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Kathryn Barbara LT, MSC, USNKathryn Barbara LT, MSC, USN
Navy Entomology Center of ExcellenceNavy Entomology Center of Excellence
Jacksonville, FLJacksonville, FL
Environmental Environmental Health Site Health Site
Assessments in Assessments in Southeast Asia Southeast Asia
USNS MERCY (T-AH 19) 2006 USNS MERCY (T-AH 19) 2006 Humanitarian Assistance Humanitarian Assistance
DeploymentDeployment
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Tawi Tawi, RP
Nias Island, ID
Tarakan, ID
Dili, Timor Leste
Chittagong, Bangladesh
Jolo, RP
Zamboanga, RP
Kupang, IDBanda Aceh, ID
Simeulue Island, ID
MERCY DeploymentMERCY DeploymentMay – September 2006May – September 2006
http://www.cpf.navy.mil
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USNS MERCY (T-AH 19) USNS MERCY (T-AH 19) Public Health CellPublic Health Cell
U.S. Navy:Forward Deployed Preventive
Medicine Unit (FDPMU)• 1 Public Health Physician• 1 Microbiologist• 1 Industrial Health Officer• 1 Environmental Health
Officers• 1 Entomologist• 1 Biological Technician• 6 Preventive Medicine
Technicians
U.S. Public Health Service:• 2 Primary Care Physicians• 2 Civil Engineers• 2 Environmental Health
Officers
U.S. Air Force:• 2 Public Health Officers• 4 Physical Health
Journeymen
U.S. Army:• 1 Veterinarian• 2 Veterinarian Techs
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FDPMU-6FDPMU-6Vector Component MissionVector Component Mission
• Conduct Environmental Health Site Assessments (EHSAs) on hospital grounds.
• Provide vector surveillance and control to host nation (when possible).
• Provide training and education in vector Provide training and education in vector identification, surveillance, control to identification, surveillance, control to host nationals.host nationals.
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Common EncountersCommon Encounters• Filth Flies
– Improper Waste Management• Accumulation• Disposal• Hazardous Waste
• Mosquitoes– Larvae – Adults
• Force Health Protection
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• Trash accumulation
Waste ManagementWaste Management
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• Trash maintenance• Burning• Burying
Waste ManagementWaste Management
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• Biological Waste Disposal
Waste ManagementWaste Management
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• Biological Waste Disposal
Waste ManagementWaste Management
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• Trash disposal techniques• Patients and staff are often not educated in proper
disposal practices
Waste ManagementWaste Management
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Waste ManagementWaste Management• Hazardous Material Disposal
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Filth Fly ManagementFilth Fly ManagementOur ContributionOur Contribution
• Provided temporary control– Methomyl (Blue Streak)– Nithiazinine (Quick Strike)– Sticky fly paper
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Filth Fly ManagementFilth Fly ManagementOur ContributionOur Contribution
• Suggested ways to improve solid waste management
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MosquitoesMosquitoes• Larvae
– Standing water common (commonly septic water)
– Artificial containers– Open sewers and septic tanks
• Adults– Limited surveillance conducted– Landing rates not conducted (inability to RON)– Interviews often revealed common disease
vectors
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MosquitoesMosquitoes• Common Issues throughout deployment
area:– Rain water collection
• artificial containers• often used for drinking or wash water
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MosquitoesMosquitoes• Common Issues throughout deployment
area:– Rain water collection
• artificial containers• often used for drinking water
– Open sewer systems• Culex spp.
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MosquitoesMosquitoes• Common Issues throughout deployment
area:– Rain water collection
• artificial containers• often used for drinking water
– Open sewer systems
– Open or unsecured septic tanks
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MosquitoesMosquitoes• Common Issues throughout deployment
area:– Rain water collection
• artificial containers• often used for drinking water
– Open sewer systems• Culex spp.
– Open or unsecured septic tanks
– “Indonesian Style” toilets/
mandi
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MosquitoesMosquitoes• Common Issues throughout deployment area:
– Rain water collection • artificial containers• often used for drinking water
– Open sewer systems• Culex spp.
– Open or unsecured septic tanks
– “Indonesian Style” toilets
– Open windows or doors
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MosquitoesMosquitoes
• Adults– Limited surveillance conducted
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MosquitoesMosquitoes
• Adults– Limited surveillance conducted– Landing rates not conducted (often unable to
RON)
www.collier-mosquito.org/factsheet.asp
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MosquitoesMosquitoes
• Adults– Limited surveillance conducted– Landing rates not conducted (inability to RON)– Interviews often revealed prevalent disease
vectors• Unable to leave secured area around hospital due
to force protection concerns
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Mosquito ManagementMosquito ManagementOur ContributionOur Contribution
• Larval insecticide applications
• No adult applications (inability to RON)
• Donations of larval and adult insecticides compatible with host nation equipment
• Advice on IPM techniques and equipment maintenance
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Training ActivitiesTraining Activities
• Requested at nearly every location
• The most valuable product delivered to the countries visited
• Audiences consisted of:• Physicians, nurses, mid-wives• Medical/ nursing students• Sanitarians/ public health workers• Non-governmental organization members
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Training ActivitiesTraining Activities
• Classes were didactic and/or hands on
• Class sizes ranged from 5-200 students
• Topics included:– Mosquito biology, identification, and control– Country specific disease and vector
information– Integrated pest management– Non-chemical pest management
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Training ActivitiesTraining Activities
• Development and distribution of educational pamphlets and posters
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Training ActivitiesTraining ActivitiesIOM Public Health IOM Public Health
PhysiciansPhysicians
Banda Aceh, IndonesiaBanda Aceh, Indonesia
Udana School of Public Udana School of Public Health StudentsHealth Students
Kupang, IndonesiaKupang, Indonesia
Chittagong SanitariansChittagong Sanitarians
Chittagong, BangladeshChittagong, Bangladesh
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Overall Overall Effectiveness/Lessons Effectiveness/Lessons
Learned Learned • Training of host nation public health personnel
is a high-impact activity for Preventive Medicine as component of humanitarian assistance missions.
• Preventive Medicine team could have been more effective if they had the ability (and security) to asses community efforts.
• Longer duration of visits would be more effective for preventive medicine efforts.
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Overall Overall Effectiveness/Lessons Effectiveness/Lessons
LearnedLearned• Use of the FDPMU equipment set and
personnel is appropriate for HA missions.
• A preventive medicine professional should be a part of the advanced party.
• Remaining overnight is required for effective vector control measures.
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http://www.cpf.navy.mil
Thank Thank YouYou