Ibarra Drain Services

[Salomon Thoj]

Extensiveexperience in civil engineering including: water main extension, water distribution systems, sewage collection systems, storm water collection systems, French drains. Our projects include both commercial work such as new water lines, new fire hydrants, and fire lines. We work in Miami Dade County, Broward County, as well as Palm Beach County.

Responsible for the design, Inspection and certification of Water distribution and Sewage collection systems in Miami Dade County. Extensive experience with Miami Dade Water and Sewer department and Miami Dade county DERM.

Extensive experience in civil engineering design and permitting services. Responsible for the design, Inspection and certification of construction projects encompassing roadway improvements excavation and earth work, storm water collection pavement markings, water distribution, sewage collection, paving & grading.

Small island developing states (SIDS) in the Caribbean region are challenged with managing the health outcomes of a changing climate. Health and climate sectors have partnered to co-develop climate services to improve the management of emerging arboviral diseases such as dengue fever, for example, through the development of climate-driven early warning systems. The objective of this study was to identify health and climate stakeholder perceptions and needs in the Caribbean, with respect to the development of climate services for arboviruses.

Stakeholders included public decision makers and practitioners from the climate and health sectors at the regional (Caribbean) level and from the countries of Dominica and Barbados. From April to June 2017, we conducted interviews (n = 41), surveys (n = 32), and national workshops with stakeholders. Survey responses were tabulated, and audio recordings were transcribed and analyzed using qualitative coding to identify responses by research topic, country/region, and sector.

Health practitioners indicated that their jurisdiction is currently experiencing an increased risk of arboviral diseases associated with climate variability, and most anticipated that this risk will increase in the future. National health sectors reported financial limitations and a lack of technical expertise in geographic information systems (GIS), statistics, and modeling, which constrained their ability to implement climate services for arboviruses. National climate sectors were constrained by a lack of personnel. Stakeholders highlighted the need to strengthen partnerships with the private sector, academia, and civil society. They identified a gap in local research on climate-arbovirus linkages, which constrained the ability of the health sector to make informed decisions. Strategies to strengthen the climate-health partnership included a top-down approach by engaging senior leadership, multi-lateral collaboration agreements, national committees on climate and health, and shared spaces of dialogue. Mechanisms for mainstreaming climate services for health operations to control arboviruses included climatic-health bulletins and an online GIS platform that would allow for regional data sharing and the generation of spatiotemporal epidemic forecasts. Stakeholders identified a 3-month forecast of arboviral illness as the optimal time frame for an epidemic forecast.

Small island nations in the Caribbean are highly vulnerable to climate change, whose effects include increased frequency and severity of droughts and increased intensity of tropical storms and hurricanes. Extreme weather and climate events affect directly or indirectly most dimensions of human well being, including mental and physical health, food, housing, freshwater, and livelihoods. Climate-driven early warning systems (EWS) to predict epidemics of dengue fever and other mosquito-borne diseases can help nations to adapt to changing climate conditions. In this study we assessed climate and health sector stakeholder perceptions and needs to inform the development of a dengue EWS. Stakeholders identified capacity limitations (financial resources, trained personnel), and the need for local research on climate-arbovirus linkages to inform decision makers. They identified six key strategies for strengthening the partnership between the climate-health sectors, and they assessed the viability of public health actions that could be take in response to short (2 week), medium (3 month) and long-term (1 year) forecasts of dengue fever epidemics. The results of this study contribute to Caribbean efforts to develop climate services for health, a key adaptation strategy to reduce the health impacts of climate change.

Copyright: 2019 Stewart-Ibarra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files. Derived data from interviews are presented in the paper (primary themes) and summaries from surveys are presented in supplemental tables. We have not included the full interview transcripts as supplemental files, as confidentiality could be breached due to identifiable information in the transcript.

Dengue fever, chikungunya and Zika fever are arboviral diseases transmitted by the Aedes aegypti and Aedes albopictus mosquitoes. Theses diseases among the top public health concerns in the Caribbean region [5,6]. In 2019, the Caribbean Public Health Agency (CARPHA) issued an advisory for the possibility of a severe dengue epidemic [7], given a rise in dengue activity in Latin America, the increasing burden of arboviruses over the last number of years, and the large gap in time since the last dengue epidemic in the Caribbean region, which occurred in 2009. The Caribbean is the region of the Americas with the highest incidence of dengue [8]. Vector control is the main public health intervention to prevent and control disease outbreaks through insecticide application, elimination of larval habitat sites, public education and community mobilization [9]. Despite these efforts, the annual number of dengue cases in the region increased from an estimated 136,000 to 811,000 cases between 1990 and 2013, with case estimates adjusted to account for underreporting [8]. New tools and management strategies are urgently needed to increase the capacity of the public health sector to prevent and respond to arboviral disease outbreaks.

The key ingredient for embedding climate services in public health operations is creating an enabling environment for partnership with different stakeholders. This is done by identifying the common priorities, needs for research, and by building necessary capacities for understanding among climate and public health stakeholders and researchers [26,27].

(A) Location of the Caribbean region within the Americas, (B) Archipelago of islands making up the Caribbean and their location within Meso-America. (C) Location of Dominica (purple) and Barbados (green) within the islands in the region. This map was created using freely available country boundary datafrom GADM.org, rendered in ArcGIS. Image files were created using GIMP freeware.

Barbados (pop. 284,996; land area: 439 km2) has a service-based economy, with tourism accounting for 12% of the gross domestic product (GDP). Barbados is a water scarce country. Droughts threaten to reduce the already limited freshwater resources [55], and tourism is a water-intensive sector. The Ministry of Health is responsible for arbovirus and vector surveillance and control.

The national health agencies of both countries are supported by the Caribbean Public Health Agency (CARPHA) and the Pan American Health Organization (PAHO), the regional arm of the WHO. Each country has its own national meteorological and hydrological service (NMHS) supported by the Caribbean Institute for Meteorology and Hydrology (CIMH), the technical arm of the Caribbean Meteorological Organization (CMO). Details regarding the mandates and capabilities of the public health and climate national and regional organizations, with respect to arbovirus and vector surveillance and control, and climate monitoring and forecasting, are provided in S1 Text.

Printed surveys were distributed to health sector stakeholders at national vector control, environmental health, and epidemiology offices, as well as those who participated in national workshops on the development of climate services for arboviruses in Barbados and Dominica in April 2017. The workshop in Dominica was organized by the CIMH and the Ministry of Health and Environment (6 health sector participants). The workshop in Barbados was organized by the PAHO and the CIMH (21 health sector participants). Survey responses were entered into an online digital database using Qualtrics and responses were tabulated.

An interview instrument was developed for stakeholders from the climate and health sectors. Questions in the interview and survey were similar so that we could triangulate and validate the responses. We also asked which organizations they had partnered with to manage vector borne diseases, which organizations they would like to partner with, how climate and health fit within their current institutional priorities/mandates/competencies, and what strategies would stimulate collaboration between the climate and health sectors. In interviews with program directors, we asked additional questions about available climate and arbovirus/vector data and information, as well as arbovirus and vector surveillance and control strategies (see institutional competencies in S1 Text).

Project investigators interviewed stakeholders from the climate and health sectors through in-person meetings or via Skype in April and May 2017. Interviews were audio recorded following permission from interviewees. Recordings were transcribed and coded by project investigators to identify responses by research topic, country/region and sector [57,58].

3a8082e126