USNS Comfort Mission

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USNS Comfort Mission

• Presentation by
• Christopher P. Brady, P.E.
• CAPT U.S. Public Health Service
• Indian Health Service, Sacramento, CA
• 20 March 2008
• U.S. Navy Preventive Medicine Conference

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USNS Comfort Mission

• Environmental Engineering
• with the
• Preventive Medicine Team
• Humanitarian Assistance Mission
• Latin America and the Caribbean
• June October 2007

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Presentation Objectives

• Overviews of
• U.S. Public Health Service (PHS) and Indian
  Health Service (IHS)
• Host country water and sanitation situation
• Environmental engineering role
• Activities and experiences in host countries
• Lessons learned

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U.S. Public Health Service

• Lead public health organization in the U.S.
• Over 200 years of service
• Under the Department of Health and Human Services
  (HHS)
• More than 6,000 Commissioned Corps Officers
• Includes 450 Engineer Officers

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U.S. Public Health Service

• PHS Environmental Engineer Commissioned Officers
  serve in agencies including
• Indian Health Service (IHS)
• Food and Drug Administration (FDA)
• Center for Disease Control and Prevention (CDC)
• National Institute of Health (NIH)
• Agency for Toxic Substances and Disease Registry
  (ATSDR)
• Environmental Protection Agency (EPA)
• National Park Service (NPS)

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Indian Health Service

• Majority of the Engineer Officers serve in IHS
• The mission of the IHS is to raise the health
  status of the American Indians
• IHS Engineers support this mission by providing
  technical assistance for the development of water
  and sewer systems
• IHS Engineers perform
• Surveys to identify sanitation deficiencies
• Develop projects to correct deficiencies
• Design and inspect water and sewer projects
• Trainings
• Assist Tribes during emergencies

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IHS Engineers
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IHS Engineers
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PHS Teams

• PHS Office of Force Readiness and Deployment
  (OFRD) deployed teams of Commissioned Officers on
  the USNS Comfort
• Four PHS Teams deployed for 1 month each
• PHS environmental engineers deployed on three
  teams
• Deployed PHS Engineer Officers include
• CAPT Christopher Brady (IHS) Team 1
• CAPT Philip Rapp (IHS) Team 3
• CDR Leonila Hanley (EPA) Team 4

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USNS Comfort PHS Team 1
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Host Country Water and Sanitation Indicators
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Water and Sanitation Indicators

• Latin America and Caribbean host country regions
• Central America
• Andean Area
• Latin Caribbean
• Non-Latin Caribbean
• Data from the WHO and UNICEF water and sanitation
  sector monitoring
• Relative perspective of water and sanitation
  coverage
• Developed regions 98
• Sub-Saharan Africa 58-36

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Access to Water Supply

• Includes
• Household connection (urban areas)
• Public standpipe (rural areas)
• Protected dug well or spring (rural areas)
• Does not include
• Unprotected well or spring
• Rivers or ponds
• Access to water does not preclude water quality
  issues from unsafe transportation and storage

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Access to Sanitation

• Includes
• Connection to public sewer (urban areas)
• Connection to septic system (rural areas)
• Simple/improved pit latrine (rural areas)
• Does not include
• Bucket latrines
• Open pit latrines

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Central America
Belize El Salvador Guatemala                      
                                                  
              
Nicaragua Panama                                  
                                                  
  
                                                  
                                          
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Central America

• Water supply and sanitation coverage (average)
• Total water supply 81
• Total sanitation 77
• Nicaragua rural water supply coverage 59
• Belize rural sanitation coverage 21
• Diarrhea is one of the main diseases children
  under 5 years of age most severely affected

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Andean Area
Colombia Ecuador Peru                             
                                                  
      
                                                  
                                          
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Andean Area

• Water supply and sanitation coverage (average)
• Total water supply 79
• Total sanitation 73
• Ecuador and Peru rural water supply coverage 51
• Ecuador rural sanitation coverage 37
• Diarrhea is one of the main causes of ambulatory
  care and cases have increased by 40 (1990-2003)

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Latin Caribbean
Haiti                                           
                                           
                                                  
                                          
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Latin Caribbean

• Water supply and sanitation coverage (average)
• Total water supply 46
• Total sanitation 28
• Haiti rural water supply coverage 45
• Haiti rural sanitation coverage 16
• Acute diarrheal diseases is the number one health
  problem in children

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Non-Latin Caribbean
Guyana Suriname Trinidad and Tobago               
                                                  
                  
                                                  
                                          
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Non-Latin Caribbean

• Water supply and sanitation coverage (average)
• Total water supply 91
• Total sanitation 86
• Guyana rural water supply coverage 83
• Guyana rural sanitation coverage 60
• Diarrheal diseases are not a significant health
  problem however water supply quality issues

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Environmental Engineering On Ship
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Environmental Engineer Role

• PHS Engineer Officers assigned to Preventive
  Medicine Operations
• Team approach working Preventive Med personnel
  (Entomology and Environmental Health) and Seabee
  teams
• Assisted in planning activities
• Identifying metrics for engineering
• Developing training and technical information
• Reviewing the Pre-Deployment Site Survey (PDSS)
  for each host country

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Metrics Environmental Engineering

• Assessments/Technical Assistance
• Drinking water systems
• Sanitation/wastewater systems
• Training
• Water quality and treatment
• Household water storage and treatment
• Sanitation collection and treatment

