Perspective

Field epidemiology plays a central role in strengthening public health systems through disease surveillance, outbreak investigation, emergency response, and mentorship of frontline health workers. Programs such as the Field Epidemiology Training Program (FETP) have significantly strengthened workforce capacity in low- and middle-income countries by equipping health professionals with practical skills to respond to public health threats and support routine surveillance activities [1–3].

Existing literature on field epidemiology has largely focused on measurable outputs such as outbreak detection, surveillance performance, response coordination, and workforce development [4]. While these contributions matter, they often overlook the lived experiences of those conducting field activities in remote, resource-limited settings. In practice, field epidemiology extends far beyond technical investigation and data analysis [5]. Mentorship visits, supervision of trainees, active case finding, community engagement, and routine surveillance activities frequently occur under difficult environmental, infrastructural and sociocultural conditions.

Field teams may travel through impassable roads, work in areas with limited communication networks, navigate unfamiliar cultural norms, and adapt to inadequate accommodation or transportation systems [6,7]. Such experiences, although rarely documented in formal reports, shape both the effectiveness of public health interventions and the experiences of field personnel themselves. The realities of field deployment often require improvisation, local collaboration, flexibility, and continuous risk assessment beyond what is commonly reflected in technical publications [8,9].

Despite the critical role these contextual factors play in field operations, narrative accounts describing the everyday realities of field epidemiology remain underrepresented in public health literature [8–10]. Most available reports prioritize epidemiological findings while giving limited attention to the operational, human and environmental experiences that accompany field practice.

This paper presents a series of narrative reflections drawn from field deployments, outbreak responses and mentorship activities conducted in remote settings in Tanzania. Through these experiences, the paper highlights the infrastructural challenges, sociocultural encounters, logistical barriers, and adaptive strategies that characterize field epidemiology beyond surveillance data and outbreak reports.

Reflective narrative approach
This paper is presented as a reflective narrative perspective. It documents and reflects on lived experiences encountered during field epidemiology activities conducted in Tanzania. The narratives describe selected experiences from field deployments involving outbreak response, mentorship visits, surveillance support and training activities carried out in remote and resource-limited settings

Sources of narratives
The experiences presented in this paper were drawn from the firsthand field experiences of the authors during field epidemiology activities conducted under the Field Epidemiology Training Program and related public health operations. The narratives included experiences from outbreak investigations, mentorship visits, community engagement activities, and routine field support operations.

Narrative selection and development
Approximately 10 field experiences were considered in developing this perspective, of which four were selected for inclusion. Experiences were purposively selected for their relevance to the practical realities encountered during field epidemiology deployments and their ability to provide clear, illustrative lessons. The selected experiences were then developed into concise narrative accounts based on the authors’ firsthand reflections.

Organization of reflections
The narratives were reviewed collectively to identify recurring operational, environmental and sociocultural issues across the field deployments. Similar observations were grouped into broad themes, including communication constraints, travel and infrastructure, accommodation, community engagement and adaptation to unexpected conditions. These themes guided the organization of the reflections and the practical lessons presented in the discussion.

Ethical considerations
This perspective is based exclusively on the authors’ reflections on routine field activities and did not involve recruitment of research participants, collection of personal data or analysis of identifiable records. Formal ethical review was therefore not sought. Names and details that could identify individuals or specific communities have been omitted to protect privacy and confidentiality.

Story 1: Hill that became a communication tower
In 2022, during a measles outbreak response in the Kilindi District Council, our field team was deployed to support surveillance and response activities and outbreak investigation in some of the district’s most remote villages. Kilindi lies nearly 150 kilometres from Tanga, and many wards (Kibirashi, Msanja, Kilwa, Kimbe, Mabalanga, Kilindi etc.) are separated from the district headquarters by long, difficult roads and limited infrastructure.

Among the villages assigned to our team was one that local hosts repeatedly warned us about – Misufini. The concerns were not about insecurity or resistance from the community, but about the journey itself. The road conditions were poor, they said, worsened by rain and spring water that had rendered the shortest route impassable. Communication networks were also nearly nonexistent. Before departure, they jokingly advised us to call our loved ones in advance because once we entered the area, we might disappear from communication entirely.

