IBP1174_09

THE IMPORTANCE OF AN ENTOMO-EPIDEMIOLOGICAL

MONITORING IN THE CONSTRUCTION

OF PIPELINES AT THE AMAZON 1 2 3 Elidianne da S.Cruz , Luciana L.Valgas , Rita de Cássia G. Batista , 4 5 Lucimara de Agostini , Andréia Lábrea Pereira , Wanderleia Isabel P. de Freitas6 , Amadeu Farage Frade7

Copyright 2009, Brazilian Petroleum, Gas and Biofuels Institute - IBP This Technical Paper was prepared for presentation at the Rio Pipeline Conference and Exposition 2009, held between September, 22-24, 2009, in Rio de Janeiro. This Technical Paper was selected for presentation by the Technical Committee of the event according to the information contained in the abstract submitted by the author(s). The contents of the Technical Paper, as presented, were not reviewed by IBP. The organizers are not supposed to translate or correct the submitted papers. The material as it is presented, does not necessarily represent Brazilian Petroleum, Gas and Biofuels Institute’ opinion, or that of its Members or Representatives. Authors consent to the publication of this Technical Paper in the Rio Pipeline Conference Proceedings. (simple line, 10) (simple line, 10) Abstract (Times New Roman 12, Bold, Upper/Lower case) (simple line, 10) This work has as objective to evidence one of the consequences of most satisfactory results, talking about attendance to the legal requirements of health on a pipeline undertake at the Amazon: a positive result of index zero of malaria cases until the present days. This work, in its peak, reached the contingent of eight thousand workers lodged in rafts, boats, carps and jungle camps. To reach this index, a methodology of prevention through an entomo epidemiological control was adopted, recommended for the World-wide Organization of Health, as basic activity for malaria control in endemic areas, as in Amazon. The activities had consisted to identify the epidemiologic profile of each area, to elaborate procedures of vectorial control, to implant laboratories for analysis of malaria blades, to enable staff to accomplishment of vectorial control, to realize thermonebulization and domestic spread and to sensitize the workers of prevention and control measures. Therefore, by means of accomplishment of these basic actions, it was possible to assure an integral, equitable and qualitative attendance providing a critical and conscientious vision of involved and the success of the procedures adopted by , represented by ENGENHARIA/IENOR (Northern Undertake Implementation), unit responsible for the pipeline Urucu- Construction.. (simple line, 10) (simple line, 10) (simple line, 10) 1. Introduction (Times New Roman, 12, Bold, Left Aligned) (simple line, 10) The history of human interventions at the Amazon is full of evidences of adverse results caused by ineffective management of the regional environment requirements. Among these interventions, we may distinguish the undertaking infrastructures of the past century, such as railroads, hydroelectric plants and highways. When analyzing those undertakings under a historical point of view, we can notice some common points, such as: The necessity of Governments to install undertakings with infrastructure in unilateral ways, without planning and considering local particularities; The high investments of financial, material and specially, human resources; The significant impact of those enterprises, been of anthropic, biotic or physical order. The learned lessons with these interventions require a special attention to local peculiarities. It’s the case of Urucu-Manaus Pipeline, located at Amazonas State, which routes are established in cities with high potential regions to malaria outbreak, and other tropical illnesses such as leshmaniose, filarioses and yellow fever. Malaria is a serious public health problem because of its high incidence and debilitating effect for people and regional economy, since it reduces their productive capacity. From this perspective, the Urucu-Manaus Pipeline, which at the peak sheltered more than eight thousand employees working inside the Amazonian biome, lined up to the

______1 MBA Audit and Health Management - PETROBRAS/CONCREMAT 2 Psychologist - PETROBRAS/CONCREMAT 3 Nurse - PETROBRAS/CONCREMAT 4 Nurse - PETROBRAS/CONCREMAT 5 Environmental Management Specialist – PETROBRAS/CONCREMAT 6 MBA Environmental Management – PETROBRAS

