Emergency Plan of Action (EPoA) CAR Monkey-pox epidemic outbreak

Transcription

1 Emergency Plan of Action (EPoA) CAR Monkey-pox epidemic outbreak DREF Operation Operation n MDRCF020; Date of issue: Date of disaster: 5 February 2016 Operation manager (responsible for this EPoA): Pierre Danladi Operation start date: 17 February 2016 Overall operation budget: CHF 55,848 Point of contact (name and title): Pierre Danladi, IFRC operations manager for CAR Expected timeframe: Two months Number of people affected: 13 cases (2 deaths) and risk Number of people to be assisted: 164,000 people of human to human transmission indirectly and 64,000 people directly Host National Society(ies) presence (n of volunteers, staff, branches): Four national headquarters staff (Head of Health, Head of Communications, Programme Coordinator, and Finance Officer), three national disaster response team members, 300 volunteers, and two drivers. Red Cross Red Crescent Movement partners actively involved in the operation (if available and relevant): International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Committee of the Red Cross (ICRC) Other partner organizations actively involved in the operation: MoH, WHO, UNICEF, MSF Belgique, COHED, Caritas, CRS, MINUSCA, A. Situation analysis Description of the disaster On 4 December 2015, two children aged 9 and 5 from a hunter family in Lengo village, 15 kilometres from Bakouma in the Mbomou Province, eastern Central African Republic (CAR), were taken to the Bakouma Health Centre suffering from an unidentified disease with rashes all over their bodies. On the 10 December 2015, in response to the outbreak in Bangassou, the WHO facilitated an initial assessment carried out by the Ministry of Health (MoH) in the affected province and a joint mission was undertaken by the health district and Médecins Sans Frontières (MSF) Belgium. On 17 December 2015, the children were transferred to the Bangassou Regional Hospital, run by an international non-governmental organization (NGO) and MSF. While at the hospital, the children s condition got worse. Samples were taken and sent to the Pasteur Institute of Bangui for laboratory testing. On the 29 December 2015, following the testing of samples and diagnosis, the Minister of Health declared a Monkey-pox outbreak and requested World Health Organization (WHO) s support in carrying out further analysis and immediate response. A person infected by Monkey-pox. Photo CARC

2 P a g e 2 Given the relative rareness of the Monkey pox, the CAR population s limited knowledge on how the disease is spread (mostly through contact with animals, or direct contact with an infected person), there has been an urgent need to contain the outbreak. Due to logistical and access constraints, the MoH and MSF were only able to deploy a health team on the 13 January Meanwhile, the disease continued to spread among family members of the affected children, health staff and people who had come in contact with the affected family. The Provincial authorities activated a Response Crisis Taskforce composed of NGOs and WHO s team and including the local Red Cross Committee in Bangassou. On 14 January 2016, considering the high risk of a rapid spread of the epidemic, another joint mission co-led by the CAR MoH and the WHO Representative, was undertaken with the aim of boosting the response. From 14 to 19 January 2016, A WHO senior epidemiologist was also deployed for in-depth assessment in the affected areas After the initial mission, the following main recommendations made were: Conduct an epidemiological analysis around the affected household in order to curb any potential risk of further contamination (the team will be led by WHO senior epidemiologist). Strengthen the response - WHO has prepositioned medications for the treatment of complications linked to the disease. Boost communication by ensuring sensitization of the local population. Provide universally recommended protection gear for medical staff in charge of those affected. (Central African Red Cross (CARC), MSF and WHO have provided initial protection equipment). Set-up a technical coordination team to ensure daily management of the response process. Conduct further research by Bangui s Institut Pasteur going-on On 5 February 2016, a new Monkey pox case was reported from the same area where the first two cases originated. According to WHO, the case is a 16 years old boy without any linkage with the previous cases. In relation to this new case, four people have been identified as contact cases.. TAs of 5 February 2016, the epidemiological situation in CAR can be summarized as follows: 13 people have been affected and confirmed positive for the disease. Out of these 13 cases, 10 have been discharged from the hospital, while 2 patients have died. 1 person is still hospitalized in a serious condition. All cases are from the same region or prefecture which is Mbomou prefecture in the eastern part of CAR. However, there is no formal established link between the two sets of cases. According to analysis, it seems that the contamination is still active and ongoing in the affected region. Three ways of transmission have been identified so far: o A first animal to human transmission from the first index case reported in December, o A human to human transmission from the first index case o A second animal to human transmission for the new case reported on 5 February The Mbomou province of the CAR is an area where the population consumes monkey meat. Further, an attack on the populations in this areas in the first week of February has led to population movement into the bushes, thus increasing the risk of animal to human transmission. It is therefore important to educate the population of the risk of contamination from the Monkey-pox disease, while consuming contaminated animals. Summary of the current response Overview of Host National Society The CARC, as an auxiliary to the government, is fully involved responding to all the epidemic outbreaks in the country. The CARC is organised into two main structures:- the operational structure which includes programmes in Disaster Management, Community Health/HIV/Malaria/TB and Social Affairs, Water & Sanitation, Communication and Dissemination and the Support Services, which comprises Administration, Finance, Organizational Development.