Despite the warnings, we insisted on going. After all, that was the purpose of the deployment. An alternative route was identified—longer, rough, but at least passable. The journey lasted between four and six hours. By the time we approached the village, our phones had already switched to “Emergency Calls Only.” At that moment, we remembered the warnings and realized they had not been exaggerated.

After introducing ourselves to village leaders, we immediately began our work. Because of the time constraints and the large geographical area to cover, the team split into smaller groups and moved through different routes within the village. Hours passed walking from household to household, collecting information and supporting local response efforts.

Later in the afternoon, around 4 p.m., we regrouped to assess progress. The discussion quickly shifted from data to logistics. We had not completed the work we came to do, yet returning to town and attempting the same journey again the following day was unrealistic. The decision was made—we would spend the night in the village.

That decision introduced another challenge: where would we stay? There were no guest houses, lodges, or formal accommodations. Food could only be obtained from small local “hotels.” As we tried to figure out our next move, our local hosts reassured us that they would speak with community members to arrange places for us to sleep. Eventually, some households agreed to accommodate members of the team. We squeezed ourselves into the limited spaces available and settled in for the night.

However, communication remained impossible. Completely isolated, we began asking whether there was any point nearby where a phone network could be found. The villagers told us about a hill not far from the settlement where signals occasionally appeared. As evening approached, we climbed the hill accompanied by local guides. Halfway up, phones suddenly began vibrating. Missed calls flooded in. Messages started arriving all at once. For several minutes, the hill transformed into a communication centre as everyone hurried to call family, colleagues, and friends before the signal disappeared again.

Then came another interruption. A distinct smell spread through the area, which the villagers associated with the presence of snakes. Concerned about the possibility of encountering a snake, we quickly descended the hill and returned to the houses where we were staying.

Reflection
This experience illustrates how field epidemiology extends beyond technical outbreak investigation. Geographic isolation, limited infrastructure and unreliable communication can affect field activities, while support from local communities can help teams work effectively in settings where formal services are limited.

Story 2: Where the road ended
In 2022, our team was deployed to support cholera surveillance and response activities in Uvinza District Council following an outbreak affecting several villages along the shores of Lake Tanganyika. Among the areas of greatest concern were Sibwesa and Kalya villages. After paying a courtesy visit to the District Medical Officer, we began the long journey toward the affected communities. The road stretched for nearly 160 kilometers through rough terrain, and by the time we arrived in Kalya, it was already mid-afternoon. We were warmly received by local teams and quickly integrated into the ongoing response efforts. Although teams were already on the ground, additional epidemiological support was needed to strengthen surveillance, coordinate response activities, and support measures aimed at interrupting disease transmission.

Beyond the outbreak itself, another challenge quickly became apparent: accommodation. Kalya had only two small guest houses. One was relatively functional, while the other remained partially unfinished despite still being used to host visitors. Some rooms lacked completed roofing, yet there were few alternatives. Members of the Council Health Management Team and other stakeholders had already occupied much of the available space, leaving very limited accommodation for the rest of us. To manage the shortage, team members paired together in the available rooms. I shared one with a fellow Field Epidemiology and Laboratory Training Program resident. Exhausted from the long journey, we quickly settled in and fell asleep.

Sometime after midnight, I woke to the sensation of water droplets striking my face. At first, it seemed minor, but within moments the rain intensified. Water began pouring through the unfinished sections of the roof, and before long, parts of the room were completely soaked. It felt as though we were sleeping outdoors in the middle of a storm. Half-awake and confused, we tried repositioning ourselves toward the driest corners of the room. We even considered rotating the bed to avoid the leaking sections, but the room was too small to make any meaningful adjustments. Eventually, we gave up trying to outmaneuver the rain and simply waited for the storm to pass.

The next morning, we prepared for a field visit to Sibwesa, one of the villages most affected by the outbreak. Reaching Sibwesa required leaving our vehicles behind and continuing the journey by motorcycle through narrow bush paths, muddy terrain and flooded sections. Midway through the journey, we encountered a river flowing into Lake Tanganyika. There was no bridge, and motorcycles could not simply be ridden across. Everyone had to dismount.

