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    01/27/2010

    As CDC continues its public health mission in Haiti, we take a look at its role, the priorities of the mission, and the public health dangers. Here is an interview with CDC's incident manager for Haiti, Scott Dowell, M.P.H., M.D. (CAPT, USPHS), medical officer with the Global Disease Detection and Emergency Response Branch, Office of Global Health.

    What is CDC's role in the Haiti relief effort?

    CDC in Atlanta is gearing up to become a fairly large part of the Haiti relief effort in the upcoming weeks and months. CDC's public health role was small and back-seat in the initial three or four days of search and recovery after the earthquake, but has become much more prominent as attention turned toward potential public health disasters that are looming in the weeks and months ahead. Our role is to help prevent tropical diseases, airborne and waterborne, from spreading through the population.

    The key point is that this earthquake struck what was the most precarious public health system in the entire hemisphere. So even before the earthquake hit, Haiti had the lowest rate of immunization of infants, had the highest rate of mortality during childbirth, and had other serious public health problems. When you add the earthquake disaster to that, you have the potential for outbreaks of disease and other public health problems in the coming weeks. So one of the first priorities that we're focusing on is public health information because it's the quality of that information that's going to guide the response and sort of avert these more predictable mortality risks.

    What are the public health dangers that you foresee developing in Haiti in the coming weeks and months?

    Scott Dowell, M.P.H., M.D.
    (Capt., USPHS)
    CDC's Incident Manager for Haiti

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    There's a long list of potential problems, and the public health information, along with surveillance that we will be conducting, will help us identify the priorities more precisely as they unfold. Part of what we're putting in place is a rapid assessment of the current situation and a surveillance system that will identify problems as they arise. But we can predict from past disasters the ones that are of greatest concern. Problems that result from the lack of clean water are the first ones. Outbreaks of diarrheal disease have struck populations in this kind of circumstance in the past and could be disastrous. After water, we'll focus on food. We knew that malnutrition was already a severe problem in Haiti, and people are going to need to have adequate supplies of safe food.

    In the first days after the earthquake there are continued concerns about trauma and injuries. As time unfolds and that concern will decrease, there will be outbreaks of infectious disease. Measles is one of the classic ones that infect populations like the one in Port-au-Prince. Fortunately, measles has been all but eradicated as an endemic problem in the western hemisphere. But there are periodic re-importations and the fact that Haiti's measles vaccination coverage was so low to start with — about 50 percent — puts them at risk for even more importations of disease like that, in addition to the normal vaccine-preventable diseases that are already there. Part of what we're putting in place is a rapid assessment of the current situation and a surveillance system that will identify problems as they arise.

    How many CDC people are working on Haiti now?

    CDC now has 17 full-time US citizens on the ground in Haiti (as of Monday, January 24), plus 35 local CDC staff. Supporting them are 235 CDC staff members at the Centers' headquarters in Atlanta, two liaison officers in Washington, and one in Miami. That number will increase and fluctuate as CDC becomes more involved in addressing the long-term public health challenges facing Haiti. Most CDC staff members are assigned to work with the Centers' partner organizations — the UN organizations, the U.S. military organizations, the U.S. aid organizations, and the Haiti Ministry of Health. The exact numbers that CDC will eventually deploy to Haiti will depend on what these organizations identify as their public health needs, but I anticipate two or three dozen CDC staff in Haiti in the coming months.

    Will CDC be establishing camps for the displaced Haitians?

    Tent cities already have been established in informal ways across the city of Port-au-Prince, and part of the job in the coming days is going to be to move the people in these camps into more formally organized settlements. Various international organizations probably will take charge of those settlements on a temporary basis.

    Who's the overall international coordinator of the Haiti disaster relief response?

    Ultimately, the international response is coordinated by the United Nations, which has delegated the Pan American Health Organization (PAHO) as the public health lead, with the US response coordinated by US Agency for International Development (USAID).

    How does CDC become involved in such operations?

    PAHO, USAID and other coordinating agencies ask for CDC experts in a variety of areas — epidemiologists, environmental health specialists, technical advisors, veterinarians, sanitarians, nurses and information specialists — to handle information flow.

    Is Atlanta particularly well-positioned to become a staging point for long-term assistance to Haiti?

    We are at an advantage because Atlanta is a transportation hub. For example, the large group that the US government HHS sent down at the very beginning was staged out of Atlanta. So people can gather here or get down there very quickly. Through all these partnerships, CDC is well positioned to respond with agility to these kinds of crises. CDC does this a lot. We have a plane available to us that can get our people and supplies in and out very quickly. And we're able to be quick in responding when people ask us for help.

    What do you see as the top priority in the next seven or eight days?




    CDC has two immediate tasks that I will be concerned with:
    • Making sure we have the kind of public health system communication in place that will guide the response and avert the mortality that we've been concerned about, and
    • The long-term reconstruction of a public health system for Haiti, which wasn't that strong to begin with, and was essentially destroyed by the earthquake.
    Reposted from CDC Connects
    by Published on 01-29-2010 01:31 AM
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    CDR Audain, 43, a Clarksburg resident born to Haitian immigrants, is serving as a translator and medical assistant with the US Public Health Service at Terminal ...