Rio Pipeline Conference and Exposition 2009 recommendations of OMS and of the Ministério da Saúde (World Health Organization and Health Ministry ), produced efforts with the basic goal of preventing that a malaria outbreak paralyzed such great man enterprise. With this objective it was established a monitoring combat and control methodology for all the involved workers who consisted in: Entomo-epidemiological monitoring identifying the epidemiologic profile of each area; Elaboration of procedures of vectorial control; Laboratories implantation for malaria detection in 100% of the workers; Staff training and qualification for accomplishment of vectorial control; Use of the Thermo nebulization (fogginess) technique combined with spraying buildings and rooms with insecticide and workers sensitization for the importance of prevention and control acts.

The result of this effort is that, being few days away from the ending of this great undertake, there was not a single autochthony case, no worker contracted malaria as result of their activities of construction and assembly of the pipeline, and there was no interruption of activities for such fact. (simple line, 10) (simple line, 10) 2. The Pipeline Urucu-Manaus (simple line, 10) In the last few years, because of the energetical politics adopted by the Brazilian Government, the natural gas has reached an important energetical input with crescent participation at the national energetical matrix. Their qualities and advantages against other energy sources encouraged the industry, home and automotive applications of the natural gas, significantly at the great urban and industrial centers of south, southeast and northeast regions. This growth, demands a better infrastructure turned to the natural gas industry, especially regarding the network distribution expansion (pipelines). The pipeline is a set of pipes that carries the natural gas from the source to the consumer centers. The energetic matrix of the Amazon State is based, largely, on imported liquid fuels, making the electrical energy production, land and river transportation more expensive. To solve the energetical cost problem is essential that the diesel and fuel oil used on thermoelectric and at the industries are replaced by natural gas, which is an abundant fuel of the Amazon State presenting approximately 82,4% of it natural gas reservation . Among all large scale available fuels, the natural gas contrasts been more economic, save and pure. In this context, we can emphasize the “Petrogaseífera” Province of Urucu River, located at Solimões River basin, the second major natural gas reservation of Brasil. All the gas extracted in Urucu is drained for a pipe until the terminal at the Solimões river shore, next to the city of Coari, by the river until Isaac Sabbá Refinery (REMAN) located at Manaus/AM. Recently, Petrobras redefine the Urucu project, prioritizing the natural gas outflow from Coari to Manaus thru a pipeline with approximately 665 km of extension. According with article 2 of resolution number 001/89 of CONAMA, the construction of a natural gas pipeline is consider a potential cause of environmental damages, must therefore submit to a preliminary study of ambiental impacts and intensive monitoring. The concerning about the possibility of ambiental deterioration associated with natural gas transport by pipelines at the Amazon Region are relevant, due to the fact of the area hosts the major terrestrial biome ( Amazon Forest ), depositary of one of the majors biodiversity of the world, as well for the fragility of its natural ecosystems. (simple line, 10) 3. The pipeline at the Amazon and Tropical diseases (Times New Roman, 12, Bold, Left Aligned) (simple line, 10) The Amazon region concentrates a diversity of diseases that according to Confanoliere (2005), is primarily because of the geographic and ecologic aspects that stand out like: the territorial extension and it predominant fluvial access, the great biologic and social diversity related to the ecosystems preservation. Cofaloniere (2005), says that the total extension of aquatic environmental ( rivers, lakes, floodplains ) that at the Brazilian Amazon, reaches to 300 thousand km2 , is relevant to health, because some infectious processes occurs by water contamination , like cholera and microbial gastroenteritis. The water distribution, according to this author, defines largely, the proliferation local of insect vectors diseases, mostly the malaria mosquitoes. The environmental peculiarities of Amazon encourage the high density of mosquitoes populations development. This fact is related to the tropical conditions of the region providing ways of adaptation and development during all the year, with annual variations. This factors aloud a high diversity of species at the region, spreading to man pathogenic causes. ( Tadei, 2004 ) The Amazon concentrates the great majority of malaria cases in (98% of registered cases ) and the second higher rate of tuberculosis of the country. Its also endemic to viral hepatitis and yellow fever ( Bensabath e Soares , 2004 ) This way, when the man is inside of jungle, exposing yourself to mosquitoes populations, he becomes part of a zoonosis (diseases transmission in natural conditions between vertebrates animals and the man). This way man becomes 2 Rio Pipeline Conference and Exposition 2009 the link of restricted diseases from wilderness areas and transmitted in urban areas becoming the vehicle of harm to human health. In this scenario is been built the Urucu-Manaus Pipeline. But, how is possible to execute a construction in the middle of the jungle with a propitious environment to endemic diseases? (simple line, 10) 4. Undertakings at the Amazon: A conterminal intervention to workers health

