. I think it's the most interesting part for me although it can get depressing at times.'' That information, she explained, is then sent on to the Epidemiology Centre in Trinidad. "And what we've found, is that the causes of death in Bermuda are compatible with the trends in the rest of the world. We tend to mimic what goes on elsewhere, particularly in the United States.'' According to Mrs. Daniels, a disturbing trend has seen the number of AIDS cases in Bermuda increase from 75 in 1988 to 383 at the end of February of this year. The Island, she said, runs on average between 25 and 35 new cases each year, with the record being 1994 when there were 48 new cases reported. "Because we deal primarily with communicable diseases and provide that statistical information, anyone who is diagnosed with AIDS or HIV is reported to me. Our main diseases of concern in Bermuda are HIV, AIDS and STDs. "I think that people don't realise that (STDs) can go on to have a ripple effect. They not only affect the individual, but their family and also newborn and unborn children. And if left untreated, they can cause blindness and other problems in newborns. We're also finding that social problems in Bermuda are impacting on the health of people. Drugs impact on violence and violence on abuse; all problems in Bermuda are connected. Even HIV and AIDS are in there with drugs and violence.'' Clinics also report any instances of communicable disease to the facility, said Mrs. Daniels, and it is also open to receive calls from the public on any incidence of alarm. As such, it can rightly be described as being at the centre of things at the Department of Health. "We're now working with individual clinics to set up a computer programme so that we are able to get meaningful information from them,'' she said. "Not just the raw data such as gender, age and the disease.'' PHOTO Nurse epidemiologist, Rhonda Daniels HEALTH HTH