3 P a g e 3 The CARC has 69 sub-branches (Comités sous-préfectoraux), eight local committees in Bangui, and 117 community-based committees, though not all are active. It counts on approximately 12,000 volunteers countrywide. In the Mbomou province, the CARC is represent by five local Red Cross committees, comprising approximately 800 volunteers. The volunteers in this part of the country have knowledge of Monkey-pox because an epidemic occurred in the same area in 2001 and in the neighbouring province of Haute Kotto in 2014, although not all the volunteers were involved in the response in these two cases. The National Society (NS) has managed DREF and Emergency Appeal (EA) operations, and is experienced with the IFRC modalities and procedures. To date, the CARC is implementing activities of an EA targeting 23 areas of the country hardest hit by the ongoing violence in CAR, that has left over one million people homeless. The areas affected and targeted by this DREF are, however, not part of the 23 areas that were targeted by the EA. As such, the funding from the DREF will strictly target the Monkey-pox outbreak and not the EA activities or any other epidemic outbreak outside the one intended by the DREF. Since 13 January 2016, when the information on the outbreak of Monkey-pox was shared by the WHO, the CARC has continued to take part in the crisis meeting co-led by the MoH and the WHO on the strategic response plan for this outbreak. As part of the initial response, the CARC, with the support of United Nations Children s Fund (UNICEF) has provided the following materials at the request of the MoH: Table 1: Joint CARC / UNICEF provision of materials in response to Monkey-pox outbreak NO Material Description Quantity 1 Apron, protection, plastic, Pack/ Mask, surg type IIR,disp Gloves household cleaning reusable M/L 20 4 Gloves, nitril, non-reusable, pair, BOX/ Boots rubber,pvc,reusable,pair,size Boots rubber,pvc,reusable,pair,size Boots rubber,pvc,reusable,pair,size Goggles,protective,indirect,sideventil 15 9 Cap,surh,non-woven,disp,BOX/ Trouser,surg,woven,size XL Tunic,surg,woven,size L Coverall,protective,CatIII,type 6 B,L Coverall,protective,CatIII,type 6 B,M Coverall,protective,CatIII,type 6 B,XL 25 In addition, the Bangassou Red Cross local Committee is part of the provincial response crisis taskforce put in place by the provincial authorities. The MoH has requested the CARC, with the support of the International Federation of Red Cross and Red Crescent Societies (IFRC), to carry out social mobilisation, community communication and epidemiological surveillance. Overview of Red Cross Red Crescent Movement in country The IFRC is providing assistance through its CAR Country Representation, Central Africa Country Cluster Support Team, and Africa Regional Office. From the onset of the disaster, there has been regular contact with the IFRC CAR Country Representation, and Africa Region Disaster Crisis Prevention, Response and Recovery (DCPRR) unit and regular updates on the situation and activities. On 18 January 2016, an alert was issued using the IFRC Disaster Management Information System (DMIS), and an Operational Strategy Call was carried out with colleagues at regional and Geneva levels. It was agreed that given the nature of the outbreak, specifically the lack of evidence of sustained

