Student: Andrea Trubody s5048151

Assignment Topic: Going to the field.

Word Count: 1495

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Background to the field setting and Introduction.

The purpose of the operation is to study the recent outbreak of Zika virus in

Montecristi, Ecuador. Planning a field trip to conduct research in unfamiliar cultural

conditions raises challenges of a socioeconomic and logistical nature. In order to

derive a thorough understanding of the health system and the problems it faces in

realms such as service delivery (Diefenbach-Elstob et al n.d.) the daily challenges

faced by the inhabitants need to be observed.

Key Objectives

(1) Stop the spread of Zika in the temporary villages by introducing mosquito

control (see appendix) providing personal insect repellants, disposing of

containers around dwellings that hold water which provide mosquito breeding

grounds, wearing of clothing with long sleeves and pants to prevent mosquito

bites, supervise provision and distribution of mosquito nets and ensuring any

mosquito screens in damaged and non-damaged buildings seal properly

(IAMAT 2016).

(2) Improve sanitation, water supply and mosquito proofing of houses

(3) Establish that there is an outbreak of Zika Virus in Montecristi.

(4) Identify areas in the province which are ‘hot spots’ for populations of

mosquitoes infected with Zika Virus.

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(b) The team will consist of 12 members from both Australia and Ecuador. Skills will

be required in areas of pathology testing to screen for cases of Zika as well as in

mosquito collection and analysis and vector control. Community engagement is

essential to the success of the project to ensure that the wishes and needs of the

community are observed so local health workers especially as translators, research

staff and community nurses should be included in the team. In order to recruit these

individuals community leaders should first be approached. Local community

members should be involved to foster a feeling of trust. (Tulsi Ram Pandey 2008).

The Entomology Research Leader from CIREV should be approached. His experience

in identification of vectors, their ecology/biology and effectiveness of pesticides

would be invaluable. Field assistants from CIREV who have experience in ecological

research would be used to collect and identify mosquito samples to pinpoint breeding

grounds (see appendix 2 for team structure).

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(c)

Setting

Source: Maps of the World 2016

Ecuador is situated in Western South America between Columbia and Peru. It borders

the Pacific Ocean. Manabi province is on the coast near Bahia de Manta (see map). Its

climate is tropical. It has an area of 283,560.0 km2. The 2011 census puts

Montecristi’s population at 70,292 inhabitants (IT1ME 2015). Montecristi

experienced a 7.8 magnitude earthquake on 17 April 2016. The Manabi Province was

hardest hit with over 200 people killed (Ellis et al 2016). According to Smart

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Traveller there is still a state of emergency in six provinces (DFAT 2016). Ecuador

has been classified by the Center for Disease Control and Prevention as an area with

active Zika Virus transmission (2016). Immediately following the quake shelters

housing over 25000 displaced person sprang up. Infrastructure including roads,

healthcare facilities and water supply has been severely impacted. Twenty-four

medical facilities were effected with many ceasing operations due to damage and

personnel shortages. Cases of Zika have increased from 92-1106 since the earthquake

with 80% of cases being recorded in the Manabi Province (UNICEF 2016). Due to the

deteriorating environmental and housing conditions the risk of vector-borne disease

has increased. Politically, the first presidential elections were held in 1979 after years

of military rule. The current President has been in power since 2007 and has spent

heavily in the areas of infrastructure, education and welfare. Funding for these

projects has been backed by oil. Ninety-five percent of the population lists

Catholicism as its religion.

Local Laws and Customs

Casual clothing is acceptable but revealing clothing should not be worn in towns.

When taking photographs it is advisable to first seek permission. Due to drug

problems within the country any drug-related activity is regarded as a serious crime. It

is also a legal requirement for ID to be kept on the person at all times. US currency as

well as Ecuadorian minted coins are the only legal currency, with credit cards and

travellers cheques accepted in the cities.

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Collaborating Institutions

The National institute for Public Health Research (INSPI) (National Institute

for Public Health Research 2016).

