From tuberculosis to Ebola, Dr. Sayone Thihalolipavan, San Diego County’s newly appointed public health officer, has plenty of experience treating and tracking infectious diseases. But it is his personal story that most influences his approach to a job that requires him to be both a friendly, approachable medical expert and a quarantine cop.
Born in Nigeria to Sri Lankan parents who fled civil war in their home country, the family sought asylum in Canada after his father, Dr. Thihalolipavan Sayalolipavan, became concerned with corruption in the African nation. As is customary in Sri Lankan culture, the father’s first name becomes the son’s last name.
Arriving in Toronto’s inner city neighborhood, his father found that his medical credentials were not accepted by the establishment, forcing both parents to find whatever work they could.
Finally, by the time Sayone had reached the fourth grade, his father took the U,S. Medical Licensing Examination, ing its three steps for licensure but learning that he would have to re-do his medical residency. A position in pathology moved the whole family, including mother, Ranjini, and brother, Dr. Sudarone Thihalolipavan, to Long Island where dad was eventually able to move back into family medicine, later finding a job in a community clinic near Buffalo, N.Y.
It was not until eighth grade, Sayone Thihalilipavan recalls, that the family’s overall prosperity took an upturn. But the expectations had never changed through this journey.
“My brother and I, we had to be doctors,” he said. “My dad’s a doctor, his dad’s a doctor, so I had to be a doctor.
“There was no other choice.”
A medical doctorate from New York University followed a bachelor’s in biology from Purdue University in Indiana. Columbia University awarded a master’s degree in public health. That credential facilitated a job with the New York Department of Public Health, which led to a wide range of assignments in everything from tobacco control to lead poisoning.
In 2014, he found himself making regular follow-up visits to two of the close s of Dr. Craig Spencer, the Doctors Without Borders physician who unknowingly returned to his home in New York after becoming infected with the Ebola virus during a medical mission in West Africa.
“That was one of the last things I did before I came out to San Diego,” Thihalolipavan recalled. “My job was to visit every day for 21 days, to talk to them and make sure they were OK.”
Because Ebola is not an airborne virus, these visits were not the sort of chilling scene that Hollywood often depicts.
“We’d open the door, I’d look at them and ask a bunch of questions, and then just hang out for a while,” he said. “I wore a disposable mask and a gown, but it wasn’t the full hazmat suit they like to show in movies.”
Time in the room with one of the world’s deadliest viruses surely provides a little grounding as Thihalolipavan assumes a role that will sometimes require him to face down a dozen TV cameras, calmly explaining the latest spreading threat, whether bird, flu, botulism or the next coronavirus variant.
The sheer number of letters in his last name, pronounced THEE-ha-lo-li-pah-vahn, has never been a problem in his decade of local work, first as a deputy public health officer, then as the county’s public health medical officer. Those unsure of the pronunciation tend to go with “Doctor Sayone” or “Doctor T”, monikers he accepts with a certain sense of inevitability.
Thihalolipavan, 42, is the father of three daughters ages one, five and 13, and lives with his partner in San Diego. He took a few minutes out of his schedule this week to discuss his new role. What follows is a condensed set of questions and answers:
Q: Let’s start with the basics. What does a public health officer do? The word officer in your title sounds a little like law enforcement.
A: I do have some regulatory powers or authority. We work, for example, with environmental health to do inspections of restaurants and of custodial settings such as jails, the probation department and youth custody facilities. But, we also have public health powers, including the ability to quarantine individuals and declare public health emergencies if there is an urgent threat. Some of the role is in licensing, for example; we check to see if the county’s retail tobacco ordinance is being met, making sure that products intended only for adults are not being sold to youth. Going beyond those roles, the public health officer is also an ambassador for health in the region. We’re trying to prevent disease, but we’re also trying to promote and protect health.
Q: How has your background, especially as a youngster coming to Canada then New York as part of a family seeking asylum, influenced how you think about the public health officer role?
A: It significantly informs my view because we grew up with very little. I saw how, when you’re working poor, every little economic stressor plays an outsize role, and you just don’t have the luxury of prioritizing your health. When you are experiencing homelessness, you’re not thinking about chronic disease prevention, right? You’re thinking about shelter and food and your immediate needs. We have to figure out how to effectively communicate to people who can’t prioritize health because they have more immediate needs.
Q: Why did you decide to get into public health?
A: Even in high school, with student government and all of that kind of stuff, I was always thinking about what was beyond the individual level, you know, about impacting the system and how you could make those larger systems better. So, when I found out there was this field called public health, that just seemed to follow my natural tendencies. This work is at that systems level where we’re not just issuing birth certificates and death certificates; we’re involved in everything from people being exposed to diseases to helping respond to natural disasters.
Q: Looking forward, what is the biggest public health threat you see on the horizon?
A: I think the biggest concern is the erosion, this loss of trust, we’ve seen in the public health system, and the question is, how do we get back to a place where we can hear the message and all work together and collaborate? In of diseases, you know, there’s measles and there’s bird flu, and we’re keeping a close eye on all of those through advanced surveillance, including detection in wastewater. But, how we effectively communicate on these issues, I think that’s the biggest challenge at this moment.
Q: How does public health regain public trust with so much misinformation and performative outrage going around these days?
A: There’s a quote that I really like that people don’t care what you know until they know that you care. To me, that really symbolizes and embodies how we rebuild that trust by being open and up front. The next time there’s a new disease or something like that, we have to be really clear on what we know and what we don’t know. I think we did a great job of that during the pandemic, but we need to keep building relationships. It goes back to the idea that you don’t want to make friends during an emergency. You want to show people that they can trust you and rely on you long before you need to communicate with them about an emergency. One thing that the county really did well, I think, during the pandemic was acknowledge that we are not always going to be perceived as the trusted voice. We contracted with trusted messengers in the community, and that approach, I think, was really effective.
