The local community in Irian Jaya welcomes the
Indonesian and U.S. Navy health specialists.

A particularly useful and valuable military organization in the U.S. Pacific Command is a U.S. Navy unit which specializes in helping Asia-Pacific nations improve their public health through disease control. This unit is U.S. Naval Medical Research Unit 2 (NAMRU-2). NAMRU-2 works collaboratively with ministries of health throughout the region to deal with infectious diseases of mutual interest. By assisting regional countries to improve their public health, U.S. military personnel also benefit through the resulting reduced exposure to disease.

NAMRU-2 is located in Jakarta, Indonesia, and is part of the U.S. Department of Defense's network of overseas infectious disease research laboratories. NAMRU-2 has been in Indonesia since 1970. Its mission is to conduct research on infectious diseases of military relevance in Southeast Asia and to assist host nations to improve their public health and laboratory infrastructure. In 1997, NAMRU-2 became a Collaborating Center for New, Emerging and Reemerging Diseases for the World Health Organization (WHO), Southeast Asia Regional Office (SEARO).

A. U.S. Navy medical corpsman from NAMRU-2 based in Indonesia, HMC Richard Soderquist, demonstrates the vacutainer system for blood sample collection to disease response trainees in Irian Jaya, Indonesia.

In this capacity, NAMRU-2 organized and conducted a workshop in November 1997 to develop disease outbreak surveillance and response capabilities for WHO-SEARO member nations, the first such workshop ever held in the Southeast Asia region. A second outbreak response workshop, supported by funding from the U.S. Pacific Command, was conducted in Laos in February 1998 in cooperation with the Lao National Institute of Hygiene & Epidemiology, to further U.S. Pacific Command-directed humanitarian efforts for the region. The third and most recent U.S. Pacific Command funded workshop, and the subject of this article, was held as part of an overall strategy to develop outbreak response capabilities in disaster-affected eastern Indonesia.

This workshop was held in the highlands of Wamena, Irian Jaya, 10-18 September 1998 and included Indonesian health officials as both trainers and trainees. It provided the training necessary for Irian Jaya Province officials to respond independently and effectively to a number of infectious diseases, the incidence of which recently increased to epidemic proportions. Of particular concern was the continued outbreaks of malaria in the highlands (above 1500 meters), occurrences that are without precedence in this region and are devastating because they affect Irianese populations that are generally not immune to malaria. In addition to the workshop, the U.S. Pacific Command-sponsored project donated diagnostic equipment, supplies and communication equipment which will be prepositioned at strategic locations to enable rapid response.

Indonesian and U.S. officials of the successful training program. Dr. Cyrus Simanjuntak of the Indonesian Ministry of Health sits with Cmdr. Jeffrey Yund. Standing are Cmdr. Andrew Lee Corwin, Lt. Cmdr. Michael J. Bangs, and Dr. Richard Brennen.

The planning, organization and execution of this project involved two affiliate institutions of the Indonesian Ministry of Health: the National Institute for Health Research and Development (LITBANGKES) and the Center for Communicable Disease Control and Environmental Health (P2M-PLP).

Actual training was carried out by staff members from NAMRU-2, augmented by U.S. Navy Environmental and Preventive Unit No. 6 (NEPMU-6) of Pearl Harbor, Hawaii; the Center of Excellence in Disaster Management and Humanitarian Assistance, Honolulu, Hawaii; and Indonesia's LITBANGKES health institute. NAMRU-2 developed a simple training course that provided focused, short-term instruction to develop regional surveillance and outbreak response capabilities. The workshop also addressed, in practical terms, Irian Jaya's limited disease outbreak response expertise and limited resources. The trainers used disease outbreak examples specific to the area to make the course more relevant to participants and taught response actions targeted to the region's unique needs.

Participants and instructors in the U.S. Navy NAMRU-2 Outbreak Response Training program in Irian Jaya.

NAMRU-2 designed the training to teach students the skills and knowledge necessary to investigate and manage disease outbreaks. They taught the students how to conduct complete investigations, how to recognize indicators of outbreak potential and how to translate outbreak investigations into information that can be used to define appropriate public health preventive and control measures. Once trained local officials do effective outbreak investigations, local officials can define the endemic and epidemic nature of outbreaks. They can also identify contributing environmental and cultural factors associated with outbreaks, identify outbreak related attack rates and case-fatality rate, and determine case definitions. They can then identify the causative agents of the outbreaks, determine appropriate preventive and control measures and summarize the findings for dissemination.

Instruction emphasized early warning surveillance methods, field and laboratory specimen collection requirements, study design, preparation of data collection instruments and applied analysis. Each trainee received hands-on training in the use of Epi Info, a widely-used epidemiologic computer software program.

The Irian Jaya workshop was but one of several training initiatives NAMRU-2 has undertaken recently to improve regional outbreak response capabilities to recognize and deal with emerging and re-emerging diseases. These activities, which support the World Health Organization's regional objectives and the goals of the U.S. Department of Defense Global Emerging, Infectious Diseases Surveillance Program, make real contributions to improving the health and well-being of the people of Southeast Asia.