Kathryn Barbara LT, MSC, USN

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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
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MERCY DeploymentMay September 2006
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
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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

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FDPMU-6Vector 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.

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Common Encounters

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

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Waste Management

• Trash accumulation

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Waste Management

• Trash maintenance
• Burning
• Burying

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Waste Management

• Biological Waste Disposal

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Waste Management

• Biological Waste Disposal

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Waste Management

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

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Waste Management

• Hazardous Material Disposal

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Filth Fly ManagementOur Contribution

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

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Filth Fly ManagementOur Contribution

• Suggested ways to improve solid waste management

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Mosquitoes

• 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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Mosquitoes

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

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Mosquitoes

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

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Mosquitoes

• 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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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

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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

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Mosquitoes

• Adults
• Limited surveillance conducted

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Mosquitoes

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

www.collier-mosquito.org/factsheet.asp
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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

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Mosquito ManagementOur 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 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 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 Activities

• Development and distribution of educational
  pamphlets and posters

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Training Activities
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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.

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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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Thank You