7708MED Assignment 1 Going to the Field_ Andrea Trubody_s5048151 FINAL

7708MED Assignment 1 s5048151 Andrea Trubody
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Student: Andrea Trubody s5048151
Assignment Topic: Going to the field.
Word Count: 1495

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Background to the field setting and Introduction.
The purpose of the operation is to study the recent outbreak of Zika virus in
Montecristi, Ecuador. Planning a field trip to conduct research in unfamiliar cultural
conditions raises challenges of a socioeconomic and logistical nature. In order to
derive a thorough understanding of the health system and the problems it faces in
realms such as service delivery (Diefenbach-Elstob et al n.d.) the daily challenges
faced by the inhabitants need to be observed.
Key Objectives
(1) Stop the spread of Zika in the temporary villages by introducing mosquito
control (see appendix) providing personal insect repellants, disposing of
containers around dwellings that hold water which provide mosquito breeding
grounds, wearing of clothing with long sleeves and pants to prevent mosquito
bites, supervise provision and distribution of mosquito nets and ensuring any
mosquito screens in damaged and non-damaged buildings seal properly
(IAMAT 2016).
(2) Improve sanitation, water supply and mosquito proofing of houses
(3) Establish that there is an outbreak of Zika Virus in Montecristi.
(4) Identify areas in the province which are ‘hot spots’ for populations of
mosquitoes infected with Zika Virus.

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(b) The team will consist of 12 members from both Australia and Ecuador. Skills will
be required in areas of pathology testing to screen for cases of Zika as well as in
mosquito collection and analysis and vector control. Community engagement is
essential to the success of the project to ensure that the wishes and needs of the
community are observed so local health workers especially as translators, research
staff and community nurses should be included in the team. In order to recruit these
individuals community leaders should first be approached. Local community
members should be involved to foster a feeling of trust. (Tulsi Ram Pandey 2008).
The Entomology Research Leader from CIREV should be approached. His experience
in identification of vectors, their ecology/biology and effectiveness of pesticides
would be invaluable. Field assistants from CIREV who have experience in ecological
research would be used to collect and identify mosquito samples to pinpoint breeding
grounds (see appendix 2 for team structure).

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(c)
Setting
Source: Maps of the World 2016
Ecuador is situated in Western South America between Columbia and Peru. It borders
the Pacific Ocean. Manabi province is on the coast near Bahia de Manta (see map). Its
climate is tropical. It has an area of 283,560.0 km2. The 2011 census puts
Montecristi’s population at 70,292 inhabitants (IT1ME 2015). Montecristi
experienced a 7.8 magnitude earthquake on 17 April 2016. The Manabi Province was
hardest hit with over 200 people killed (Ellis et al 2016). According to Smart

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Traveller there is still a state of emergency in six provinces (DFAT 2016). Ecuador
has been classified by the Center for Disease Control and Prevention as an area with
active Zika Virus transmission (2016). Immediately following the quake shelters
housing over 25000 displaced person sprang up. Infrastructure including roads,
healthcare facilities and water supply has been severely impacted. Twenty-four
medical facilities were effected with many ceasing operations due to damage and
personnel shortages. Cases of Zika have increased from 92-1106 since the earthquake
with 80% of cases being recorded in the Manabi Province (UNICEF 2016). Due to the
deteriorating environmental and housing conditions the risk of vector-borne disease
has increased. Politically, the first presidential elections were held in 1979 after years
of military rule. The current President has been in power since 2007 and has spent
heavily in the areas of infrastructure, education and welfare. Funding for these
projects has been backed by oil. Ninety-five percent of the population lists
Catholicism as its religion.
Local Laws and Customs
Casual clothing is acceptable but revealing clothing should not be worn in towns.
When taking photographs it is advisable to first seek permission. Due to drug
problems within the country any drug-related activity is regarded as a serious crime. It
is also a legal requirement for ID to be kept on the person at all times. US currency as
well as Ecuadorian minted coins are the only legal currency, with credit cards and
travellers cheques accepted in the cities.

