Last Day of Teaching!

Today was the last day of teaching/evaluating the trainers, and all in all, it went pretty well. Like yesterday, they had one real lecture, and then the rest of the time was spent working on an exercise. Today's exercise was pellagra in South Carolina around 1916ish, which is a case that I did last year in my Epi Field Studies class. The case is set up as a mystery illness, referring to it as "the disease" throughout. The reason they did this (and by "they", I mean the CDC, since it is a CDC case) is to get you to think outside the box as far as outbreaks. Most people think of outbreaks as infectious diseases, but pellagra is a dietary deficiency of niacin, one of the B vitamins (B3). I think the goal was to trick people into going down the infectious disease pathway, instead of immediately thinking of dietary deficiencies, which is where most medically-trained people would go at the word "pellagra".

If it were an infectious disease, though, it would be a strange one, because it didn't affect infants under 12 months old, affected children more than adults, women more than men, married women more than single women, older people more than young adults, and people who worked in the factories least of all. The reasons for this are that infants are breastfed or get milk preferentially when the family has it (milk has niacin); children are growing and therefore need more nutrients; women with families are a) getting pregnant and have the dietary requirements of that, b) are breastfeeding, or c) are giving their children/husbands the good food preferentially to themselves; factory workers get lunch at work, provided by the factories; and older adults are no longer working and therefore no longer getting their diets supplemented by their jobs. People who lived in the same houses were more likely to be affected, but that's only because people who live in the same houses usually have similar diets.

So we went through this case, and there were some minor things that the trainers didn't do perfectly (such as saying that work had no affect on the disease, because people with jobs had lower rates; they should have said that work was a protective factor) and some things that the students had questions about afterwards (mostly relating to cultural questions and things they didn't understand about early 20th century South Carolina, not that I can blame them... I don't know much about early 20th century Ukraine), but overall, it went really well, even better than yesterday's exercise.

After the day of teaching (which ended a bit early), we headed back to the hotel and then went down by the Opera House for dinner. Here's a picture of the Opera House:

And again at night:

We ended up eating at a Belgian place (called Belgian Bar Restaurant), which had really good, although a bit more spendy than what we had been paying (and by "more spendy", I mean still significantly less than per diem), and then stopped at a chocolate place for dessert. We were going to get hot chocolates, but were both too full from dinner. Maybe tomorrow.