1. 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

2. MERCY Deployment May – September 2006 Chittagong, Bangladesh
Jolo, RP
Tawi Tawi, RP
Zamboanga, RP
Chittagong, Bangladesh
Simeulue Island, ID
Nias Island, ID
Dili, Timor Leste
Banda Aceh, ID
Kupang, ID
Tarakan, ID

3. 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

4. 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.

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

6. Waste Management
Trash accumulation

7. Waste Management
Trash maintenance
Burning
Burying

8. Waste Management
Biological Waste Disposal

9. Waste Management
Biological Waste Disposal

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

11. Waste Management
Hazardous Material Disposal

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

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

14. 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

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

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

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

18. 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

19. 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

20. Mosquitoes
Adults
Limited surveillance conducted

21. Mosquitoes Adults Limited surveillance conducted
Landing rates not conducted (often unable to RON)

22. 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

23. 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

24. 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

25. Training Activities Classes were didactic and/or hands on
Class sizes ranged from students
Topics included:
Mosquito biology, identification, and control
Country specific disease and vector information
Integrated pest management
Non-chemical pest management

26. Training Activities
Development and distribution of educational pamphlets and posters

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

28. 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.

29. 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.

30.
Thank You