PHOTO CAPTIONS:

1. U.S. military medical experts help the Republic of Palau overcome outbreaks of Dengue fever. Phase II involved field training for
Ministry of Health personnel.

2. The President of Palau's letter of appreciation for U.S. military assistance.

3. A makeshift lab contains adult mosquitoes and larvae collected for analysis and to teach health workers.

4. The team trained 43 Palau physicians, nurses, sanitary specialists and laboratory personnel. This included field training in the ecology of dengue fever and an integrated pest management program stressing reduced chemical use.

5. As there is no vaccine or cure for dengue fever, training focussed on preventive medicine to reduce risk of exposure.

6. The team was from the U.S. Navy Environmental and Preventive Medicine Unit Six (NEPMU6) from Pearl Harbor, Hawaii, augmented by the U.S. Navy Disease Vector Ecology and Control Center from Bangor, Washington; U.S. Air Force Detachment 3 Human Systems Center from Kadena Air Base, Okinawa, Japan; and the U.S. Center for Disease Control and Prevention (CDC) Division of Vector-Borne Infectious Diseases, Fort Collins, Colorado.

7. Class work, which used state-of-the art equipment donated by the U.S. team, led to a final exam.

8/9/10. Reminders of the sacrifices by U.S. troops to liberate these Pacific islands during WW II still abound in Palau.

Ten medical experts from the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Navy, and the U.S. Air Force traveled to the Republic of Palau in the summer of 1998 to participate in an educational project known as the "Rapid Disease Outbreak and Control of Mosquitoes Harmful to Humans." The project was part of an ongoing effort to fight deadly diseases on this beautiful Pacific island.

In 1995, Palau experienced a disease outbreak of unknown origin. When several hundred residents became ill and several died, the President of Palau requested the assistance of the CDC to find the cause. CDC and U.S. Navy medical personnel formed a team to investigate the disease outbreak. They confirmed that Palau was experiencing its second outbreak of dengue fever since 1988.

In 1996, the Navy Environmental and Preventive Medicine Unit 6 (NEPMU6) from Pearl Harbor, Hawaii conducted a technical assistance visit, hosted by the U.S. Navy Sea Bee's Civic Action Team working in Palau. During this visit, NEPMU6 proposed, with the Palau Ministry of Health, a humanitarian assistance project to conduct training pertaining to dengue fever.

NEPMU6 conducted the humanitarian assistance training project in the summer of 1998 with the assistance of personnel from the CDC's Division of Vector Borne Infectious Diseases; the U.S. Navy Disease Vector Ecology and Control Center, Bangor, Washington; and U.S. Air Force Detachment 3 Human Systems Center, Kadena Air Base, Okinawa, Japan.

The project entailed two visits to Palau. In July 1998, thousands of mosquitoes were collected in order to better determine the threat from mosquito-borne diseases. Mosquitoes were primarily collected as larvae from water sources such as rain barrels, leaf axles, discarded tires, banana fronds, buckets, tree holes, and ponds. They collected adult mosquitoes using aspirators and light traps. Several hundred of these mosquitoes were then pinned and placed into a teaching collection for the subsequent training visit. As there are no vaccines for dengue fever, education concerning surveillance and mosquito control is the only known method to reduce the risk from future outbreaks.

During the second visit, the team provided training to Palau Ministry of Health personnel on dengue fever. The team trained a total of 43 physicians, nurses, sanitarians, and laboratory personnel from the Belau National Hospital during formal training sessions in August and September. Training classes focused on the ecology of dengue fever, with a strong emphasis on integrated pest management. The proposed integrated pest management program stressed reduced dependence on chemicals.

In addition, laboratory personnel were trained to use state-of-the-art technology for the rapid diagnosis of dengue fever. Prior to this training, physicians had to wait weeks before receiving dengue test results from laboratories off-island. As a result of this training, these physicians now have results in a matter of hours. In fact, during the training session physicians used the new technology in order to diagnosis dengue fever in seven patients.

Preventive medicine is one of the most important tools in combating diseases around the world. This is especially true for dengue fever, since there is no known cure. The most effective way to protect people from dengue is to prevent the population's exposure to the virus. By knowing the life cycle of the mosquitoes which transmit dengue fever, the government of Palau will be able to focus its public health resources and greatly diminish the threat of another dengue fever outbreak.

Kuniwo Nakamura, President of the Republic of Palau, praised "the excellent performance and diligent work of . . . team members [who] have greatly enhanced the capability of health and states' officials to respond more readily and effectively to emerging disease threats." He added the project allowed "the U.S. military and the people of Palau to work together in a training project which has greatly improved the health and welfare of the Palauan community."