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Frequently, entomological and vector control consultants or teams of multidisciplinary control personnel are needed in the period following a natural disaster. The composition of such teams will depend upon the nature of the disaster and the needs of the country. In general, the team may include an entomologist, a vector control specialist, a rodent control specialist and a sanitarian. If the country has a serious malaria problem, a malariologist should be added to the team. Any individual or team should collaborate with members of epidemiological teams and existing medical and vector control staffs.

Perhaps also needed are personnel who have had practical experience and training in the assembly, calibration, operation and maintenance of vector control equipment.

The Pan American Health Organization maintains a list of experts in these fields, some of whom have had experience as consultants during natural disasters. The Organization also has a procurement unit that is experienced in handling orders for equipment and supplies, and the unit is available to assist governments in emergency situations.

Recruitment

The Pan American Health Organization and cooperating international and bilateral agencies which provide assistance to other nations have developed a system for rapidly recruiting consultants to disaster relief efforts in cooperation with other international and bilateral aid agencies. Any country that needs this type of technical collaboration should determine the exact consultant requirements such as entomologist, technical officer, sanitarian, or malariologist, and express this need to the PAHO Country Representative so that prompt action can be taken.

Briefing and Equipment

Consultants should be briefed both before and after arrival to the requesting country. The Pan American Health Organization should furnish the consultant the following information prior to departure:

(1) The general objectives of the visit
(2) The expected duration of the visit
(3) Names of contacts, especially of the officers in positions of responsibility and, whenever possible, names of entomologists, vector control specialists, civilian and military public health officials, and other potential sources of assistance within the country
(4) The status of the disaster and its relation to potential problems
(5) The types of supplies and equipment that the consultant should take (beyond those listed in Annex 11)
(6) A list of individuals who will supply logistic requirements, such as food, transportation, shelter and communication support
(7) A profile of the country containing information about geographic, climatic and demographic features, political and socioeconomic conditions, past communicable disease history and the public health infrastructure
(8) Current information concerning the following:

(a) The vector control staff
(b) Vector control equipment
(c) Insecticides and rodenticides
(d) Transportation and communication systems

(9) Information for purposes of communication, such as:

(a) The address, telephone, cable and telex number of the Pan American Health Organization office
(b) Names and addresses of hotels, especially if the consultant is to reside in an area that is not near an office of the Pan American Health Organization
(c) United Nations Development Program, other United Nations, and international or national agencies which operate in the country.

(10) Information regarding passport and visa requirements, appropriate currency, airline ticket, and excess accompanied luggage allowance.

The consultant can supplement this by reviewing information about diseases, vectors and geographical conditions of the country. Possible sources of such information are libraries, newspapers, United Nations country background reports, universities, area handbooks, other consultants' reports, and individuals with past experience of the conditions in the country. Local amateur radio operators who have contacts in the country can provide valuable additional information.

The Pan American Health Organization, other international agencies and bilateral aid programs handle arrangements for travel and local contacts. They will inform their officials within the country about the consultant's arrival and request arrangements be made to meet with the appropriate national authorities.

The local contact in the Pan American Health Organization should brief the consultant about the following:

(1) Government contacts who work in the areas of public health, agriculture, defense, and natural resources
(2) The current status of disaster and vector or rodent problems
(3) Past reports about vector and rodent-borne diseases, in the possession of the Pan American Health Organization or the national government
(4) Other assistance being provided by international agencies and organizations
(5) Nongovernmental contacts and/or other sources of information, including local pest control firms and aerial spray operators
(6) Any recent changes in government plans
(7) The political or economic implications of the disaster
(8) Road conditions and the availability of ground transportation for field work
(9) A sample of press reports about disaster conditions.

Activities of Consultant upon Arrival

We recommended that the consultant initially contact the international or bilateral agency that arranged the visit. The emergency or disaster committee with a vector control subcommittee if one exists, should then be contacted. Whatever the points of technical contact may be, it is the consultant's responsibility to obtain a clear concept of what is required to identify his designated counterpart in the government and to maintain close communication with appropriate authorities.

