Communicable Disease Surveillance
- Appointed in 2006 to lead the Team responsible for CD surveillance. Inherited a system in which CD surveillance was viewed as a ‘burden’ by staff at the existing reporting sites. This was manifested by late reporting, failure to report and inaccurate reports.
- Convened a multi-stakeholder Workshop with technical assistance from CAREC, during which the importance and attributes of a good surveillance system were discussed in the context of national, regional and international obligations and benefits. At the Workshop the existing surveillance Manual was reviewed and recommendations made for improvements.
- Over 12 month period immediately following the Workshop, announced and unannounced audits were conducted; observations were discussed and corrective actions applied as needed.
- Updated CD Surveillance Manual.
- Agreement among stakeholders on standard operating procedures and reporting deadlines.
- Improvement in the acceptability of the CD Surveillance system – demonstrated by increased participation (to 100%) and on-time reporting
Recognition from PAHO/ CAREC, – 2009 Award of Excellence and 2nd place on two other occasions.
Pandemic Influenza Preparedness & Response
- In 2006/07 WHO raised the alert regarding H5N1 as a virus with pandemic potential, and provided technical assistance to train public health staff in the preparation of Strategic and Operation Plans for responding to the threat. Epidemiologist was one of the beneficiaries of the training as Chair of the National Influenza Pandemic Preparedness Committee.
- 2009 H1N1 identified as having pandemic potential, and advised of the need to prepare.
- Multi-disciplinary Team assembled and plan drafted and submitted to Cabinet.
- Training undertaken, particularly in infection control, proper use of PPE, outbreak investigation and contact tracing.
- Enhanced the surveillance of fever and respiratory symptoms
- When the first case of H1N1 was identified in November 2009, plan was implemented
- National Influenza Pandemic Preparedness Plan
- Trained staff – outbreak investigation, Correct use of PPE
Training in Proper use of PPE
- A co-ordinated response to a public health threat.
- In December 2013, Chikungunya was identified in the Caribbean.
- April 2014, the disease had spread to several neighbouring islands prompting the need to prepare, given the ubiquitous nature of the vector.
- First local transmission of ChikV identified in August 2014.
- Surveillance Response Team met and reviewed available data on the vector indices around the island. We noted that there was a need to act immediately to reduce the vector population, so that when affected individuals arrived on island, we could reduce the likelihood of extensive spread.
- Commenced a communication campaign outlining the key facts about Chikungunya and its vector the Aedes aegypti mosquito.
- A variety of educational tools targeting different sub-groups of the population, designed to education and to increase compliance with environmental regulations.
- Island-wide fogging – reduced adult mosquito population.
- ‘Clean-up Campaign’ – reduction in available mosquito breeding sites.
- Budget Submission ChikV Response
- Total budget approved and project being implemented;
- Mobilisation of the community to work towards keeping their surroundings clean and un-cluttered.
Other Disease Outbreaks
- Over the years the Surveillance Response Team has responded to increases in reported CD syndromes.
- When this happens the Team is usually alerted by the Weekly Surveillance Report that is shared with all stakeholders
- Education campaigns outlining the nature of the outbreak being monitored, and the ways to avoid/reduce the likelihood of contracting it. Warning signs of complications and when and where to seek medical attention.
- Enhanced surveillance for the specific syndrome, and increased frequency of Team meetings as indicated.
- Collection of appropriate diagnostic specimens for definitive diagnosis.
- Training of staff for appropriate response for their own protection and management of patients.
- Educational material, Outbreak Reports.
- Influenza B Outbreak Report Jan. 2007
- Norovirus Outbreak Report Dec. 2011
- A co-ordinated response to emerging and re-emerging public health threats.
Contingency Planning for Public Health Emergencies
- Following the January 2010 earthquake in Haiti, an outbreak of cholera was reported in October that same year. Eventually, the neighbouring Dominican Republic reported cases of cholera due to the movement of persons between the two countries. Given the frequency of travel between the Dominican Republic and the rest of the Eastern Caribbean, it was necessary to prepare for the possibility of affected persons presenting on Montserrat.
- Following the outbreak of Ebola Virus Disease in countries in West Africa and the subsequent introduction of cases to the United States and Spain, it was deemed necessary to prepare for the possibility of affected persons presenting on Montserrat.
- Multi-stakeholder Team was assembled and with technical assistance from PAHO and the OECS plans for a joint response have been drafted. However, cognizant of the possibility that several of our neighbours may be affected and be in need of assistance concurrently, local response plans have been drafted.
- Increased confidence in the Ministry’s commitment to protecting the health of the population.
- Recent estimates for the prevalence of hypertension in the resident population range from 12 – 16%. Under the Hospital & Healthcare Improvement Project, budgetary allocation was made for programmes to prevent and/or improve the management of non-communicable diseases.
- A multi-sectorial Team was established to plan and implement interventions.
- The following areas were identified for focus during the first two years of the project:
- A national forum was facilitated to sensitise key decision makers,
- Public education on NCDs and risk factors for these conditions,
- Targeted education for persons living with NCDs and significant persons in their lives,
- Interventions to address risk factors starting with childhood obesity. These include five- day Health Camps, demonstrations of preparation of healthy meals and snacks, liaising with Ministry of Education to increase opportunities for increased physical activity.
- National Forum on Non-Communicable Diseases Agenda NCD Forum, Status Report
- Billboards and leaflets with ‘healthy living’ themes erected around the island. Billboard
- Hypertension self-management course developed and piloted among persons living with hypertension, registered in the four government-operated Health Centres. Hypertension Course Outline
- Health Camp for children identified as overweight, during school-health assessments. Health Camp Timetable
- Increased awareness of NCDs.