Reaching the troubled parts that others don't

It wasn't difficult to become fluent in Bangla. After all, it's what you have to do if you want to work in Bangladesh, says Jean Long, who appears to pitch her voice low (occasionally inaudible) and keep her narrative understated, in a bid to relegate the exotic to the prosaic.

Her career has taken her to places most of us would be happy to avoid: poverty-stricken Bangladesh, cholera-stricken Rwanda, the prisons of Ireland - where her research revealed that more than one third of the inmates have hepatitis C. But she minimises the risks involved. She travelled overseas with Concern, which looked after its staff well. "After all, it would be very expensive to allow us to get sick. You're no longer useful if you're ill," says Long.

Now lecturing in public health in TCD, Long initially trained as a general nurse in St Vincent's hospital, Elm Park, Dublin. The journey to academia's quieter waters has been an unlikely, and extremely eventful, one.

Nursing was not a vocation but a career choice. "I was never one to say, 'I'd love to be a nurse'. When I left school, I started studying applied science in Kevin Street but when I was offered a nursing place, I took it because I got paid while training."

She enjoyed the two-year midwifery course in the National Maternity Hospital, Holles Street, as it gave her the opportunity to support mothers, particularly first-time mothers, who needed help with breast-feeding and looking after new babies. She never worked as a nurse or a midwife.

Instead, she went to Bangladesh, in 1986, where she managed one of Concern's eight healthcare projects. "Bangladesh was ruled then by the military but it was not a restrictive regime. Politically, it was quite a positive phase. But, from an economic point of view, there were major problems.

"In all societies you have the very wealthy, the middleclass and the poor. In Bangladesh, it was the same - but 80 per cent of the people fell into the very poor category. There was very little work for women, particularly those without education. If their husbands left them, they were in a very difficult position."

She spent three years there, with the latter two years devoted to taking over a project that had been previously run by another non-governmental organisation (NGO). This project had provided curative health care and Long's job was to change the emphasis to community care, thereby decreasing dependency among people in the local community. However, the change in emphasis also meant a change in work practice for staff, which, in turn, meant Long had to spend a lot of her time in negotiation with staff. "They'd been very comfortable, sitting in chairs in the clinic; now, we were asking them to go out into the slums."

Long felt frustrated by her lack of management skills. She returned to Ireland and did a management qualification before returning to Bangladesh as health co-ordinator, overseeing all of Concern's projects in the country. "Local staff out there are very vulnerable to our decisions. They have no unions. So, you have to be very conscious of putting fair systems in place."

Back in Ireland, two-and-a-half years later, Long enrolled on TCD's MSc in community health (see postgraduate course focus on opposite page). "It was a year full-time. During that time, I went to Rwanda, where there was a major cholera epidemic in 1994." She says Concern's response was reasonable, better than many other NGOs, but there was a lot that could be improved upon.

She became a technical adviser to Concern, with two main roles. One was setting up emergency responses in epidemics or areas of high malnutrition. She would employ local staff and, maybe, bring in some expatriate staff. "Then I would leave and hand over."

The other role saw her designing new projects, redirecting current health strategy and evaluating health-related interventions.

Long has participated in the formulation of emergency response policy for bodies such as the World Health Organisation. She is a board member of the Emergency Nutrition Network, in TCD, which produces a quarterly journal for persons working in nutrition programmes in developing countries.

Having spent three years as a technical adviser to Concern, it was time for a further career change: lecturing in TCD. "I got a job, in 1997, teaching public health in developing countries. I am now a lecturer in international health. A year after taking the post, I began work on my PhD."

A senior lecturer in epidemiology in the Department, Dr Shane Allwright, had secured a contract with the Department of Justice to investigate the prevalence of blood-borne viruses in Irish prisons. She needed a researcher. Long found her niche. "I like questioning things, investigating, finding out why. When someone tells me something, I always ask 'where's the proof?'

"We found that over one third of all prisoners have hepatitis C. Four out of five prisoners who reported injecting drug use have Hepatitis C. Some 43 per cent of those surveyed were or had injected drugs.

"Perhaps the most unexpected finding was the low percentage of prisoners with HIV. Only 2 per cent were HIV positive. This rose to 3.5 per cent in drug users." The results of the survey formed the substance of two reports for the Department of Justice and a publication in the British Medical Journal. Other publications are pending.

The Department of Justice needed to determine the extent of the drug problem in prisons, she says.

"Quite a lot of work has been done in creating drug programmes for prisons. Some have started methadone maintenance. There are plans to extend this. There are also plans to have a link person between prisons and the eastern health region."

Long is a member of the health and development group at Comhlamh, the organisation for returned development workers. This group is currently involved in creating awareness among health professionals and the general public on issues of non-nationals' access to health services and female genital mutilation.

She is now engaged in qualitative research on the drug-using practices of prisoners. This will include research on how they feel about HIV and hepatitis.

"I have some funding from the Health Research Board, that will finish next April. Then I'm hoping to get a postdoctoral fellowship. That's how we (untenured staff) all survive; research fellowships, grants and contract lectureships. It's not conducive to long-term plans. However, I would like to stay in academia."