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    Published on 01-14-2010 11:36 AM
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    2/11: The USPHS Public Health Advance Team on the USS Bataan continues working as part of the CMOC to help coordinate activities off the ship with those on the ground in Haiti. The Applied Public Health Expeditionary Team (APHET) returned to the area in and around Leogane today to perform public health assessments, provide primary care, evaluate veterinarian requirements and continue their work with the National Vaccination Program. Their mission has incorporated additional NGOs, local representatives of the Ministry of Health, a regional school of nursing, the Canadian Medical Assistance Team, the U.S. Army veterinarian contingent and others. The APHET will transition their activities to these assets before proceeding to Carrefour and Petit Goäve in the next days and weeks.

    Round the clock support for EMG operations continues with officers identified in previous updates. Due to the storms in D.C., officers rotating in to support EMG operations will be reporting over the next several days as they are able. Two French-speaking pharmacists are actively supporting IRCT operations in Haiti.

    The medical strike team performing triage of repatriated persons at Miami International Airport continues around the clock operations. The team has been partially demobilized due to operational demands.

    Total officers deployed to date: 75

    Total officers currently deployed: 45


    2/8: Public Health Advance Team on the USS Bataan continues working as part of the CMOC to help coordinate activities off the ship with those on the ground in Haiti. The Applied Public Health Expeditionary Team (APHET) went ashore today in the area around Leogane to perform water and sanitation assessments and help focus U.S. Navy Construction Battalion activities in this regard. The APHET members were also to continue their work vaccinating in support of the Haiti Ministry of Health’s (MOH) National Vaccination Program as well as provide primary care and veterinarian services. The APHET is working in conjunction with the Haitian MOH, NGOs, the PAHO-organized Health Cluster, the U.S. Navy and Marines and Canadian Forces in the area.

    The mental health LNOs to the IRCT continue to work in support of their activities. An officer from the on-call MHT#5 has been rostered to deploy in place of these LNOs later this week. Twelve officers continue supporting the IRCT in Haiti, in the planning, administration and finance, operations, and logistics sections.

    The medical strike team at Orlando International Airport in Florida, deployed in support of repatriation medical triage activities, has been demobilized as of yesterday.

    The medical strike team at Miami International Airport continues around the clock operations. Consideration is being made for realigning these medical teams with evolving operational demands, potentially demobilizing the team in the next day or two.

    Total officers deployed to date: 69
    Total officers currently deployed: 55

    2/2: The entire Applied Public Health Expeditionary Team (APHET) went ashore today with Navy and Marine personnel, performing water and sanitation assessments, administering vaccines and providing medical and veterinarian services in the area in and around Grand Goäve.

    Eleven officers continue supporting the IRCT in Haiti, in the planning, administration and finance, and logistics sections. LT Stone is now due to deploy in to Haiti tomorrow, 03 February. Her scheduled travel date has been pushed back due to logistical considerations.

    Four USPHS officers with Creole language skills continue assisting in ASPR operations in Haiti. Two French-speaking pharmacists have been rostered to deploy in support of IRCT operations. Both of these officers are now due to deploy to Haiti tomorrow, 03 February, with delays in their departure date due to logistical considerations.

    The medical strike team at Orlando International Airport in Florida continues around the clock operations, providing medical triage to evacuees. The medical strike team at Miami International Airport continues around the clock operations, augmented by the redeployed team from Homestead Air Force Base. Consideration is being made for realigning these medical teams with evolving operational demands.

    Total officers deployed to date: 66
    Total officers currently deployed: 53




    1/27: The Haiti Minister of Health requested that the Navy and USPHS Advance Team develop and implement an immunization plan in the USS Bataan’s area of responsibility in concert with an overall plan for vaccination in the country. The Minister of Health also provided the USPHS Advance Team with a written document outlining their request for overall USPHS assistance. Eleven additional officers have been rostered by OFRD and are being traveled by ASPR to serve in the IRCT in Haiti in various capacities, as reported. They are due to report in to Haiti tomorrow, 28 January.

    Total officers deployed to date: 57
    Total officers currently deployed: 51





    1/25: Five USPHS officers with Creole language skills continue assisting in ASPR operations in Haiti. Plans to redeploy these officers to their home stations were begun this afternoon along with plans for rotating subsequent officers in their place, should it be requested from ASPR. Twelve USPHS officers were deployed to help field 2 medical strike teams to perform repatriation triage at Homestead Air Force Base in Florida.

    OFRD has rostered 4 pre-configured on-call response teams (~188 officers) and ~800 on-call Tier 3 officers who remain available for deployment this month. Communication with all Tier 1 and Tier 2 Team Leads took place this afternoon.