4 P a g e 4 transmission (limited only from animal to human, restricted to people directly in contact with those initially infected) that a DREF allocation could not be considered but continual monitoring of the situation should be carried out to establish how the epidemic was evolving (i.e. moving to human to human transmission, and/or increase in the cases reported). Given the reporting of a new case (on 5 February 2016), a follow up Operational Strategy Call was convened (on 10 February 2016), and it was agreed that a targeted DREF allocation should be considered for imminent crisis linked to the strengthening of CARC s volunteer capacity, and to carry out social mobilization in the Mbomou Province. The IFRC CAR Representation, in collaboration with the CARC, continues to attend the crisis meetings co-led by the MoH and the WHO on the strategic response plan for Monkey-pox outbreak. Movement partners in CAR have set up Movement coordination meetings on the areas of security, communication and programme management. In this regard, regular meetings are being held to improve collaboration and seek, where necessary, synergies that will have a positive impact on activities implemented for the affected population. Following the issue of a DMIS, discussions were held between IFRC CAR and ICRC counterparts on the intention to launch a DREF operation for the Monkey pox outbreak; then following the initial Operational Strategy Call, and decision given the stabilization of the situation, to stand down the response. Following the reporting of a new case (on 5 February 2016), and subsequent decision to launch a DREF operation, efforts will be made to ensure coordination at all levels, including the sharing of information on the implementation of the activities planned. Overview of non-rcrc actors in country In total, approximately 105 national and international non-governmental organizations and United Nations agencies are operating in CAR; however they are mostly involved in the response to the on-going civil unrest, and not in the Monkey pox response in Bangassou. Caritas, Catholic Relief Services (CRS), themultidimensional Integrated Stabilization Mission in the Central African Republic (MINUSCA), UNICEF and WHO are the only organisations that are involved in supporting the MoH in this response to the Monkey-pox outbreak. Regular crisis meetings are held at the WHO headquarters in Bangui and at the provincial level in Bangassou to coordinate the strategic response plan. In addition, following the occurrence of the new case on 5 February, the MoH response plan was set up to strengthen activities in the following five areas: Epidemiological surveillance, Social mobilisation and community communication, Treatment of contaminated cases in quarantine areas, Research of contact cases, Coordination. Based on past campaigns, the MoH has requested the CARC to assist with social mobilization and community communication as part of response to the Monkey pox outbreak. Needs analysis, beneficiary selection, risk assessment and scenario planning According to the WHO, the first case was of a 9 year old person identified on the 4 December 2015 in the Bakouma Health Centre. In addition, the Bakouma Health Centre transferred two cases to the Bangassou regional hospital on the 17 December As of 15 February 2016, 13 persons have been so far tested positive by the Institut Pasteur of Bangui. The WHO situation report ( 5 February 2016) revealed that the fatality rate is 15.38%. Two nurses of the Bangassou regional hospital, an International NGO staff member who assisted in the transfer of the affected people to the hospital, the driver of the boat who assisted in crossing the river to reach the regional hospital and several members of the same family have all been contaminated. Table 2: Distribution of tested cases by sex, age and fatality

5 P a g e 5 Distribution of tested cases by sex, age and fatality Sex Ages Lethality Total Deaths < 5 years old 5 years old rate % Male Female Total Source: WHO situation report of the 27 January to 05 February 2016 With this situation and since the declaration of the outbreak, the response has been organized around 5 axes: epidemiological surveillance, social mobilization and community communication, treatment of contaminated cases in quarantine areas, research of contact cases and coordination. Given the role of the RC as auxiliary to the public services and given the usual classic role of the RC in responding to outbreaks, we foresee the involvement of CARC mainly on the communication and social mobilization component, as well as in the epidemiological surveillance at the community level. Risk Assessment As of 5 February 2016, 13 contaminated cases were reported in the affected area. The disease is highly contagious through three contamination channels:- Infection of index cases, which results from direct contact with the blood, bodily fluids, or rashes of infected animals; secondary transmission, which results from human to human contact through infected respiratory tract excretions, skin lesions or contact with recently contaminated objects; and third channel of transmission via respiratory droplets. Transmission can also occur through inoculation or via the placenta (congenital monkey pox). As such, it is highly risky for the population in the affected areas and its environs mainly the Bangassou, Bakouma, Gambo, Ouango and Rafaï sub-prefectures. Population movement in Bokouma, Bangassou district, following an invasion by armed groups in five villages on 28 January, has increased the risk of contamination. According to the local Red Cross Committee, the affected people moved into the bushes and are at a risk of being contaminated by this disease, since they are interacting with animals and most likely eating bush meat. In addition, the country is still experiencing the impact of the conflict between the Anti-Balaka and Ex-Seleka armed groups and of attacks from other unidentified armed groups. Further, the country has just finished the first round of the Presidential and legislative elections, of which the official results were announced and the second round for both is scheduled for February weeks. It is possible that the publication of the results could create challenges that could have implications for the implementation of this DREF operation, however as the CARC is well respected in the country and have access to the prefectures in Mbomu Province where the activities planned will be carried out. to the and efforts will be made to ensure their visibility (e.g. issue of Red Cross t-shirts and camps). The CAR will also make efforts to ensure the visibility of staff and volunteers involved in the DREF operation (refer to Communications section), and also ensure that they briefed on security protocol and are adequately protected when carrying out their activities (e.g. issue of personal protective equipment if required etc.) Beneficiary selection High-risk communities in the Bangassou, Bakouma, Gambo, Ouango and Rafaï sub-prefectures of the Mbomou Province are therefore targeted through this DREF operation. Specific groups of individuals (community leaders etc.) are going to be targeted in the cities as disseminators of messages to others in those high risk areas. WHO and MoH have already undertaken some social mobilization and communication activities. Through this DREF operation, the National Society aims to reach a further 164,000 people (indirectly) and 64,000 people (directly). The CARC will ensure that the DREF operation is aligned with the IFRC s commitment to realize gender equality and diversity, by adapting beneficiary selection criteria to target women headed-households and people with disabilities. Other aspects to be considered will include the prevention of sexual and gender-based violence, and the protection of children.

