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

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

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

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.

Common EncountersCommon Encounters• Filth Flies

– Improper Waste Management• Accumulation• Disposal• Hazardous Waste

• Mosquitoes– Larvae – Adults

• Force Health Protection

• Trash accumulation

Waste ManagementWaste Management

• Trash maintenance• Burning• Burying

Waste ManagementWaste Management

• Biological Waste Disposal

Waste ManagementWaste Management

• Biological Waste Disposal

Waste ManagementWaste Management

• Trash disposal techniques• Patients and staff are often not educated in proper

disposal practices

Waste ManagementWaste Management

Waste ManagementWaste Management• Hazardous Material Disposal

Filth Fly ManagementFilth Fly ManagementOur ContributionOur Contribution

• Provided temporary control– Methomyl (Blue Streak)– Nithiazinine (Quick Strike)– Sticky fly paper

Filth Fly ManagementFilth Fly ManagementOur ContributionOur Contribution

• Suggested ways to improve solid waste management

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

MosquitoesMosquitoes• Common Issues throughout deployment

area:– Rain water collection

• artificial containers• often used for drinking or wash water

MosquitoesMosquitoes• Common Issues throughout deployment

area:– Rain water collection

• artificial containers• often used for drinking water

– Open sewer systems• Culex spp.

MosquitoesMosquitoes• Common Issues throughout deployment

area:– Rain water collection

• artificial containers• often used for drinking water

– Open sewer systems

– Open or unsecured septic tanks

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

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

MosquitoesMosquitoes

• Adults– Limited surveillance conducted

MosquitoesMosquitoes

• Adults– Limited surveillance conducted– Landing rates not conducted (often unable to

RON)

www.collier-mosquito.org/factsheet.asp

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

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

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

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

Training ActivitiesTraining Activities

• Development and distribution of educational pamphlets and posters

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

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.

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.

http://www.cpf.navy.mil

Thank Thank YouYou