- the body has the resources of their network laboratory network

which will be utilized to carry out analysis of biological samples.

(contact: Dr Leopoldo Perez Izquieta)

The INSPI center for research and reference in Vectors (CIREV)(Global

registry of biodiversity repositories (GRbio) 2016).

Required Approvals

Griffith University Ethics Committee

Sponsors providing funding

Stake holders such as the Ministry of Health, Ministry of the Interior, Minister

of Roads and Transport

National police

Local Authorities – province, canton and parish government bodies

Montecristi officials such as the Mayor.

Resources in the field

UNICEF is working with the Ecuadorian government to reestablish sanitation ,water

supplies and also vector control in shelters and temporary villages. IsraAID was

operating a field hospital since late April (Times of Israel 2016). Contact with the

group has revealed that they are keeping on office in Manabi province but have

ceased operating the field hospital (see appendix 3 for full list).

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Operational Plan

The project focusing on the Zika outbreak in areas of both establishing the the

existence and size of the outbreak as well as in prevention. A preliminary timeline

outlining the tasks to be conducted to implement this regime is found in Appendix 7.

OTHER CONSIDERATIONS

Weather

Temperatures in September range between 21-27 C. Rainfall is approximate 5mm for

the month with an average of 1 day with rainfall. The climate is best categorized as

wet equatorial.

Clothing

This should be made from lightweight natural fabrics. Manabi province is not in the

area where warmer clothes are required for cooler climates. Consideration should be

made for rainwear. Boots should be comfortable, swell fitted and should be suited for

trekking and walking on uneven terrain. They should be well broken in and provide

plenty of ankle support.

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Safety & Security

Smart Traveller has a warning of ‘high degree of caution’ for the whole of Ecuador

due to the threat of violent crime including armed robberies and kidnapping (DFAT

2016). There are no warnings in place specifically for the Manabi province. Besides

physical security emergency procedures should also be addressed (OSU 2012)

Protective equipment

The following need to provided

A mobile phone which has global roaming activated/satellite phone

PPE such as protective clothing, mosquito repellent, gloves and protective

equipment, first aid kit, extra water.

Funding/Budget

Funding is be sought from programs such as NHMRC TRIP fellowship or through

organizations such as WTA. (see appendix 6 for a preliminary budget).

Family

The contact details of all team members’ family/emergency contacts and directions to

the closest medical facilities need to be recorded.

Instructions to family members regarding the location of team members wills and last

wishes should also be chronicled.

Insurances

When planning any field research activities insurance is required. The following

needs to be arranged before departure.

Travel insurance – covering flights, accommodation, hire vehicles as well as

medical cover. Insurance has been arranged through 1cover Travel insurance

(for details see Appendix 3).

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Accommodation

The team will be staying at a manta property which is in a ‘quiet and safe’

neighbourhood. It has kitchen, BBQ, and laundry facilities as well as security cameras

for added security. No suitable accommodation within Montecristi was available for

the specified period. Due to the earthquake many houses are still damaged or

destroyed.

Flights/Transport to Montecristi

Six team members will be travelling from Australia. Flights from Brisbane to

Guayaquil airport (Ecuador) have been booked for 6 people. The team will be

travelling American Airlines with two stopovers. Transportation from the airport to

can be done by road (Ministry of Transport and Public Works 2016 ).For the itinery

see Appendix 5.

Entry Requirements/Process

These have to be given great attention as any team members not in possession of the

correct paperwork will be denied entrance. This would have a direct impact upon the

efficiency and efficacy of the team. The requirements are

A passport which is valid for at least an extra six months and must be carried

at all times

A visa is not required as the project is for 30 days and is under the 90 day

exclusion requirement.

A return airline ticket

Upon entry an international embarkation/disembarkation form needs to be

completed. This will be stamped and must be kept with your passport. Both

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need to be presented upon exit from Ecuador. Australian nationals are not

required to obtain transit visas whilst in Ecuador.

