I was a bit nervous about moving up to Ann Arbor - it's a small college town in the middle of farm country, and it didn't have any of the natural attractions that I've gotten used to, like mountains or a place to dive.  This weekend, my fears were alleviated upon discovering a great Midwestern tradition - cider and doughnuts.  Being in the middle of farm country has it's advantages.  The first of these is that Ann Arbor is surrounded by small, former farming towns with old(ish) buildings, main streets, and central parks.  Dexter is a great example of one of these towns.  It's about 10 miles away and it has a downtown with a few unique coffee shops, bars, and restaurants, but the main draw is the Dexter Cider Mill.  It's the oldest cider mill in Michigan, and if the crowd yesterday was any indication, it's still doing a pretty brisk business.

Luckily, the mill has managed to keep a nice feel about it - you can watch every part of the cider-making process and then purchase a surprising array of apple-related products (apple bread with apple butter and cheese anyone?), but the cider itself and the fresh cinnamon-sugar doughnuts are clearly the main draw.  Once you purchase your cider and doughnuts, you can walk a few feet down and eat/drink them along the Huron River (much shallower than I thought that it would be).  Sadly, the cider mill is only open for part of the year, so I'll have to get as much out of it while I still can. 

One of the things that I really like about public health is it's broad scope:  sometimes it seems that pretty much everything has some impact on health.  While these influences may be non-intuitive, their effect on health can be huge.  Climate change is a good example.  Whatever your thoughts on the subject, global temperatures and weather patterns are changing at an especially rapid pace, and this change is likely to cause a lot of problems.  The Center for Global Health here at the University of Michigan hosted a nice talk today by Howard Hu about some of climate change's possible ramifications.  His research focuses on environmental health, specifically air quality, so the presentation was a bit heavy on the negative effects of fine (2.5 micron!) particles produced by burning fossil fuels (it's bad, when the atmospheric concentration gets too high, risk of heart disease increases significantly).  However, he also talked about how climate change will change a lot of the factors that we take for granted - especially that certain "tropical" diseases, like Dengue Fever and Malaria will stay in the tropics. 

The diseases that he focused were those that are spread by mosquitoes.  If the earth warms, we expect that there will be many more warm low-lying swampy areas, and these regions provide mosquitoes with an ideal habitat.  In Africa, malaria is the single largest cause of death in children under 5. More than 110 million people are currently at risk of acquiring malaria, and based on some conservative projections (it should be stressed that "projection" does not mean "this is guaranteed to happen") up to 500 million people could be at risk in the near future.  Perhaps most frighteningly (for us in the US anyways) is that the American South and Northern Europe, especially along the Baltic coast, are predicted as likely habitats.

It's not just patterns of malaria incidence that will be changed; a very nice recent study by Danovaro et al. in PLoS ONE determined that changing patterns in the distribution of marine snow in the Mediterranean could act as a vector for spreading bacterial pathogens.  Who knew that public health might lead you to study microscopic marine algae?  It's been known for quite some time that climate impacts health - the environment is one of the three key features in the classical "epidemiologic triad", but the recognition that changing climate patterns (which also occurs naturally) can have far-reaching consequences on health is new and has opened up a whole new field (literally) and possibilities for transdisciplinary research.

Summer camp officially ended Tuesday, and I kicked off the new school year in style - Biostatistics at 8AM, followed by five hours of class, a quick break for lunch/reading, and then another hour and a half.  While it sounds slightly terrible, I love most (still undecided about one...) of my classes - it's just about what I thought that it would be, and my professors get just as excited as I do about odd things, such as vector-borne diseases and the philosophy of science.  Most of my classes are pretty big (for me at least, I'm used to about 30 per class), so I'm moderately nervous about that.  But each of the core classes for me (epidemiology and biostatistics) have much smaller (about 20) lab and discussion sections, so that should make learning closer to what I'm used to.