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Collaborating Institutions
 The National institute for Public Health Research (INSPI) (National Institute
for Public Health Research 2016).
- the body has the resources of their network laboratory network
which will be utilized to carry out analysis of biological samples.
(contact: Dr Leopoldo Perez Izquieta)
 The INSPI center for research and reference in Vectors (CIREV)(Global
registry of biodiversity repositories (GRbio) 2016).
Required Approvals
 Griffith University Ethics Committee
 Sponsors providing funding
 Stake holders such as the Ministry of Health, Ministry of the Interior, Minister
of Roads and Transport
 National police
 Local Authorities – province, canton and parish government bodies
 Montecristi officials such as the Mayor.
Resources in the field
UNICEF is working with the Ecuadorian government to reestablish sanitation ,water
supplies and also vector control in shelters and temporary villages. IsraAID was
operating a field hospital since late April (Times of Israel 2016). Contact with the
group has revealed that they are keeping on office in Manabi province but have
ceased operating the field hospital (see appendix 3 for full list).

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Operational Plan
The project focusing on the Zika outbreak in areas of both establishing the the
existence and size of the outbreak as well as in prevention. A preliminary timeline
outlining the tasks to be conducted to implement this regime is found in Appendix 7.
OTHER CONSIDERATIONS
Weather
Temperatures in September range between 21-27 C. Rainfall is approximate 5mm for
the month with an average of 1 day with rainfall. The climate is best categorized as
wet equatorial.
Clothing
This should be made from lightweight natural fabrics. Manabi province is not in the
area where warmer clothes are required for cooler climates. Consideration should be
made for rainwear. Boots should be comfortable, swell fitted and should be suited for
trekking and walking on uneven terrain. They should be well broken in and provide
plenty of ankle support.

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Safety & Security
Smart Traveller has a warning of ‘high degree of caution’ for the whole of Ecuador
due to the threat of violent crime including armed robberies and kidnapping (DFAT
2016). There are no warnings in place specifically for the Manabi province. Besides
physical security emergency procedures should also be addressed (OSU 2012)
Protective equipment
The following need to provided
 A mobile phone which has global roaming activated/satellite phone
 PPE such as protective clothing, mosquito repellent, gloves and protective
equipment, first aid kit, extra water.
Funding/Budget
Funding is be sought from programs such as NHMRC TRIP fellowship or through
organizations such as WTA. (see appendix 6 for a preliminary budget).
Family
The contact details of all team members’ family/emergency contacts and directions to
the closest medical facilities need to be recorded.
Instructions to family members regarding the location of team members wills and last
wishes should also be chronicled.
Insurances
When planning any field research activities insurance is required. The following
needs to be arranged before departure.
 Travel insurance – covering flights, accommodation, hire vehicles as well as
medical cover. Insurance has been arranged through 1cover Travel insurance
(for details see Appendix 3).

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Accommodation
The team will be staying at a manta property which is in a ‘quiet and safe’
neighbourhood. It has kitchen, BBQ, and laundry facilities as well as security cameras
for added security. No suitable accommodation within Montecristi was available for
the specified period. Due to the earthquake many houses are still damaged or
destroyed.
Flights/Transport to Montecristi
Six team members will be travelling from Australia. Flights from Brisbane to
Guayaquil airport (Ecuador) have been booked for 6 people. The team will be
travelling American Airlines with two stopovers. Transportation from the airport to
can be done by road (Ministry of Transport and Public Works 2016 ).For the itinery
see Appendix 5.
Entry Requirements/Process
These have to be given great attention as any team members not in possession of the
correct paperwork will be denied entrance. This would have a direct impact upon the
efficiency and efficacy of the team. The requirements are
 A passport which is valid for at least an extra six months and must be carried
at all times
 A visa is not required as the project is for 30 days and is under the 90 day
exclusion requirement.
 A return airline ticket
 Upon entry an international embarkation/disembarkation form needs to be
completed. This will be stamped and must be kept with your passport. Both

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need to be presented upon exit from Ecuador. Australian nationals are not
required to obtain transit visas whilst in Ecuador.
Travel Medicine
Vaccinations are required
 Diptheria
 Hepatitis A
 Tetanus
 Typhoid
 Malaria is required sometimes. It is advisable as there is a moderate to high
transmission risk in the Manubi province.
 Proof of Yellow Fever vaccination is sometimes required for anyone over the
age of 12 months who is travelling from infected areas.
Medical facilities are located in urban areas. Drinking bottled water and avoiding
unpasteurized foods is recommended (World Travel Guide 2016). Personal
medications and aids such as Asthma puffers should also be carried.

