Mentoring About Vector-borne Disease Control

Mentoring About Vector-borne Disease Control

D Scott Smith, MD, MSC, DTM&H

Fall 2010 - Volume 14 Number 3

After the earthquake struck Haiti's most populous area in and around Port-au-Prince, and just before the rainy season started, several Kaiser Permanente (KP) physicians moved in to coordinate the medical arm of the Malaria Emergency Technical Operational Response (MENTOR) program. Traditionally, MENTOR has focused on malaria in war zones and after major natural disasters. Several KP physicians initially worked with this French Nongovernmental Organization (NGO) after the 2004 earthquake and tsunami in the Indian Ocean on the Island of Sumatra in Indonesia. These physicians shared shifts for several months assisting in the rebuilding with a focus on vector-borne disease reduction and control. Since then, they have assisted MENTOR in other natural disasters. After the 2008 Cyclone Nagris in Myanmar, MENTOR implemented programs for not only malaria but also for other vector-borne diseases, such as dengue. Between those disasters, KP physicians have also worked as trainers for MENTOR workshops on clinical program management of malaria and other vector-borne diseases in such places as Uganda, Kenya and Japan and even New York and Mill Valley, CA.

Mentoring About Vector-borne Disease Control

Haiti's earthquake was the sixth deadliest natural disaster in recorded history (ranking just after the 2004 tsunami) and is estimated to have killed 230,000 people. Importantly, this event displaced over one million people, leading to large scale movements and increasing risks of insect-borne diseases. This risk is amplified by three factors: exposure, migrations, and infrastructure disruption. In Haiti, the population has increased exposure as they are now living in densely populated tent camps with little between them and the elements. Rainy season starts in April and vectors burgeon. Second, when people move from areas of low endemicity to areas where disease rates are high, there are more susceptible people at risk. This also works in reverse to the disadvantage of a population when individuals who are infected move into zones that have no disease but the mosquito vectors are established and can spread the disease into the nonimmune and previously unaffected majority population. The third risk element is simply the disruption of public health systems that can coordinate the prevention of disease. The public health system was arguably underfunded and ineffective before the earthquake as the deadly Plasmodium falciparum and mosquito-borne parasitic disease, lymphatic filariasis continued to thrive in Haiti, one of the few places in the Americas it is still observed.

The KP-MENTOR initiative focuses on clinical trainings, vector assessments and control using indoor residual spraying and larviciding. We coordinate with the health sectors of many of the 391 registered health NGOs in Haiti to build capacity around vector-born disease recognition, diagnosis, and treatment. We collaborate with the Ministry of Public Health and Population to promote guidelines and develop strategy for managing these often silently persistent diseases that put a major drag on human comfort and progress.

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