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Technical and Training Information

• Located and developed technical information for
• Assessments
• Water and sanitation survey form
• Training material
• Water quality and treatment
• Household water storage and treatment
• Backflow prevention and cross-connection control
• Hygiene and food preparation trainings prepared
  by EHO

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Technical References

• Environmental engineering technical references
  used on the mission include the following
• Guidelines for drinking water quality (WHO)
• Environmental health in emergencies and disasters
  (WHO)
• Engineering in emergencies (ITDG)
• Environmental engineering and sanitation
  (Salvato)
• Websites
• WHO Water Sanitation and Health
• UNICEF Water, environment and sanitation

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Mission Planning Activities
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Pre-Deployment Site Survey (PDSS)

• Primary focus of PDSS was recommendations and
  services at health clinics and schools
• Of the sites listed (3-5) for each host country,
  determined which one was the best match for
  engineering needs
• Once on site, address needs identified in the
  PDSS and then provide additional services
  (assessments, technical assistance, trainings) in
  coordination with host country officials and USN
  command

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Pre-Deployment Site Survey (PDSS)

• PDSS report factors for best match
• Main health issues include gastrointestinal
  diseases related to water, sanitation, and
  food-borne
• Deploy PHS environmental health officer and
  engineer to assess and provide recommendations
• Local water is said to be chlorinated however
  significant problems with water-borne diseases

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Underway to Host Country
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Host Country Sites

• Belize Valley of Peace
• UN settlement for refugees from El Salvador and
  Guatemala
• Guatemala Livingston
• Health clinic and village water systems
• Panama Colon
• Health clinic and city water system
• Colombia
• Elementary school and health clinic
• Haiti
• Health clinic

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Environmental Engineering - On Shore

• Primary focus and activities were assessments,
  technical assistance, recommendations, and
  trainings for
• Health clinic drinking water and sewer systems
• Elementary school drinking water system
• Community drinking water and sewer systems
• Household water storage and treatment
• Water system cross-connections
• Forming partnerships with host country local
  public health officials

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Partnerships with Host Country
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Water Sources Findings

• Water sources springs, rivers, shallow wells,
  and rain water catchment
• Surface water (rivers) with varying levels of
  turbidity
• Springs and wells with limited source water
  protection
• Down gradient of septic systems
• Less than 30 feet from septic systems
• Subject to surface run-off from streets

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Water Treatment Findings

• Water treatment storage and disinfection with
  chlorine
• Preliminary treatment of surface water (rivers)
  by storage to help settle out the suspended
  solids
• Disinfection
• Several water sources with no disinfection
  systems
• Disinfection systems but only intermittently
  fully operational
• Lack of consistent chlorine residual

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Water Sources and Treatment Recommendations

• Recommendations and strategies presented include
• Water source protection
• Abandonment of septic system
• Sealing catchment tanks and piping from surface
  water intrusion
• Water treatment
• Location of disinfection systems
• Chlorine dosage increasing chlorination during
  periods of higher turbidity

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Water Source Assessments
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Water Source Assessments
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Water Leaks and Cross-Connections Findings and
Recommendations

• Urban water systems (City of Colon, Panama)
• Significant loss of water from leaks
• Significant surfacing wastewater from sewer line
  leaks
• Combination of water and sewer leaks created
  habitat for mosquitoes dengue fever and malaria
• High potential for cross-connections
• Presented strategies on prioritizing resources
  for leak repairs and conducted trainings on
  cross-connections

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Water and Sewer Leak Investigations
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Typical Water Service Lines
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Health Clinic Water and Sanitation Activities

• Identified and made recommendations to address
  water hammer issues
• Teamed with Seabees from Construction Battalion
  Maintenance Unit (CBMU) in the construction of a
  new health clinic
• Water catchment and supply system
• Drain and waste piping
• Teamed with Seabees in the renovation of an
  existing health clinic
• Storage reservoir, pressure system, and plumbing
  water restored to the facility for the first
  time in 3 years

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New Health Clinic Construction - Water and Sewer
Facilities
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Water and Sanitation Trainings

• Trainings provided to
• Elementary school children grades 4th 6th
• Ministerio de Salud Publica staff
• College students in Colombia
• Host country populations at clinics
• Local water boards
• Training and material developed for each audience
  and provided in English, Spanish, and indigenous
  language Mayan (Qeqchi) in Guatemala

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Trainings Elementary Schools
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Trainings - Ministerio de Salud, Panama
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Training Cross-connections
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Lessons Learned Future Missions

• Provide specific focus on environmental health
  and engineering needs during the development of
  the Pre-Deployment Site Survey (PDSS)
• Identify environmental engineering needs in the
  village or community as well as at the health
  clinic and school
• Consider high-impact community engineering
  projects with Seabee teams, which could include
• Water source protection measures
• Water treatment filtration systems
• Disinfection facilities for the community water
  systems

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Lessons Learned Future Missions

• May need additional time at each site challenge
  to complete major tasks and projects in 4 6
  days with long transportation times from ship to
  shore/site
• Prior to departure
• Coordination/planning between the PHS and USN
  Preventive Med Teams
• Review PDSS for planning purposes
• Achieved highly effective partnership between the
  USN and PHS that resulted in many accomplishments
  and hopefully set a foundation for future
  missions

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USNS Comfort
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Preventive Medicine Multi-Service Team Effort
USN, PHS, USA, and USAF
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USNS Comfort Mission