In the last century Brazils assumed the commitment of building a railroad connecting Guajará Mirim at Brazil- Bolivia border on the Mamorés river, to Porto Velho, at Madeira´s river. This railway had the objective to contour Madeiras River between Guajará Mirim and Porto Velho, allowing the rubber exportation, including Bolivians rubber. The construction took six years, from 1907 to 1912, and according to historian, caused more than a thousand deaths. The railroad Madeira-Mamoré has became known as Devil’s railroad, because of the large number of human losses for tropical diseases, specifically malaria. Other examples of infected workers by tropical diseases can be mentioned with the construction of a hydroelectric at the region. According to Barata (1995), there are different epidemiological situations, due to different kinds of soil occupation and because of the great methods of natural resources economic exploration at the Amazon. Are from a great importance for disease control, the individual frequent displacements that for occupational reasons, mostly, transit among endemic areas and other safe areas of the country. The Urucu-Coari-Manaus pipeline at your peak, displace by air and by river eight thousand workers and would be a large outbreak of tropical epidemic diseases at the region, if they haven’t thought about prevention. This was one of the greatest challenges of this undertaking, realize the work on schedule, with minimum of workers unable to work because of endemic diseases. For example, each worker infected with malaria has to be displaced for at least ten days.

5. Preventive Measures: Entom-epidemiological monitoring and control.

The National Program of malaria control, of Health Minister, utilizing the recommendations of World Organization of Health, defined as a primordial strategy the precocious diagnoses, immediate treatment and the immediate detection of epidemic, for the human control of infectious sources, and at the same time operates with selective interventions for vector control. To protect the workers of Urucu-Manaus pipeline against diseases, the Northern Undertaking Implementation (IENOR) at the Engineering section established an agreement with public institutions like Fundação de Vigilância de Saúde (FVS) and Instituto Nacional de Pesquisas “National Institute of Research” (INPA) that holds the knowledge and experiences at the preventive actions and control of diseases at this region. From this partnership it was created the Structuring Project for Monitoring Possible Health Impacts at the pipeline construction. This agreement was extended to all the companies engaged at the pipeline activities. The major objectives of this plan was to promote monitoring, preventive and controlling actions looking for the quality improvement at workers life and of the adjacency population involved with the pipeline work, at the communities and Municipal Head Offices of Amazonas State. Before the beginning of work it was realized an entomologic study, where it was possible to identify and catalog the most important vector at the construction line of pipeline and the entomologic study where it was drawn the endemic profile of this line. From this studies there were established the routines and actions to combat the endemic diseases. The first adopted measure it was the malaria’s triage, where every worker that gets on the work front must realize the “Gota espessa” exam (Figure 1), where is possible to diagnose with a sigle drop of blood if the worker is infected or not for malaria. This measure is intended to isolate sick workers of the pipeline area, because this worker turns into a source of this illness. Thru the malaria triage it’s possible to search all the positive cases. Any worker that presents fever is sent to the health sector to do the malaria quick test, and if its positive, an entomological research is done to verify where the worker was infected.

