Kathryn Barbara LT, MSC, USN Navy Entomology Center of Excellence Environmental Health Site Assessments in Southeast Asia USNS MERCY (T-AH 19) 2006 Humanitarian Assistance Deployment Kathryn Barbara LT, MSC, USN Navy Entomology Center of Excellence Jacksonville, FL

MERCY Deployment May – September 2006 Chittagong, Bangladesh Jolo, RP Tawi Tawi, RP Zamboanga, RP Chittagong, Bangladesh http://www.cpf.navy.mil Simeulue Island, ID Nias Island, ID Dili, Timor Leste Banda Aceh, ID Kupang, ID Tarakan, ID

USNS MERCY (T-AH 19) Public 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-6 Vector 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 identification, surveillance, control to host nationals.

Common Encounters Filth Flies Mosquitoes Force Health Protection Improper Waste Management Accumulation Disposal Hazardous Waste Mosquitoes Larvae Adults Force Health Protection

Waste Management Trash accumulation

Waste Management Trash maintenance Burning Burying

Waste Management Biological Waste Disposal

Waste Management Biological Waste Disposal

Waste Management Trash disposal techniques Patients and staff are often not educated in proper disposal practices

Waste Management Hazardous Material Disposal

Filth Fly Management Our Contribution Provided temporary control Methomyl (Blue Streak) Nithiazinine (Quick Strike) Sticky fly paper

Filth Fly Management Our Contribution Suggested ways to improve solid waste management

Mosquitoes Larvae Adults 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

Mosquitoes Common Issues throughout deployment area: Rain water collection artificial containers often used for drinking or wash water

Mosquitoes Common Issues throughout deployment area: Rain water collection artificial containers often used for drinking water Open sewer systems Culex spp.

Mosquitoes Common Issues throughout deployment area: Rain water collection artificial containers often used for drinking water Open sewer systems Open or unsecured septic tanks

Mosquitoes 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

Mosquitoes 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

Mosquitoes Adults Limited surveillance conducted

Mosquitoes Adults Limited surveillance conducted Landing rates not conducted (often unable to RON) www.collier-mosquito.org/factsheet.asp

Mosquitoes 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 Management Our 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 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 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 Activities Development and distribution of educational pamphlets and posters

Training Activities Udana School of Public Health Students Kupang, Indonesia IOM Public Health Physicians Banda Aceh, Indonesia Chittagong Sanitarians Chittagong, Bangladesh

Overall Effectiveness/Lessons 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 Effectiveness/Lessons Learned 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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