Infectious disease and a mathematician

August 10, 2017

Dr. Rwayda Hassan closes herself in a conference room at Multnomah County’s Health Department headquarters and spreads a stack of papers across the table – papers covered in pink, blue, green boxes connected by a maze of lines and numbered pages. “Amy says I need a whiteboard,” she murmurs as she pieces them together, her brows knitted in concentration, her glasses askew on the bridge of her nose.

“We need to solve this maze,” she said and shook her head, waving at the mess of papers. “This is all I have.  The first things I must know are the types of fields, the essential connections, the type of key.” She continued to run down her technical to-do list.

Dr. Rwayda Hassan is helping Multnomah County epidemiologists overhaul a clunky data analysis process

Hassan is puzzling out a solution to a problem that has frustrated health experts for years – how to analyze infectious disease data quickly and present their findings clearly.

“To get access to communicable disease information we use the Oregon Public Health Epidemiologists' User System,” said Dr. Amy Sullivan, director of Communicable Disease Services for Multnomah County who recruited Hassan. “We feed the system, but we can’t get it back in a simple way.”

Sullivan’s lead epidemiologist Taylor Pinsent said her team spends too much time preparing vital data of transmission of diseases such as tuberculosis, hepatitis and measles, rather than analyzing it. “It adds an hour, and hour-and-a-half to something that should take 10 minutes,” she said.

Hassan’s job is to coordinate a transition of raw data from a clunky state system to a streamlined database maintained at the county, and to bridge the technical experts in Information Technology and the health experts in Communicable Disease Services.

As a contract employee, she’s working herself out of a job, which is scheduled for completion this fall. Then she’s not sure what she will do. For now she spends long hours, quietly clacking away at her keyboard. The few county staff who know her call her by her first name, but most don’t know her at all.

It’s humbling for a woman used to being called “doctor Rwayda,” a college professor who holds a doctorate in mathematics and computer applications. It’s a humbling position for the woman who helped develop a model for the national online stock trading system and national online banking system for the country of Iraq. It’s a humbling position for a woman used to being in demand, being wealthy, being so prominent that it put her life at risk. But it far exceeds the work she was told to accept when she came to the United States as a refugee in 2014, when she was told to be grateful for any job she could get.

“Many people told me, ‘You must be satisfied with what you get… you must accept any kind of job,” she said. “Some people here make you feel that you are nothing, that when you come here, you are nothing. Why should I feel that? I have a lot of experience. I can work.”

Dr. Sullivan, meet Dr. Hassan

Within two months of arriving in the United States, in July 2014, Hassan began attending meetings with refugee resettlement contacts at state and local agencies. With a fluent command of English and an advanced technical degree, she was frustrated that the employment pipeline for newly arriving refugees led largely to minimum-wage, blue-collar, and often manual labor jobs.

“It’s not wrong, the work,” she said at a meeting in October 2014. “But I spent 22 years going to school to get a Ph.D. I don’t want to start from zero.”

Sullivan, who was working on rapid-response protocols for disease outbreak for Multnomah County’s Health Department, was sitting in one of those meetings as chair of the Oregon Refugee Public Health Advisory Group. She began thinking of ways to employ people with advanced skills such as Hassan’s. And soon she had a project she thought Hassan might be perfect for – mathematical models of disease transmission.

“I was thinking it would be really nice to have a mathematician here; they look at things so differently,” Sullivan said. “I have done some math modeling but these models have dozens to hundreds of formulas that interrelate.”

It took time for Sullivan to track Hassan down, but once she did, Hassan, who had never worked with health data, immediately agreed to help. After all, the math was the same.

Dr. Rwayda Hassan, right, has helped communicable diseases exerts prepare for outbreaks and streamline data analysis.

“I put a big stack of math modeling papers and a couple books on the dynamics of infectious disease on her desk,” Sullivan said. “She called out things I was overlooking. There were things she picked up on right away, that ‘You can’t do that because blah blah blah.’ It allowed me to see that my first round of calculations were off.”

An analysis of measles outbreaks among area school children allowed Sullivan to shape a strategy for the county’s response to future outbreaks. "The research gave me a lot of information about how we think about unvaccinated pockets. It’s about focusing resources,” Sullivan said.