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Figure 1. “Gota espessa” exam

The thermo nebulization (fogginess), in the figure 2, was another preventive measure adopted. In every places of work, clearings, work fronts, boats, accommodations, the fogginess are realized every morning and at the afternoon, time that the mosquitoes appears with a high frequency. The household spraying it’s to be realized essentially inside the accommodations, boats and gantries. Those actions can minimize the vectors presence at these areas.

Figure 2. Thermo nebulization (fogginess)

The admission of worker at the pipeline work it’s combined to vaccination requirement against yellow fever, antitetânica, hepatitis A and B, the last one at lest ten days before goes to work front and every worker of Urucu-Coari- Manaus pipeline receives repellent to use during the day of work.

Figure 3. Vaccination 4 Rio Pipeline Conference and Exposition 2009

All those and other actions counted with a great structure of health sector where were installed , nurseries with vaccination rooms and laboratories to malaria, leishmaniose and chagas disease diagnoses. The health professionals were trained for (FVS) and (INPA) to execute the entomologic and epidemiologic activities in additional to lectures about how to recognize the symptoms of endemic diseases to workers and community. The result of those preventive actions, monitoring and control is that until the present days at the undertaking, that it’s almost finished, no case of autochthonous endemic disease at the construction and assembly of the pipeline Urucu-Manaus were registered.

Figure 4. Structure of health sector

6. Conclusion and final considerations

After reading this work, we can observe that the satisfactory result in the case of malaria or other autochthony endemic disease observed during four years of work for the construction of Urucu-Manaus pipeline, located in the heart of the Amazon forest, that involved eight thousand workers hosted in rafts, boats and jungle camps, due to developed work, to ensure the attending of entomo epidemiologic guidelines monitoring, by World Health Organization for activities of endemic zones control, such as Urucu-Manaus pipeline tracing.

We conclude that the age of “"Railways of Devil" and other works, where large human losses occurred because of tropical diseases, especially for malaria, came to an end and the permanence of this new age of sustainable development of our forests without losses of lives by malaria or other endemic diseases depends only of our efforts to controlling and monitoring of the human entomo epidemiologic activities in endemic areas of the forest.

7. References (Times New Roman, 12, Bold, Left Aligned) (simple line, 10) BARATA, R C. B. Malaria in Brazil: Trends in the Last Ten Years. Cad Saúde Púb1., Rio de Janeiro, 11 (1): 128-136, Jan/Mar, 1995. BENSABATH, G. e SOARES, M.C.P. A evolução do conhecimento sobre hepatites virais na região Amazônica: da epidemiologia e etiologia à prevenção. Rev. Soc. Bras., 3 Med. Trop., 37 v. II, p. 14-36, 2004. CONFALONIERE, U.E.C. Saúde na Amazônia: Um modelo conceitual para análise de paisagens e doenças v19n53. Estudos Avançados v.19, n.53, p.221-236, 2005. DARWICH, A.J, ROBERSTON, B.A, ALVES, L.F, SUAREZ, P.A, APRILE, F.M, SILVA, M.S.R. Proposta de Monitoramento Ambiental da Área de Influencia Direta do Gasoduto Urucu-Coari-Manaus, Amazônia Central, Brasil, 2005.

5 Rio Pipeline Conference and Exposition 2009 OLIVEIRA, A.E.M, TADEI, W.P, PINTO, R.C, SOARES, A.G, SILVA, L.S.F, AZEVEDO, W.M, FIALHO, R.R, TERRAZAS, W.C.M, FREIRE, C.S, MACHADO, L. Projeto de Estruturação para o monitoramento de possíveis impactos à saúde no eixo da faixa de domínio da área do gasoduto Urucu-Coari-Manaus, 2006. TADEI, W.P. Relatório Técnico: Área: Entomologia Médica: Anofelino e Outros Culicídeos, 2004.

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