Preventive Medicine Team Observations

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Preventive Medicine Team Observations
47TH NAVY OCCUPATIONAL HEALTH PREVENTIVE
MEDICINE CONFERENCE 14 20 March 2008 HAMPTON, VA
CAPT Craig A. Shepherd, RS, MPH, DAAS Chief
Environmental Health Officer, USPHS Centers for
Disease Control and Prevention Atlanta, GA
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USPHS Comfort Team

• 6 Medical Doctors
• 3 Family Practice/ER (DHS, HRSA, IHS)
• 1 Preventive Medicine Physician (CDC)
• 1 Infectious Disease Physician (CDC)
• 1 Internal Medicine Physician (IHS)
• 2 Dentists (DHS, FDA)
• 4 Dental Hygienists (2-BOP, 2-IHS)
• 1 Pharmacist (FDA)
• 1 Veterinarian (EPA)
• 2 Medical/Surgical Nurses (HRSA, OS)
• 1 Environmental Engineer (EPA)
• 1 Environmental Health (DHS)
• 1 Environmental Health (CDC)
• Assigned to PM Team

Team 4
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Preventive Medicine Team

• Composition
• Challenges
• Successes
• Highlights

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Preventive Medicine Team Composition
2- U.S. Air Force Preventive Medicine
Environmental Health Technicians 2 - USN
Environmental Health Officers (includes CAPT
Villanueva, PM Team Leader) 1 USN
Entomologist 1 U.S. Army Veterinarian
Technician 2 USPHS Environmental Health
Officers (including USPHS-OIC) 1 USPHS
Environmental Engineer 1 USPHS Veterinarian 1
USPHS Preventive Medicine Physician
October 9, 2007 (Team 4)
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Challenges

• Representation on PDSS and ACE Teams lacking
• Personnel with PM and EH humanitarian experience
  should be included on PDSS teams to identify PM
  and EH projects. Include an Environmental Health
  Officer or Environmental Engineer who has
  humanitarian assistance experience on PDSSs.
• PDSS No identified projects or specific
  training needs identified for PM team
• Until relatively late into mission no PM team
  representation on ACE
• No or limited contact with middle and top level
  professionals to ID priorities so activities
  could be adequately planned and resourced
• SeaBees good example to go by (representation
  on PDSS and ACE), identified projects and had
  clear mission.

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Challenges

• Initially, leadership was not real receptive to
  having changes made to the manifest that included
  locations outside the confines of established
  clinical setting that clinical providers would be
  seeing patients.
• Many times PM staff did make contact with host
  nation environmental health, veterinarian and
  engineering staff who requested training and
  services of PM personnel outside of the already
  approved provider sites.

Guatemala
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Challenges

• Each new site that requested PM services and
  training (off-site) had to be vetted through and
  approved by the chain of command.
• Before being formally approved each site also had
  to be visited by the Navy Criminal Investigative
  Service (NCIS) personnel to ensure the site(s)
  were safe to provide the requested training and
  services.

Guatemala
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Veterinarian Services a great success!

• Beginning with the country of Nicaragua we gained
  the support to venture outside the clinical
  provider sites and were able to visit several
  large animal farms.
• The NCIS personnel made visits to each of these
  sites before hand and were approved for the
  veterinarian team to visit and work on.

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Nicaragua Veterinarian Services
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Peru Veterinarian Services

• The ability to travel throughout remote and rural
  communities worked extremely well.

El Salvador
Peru
Peru
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Ecuador Veterinarian Services
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Ecuador Veterinarian Services
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Guyana PM Team Success

• ACE CAPT Villanueva, Team Leader PM
• PM team functioned independently and had clear
  mission.
• LCDR Amy Dubois, MD, USPHS, CDC employee assigned
  to Guyana
• Met with Guyana Embassy staff
• PM team met with Minister of Health, Chief
  Medical Services, Chief Environmental Health
  Officer, Chief Veterinarian, and other key staff.
• Minister of Health made four requests
• Review and comment on medical waste proposal to
  World Bank
• Visit the Diamond Grove community water system
  plant
• Visit community open dumps and provide
  recommendations
• Veterinarian make bio-security presentation to
  country veterinarians

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Review and comment on medical waste proposal to
World Bank
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Diamond Grove - Guyana
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L to R LCDR Harrichand Rhambarose, EHO,
USPHS, Guyana Water Plant Engineer, CDR Leonila
Hanley, ENG, USPHS and LT Lawrence Sproul, EHO,
USN
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GUYANA - OPEN DUMP
LCDR Harrichand Rhambarose, USPHS Environmental
Health Officer meeting with Guyanas Chief of
Environmental Health on solid waste issues.
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Biosecurity Presentation- Guyana
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Reporters interviewing LCDR Rhambarose
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Guyana
L to R LCDR Rhambarose, LT Sproul, CDR Hanley,
Guyana Chief EHO, CAPT Shepherd, Kathy Nellis
and Guyana Junior EHO
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PM Training
Belize
Livingston, Guatemala
Livingston, Guatemala
Panama City
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PM Training
El Salvador
Nicaragua
El Salvador
Peru
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PM Training
Ecuador
Columbia
Columbia
Haiti
Columbia
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Haiti
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PM Training
Guyana
Trinidad and Tobago
Suriname
Guyana
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Mission Statistics

• Highlights of mission include the following
  statistics
• 98,658 patients treated
• 32,322 patients immunized
• 122,322 pharmaceuticals dispensed
• 24,242 pairs of glasses dispensed
• 1,170 surgeries performed
• 25,196 dental examinations
• 3,968 dental extractions
• 20,561 dental varnishes applied
• 7,042 dental sealants applied
• 17,772 PM encounters
• 386,217 Total patient encounters.

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Superior doctors prevent the disease. Mediocre
doctors treat the disease before
evident. Inferior doctors treat the full blown
disease. Huang Dee Nai-Ching (2600 B.C., 1st
Chinese Medical Text)