Soon after, Sullivan discovered she needed Hassan again. People living on Portland streets were coming down with an intestinal disease called Shigella infection, which causes fever, stomach pain and diarrhea, and puts them at risk of serious complications such as seizures and blood infections.

Sullivan and Hassan spent long hours pouring over epidemiological models, looking for something that would address the shifting social dynamics among homeless patients. Sullivan struggled during calls with the Centers for Disease Control and Prevention, to explain what a disrupted lives people lead when they’re without stable housing. “That’s when Rwayda came in, and she said, ‘It’s like the refugee population.’ That’s why she got it all along.”

It was a pivotal moment for Sullivan, a clear example of why she employs a staff so diverse they come from 12 countries and speak 21 languages. “I want different voices in clinical care, in case management, even in technical modeling,” she said. “You never know when a person’s unique experience in life will tip you towards a solution.”

A bomb goes off, but you show up on time

By age 39, Hassan nearly had it all. It was summer 2014, and she a professor in the College of Information Engineering at Al-Nahrain University in Baghdad, where she had taught for 16 years.

She served as the technical specialist –and first woman– on the board of the Iraq Stock Exchange. She had helped a federal bank launch an a online banking system and was doing the same for stock trading. She brought home nearly 100 times what her own father made as a high-ranking government official. Meanwhile Hassan’s husband, a longtime petroleum engineer named Kadhum taught at the university as well.

They built their four-bedroom, three-bathroom home on a corner lot just off the famous 14 Ramadan Street in downtown Baghdad, amid foreign embassies and high-end shops. Their neighbors were doctors, professors and judges, she said. Like their neighbors, the Hassans built a high courtyard wall and installed metal gates. Their floors were marbled, their walls decorated in tile.

But the Hassans’ success also made their family a target in a place already numbed by indiscriminate murder following the U.S. invasion of Iraq in 2003.

“Many people don’t know why they are killed. If young people are just standing on the street. If you’re just waiting for a taxi. Without reason. If you take the bus,” she said. “We are just facing a very difficult situation in my country. ”

Civilian deaths seemed to drop by 2010, but bombings still closed roads and snarled traffic between the Hassans’ home and Al-Nahrain University. A student came into class late one day, explaining that an explosion had caused the delay. “This is my normal life,” she told the young man. “I have the same situation and I’m here before 8:30.”

The danger, however, was taking a toll.

“It’s not normal when you’re just going to work and you see someone killed in front of you,” Hassan said. “After that, you struggle to stand in front of your students and be strong.”

The risk had been easier to accept before Hassan had her two children, a boy named Mohammed and a girl named Lana. She so feared for their lives that she wouldn’t take them shopping for new clothes. Instead she would buy multiple sizes and make multiple trips. Once when they had to take their son to the doctor, they held him so tightly that he cried out in pain.

They enrolled the children in an exclusive private school in hopes it would keep them safe. But during a field trip to a zoo, her son disappeared. “My eyes didn’t leave him for a fraction of a second, and suddenly he just disappeared,” she said. “I ran like mad in all directions. I saw an officer, and I wanted to go to him. But there’s no voice. Just crying.”

It wasn’t long before her son came back to the group; He had run off to go see the bears. But for Hassan, the experience was torturous.

“I spent a lot of money just to protect them. But all of these protections, it doesn’t work,” she said. “I start to think the bad people, they walk with us, they are around us, they live with us. We wouldn’t see them, but they’re watching us.”

“I’m very strong. I do not cry.

The Hassan family applied for refugee status in 2012 and got word two years later, in June 2014, that the United States had accepted their request. She worked on campus until noon the day their flight took off. Hassan kept her position on the board of the stock exchange, and took a one-year sabbatical from her position at the university. 

“I told myself, ‘Things will get better,’” she said. “I said, ‘I will go for one year and maybe the situation will be better then we will come back.’” And so the Hassan family packed a few bags, leaving most of their clothes still hanging in the closets. They covered their furniture in white sheets. And they locked the front door.

Hassan’s parents had immigrated to Portland five years earlier, and they secured a two-bedroom apartment for the family of four, who arrived in July of 2014. The next weeks were filled with logistics of resettlement: furnishing their tiny apartment; taking English tests, attending cultural orientation classes and employment counseling at the Immigrant and Refugee Community Organization; and undergoing medical screenings at Mid County Health Center.