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REFERENCES
Center for Disease Control and Prevention A (CDC) (2016).
All Countries & Territories with Active Zika Virus Transmission. Retrieved from
http://www.cdc.gov/zika/geo/active-countries.html
Center for Disease Control and Prevention B (CDC) (2016). Integrated Mosquito
Management. Retrieved from
https://www.cdc.gov/zika/vector/integrated_mosquito_management.html
Department of foreign Affairs and Trade (DFAT) (2016). Ecuador, Retrieved from <
http://smartraveller.gov.au/Countries/americas/south/pages/ecuador.aspx#additio
nal_information>
Diefenbach-Elstob,T., Plummer,D., Dowi,R., Wamagi,S., Bisato,G. Siwaeya,K.,
Pelowa,D. & Warner,J. (n.d). Fieldwork in isolated locations and under-
resourced settings: practical insights from research in the remote Gogodala
homelands of Papua New Guinea. 7708MED lecture notes, 17 August 2016.
Ellis,R., Karimi,F., Ansari,A & Gallen,N. (2016, April 18). Ecuador earthquake:
Death toll jumps to 272; more than 2,500 injured. [Press release]. Retrieved from
http://edition.cnn.com/2016/04/17/americas/ecuador-deadly-earthquake
International Association for Medical assistance to Travellers (IAMAT) (2016).
Country Health Advice Ecuador General Health Risks: Zika Virus. Retrieved
from < https://www.iamat.org/country/ecuador/risk/zika-virus>
IT1ME 2015. Montichristi, Ecuador. Retrieved from
http://www.it1me.com/learn?s=Montecristi,_Ecuador
Ministery of Transport and Public Works (2016) 100 days after the quake road
operation at 100%. Retrieved from < http://www.obraspublicas.gob.ec/accesibilidad>
National Institute for Public Health Research (2016) Quality, Health and Safety,
Environment. Retrieved from < http://www.investigacionsalud.gob.ec/politica-
de-calidad-salud-y-seguridad-ambiente>
Office for the Coordination of Humanitarian Affairs (OHCA) (2016) Presencia
Operacional en Manabí & Esmeraldas 19 julio 2016 [Image]. Retrieved from
https://www.google.com.au/?client=firefox-b-
ab#q=Presencia+Operacional+en+Manab%C3%AD+%26+Esmeraldas19+julio+
201&gfe_rd=cr
Ohio State University (OSU) (2012) Field Research Safety Information. Retrieved
from <
https://www.osu.edu/search.html?query=Field+Research+Safety+Information>
Organización Panamericana de la Salud (PAHO) (2016). EARTHQUAKE IN
ECUADOR Situation Report No. April 4-21, 2016. Retrieved from
www.paho.org/disasters/index.php?option=com_docman&task=doc

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Pandey, T (2008) Methods of field research: encounter, experiences and strategies in
Nepali Villages. Contributions to Nepalese Studies, 35(1). 83-94. Retrieved from
<
http://go.galegroup.com.libraryproxy.griffith.edu.au/ps/i.do?p=EAIM&u=griffith
&id=GALE|A191855922&v=2.1&it=r&sid=summon&userGroup=griffith&auth
Count=1>
Times of Israel (2016.) Israeli group sets up field hospital in quake-hit Ecuador.
Times of Israel. Retrieved from
file://localhost/Volumes/GRIFFITH%201/7708MED/Israeli%20group%20sets
%20up%20field%20hospital%20in%20quake-
hit%20Ecuador%20_%20The%20Times%20of%20Israel.html
UN children’s Fund (2016) UNICEF Ecuador Humanitarian Situation Report No.9,
12 August 2016. Retrieved from < http://reliefweb.int/report/ecuador/unicef-
ecuador-humanitarian-situation-report-no9-12-august-2016>
UNICEF (2016, July 18) Twelvefold increase in Zika cases since Ecuador
earthquake. [Press release]. Retrieved from
http://www.unicef.org/media/media_91912.html
World Travel Guide A (2016) Ecuador Health Care and Vaccinations. Retrieved
from < http://www.worldtravelguide.net/ecuador/health>
World Travel Guide B (2016) Ecuador Weather, climate and geography. Retrieved
from http://www.worldtravelguide.net/ecuador/weather-climate-geography
World weather Online (2016) Ecuador. Retrieved from
http://www.weatheronline.co.uk/Ecuador.htm

