A MULTIDISCIPLINARY PUBLIC HEALTH RISK ASSESSMENT IN RURAL ETHIOPIA MAJ Matthew Levine UNCLASSIFIED December 2015

Disclosures Presenter has no interest to disclose. PESG and AMSUS staff have no interest to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS. PESG, AMSUS, and all accrediting organization do not support or endorse any product or service mentioned in this activity.

Learning Objectives At the conclusion of this activity, the participant will be able to: 1. Interpret how multiple deployments are effecting service members’ and their families’ health care needs 2. Report trauma care improvements resulting from experience treating conflict-related injuries 3. Discuss how current issues being addressed by the health executive leadership effect your workplace

1.Introduction 2.Multidisciplinary Approach 3.Composite Public Health Risk Assessment 4.Risk Assessment 5.Food-Borne Illnesses 6.Vector-Borne Diseases & Wildlife 7.Environmental Exposures 8.Conclusion Briefing Outline 4 UNCLASSIFIED

5 Introduction

6 UNCLASSIFIED Multidisciplinary Health Risk Assessment Environmental Contaminants Vector- Borne Diseases Environmental Science Officer Epidemiologist Veterinary Corps Officer

Pros –Team experience and synergy –Planning –Transportation/support on- site –Consolidated report –Battle buddy Cons –Equipment quantity –Coordination of itineraries –Shipment of samples Pros and Cons of the Multidisciplinary Approach

Infectious diseases Food borne illness Vector borne diseases and wildlife Environmental contamination UNCLASSIFIEDMAJ Carol Calix / MCHB-AE-EES / Composite Public Health Risk Assessment 1 of 3

UNCLASSIFIED Composite Public Health Risk Assessment 2 of 3

1-Complacency and Decreased Vigilance Internal to Organization 2-Increased External Threat from Organizations and Ideological Groups Opposed to U. S. Forces Time Risk Risk over time for the U.S. Personnel in Arba Minch, Ethiopia without effective mitigating measures. 1-Effective Command Climate for Risk Mitigation of Risks Internal to Organization and Operation 2-Effective Measures to Counter External Threats Risk over time for the U.S. Personnel in Arba Minch, Ethiopia with effective mitigating measures. Composite Public Health Risk Assessment 3 of 3

FWRA –TG 248 Checklist –Rack ‘n’ Stack –Control measures are often not implemented CHPRA –Exposure assessment –On-the-Spot Corrections –Control measures are emphasized versus FWRA versus CHPRA 1 of 7 UNCLASSIFIED

Hazard Identification Hazard assessment Exposure assessment Risk characterization Mitigation Strategies Methodology 2 of 7 UNCLASSIFIED Hazard Idenification Exposure Assessment Hazard Assessment Risk Characterization

Risk Mitigation 3 of 7 UNCLASSIFIED Public Health Hazard Hazard Severity Hazard ProbabilityRisk Estimate Residual Risk after implementing recommendations Food borne illnessCriticalLikelyHIGHMODERATE Vector borne diseases and wildlifeMarginalLikelyMODERATELOW Environmental pollutants MarginalOccasionalMODERATELOW Infectious diseasesCriticalOccasionalMODERATELOW Overall CPHRAHIGHMODERATE

Lack of sanitizing supplies Temperature abuse Cross contamination Lack of record keeping Improper waste management Inadequate sanitation plan Poor personal hygiene Poorly trained workforce Substandard equipment Food-Borne Risks 4 of 7 UNCLASSIFIED

Food Safety –Hand washing –Temperature Control Food Defense –Hostile elements –Physical security –Approved sources Food-Borne Risks 5 of 7 UNCLASSIFIED

Training provided on –Hand washing –Cross contamination –Sanitation –Temperature control –Record –Keeping Labeling –Signage Hands On Training 6 of 7 UNCLASSIFIED

On-The-Spot Corrections 7of 7 UNCLASSIFIED

Malaria Yellow fever Chikungunya Leishmaniasis Vector-Borne Diseases 1 of 2 UNCLASSIFIED

Mosquito surveillance Elimination of breeding sites Use of DoD uniform repellent system Malaria chemoprophylaxis Vector-Borne Diseases 2 of 2 UNCLASSIFIED

Baboons - Carry human intestinal parasites - Possible attacks Wildlife UNCLASSIFIED

Hazardous materials exposure Inadequate disposal of hazardous materials Storage of hazardous materials Environmental Exposures 1 of 3 UNCLASSIFIED

Burn pit close to living areas Inadequate trash disposal Aerosol cans in burn pit Environmental Exposures 2 of 3 UNCLASSIFIED

Water samples –Raw –Potable –Bottled None of the soil collected and analyzed exceeded the recommended thresholds Environmental Exposures 3 of 3 UNCLASSIFIED

CPHRA Written Report Report provides information and mitigation measures to different levels: –NCO on the ground –Commander –Planners –Embassy staff –Scientists

Composite Public Health Risk Assessment Conclusion CPHRA encompasses a comprehensive food borne disease, food defense, vector borne disease, and environmental risk assessment. Synergy provided many new opportunities for interdisciplinary mitigating measures Mitigating measures given by seasonality Risk assessment evaluated by short, medium and long term Final report useful at different levels The result of the CPHRA provided practical information in a timely manner efficiently using the different expertises of the PHC UNCLASSIFIED

Composite Public Health Risk Assessment Questions? UNCLASSIFIED

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