    Total officers deployed to date: 35
    Total officers currently deployed: 30






    1/23: The 7-person Applied Public Health Expeditionary Team requested by the Commodore of the USS Bataan group awaits airlift from Homestead Air Force Base in Florida. One PHS officer is aboard the USNS Comfort continued medical operations in Haitian waters. Five USPHS officers with Creole language skills continue assisting in ASPR operations in Haiti.

    OFRD has rostered personnel from the on-call Rapid Deployment Force 4 (RDF4) in response to the ASPR request for 2 strike teams, totaling 24 officers, to support a reception center, triaging evacuees returning from Haiti to Homestead Air Force Base in Florida. These teams are to be traveled to Homestead on 25 January.

    Total officers deployed to date: 23





    1/21: OFRD has rostered 4 pre-configured on-call response teams (~188 officers) and ~ 800 on-call Tier 3 officers who remain available for deployment this month. Communication with Team Leads occurs daily. Communication with all Tier 1 and Tier 2 Team Leads took place this afternoon.

    Total officers deployed to date: 22

    1/18: Three USPHS officers on board the USS Bataan into Haiti for shore duty. USS Bataan is due to arrive in Haitian waters on Tuesday, 19 January. This USPHS/USN advance element intends to link up with the Incident Response Coordination Team at the U.S. Embassy in Haiti in order to develop intelligence on possible public health needs. The USPHS/USN will return to the USS Bataan on 20 January.

    CAPT McRae, mental health LNO to the IRCT in Haiti is due to Haiti by chartered flight. Four Creole-speaking USPHS officers are scheduled to deploy into Haiti by charter on the 19th.

    1/17: According to the Office of Force Readiness and Deployment (OFRD) the operational period for this mission will be 15 January 2010 with an unspecified end date. Unless otherwise notified, deployments will be 2 weeks in duration.

    USNS Comfort Commanding Officer requested a senior medical planner from USPHS. CAPT David Robbins (environmental health officer from IHS and on call for APHT4 will fill the slot. LCDR Robin Lewis (HSO detailed to DoD - Naval Hospital Portsmouth) selected for deployment, under the USN, to the USNS Comfort. USNS Comfort is due to arrive in Haitian waters on 21 January.

    CDR Ed Dieser, as the USPHS liaison (LNO) to US Southern Command (SOUTHCOM), is facilitating communication regarding HHS response activities and is in contact with U.S. Northern Command (NORTHCOM) liaisons at SOUTHCOM, including CAPT Havens from ASPR.

    1/16: LCDR Angela Girgenti reported to USNS Comfort at 1330 15 January. This officer’s role initially is as an administrative officer in the USNS Comfort planning division. The USNS Comfort will depart Baltimore for Haiti on Saturday 16 January.

    The three officers onboard the USS Bataan continue to work with Navy shipboard planners to develop operations anticipated upon the ships arrival in Haiti. USS Bataan is currently in port in North Carolina, embarking a Marine Expeditionary Unit and is due to sail for Haiti on Saturday.

    OFRD had been requested by 4th Fleet Surgeon’s office to deploy officers to the USS Carl Vinson to perform disaster public health assessments in Haiti. However, this augmented detachment was not able to be assumed by the ship, given its primary mission in logistics support for relief activities. Similarly, the USS Bataan reported no available berthing due to the embarkation of a full Marine Expeditionary Unit (2,200 troops), thus prohibiting any augmentation with USPHS personnel requested by the 4th Fleet Surgeon. The requested officers for the USNS Comfort were identified; however, due to timing of the ships departure today, 16 January, USPHS officers are unable to travel for timely embarkation.

    Round the clock support for EMG operations continues with officers identified in previous OFRD updates.

    Confirmation was established today for travel for CDR Ed Dieser to US Southern Command (SOUTHCOM) as the USPHS liaison officer (LNO) to assist in facilitating communication with DHHS response activities. CDR Dieser is due to travel to Miami this morning, 16 January.

    CAPT Phil McRae awaits travel through ASPR to Haiti to imbed in the Incident Response Coordination Team (IRCT) as the Mental Health liaison. The IRCT was due to deploy into Haiti on the 15th. OFRD continues to coordinate with ACF and ASPR’s liaison at Department of State about possible incoming repatriation flights and related activities.

    1/15: On-call teams from Roster #4 Rapid Deployment Force, Applied Public Health Team, Mental Health Team, Services Access Team and Tier 3 officers from Roster D are the pool of initial responders. Emergency Support Function #8 has been activated. USPHS officers will support the Navy's response.


    The USNS Comfort sits at its pier in Baltimore, being readied to move out to provide medical support for earthquake-ravaged Haiti.

    1/14: OPDIV Liaisons were notified today that the Commissioned Corps was activated by the Assistant Secretary for Health, and on-call officers assigned to report to the Secretary's Operation Center, to begin the process of filling liaison, admin and operational assignments and roles for a response to the earthquake in Haiti. Officers are anticipated to fill assignments aboard the USNS Comfort, and possibly ground missions in Haiti, with other Corps officers on call as needed.