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Appendix 1
Program of Mosquito control
 Conduct surveillance
 Remove places where mosquitoes lay eggs
 Control young and adult mosquitos by the use of chemical fogging
 Monitor and evaluate control programs.
Complied from information from the CDC (2016)
Appendix 2
Team Format
 Phlebotomist – taking of blood tests
 Epidemiologist x 2 – data analysis and observational studies.
 Entomologist x 2 – identification of species, confirmation of virus and vector
control
 Translator
 Research assistants x 2 – collation of data
 Nurses x 2 – helping with blood collection and patient relations
 2-3 persons to collect mosquito specimens.

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Appendix 3
Travel Insurance Details
 The policy provides unlimited coverage for medical expenses including
medical evacuation (as advised by Smart Traveller) (DFAT 2016).
 It provides coverage for loss of luggage and personal items.
 It also covers the loss/fraud of credit cards and travel documents.
 Zika is an exclusion on this and all travel policies due to the travel warnings
issued concerning the transmission status of Ecuador.
Appendix 4
Agencies already in the field.
The following is a list of agencies who have been operating in the field and could be
approached to pool resources.
 ldeas Infantiles SOS
 CISP
 Danielle Children's Fund
 DNVIG
 Education for development
 Habitat Internacional
 HIAS
 OCHA
 OIM
 OPS/OMS
 Oxfam
 Plan Internacional
 PMA
 PNUD
 Refugee Education Trust
 UNFPA
 World Vision
Source: Office for the coordination of humanitarian affairs (OCHA) 2016.

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Appendix 5
Travel Itinery/Arrangements
Departing 1 September. Leaving 29 September.
First Section:10:00am to 6:00am 13h
Brisbane (BNE) to Los Angeles (LAX)
American Airlines 7380 operated by Qantas Airways
Economy / Coach (M)
layover 2h 40m
Second Section: 8:40am to 4:54pm 5h 14m
Los Angeles (LAX) to Miami (MIA)
American Airlines 1088
Economy / Coach (M)
layover 4h 35m stop
Third Section : 9:29pm to 12:57am 4h 28m
Miami (MIA) to Guayaquil (GYE)
American Airlines 933
Economy / Coach (M)
Flights have been booked to Guayaquil due to no flights to closer Airports being
available due to runway and buildings maintenance.
Two mid-size all terrain vehicles will be hired until no longer needed to provide
transport to and from sites for staff, luggage and equipment at a total of $2029 per
vehicle (Expedia 2016)

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Appendix 6
 Accommodation $10153
 Hire vehicles $4058.
 Airfares $26449 (return, 6 team members)
 Travel Insurance $1000.45
 Other* $ 8000
* supplies, incentives, scientific needs.
Appendix 7
Timeline/Activities
Daily
Gathering of mosquito samples from three types of terrain. This will be done daily at
18:00 -21:00 hrs.
 Forest/savannah
 Agricultural
 Village
Week 1-4 (in the field)
Establishment of responsibilities
Prioritizing order of areas to be screened and allocation of personnel to specific areas.
Screening ‘at risk’ populations in these areas
Coordinating of cleaning up temporary settlements and fixing mosquito screening
Distribution of personal repellents and mosquito netting in quadrants 1-4.
Attending to daily mosquito sampling (as above). Taking samples (both pathology
and entomology) to respective processing facilities.

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