Some crossed the water on foot, while others relied on local residents for assistance. The motorcycles themselves had to be carefully pushed or physically carried across the river before the journey could continue on the other side. Despite the difficult conditions, the team eventually reached Sibwesa, supported surveillance and response activities, and later returned safely to Kalya.

Reflection
This experience illustrates how environmental and infrastructural conditions can affect outbreak response in remote settings. Difficult terrain, transportation barriers and limited accommodation can influence the movement and well-being of response teams and are important considerations in planning field activities.

Story 3: Navigating gender-related barriers to community engagement
During a field exercise in Mafia Island, two female field officers travelled to a remote village to conduct community engagement activities. This account was contributed by the officers involved and included among the authors’ collected field experiences. Upon arrival, they followed the usual protocol and paid a courtesy visit to village leaders before beginning their work.

After introductions, the leaders asked whether the team had a male colleague accompanying them. The women explained that apart from the driver, they were alone. The atmosphere shifted immediately. According to the village leaders, women were not traditionally permitted to stand before men and address public gatherings. In their view, allowing the exercise to proceed under those circumstances would contradict local customs. What followed was a prolonged conversation between the visitors and village representatives, balancing respect for cultural norms with the importance of the public health activity they had travelled to conduct.

Eventually, local leaders agreed to speak with the community and request cooperation despite the unusual situation. The exercise was allowed to proceed.

Reflection
Fieldwork may place public health professionals in settings where local social norms differ from professional expectations. Cultural awareness and respectful engagement are important, but these should be balanced with the safety, dignity and equitable participation of field personnel. Such experiences highlight the need for organizations to anticipate potential gender-related barriers during deployment and provide appropriate support to field teams while maintaining the objectives of public health activities.

Story 4: Exploring new routes
During a mentorship visit for frontline trainees in Songwe Region, our team traveled to Songwe District Council to support participants enrolled in the frontline Field Epidemiology course. The journey from Vwawa, one of the region’s central towns, involved long hours on rough terrain and isolated roads.

We began the journey in the afternoon expecting to arrive later that evening. As the night deepened and we approached our destination, the vehicle suddenly struck a large stone hidden along the road. A loud impact followed, and within moments it became clear that the damage was more than a simple puncture. The tyre was destroyed, and other components beneath the vehicle had also been affected.

It was nearly 10 p.m. Several people passing along the road stopped to ask what had happened and whether help was needed. Among them was the District Medical Officer of Songwe DC, who assisted us in arranging support. At the same time, we contacted the trainee we had traveled to mentor and explained the situation. Within a short while, another vehicle arrived from town to transport us safely while the driver and local mechanics remained behind attempting temporary repairs. Eventually, the damaged vehicle was repaired just enough to be dragged slowly into town for more extensive fixing. The following morning, repairs continued. Fortunately, our hosts provided another vehicle to support our movement while ours remained in the garage, allowing mentorship activities to continue without major interruption.

After the vehicle was finally repaired, we prepared to continue to Tunduma, where another trainee awaited mentorship support. Our hosts suggested an alternative route they described as much shorter than returning through Vwawa. The idea sounded reasonable, and after some discussion we agreed to try it.Before departure, however, we were warned about a steep hill along the route. The journey progressed smoothly at first. Then the climb began. The vehicle continued ascending higher and higher along the winding slope.

As we approached what appeared to be the final section of the hill, the engine suddenly lost power. Within seconds, the vehicle began slipping backward down the incline. Conversation stopped immediately. Fortunately, the driver maintained control and managed to halt the vehicle before the situation became dangerous. We quickly stepped out to reduce the weight while the driver carefully reversed through the narrow corners until reaching a safer section of the road below.

No one suggested attempting the climb again. Instead, we returned to Songwe DC and resumed the longer but familiar route toward Tunduma. The experience left us with an important lesson: in fieldwork, every “shorter route” carries its own uncertainty and unfamiliar paths are often explored at one’s own risk.

Reflection
Field mentorship activities frequently require travel across difficult terrain and unfamiliar environments. This experience highlighted the importance of journey planning, assessing vehicle and route suitability, maintaining communication arrangements and using local information when making travel decisions. Where conditions are considered unsafe, teams should have clear criteria for delaying or discontinuing travel.

