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# NAMRU SOUTH Hosts Students for Military Tropical Medicine Field Exercise in Peru

By Courtesy Story

                LIMA, PERU  –              
This past Summer, U.S. Naval Medical Research Unit (NAMRU) SOUTH welcomed nine U.S. military students to a field exercise in Peru for the Military Tropical Medicine (MTM) course.This year’s exercise was part of an MTM course coordinated by the Uniformed Services University and NAMRU SOUTH and was the first held in Peru since 2019. Students, having just completed a rigorous four-week classroom curriculum held in Bethesda, Maryland, took part in a variety of tours and field activities to expand their knowledge of tropical medicine and epidemiology surveillance of tropical diseases.Lt. Cmdr. Danielle Pannebaker, NAMRU SOUTH’s director for the Peru MTM Training Program, Dr. Juan Francisco Sanchez, clinical rotation assistant and NAMRU SOUTH Parasitology Department public health scientist, and Cmdr. Catherine Berjohn from Naval Medical Center San Diego, welcomed participants upon their arrival to Lima.“One of the main objectives of this MTM course is to strengthen relationships between the U.S. Armed Forces, Peruvian Navy, and Peruvian Army,” said Sanchez. “This goal was achieved with great success.”The Peru MTM team, along with two translators from NAMRU SOUTH, Kahoma Villaizan and Toané Zuloeta, toured several hospitals, universities, laboratories, and communities in Lima, Iquitos, and Tumbes.“The visits to the Peruvian Armed Forces hospitals allowed students to learn how military personnel can contract tropical diseases from the areas where they are deployed,” Sanchez explained. “In addition, students received instruction on the relevance of the epidemiology knowledge of the area where they are deployed, and how to prevent those diseases.”During their stay in Lima, the team toured the newly renovated laboratory facilities at NAMRU SOUTH and were briefed on current and future projects in the Bacteriology, Parasitology, Virology, Entomology, and Clinical Trials Unit departments, which conduct surveillance, epidemiology, and basic science throughout Central and South America. Recent NAMRU SOUTH projects include assisting the Peruvian Ministry of Health in identifying the H5N1 Avian Influenza strain within local bird species, providing expert instruction in entomology and parasitology at the Defense Institute for Medical Operations course, and curating surveillance data of malaria outbreaks in several regions of Peru.The Peru MTM team also engaged with local hospitals, including Centro Medico Naval, Hospital Militar Central, the Universidad Peruana Cayetano Heredia (UPCH) Institute of Tropical Medicine Alexander von Humboldt, and the Instituto Nacional de Ciencias Neurologicas hospitals. Local subject matter experts educated MTM students on the challenges of diagnosis, management, and treatment for endemic tropical disease cases such as malaria, leishmaniasis, tropical spastic paraparesis, and neurocysticercosis cases, which affect both military and civilian populations.“We reinforced lessons learned in the didactics course with hands-on clinical cases of Leishmaniasis, malaria, cysticercosis, active tuberculosis, newly diagnosed HIV, and HTLV-1.” explained Lt. Clayton Fuqua, a family medicine resident physician from Navy Medicine Readiness and Training Command Camp Pendleton, and one of the U.S. military students attending the course.Before departing Lima, the team visited the National Health Institute and Serpentarium, where Dr. Gualberto Marcas Caceres, the Institute’s coordinator of venomous animals, explained distinguishing attributes of local venomous snakes, spiders, and scorpions.In Iquitos, Peru, the MTM team toured the NAMRU SOUTH facility and its insectary, the first laboratory to successfully rear the Anopheles darlingi mosquito and to use mosquitos to monitor and test insecticide resistance. Additionally, the Peru MTM team spoke with physicians from Hospital Regional de Loreto and Hospital de Apoyo de Iquitos about the nuanced challenges of managing endemic diseases in a city of approximately 490,000 people accessible only by aerial and maritime routes.The team then charted a boat down the Nanay River to the local Ministry of Health facility in the outskirts of Iquitos, in the community of Padrecocha. Here, MTM students participated in local field environmental sampling as part of a University of Virginia project to monitor prevalence and effects of infectious diarrheal disease in children.For the last leg of their trip, the Peru MTM team visited the coastal region of Tumbes, an area recently affected by high rates of Dengue. Here, the team completed a rigorous fieldwork course led by UPCH. Carmen Flores, an entomologist with NAMRU SOUTH’s Entomology Department, taught students about larvae and mosquito identification, sampling, and surveillance practices. Dr. Claudia Guezala, a research scientist with NAMRU SOUTH’s Virology and Emerging Infections Department, instructed the team on sentient rodent trapping and surveillance exercises.Lastly, the MTM students learned about the UPCH Cysticercosis Elimination Program, which teaches the local community how to identify cysticercosis in pigs, the dangers of consuming infected pig meat, and the eradiation and treatment of pork tapeworm (Taenia solium), which causes cysticercosis infection in pigs. This knowledge is critical for preventing subsequent disease and complications, including neurocysticercosis, in humans.“The Military Tropical Medicine program in Peru is a unique and valuable course for military providers in a variety of specialties, including infectious diseases, preventive medicine, and family medicine,” remarked Pannebaker. “NAMRU SOUTH’s Peru MTM team is grateful for the support, efforts, and experiences that local collaborators in Peru provided to the class of 2023 and look forward to many successful courses to come.”

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