The reading is moderately intense (about 300 pages a week) but nothing too bad, all things considered.  Overall, my schedule is pretty light - on MWF I've only got an hour of class, so getting work done shouldn't be a problem.  Since I've got all of this free time, I started to look into possible research projects for this summer and am having quite a hard time deciding between them.  Right now the winners are Hantavirus Pulmonary Syndrome (HPS) in SE Asia, viral etiology of tumor formation focusing on HPV in Tanzania, or how chronic parasite infection affects overall health and relates to incidence of other diseases in sub-saharan Africa (sounds fancy, but it's really just a way of saying that I'm not sure where or what exactly I want to do yet).

Trying to find a research group is harder than I expected - epidemiology doesn't have as many "wet labs" (places where I can do MoBio), and unless you have a very specific study in mind, getting funding is also difficult.  To develop these studies, I'll be stuck reading lots (and lots) of papers, dissertations, and grant proposals - which is very nice in that I now have a much better perspective on what it is that I'll actually be doing here. 

Ann Arbor is a nice college town - kind of like Marburg but without a castle on a hill and (lots) more bars.  The graduate students are pretty separate from the undergrads, so the class dynamics are much nicer - everyone is just there to learn and no one wastes time asking if things will be on the test.  So now I'm hoping that the workload stays pretty manageable and looking forward to a very interesting first term.

Since classes haven't started yet and my fellow students and I are, for all practical purposes, essentially at summer camp for the next few days, we decided to explore the area around Ann Arbor.  Our main requirement was that we find somewhere that we could swim (not as hard as we'd thought, MI is full of lakes) and that it be within an hour's distance.  Pickney Park (the name is ridiculous) fit the bill nicely.  It's a State Recreation Area about 30 minutes Northwest of Ann Arbor, and contains about a dozen lakes, two of which allow swimming (it's possible in the rest, but these are rather marshy).  So off we went, passing some quaint little towns and a pumpkin donut/cider stand (this will warrant further investigation) along the way.  The weather cooperated, and at the lake we just hung around, played cards, frisbee (poorly), and soccer (also poorly) - nothing terribly exciting.  All in all, it made for a pleasant day and a nice introduction to the area before winter destroys me. 

Following two days of orientation (nothing too fancy and mostly involving sitting in large rooms with large groups of people), the School of Public Health gave us the opportunity to take a "practice plunge", which involved a visit to the Detroit Department of Public Health and then some volunteer work with The Greening of Detroit.  The experience was a good one - although I'm a public health student I still don't know what happens on a day-to-day basis at a health department - and the sheer scale and scope of the public health department was shocking.  With over 550 employees, the Detroit Public Health Department is responsible for the health and wellness of Detroit's 900,000 citizens - and "health and wellness" spans a large area.  The department's interests range from providing immunizations to animal control (rabies prevention), with community outreach and education programs, free clinics, and drug abuse prevention thrown in for good measure.   This spectrum of activities requires an equally broad workforce, and the department employs physicians, epidemiologists (we were offered a part-time job until they realized we didn't actually know anything yet...), and social workers.  Sadly, the economy has forced the department to make dramatic budget cuts (they used to have 800 employees), which makes it very difficult to provide these necessary services to an underserved population.

The second part of our day, working on a community garden, was eye-opening.  Detroit is a dying city.  It has approximately one-half of it's peak population, and there are districts which abound with abandoned houses and empty lots.  One (very idealistic) urban planning proposal wants to rebuild these vacant lots as community farms, and consolidate Detroit into a collection of "villages", each surrounded by (at least something approaching) farmland, modeled on (no, I'm not making this up) the English countryside.  Although this grand project might not be feasible, the progress that they have made has already produced some benefits, in that they've turned an empty lot into a 26-acre park with a playground, soccer fields, and a community garden (I spent the afternoon mulching and trenching this...), and picnic tables.  From what I could tell, the families in the area use the park frequently, and they enjoy it.  Since it is a community projects, the locals came out to help as well, and this sense of community ownership keeps it pretty well maintained.  Interestingly, these gardens connect to public health by providing a source of fruit and vegetables (like most low-income areas, fast-food restaurants outnumber grocery stores) and they have been shown to make the community safer.