I entered the Centers for Disease Control (CDC) through the Epidemic Intelligence Service (EIS), a 2-year fellowship run by CDC and designed to give practical field epidemiology experience to future public health practitioners who will work at international, national, state, and local levels. I had done some international work, mainly family practice, during medical school in Scotland and Ireland, and had traveled extensively through Southeast Asia. Before entering CDC, I had a great desire to work in an international health setting. Although my EIS assignment was mainly domestic (infectious disease mortality surveillance and investigation), I looked for international opportunities while at CDC, which included investigation of lead poisoning in Egypt, participation in an international refugee health training program, and participation in a national, population-based survey of disability, mortality, and mental health in Afghanistan. International work was interesting, fun, and fulfilling. However, I did not want to travel for long periods of time because of my wife and son.

After EIS, I began work with the domestic HIV/AIDS division at CDC, working as a project officer on a large cohort surveillance project. After several years, and after many discussions with my wife, we decided that the best option was to look for positions abroad, where I could work in international health with CDC, but not have to travel for long periods of time. So, I began to look at international positions that were becoming available. I was lucky to be offered a job as Director of the CDC Global AIDS Program in Hanoi, Vietnam, and we moved to Hanoi in Summer 2004.

CDC offices overseas fall under the auspices of the US Mission, meaning that we work closely with, and under the Embassy and the Ambassador. I learned quickly that the Ambassador is in charge of all Americans stationed abroad, and in-country we all answer to the Ambassador first. For administrative needs, like hiring local staff and certain funding and procurements, we work very closely with the Embassy. The Embassy also provides our mail, housing, security, and other daily essentials.

We do have regular interactions with other parts of the Embassy/State Department. For example, some of our HIV/AIDS and Avian Influenza work overlaps with the Department of Agriculture (Agriculture Section), has political implications (Political Section), requires assistance by media experts (Public Affairs Section), and involves high-level visitors (many parts of the Embassy are involved with visitors). For example, in 2006 President Bush came to Vietnam for APEC, and we worked closely with all parts of the Embassy to arrange the visit, negotiate HIV/AIDS and Avian Influenza aspects of the visit, and to assist with the visit. In fact, 19 CDC staff contributed over 6 months of person time to the Mission to assist with the President’s visit. Most of this assistance was not related to health, but to overall visit support. I also am an Embassy duty officer, which means regularly rotating to take "call" from home, with an emergency cell phone, to assist Americans in Vietnam who have all kinds of mishaps, problems, and concerns. This is actually a fun and interesting part of my job.

We also work closely with other US Government agencies involved in health, mainly USAID. We work closely with USAID on a daily basis for HIV/AIDS, and for Avian Influenza. CDC and USAID are funded for HIV/AIDS work under the US President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion initiative by the US to fund 15 "focus" countries to try to turn the tide of the epidemic. Vietnam is the only PEPFAR "focus" country in Asia. Under PEPFAR, US agencies plan programs together in a coordinated fashion, and work together on program implementation and oversight. We also interact on a regular basis with other donors and international agencies, such as WHO, UNAIDS, UNICEF, the Global Fund, the World Bank, DFiD (British), AusAID (Australian), the Clinton Foundation, and others to try to coordinate activities and maximize donor inputs. This is very difficult, requires a great deal of time, and is rewarding when successful.

I have never worked for an international non-governmental organization (NGO). However, we work closely with several large NGOs in the design and implementation of HIV/AIDS programs. The NGOs, for HIV/AIDS work, are funded under the PEPFAR program, and as such contribute to the reporting of achievements and indicators through PEPFAR. In some ways they are similar, and some ways very different from CDC. At CDC, we work under US Government rules – there are specific US Government rules for clearance of publications and presentations, for approval of protocols by human subjects committees, for talking with the media.

NGOs have their own parallel, but different, processes. NGO employees are not under the authority of the Ambassador, and thus do not report to the Ambassador directly. For technical implementation and oversight of PEPFAR-funded programs, NGOs work closely with US Government agencies, including CDC and USAID, and we work closely with the other international donors and agencies. One major difference is the hiring process – working for CDC I am a US Government employee, subject to all of the benefits and restrictions that come with it. For example, I am an officer in the Commissioned Corps of the US Public Health Service (USPHS). I have a rank, Commander, and my employment falls under specific regulations of the USPHS. These include leave, pay, health insurance, mobility, fitness requirements, uniform requirements, appearance requirements, and many other aspects. Working for an NGO there are again parallel, but very different, employment systems. Regarding actual programmatic work, I am always representing the US Government in everything that I do. For example, I represent the CDC to the Government of Vietnam. I am very conscious of this in every interaction I have with outside agencies, with the Embassy, and even in our CDC office.

It is very difficult to characterize my "typical" day. Each day is very different, but there are some recurring themes. One is being very busy almost all of the time. The CDC office is constantly working on program planning, implementation, and oversight. I oversee an office of nearly 30 people, and supervise persons in a PEPFAR satellite office in Ho Chi Minh City. There are many reporting requirements, conference calls, interagency planning meetings, supervisory responsibilities, Embassy responsibilities, travel to program sites, conferences, scientific meetings, presentations, meetings with Government of Vietnam officials.

Another recurring theme is learning and excitement. There are constantly visitors from outside Vietnam (to provide technical assistance, to see PEPFAR programs) from CDC and other related agencies, technical and programmatic issues to sort out, personnel issues to address, scientific data to interpret, Government officials to meet, Embassy events to attend, and numerous other planned and unplanned daily events that make this job interesting, exciting, hectic, challenging, and overall extremely rewarding. I work on a daily and close basis with extremely dedicated and intelligent Vietnamese and Americans, I have the privilege to see at close view another interesting and unique culture, and I have a great deal of responsibility. I feel very lucky to work for CDC, and more fortunate still to have the opportunity to represent CDC in an international setting.