In most cases, the consultant will be asked to help the government assess the problem, outline control procedures and train personnel. The initial assessment may be difficult because of problems in transportation and communication. Maps and graphs prepared by the government will provide some information. However, there will be areas from which little or no information is available, and there will have to be adjustments to insufficiency of the information. There may be inventories of vector control equipment and supplies. These should be inspected as soon as possible.

Evaluation of information gathered in an early reconnaissance of the distribution, densities and stages of development of vector species is very useful. The consultant should be provided ground transportation for surveillance purposes and, if possible, the assigned vehicle should have four-wheel drive. In addition, information obtained in aerial reconnaissance can quickly provide a comprehensive overview of the areas and can give indication of possible methods of attack.

Outlining control procedures is often a difficult task. The effects of a given disaster may warrant the use of new technology to rapidly control vectors. Not all modern technology, however, is appropriate for use under all circumstances. A country may be aware of the existence of certain new types of equipment, insecticides and technology, and will seek to find out if they should be used. Sophisticated equipment may be used for the short-term relief from vector related problems. However, usual vector control methods, directed toward the larvae or the resting adults, may prove to be more effective and less expensive. Equipment that rusts on shelves kills few mosquitoes.

Recommendations and Reports

Recommendations should be practical and directed toward that which the local government actually can accomplish in vector control. However, recommendations can also assist governments in obtaining long-term goals that are only secondarily related to the natural disaster. It is worthwhile, therefore, to discuss all recommendations with members of international agencies and the government before writing them.

Reports should contain definitions of the potential for vector related problems and the current and future implications of the availability of manpower and other resources. Ongoing evaluation of the situation, as well as of training programs, is important because the primary concern in the report is that of the probability of the occurrence of future problems and future consequences. Actions that need to be undertaken at different points in time, or because the potential of vector related diseases is altered, should be clearly specified. Also to be included in the report are alternative ways to respond to problems that develop in regard to staff or equipment.

An outline of ways to implement and evaluate control measures should be presented in the report, and actions to be undertaken in the event that epidemic occurs should be suggested. A discussion of logistics of control (including work schedules, geographical areas to be covered and ways to implement control of diseases that may contribute to epidemics) should be included in the report. The report should also contain an enumeration of methods of supervising the staff and a list of supplies and equipment that are needed to augment current stocks.

The report and recommendations can provide guidelines when such are lacking, and they may also be used for educational purposes. It should be noted, however, that because of the existence of divergent opinions an entire program is rarely accepted and implemented unchanged.

Follow-up

Consultants, remembering that it is the prerogative of the country to make final decisions, nevertheless, often outline actions to be taken in the future. To assist the government, the consultant should do the following:

(1) Be certain that everyone is briefed and that the report and recommendations are discussed before they are formally presented
(2) Inform the international organizations and country representatives of the recommendations and discuss the possibility of the organization's involvement
(3) Ensure that the personnel who are actually entrusted with the work, as well as the administrators, understand what they are doing and why
(4) Brief (by letter, telephone or in person) the technical staff of the international organization about the situation and the reasons for the recommendations.

Too often, at the departure gate, consultants forget the country and its problems. In the age of instant photocopies, sending occasional reprints of scientific reports, or a personal letter is an easy method to bridge gaps that international organizations find impossible. In many instances, such little extra effort can make the difference between the success or failure of the country to implement recommendations.

Training

Weaknesses in training are never more vividly manifested than during the period after natural disaster. Vector control programs are designed to meet the needs of normal circumstances in which adequate response may follow an inflexible routine. During disasters a flexibility that is often lacking is called for. In addition, extra staff is frequently required during disasters and demands for immediate actions are made. All of this leads to confusion, waste, and tactical error. Most critics will be more concerned about these aspects than about any real progress that is made. There are few solutions to this dilemma, but a good, visible training program may lessen the critics' blows.

Because most malaria and other vector control programs have on-the-job training and annual refresher courses, continual upgrading of the courses and the educational and proficiency levels of the staff will add to the success of any surveillance or control program. The consultant, while visiting the country, should be asked to perform on-the-job training (apart from formal training courses) of national staff members with whom the consultant has contact.