Travel Medicine

Vaccinations are required

Diptheria

Hepatitis A

Tetanus

Typhoid

Malaria is required sometimes. It is advisable as there is a moderate to high

transmission risk in the Manubi province.

Proof of Yellow Fever vaccination is sometimes required for anyone over the

age of 12 months who is travelling from infected areas.

Medical facilities are located in urban areas. Drinking bottled water and avoiding

unpasteurized foods is recommended (World Travel Guide 2016). Personal

medications and aids such as Asthma puffers should also be carried.

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REFERENCES

Center for Disease Control and Prevention A (CDC) (2016). All Countries & Territories with Active Zika Virus Transmission. Retrieved from http://www.cdc.gov/zika/geo/active-countries.html

Center for Disease Control and Prevention B (CDC) (2016). Integrated Mosquito Management. Retrieved from https://www.cdc.gov/zika/vector/integrated_mosquito_management.html

Department of foreign Affairs and Trade (DFAT) (2016). Ecuador, Retrieved from < http://smartraveller.gov.au/Countries/americas/south/pages/ecuador.aspx#additional_information>

Diefenbach-Elstob,T., Plummer,D., Dowi,R., Wamagi,S., Bisato,G. Siwaeya,K., Pelowa,D. & Warner,J. (n.d). Fieldwork in isolated locations and under-resourced settings: practical insights from research in the remote Gogodala homelands of Papua New Guinea. 7708MED lecture notes, 17 August 2016.

Ellis,R., Karimi,F., Ansari,A & Gallen,N. (2016, April 18). Ecuador earthquake: Death toll jumps to 272; more than 2,500 injured. [Press release]. Retrieved from http://edition.cnn.com/2016/04/17/americas/ecuador-deadly-earthquake

International Association for Medical assistance to Travellers (IAMAT) (2016). Country Health Advice Ecuador General Health Risks: Zika Virus. Retrieved

from < https://www.iamat.org/country/ecuador/risk/zika-virus>

IT1ME 2015. Montichristi, Ecuador. Retrieved from http://www.it1me.com/learn?s=Montecristi,_Ecuador

Ministery of Transport and Public Works (2016) 100 days after the quake road operation at 100%. Retrieved from < http://www.obraspublicas.gob.ec/accesibilidad>

National Institute for Public Health Research (2016) Quality, Health and Safety,

Environment. Retrieved from < http://www.investigacionsalud.gob.ec/politica-de-calidad-salud-y-seguridad-ambiente>

Office for the Coordination of Humanitarian Affairs (OHCA) (2016) Presencia Operacional en Manabí & Esmeraldas 19 julio 2016 [Image]. Retrieved from https://www.google.com.au/?client=firefox-b-ab#q=Presencia+Operacional+en+Manab%C3%AD+%26+Esmeraldas19+julio+201&gfe_rd=cr

Ohio State University (OSU) (2012) Field Research Safety Information. Retrieved from < https://www.osu.edu/search.html?query=Field+Research+Safety+Information>

Organización Panamericana de la Salud (PAHO) (2016). EARTHQUAKE IN

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ECUADOR Situation Report No. April 4-21, 2016. Retrieved from www.paho.org/disasters/index.php?option=com_docman&task=doc

Pandey, T (2008) Methods of field research: encounter, experiences and strategies in Nepali Villages. Contributions to Nepalese Studies, 35(1). 83-94. Retrieved from < http://go.galegroup.com.libraryproxy.griffith.edu.au/ps/i.do?p=EAIM&u=griffith&id=GALE|A191855922&v=2.1&it=r&sid=summon&userGroup=griffith&authCount=1>

Times of Israel (2016.) Israeli group sets up field hospital in quake-hit Ecuador. Times of Israel. Retrieved from file://localhost/Volumes/GRIFFITH%201/7708MED/Israeli%20group%20sets%20up%20field%20hospital%20in%20quake-hit%20Ecuador%20_%20The%20Times%20of%20Israel.html