6 P a g e 6 B. Operational strategy and plan Overall objective Reduce immediate risk to the health of the affected population, specifically in relation to the Monkey-pox outbreak, through the National Society s social mobilization and community communication activities, targeting a total of 164,000 people (indirectly) and 64,000 people (directly), in Bangassou, Bakouma, Gambo, Ouango and Rafaï sub-prefectures of the Mbomou Province, for a period of two months. Proposed strategy The proposed strategy, in accordance with the IFRC s response and preparedness strategy for epidemic countries in the region, aims to support the CARC through staff and volunteer training and awareness raising, distribution of information, education and communication materials, communication of key messages for the preparedness and prevention of Monkey-pox outbreaks, as well as social mobilisation to reduce the risk and improve prevention activities in collaboration with the MoH. Activities planned will include: Training of volunteers (300) on the Epidemic Control for Volunteers (ECV) manual, specifically linked to the risks related to Monkey-pox (two-day training). The CARC volunteers will receive training on knowledge of the disease, the signs and symptoms, the transmission risk factors, actions for suspected cases, prevention and control measures. Social mobilization will be conducted in the Bangassou, Bakouma, Gambo, Ouango and Rafaï sub-prefectures of the Mbomou Province. In total, 300 CARC volunteers will be mobilized for seven days, 150 will be involved in door to door campaigns, and 150 will be involved in mass media awareness sessions, using megaphones, and distributing information, education and communication (IEC) materials in public places (churches, mosques and schools). Community epidemiological surveillance including monitoring/referral by volunteers at community level, as well as participation by the CARC in information/coordination meetings. Please note that the target areas AR for this DREF operation are not part of the MDRCF017 Emergency Appeal that is currently ongoing, and therefore, the resources allocated for this DREF will be specifically directed toward the activities of the Monkey-pox outbreak. Operational support services Human resources This DREF operation will require the mobilisation of the following personnel, for the two month period:: One CARC Programme Coordinator (10 days per month) and one CARC Health Coordinator Officer (15 days per month) will be dedicated to support the implementation of the DREF operation. In addition, a medical staff of the Health Centre in each of the areas will join the CARC team during the training for two days each. A finance officer will be dedicated to the DREF operation (five days per month), and two drivers will also be hired (20 days per month). The CARC heads of health and communications departments will also support the supervision of the DREF operation from National Headquarters (NHQ) level, and will carry out regular monitoring missions. In order to enhance prevention activities, the CARC will mobilize 300 volunteers - Bakouma (70), Bangassou (80), Gambo (50), Ouango (50) and Rafaï (50) - who will be involved at all levels of the response, from social mobilization to epidemiological surveillance, and may be required to support the management of dead bodies if necessary. The CARC will ensure that any volunteers involved in the management of dead bodies have the appropriate PPE (if required), which was pre-positioned through the previous MDRCF019 Ebola virus disease preparedness DREF operation that was carried out in 2014, and is available to be mobilized for this DREF operation if needed. The National Society will ensure that proper training and resources are in place for their safety.