Field epidemiology is often described in terms of surveillance, outbreak investigation and response outcomes. The experiences presented in this perspective illustrate that carrying out these activities is also shaped by the settings in which field teams work. Across the narratives, infrastructure, geography, sociocultural contexts, relationships with local communities and the ability to adapt to changing circumstances influenced how field activities were planned and carried out. These practical realities are important considerations in preparing and supporting field epidemiology teams working in remote and resource-limited settings.

Infrastructure and logistics were important practical considerations across the deployments. Difficult terrain, poor roads, limited transportation, unreliable communication and inadequate accommodation affected access to communities and the continuity of field activities. Similar challenges have been reported in public health emergency operations in low- and middle-income countries, where infrastructure can constrain surveillance and response activities [11,12]. The experiences described here further illustrate the need to consider these issues before deployment, including transport arrangements, communication options, accommodation and contingency plans for unexpected disruptions.

Community support and local partnerships also facilitated field activities, particularly where formal infrastructure was limited. Local leaders, community members and district teams provided practical assistance and contextual knowledge that enabled teams to continue their work. This is consistent with previous evidence emphasizing the importance of community engagement and stakeholder collaboration in public health activities [13–15]. These experiences suggest that engagement with local stakeholders should be considered an integral part of deployment planning, as local knowledge can help teams anticipate challenges and identify practical solutions.

Sociocultural expectations can also influence how field activities are received and carried out. The experience involving female field officers illustrates how gender norms may affect access to community spaces and participation in public health activities. Cultural awareness and respectful engagement are important when working with communities, and previous studies have similarly emphasized the importance of culturally appropriate approaches in building trust and supporting community participation [14,16,17]. However, responsibility for addressing gender-related barriers should not rest solely on individual field personnel. Deployment planning should therefore consider potential gender-related challenges and ensure that field teams have appropriate institutional support, safety arrangements and clear approaches for engaging community leaders. Such preparation can help balance respect for local contexts with professional safety and equitable participation.

Adaptability was evident across the narratives, particularly when teams encountered unexpected changes in travel, communication, accommodation or field arrangements. Previous evaluations of FETPs have similarly identified adaptability, teamwork and problem-solving as important competencies developed through experiential learning [9,10]. These experiences suggest that such competencies are not only important training outcomes but are also important in managing the practical uncertainties of field deployment. FETP preparation should therefore provide opportunities for trainees to develop these skills alongside technical competencies.

The experiences have practical implications for FETPs and organizations responsible for field deployments. Pre-deployment planning should include assessment of travel routes, vehicle suitability, accommodation, communication options and other potential safety risks, particularly when teams are assigned to remote areas. Contingency arrangements should be established for communication failures, transport problems and changes in field conditions, with clear criteria for delaying or discontinuing activities when travel becomes unsafe. Deployment planning should also consider gender-related concerns and culturally appropriate approaches to community engagement. Following deployment, structured debriefing can provide an opportunity to document challenges, identify practical solutions and incorporate lessons into future preparedness and training.

Systematic documentation of deployment experiences could also support the development of community and regional profiles for areas frequently covered by field teams. Such profiles could capture practical information on accessibility, communication, transport, accommodation and relevant sociocultural considerations. Over time, this institutional knowledge could serve as a practical reference for future deployments, support preparedness and inform resource planning.

A notable contribution of this perspective is its focus on the lived experiences of field epidemiologists. Existing literature has predominantly documented what field epidemiologists accomplish, including outbreaks investigated, surveillance systems strengthened and trainees mentored [1,4,9,18]. Less attention has been given to the practical realities encountered while undertaking these responsibilities. By bringing these experiences together, this perspective complements existing literature by highlighting the human and operational dimensions of fieldwork. The perspective also highlights practical considerations for field epidemiology training, workforce development and deployment planning.

Limitations
This perspective has several limitations. The narratives were reconstructed retrospectively and may therefore be subject to recall bias. In addition, only four experiences were selected from approximately 10 considered experiences, and the selection may have favoured memorable or illustrative events. The narratives were not intended to represent all field epidemiology activities in Tanzania and cannot establish the frequency or prevalence of the challenges described. Nevertheless, they provide practical examples of challenges encountered during field deployments and lessons that may be relevant to similar resource-limited settings.