UN children’s Fund (2016) UNICEF Ecuador Humanitarian Situation Report No.9, 12 August 2016. Retrieved from < http://reliefweb.int/report/ecuador/unicef-ecuador-humanitarian-situation-report-no9-12-august-2016>

UNICEF (2016, July 18) Twelvefold increase in Zika cases since Ecuador earthquake. [Press release]. Retrieved from http://www.unicef.org/media/media_91912.html

World Travel Guide A (2016) Ecuador Health Care and Vaccinations. Retrieved from < http://www.worldtravelguide.net/ecuador/health>

World Travel Guide B (2016) Ecuador Weather, climate and geography. Retrieved from http://www.worldtravelguide.net/ecuador/weather-climate-geography

World weather Online (2016) Ecuador. Retrieved from http://www.weatheronline.co.uk/Ecuador.htm

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Appendix 1

Program of Mosquito control

Conduct surveillance Remove places where mosquitoes lay eggs Control young and adult mosquitos by the use of chemical fogging Monitor and evaluate control programs.

Complied from information from the CDC (2016)

Appendix 2

Team Format

Phlebotomist – taking of blood tests Epidemiologist x 2 – data analysis and observational studies. Entomologist x 2 – identification of species, confirmation of virus and vector

control Translator Research assistants x 2 – collation of data Nurses x 2 – helping with blood collection and patient relations 2-3 persons to collect mosquito specimens.

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Appendix 3

Travel Insurance Details

The policy provides unlimited coverage for medical expenses including

medical evacuation (as advised by Smart Traveller) (DFAT 2016).

It provides coverage for loss of luggage and personal items.

It also covers the loss/fraud of credit cards and travel documents.

Zika is an exclusion on this and all travel policies due to the travel warnings

issued concerning the transmission status of Ecuador.

Appendix 4

Agencies already in the field.

The following is a list of agencies who have been operating in the field and could be

approached to pool resources.

ldeas Infantiles SOS CISP Danielle Children's Fund DNVIG Education for development Habitat Internacional HIAS OCHA OIM OPS/OMS Oxfam Plan Internacional PMA PNUD Refugee Education Trust UNFPA World Vision

Source: Office for the coordination of humanitarian affairs (OCHA) 2016.

Appendix 5

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Travel Itinery/Arrangements

Departing 1 September. Leaving 29 September.

First Section: 10:00am   to   6:00am   13h

Brisbane (BNE) to Los Angeles (LAX)

American Airlines 7380 operated by Qantas AirwaysEconomy / Coach (M)

layover 2h 40m

Second Section: 8:40am   to   4:54pm   5h 14m

Los Angeles (LAX) to Miami (MIA)

American Airlines 1088Economy / Coach (M)

layover 4h 35m stop 

Third Section : 9:29pm   to   12:57am   4h 28m  

Miami (MIA) to Guayaquil (GYE)

American Airlines 933Economy / Coach (M)

Flights have been booked to Guayaquil due to no flights to closer Airports being available due to runway and buildings maintenance.

Two mid-size all terrain vehicles will be hired until no longer needed to provide

transport to and from sites for staff, luggage and equipment at a total of $2029 per

vehicle (Expedia 2016)

Appendix 6

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Accommodation $10153

Hire vehicles $4058.

Airfares $26449 (return, 6 team members)

Travel Insurance $1000.45

Other* $ 8000

* supplies, incentives, scientific needs.

Appendix 7

Timeline/Activities

Daily

Gathering of mosquito samples from three types of terrain. This will be done daily at

18:00 -21:00 hrs.

Forest/savannah

Agricultural

Village

Week 1-4 (in the field)

Establishment of responsibilities

Prioritizing order of areas to be screened and allocation of personnel to specific areas.

Screening ‘at risk’ populations in these areas

Coordinating of cleaning up temporary settlements and fixing mosquito screening

Distribution of personal repellents and mosquito netting in quadrants 1-4.

Attending to daily mosquito sampling (as above). Taking samples (both pathology

and entomology) to respective processing facilities.

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