7 P a g e 7 As noted, the IFRC CAR Country Representation will assist the CARC team with the support from the Country Representative, the Operations Manager and Communications delegate to support the effective implementation of the operation, specifically the ECV training, mobilization of volunteers, and monitoring and reporting of activities. Logistics and supply chain Procurement plans: The personal protective equipment (PPE) kits that were pre-positioned in country by the IFRC while implementing the EVD DREF will be used for this DREF operation. All other necessary items will be procured locally in accordance with the agreed IFRC logistics standards. Transport and fleet needs: Vehicle fuel and maintenance costs have been budgeted for both the NS and IFRC support. Communications During the DREF operation, the visibility of the work of CARC volunteers will be strengthened by the production of 300 T-shirts and 300 caps, which will be distributed to CARC volunteers and the NHQ staff involved in the implementation of the activities planned. Proper documentation and reporting to allow for lessons learnt will be ensured as well. The NS, with the support of the IFRC Communications delegate in-country, will provide regular updates on the operation for use by both the NS and IFRC digital and social media resources. Communication and community awareness will focus on decreasing fear, raising awareness on the transmission methods and raising the alertness of communities for an appropriate response. Key stakeholder groups and opinion leaders (taxi drivers, religious leaders, traditional birth attendants, community leaders and teachers) will be targeted as change agents for social mobilisation and communication activities. Where possible and relevant, cross-border communication and information sharing will be undertaken amongst neighbouring NSs and MoHs (the case of Bangassou with the Democratic Republic of Congo). Security The security situation in most parts of CAR, including in Mbomou province is remains volatile. The first and second round of the presidential and legislative elections took place reasonably peacefully, however, LRA armed militants are regularly entering the area from the neighbouring country (DRC), which often results in violence, extortion, and kidnappings. CARC staff and volunteers shall at all times during the implementation of this operation, use the Red Cross jackets, T-shirts, caps and have a valid RC identity card. In addition, the CARC must closely monitor any developments that may impact on staff security and the security of assets, and must implement security risk reduction measures when required. All staff and volunteers must also complete the relevant STAY SAFE online security courses. The movement of IFRC personnel is, for security management reasons, limited to the capital, Bangui. Planning, monitoring, evaluation, & reporting (PMER) Monitoring and reporting of the DREF operation will be undertaken by the NS. Brief weekly updates will be provided to the IFRC on the general progress of the operation, and regular monitoring reports will provide detailed indicator tracking. The ongoing monitoring will being covered by the NS local branches, and supported by the NHQ level, working in close cooperation with the IFRC country and regional offices to monitor the progress of the DREF operation and provide necessary technical expertise. Administration and Finance The NS has a permanent administrative and finance department, which will ensure the proper use of financial resources in accordance with conditions to be discussed in the Memorandum of Understanding between the National Society and the IFRC Country Representation. Management of financial resources will be carried out according to the procedures of the NS and DREF guidelines.

8 P a g e 8 C. DETAILED OPERATIONAL PLAN Early warning & emergency response preparedness Outcome 1: : Immediate risks to the population in Bangassou, Bakouma, Gambo, Ouango and Rafaï subprefectures of the Mbomou Province, Central African Republic, for a period of two months Output 1.1: The capacity of Central African Red Cross Society to prepare for the monkey-pox epidemic outbreak response is strengthened Activities planned Weeks Mobilize/train CARC volunteers and supervisors on Epidemic Control for Volunteers in the five target areas of the sous-prefectures (Target: 300 volunteers) Produce/distribute visibility materials to CARC volunteers (Target: 300 T-shirts and 300 caps) Participate in information and coordination meetings with authorities Monitor and report on activities carried out Output 1.2: Target population is provided with public awareness / sensitization on the Monkey pox epidemic outbreak (signs and symptoms, transmission risk factors, actions for suspected cases, its prevention and control measures) in Bangassou, Bakouma, Gambo, Ouango and Rafaï sub-prefectures of the Mbomou Province (Target: 164,000 people indirectly / 64,000 people directly) Activities planned Weeks Produce the information, education and communication materials in collaboration with the MoH, and distribute in the at risk communities (Target: 1,000 posters, 3,000 leaflets, 25 image boxes) Identify community leaders and conduct targeted sensitization activities Organise community discussions Conduct door to door sensitization campaign on the disease, with