When the doctor at Mid County asked Hassan what she did for work, Hassan burst into tears.

Dr. Amy Sullivan says Hassan's refugee status helped her solve a math modeling problem.

“After that, anyone ask me anything, and I start to cry. Almost every day I spent it crying. I didn’t cry in my life. We had a very difficult life, but I told myself, ‘I’m so strong,’” Hassan said in a whisper. “I’m very strong. I do not cry.”

Hassan was mourning the death of her professional life, letting go of her dream of becoming the first female dean of her college. Instead, she spent her days sitting alongside her son in his elementary school classes, helping him to adjust to the curriculum and language. At night she sat at her computer upwards of eight hours on Skype conference calls with fellow members of the Iraq Stock Exchange board.

Then on April 23, 2015, she began work with epidemiologist Amy Sullivan.

“It’s kind of the starting of a new life,” Hassan said.

For Sullivan’s part, she felt flummoxed at Hassan’s unemployment. “It reminds me of that old ad, ‘A mind is a terrible thing to waste,’” Sullivan said. “She had been in such a remarkable position of leadership. She was so technically overqualified for the jobs she was offered… She listens and interprets ideas, moving them out of the idea realm.”

Sullivan paused and shook her head. “She’s masterful.”

After working with Hassan on two modeling projects, Sullivan asked her this spring to help develop a better way to analyze communicable disease data. Most of the team who worked with Hassan knew nothing of her past.

“She’s super smart,” said Michael Hanna, Enterprise Data and Analytics Team lead for Multnomah County Information Technology. He didn’t know Hassan when they sat down to discuss visualizations and analysis. But Hassan mentioned offhand that she knew the programming language they would need to transfer data from the clunky state system to a new local system.

And the idea of having a technical expert embedded with the subject experts appealed to Hanna.

“She sits with that team. She finds out what they need. We know the technical stuff but we don’t know the day-to-day,” Hanna said. “Typically we go out, we interview them, then we come back and do our thing, then go and get feedback. The one thing that’s different is Rwayda. It’s a great model.”

For lead epidemiologist Taylor Pinsent, working with Hassan prompted her to be curious about the temporary workers who pass through the Health Department.

“You just don’t realize where people come from. It’s a good reminder, when someone new comes, to check in with them,” she said. “Rwayda was at the top of her career. I don’t know how I could give everything up if I worked so hard to get there.”

Everything has changed

Hassan gave up her job at Al-Nahrain University, and her position with the Iraq Stock Exchange. She used to tell herself, “After I get my green card, I will go back to my university. I will go back to my life. I will go back to my regular life.”

“But everything has changed,” she said. “When I see the kids, they are safe. The education here is very, very good compared to my country.” Her son, who struggled initially, seems to have blossomed in class. His teacher calls him a good worker. She says he’s smart. Both kids, her son, 12, and her daughter, 7, have been awarded “student of the month” at their schools.

Dr. Rwayda Hassan says she's staying for her children, who are happy and safe in the United States.

Earlier this year the Hassans sold their house in Baghdad, their cars, and their furniture, and bought a modest ranch-style home in Portland’s northeast Parkrose neighborhood. The living room is decorated in beige, just the way Hassan likes it, with three soft couches for guests. Her kids have their own rooms. And Hassan has a spacious kitchen where she cooks big meals. On a recent Tuesday her younger sister Rana, who worked in international law before immigrating two years ago, spent three hours preparing dolma. They stuffed eggplants, tomatoes and onions with rice, cilantro, garlic and meat, and wrapped more stuffing inside fresh grape leaves from their parents’ garden.

Hassan’s husband Kadhum played the role of sous chef between his classes in programming at Portland Community College. He knows the material, but needs a certificate, hoping that might help him land a job. Hassan will continue to focus on the disease database at Multnomah County although she worries about the coming fall, when she’ll finishes her health department project and be out of work again. 

She worries it may be a challenge to break into a technology industry without professional connections. For now she works late into the night.

“Amy sometimes tells me, ‘Just don’t take your work home.’” Hassan said with a grin. “And I say, ‘No. I must do that. We have a lot to do.’”