RMO Site Visit to Asuncion, Paraguay

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					                                 RMO Site Visit to Asuncion, Paraguay
                                      May 30th - June 2nd, 2006
                                 Pandemic Influenza Tabletop Exercise
                                             June 1, 2006


Ambassador James Cason
DCM Kevin Johnson
Colonel Bogart
Lt. Colonel Bear
Maria Lourdes Fernandez, RN
Graham Webster (Management Officer)

The purpose of this trip was to work with the Embassy, USAID, PAHO and the
Government of Paraguay to conduct a Pandemic Influenza Table top exercise. I
would like to thank the Front Office and the Management Officer, Mr. Graham
Webster for his ardent support and the provision of lunch and beverages through
representational funds. A special thanks and recognition to three individuals who
worked together to pull all the details together: Maria Fernandez RN (Health Unit),
Gabriella Avilla (USAID- Health Section) and Dra. Marta von Horoch (Ministry of

    Minister of Health: Dra. Teresa Leon                                Participants

The conference was held in the USAID conference center. A welcome address was
given by Dra. Teresa Leon (Minister of Health), Ing. Sonia Tavares (OPS) and Mr.
Graham Webster representing the US Embassy and USAID. Dr. Roberto Dullak
(Vice Minister of Health) gave a very informative overview of pandemic influenza
and the economic impact caused by diseases and natural disasters. This was
followed by Sra. Maria Diaz de Vivar (Centro de Informacion y Recursos para el
Desarrollo/Free Lance Journalist) who gave an excellent presentation on Risk
Communication. The final presentation was given by Dr. Jorge Leon
(USDA/APHIS) on Animal Surveillance in South America.

   Maria Diaz de Vivar: Risk Communications                              Dr. Jorge Leon: APHIS

Approximately seventy people participated in the table top exercise. Their were five
tables with representatives from the Ministry of Health, Ministry of Agriculture,
Ministry of Education, Ministry of Defense, Ministry of Finance, Police, Airport
Authority, Airlines (TAM Mercosur), Representatives from the Private Health Care
Sector ( Hospital Bautista, Sanatorio Migone, Sanatorio San Roque) WHO-OMS,
Private Poultry Sector, Press, USAID, Department of State, Peace Corps and
USDA-APHIS. The exercise lasted three hours. The exercise went through five
scenarios leading to a pandemic with human to human transmission. Questions
involved lines of authority, international and interagency communications,
surveillance, surge capacity, isolation and quarantine enforcement, compensation as
a means of encouraging compliance and clear channels of communication using the
press for public information. Paraguay has had the misfortune of having a national
disaster several years ago involving the death of four hundred individuals in a
supermarket fire. From this disaster, the Government has learned the lessons of a
centralized incident command system through the establishment of a Department of
Emergency Response and Disasters. One of the main issues that emerged from the
conference was that different Ministries and Departments may have plans, but these
plans have not been shared with other Ministries or the Private Sector partners.

                                       Table Top Exercise Participants


   1. The Representative Ministries in Paraguay and the Private Sector are eager
      to continue this dialogue. Through USG support (USAID/ Humanitarian
      Assistance Grants from SOUTHCOM) we should continue assisting the
      Government of Paraguay with training for emergency response personnel
      and designated leaders in the various Ministries.

2. Encourage the Ministry of Defense to work with the Ministry of Health and
   Agriculture on a unified command structure.
3. Look into the possibility of developing a national emergency operations
   center ( EOC) at a designated site. The EOC could also be used as a site for
   training and planning by other Ministries of the Government of Paraguay.
4. Consider bringing an Incident Command Training Course to Paraguay for
   local and national leaders.
5. Consider working with the State Sister Program (Commonwealth of
   Massachusetts) to take designated leaders from the respective ministries to
   see the Emergency Operations Center.
6. Encourage the National Laboratory and Ministry of Health to work with the
   Naval Medical Research Center Detachment (NMRCD- Lima) on Adenoviral
7. FAO is very active in Paraguay. I would encourage APHIS to continue their
   cooperative efforts in conjunction with FAO on animal surveillance in
   Paraguay. FAO is working on having the national laboratory in Sao Paulo,
   Brazil recognized as a certified reference lab. The NMRCD facility in Lima is
   a Biosafety Lab 3 which makes it one of the few labs outside the United
   States with the same capabilities as State Public Health Reference Labs and
   laboratory facilities of the National Institutes of Health and the Center for
   Disease Control. NMRCD is very interested and has some funding that
   would be helpful to both the Ministries of Health and Agriculture on animal
   and human surveillance.

Submitted by: Lawrence W. Gernon, MD ,MPH&TM
Regional Medical Officer: Bolivia, Brazil and Paraguay.