9 P a g e 9 dissemination of key messages on Monkey-pox prevention and control measures (Target: 164,000 people indirectly / 64,000 people directly) Carry out sessions of mass sensitization campaign in each of the targeted subprefectures to share knowledge of the disease and the control measures (Target: Five sessions) Radio broadcasting using community radios in the affected areas Output 1.3: Community epidemiological surveillance is set up / enhanced Activities planned Weeks Participate in information and coordination meetings with authorities Set up / enhance community monitoring committees for disease surveillance Epidemiological control and monitoring through community disease surveillance

10 Budget See attached P a g e 10

11 P a g e 11 Contact Information For further information specifically related to this operation please contact: Central African Red Cross: Medard Gouaye, Secretary General, Bangui, Phone: , medard.gouaye@yahoo.fr IFRC CAR: Richard Hunlede, Country Representative, Bangui, Phone , Richard.hunlede@ifrc.org IFRC Africa: Farid Abdulkadir, Head of Disaster Management Unit, Nairobi, Kenya; phone ; farid.aiywar@ifrc.org IFRC Geneva: Christine South, Operations Quality Assurance Senior Officer; phone: ; christine.south@ifrc.org IFRC Africa: Rishi Ramrakha, Head of Logistics Unit Africa, Tel: / Fax , rishi.ramrakha@ifrc.org For Resource Mobilization and Pledges: IFRC Dakar: Elisabeth Seck, Resource Mobilization Officer, Dakar; phone: ; mobile: ; elisabeth.seck@ifrc.org For Performance and Accountability (planning, monitoring, evaluation and reporting) IFRC Africa: Robert Ondrusek, PMER Coordinator, Nairobi, phone: , robert.ondrusek@ifrc.org How we work All IFRC assistance seeks to adhere to the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief and the Humanitarian Charter and Minimum Standards in Humanitarian Response (Sphere) in delivering assistance to the most vulnerable. The IFRC s vision is to inspire, encourage, facilitate and promote at all times all forms of humanitarian activities by National Societies, with a view to preventing and alleviating human suffering, and thereby contributing to the maintenance and promotion of human dignity and peace in the world.

12 DREF OPERATION 19/02/2016 Central African Republic - Epidemic (Monkey Pox) DREF Grant Budget Group Budget CHF Shelter - Relief 0 Shelter - Transitional 0 Construction - Housing 0 Construction - Facilities 0 Construction - Materials 0 Clothing & Textiles 0 Food 0 Seeds & Plants 0 Water, Sanitation & Hygiene 0 Medical & First Aid 0 Teaching Materials 11,375 Utensils & Tools 0 Other Supplies & Services 0 Cash Disbursements 0 Total RELIEF ITEMS, CONSTRUCTION AND SUPPLIES 11,375 Land & Buildings 0 Vehicles 0 Computer & Telecom Equipment 0 Office/Household Furniture & Equipment 0 Medical Equipment 0 Other Machinery & Equipment 0 Total LAND, VEHICLES AND EQUIPMENT 0 Storage, Warehousing 0 Distribution & Monitoring 0 Transport & Vehicle Costs 7,638 Logistics Services 0 Total LOGISTICS, TRANSPORT AND STORAGE 7,638 International Staff 0 National Staff 0 National Society Staff 3,835 Volunteers 11,550 Total PERSONNEL 15,385 Consultants 0 Professional Fees 0 Total CONSULTANTS & PROFESSIONAL FEES 0 Workshops & Training 12,041 Total WORKSHOP & TRAINING 12,041 Travel 2,500 Information & Public Relations 0 Office Costs 2,167 Communications 333 Financial Charges 1,000 Other General Expenses 0 Shared Office and Services Costs 0 Total GENERAL EXPENDITURES 6,000 Partner National Societies 0 Other Partners (NGOs, UN, other) 0 Total TRANSFER TO PARTNERS 0 Programme and Services Support Recovery 3,409 Total INDIRECT COSTS 3,409 TOTAL BUDGET 55,848