Page 116 - Journal of Special Operations Medicine - Fall 2014

the endogenous health threats. The complexities inher- risk area in the world for vector-borne disease. Malaria
2
ent in African politics, geopolitics, economics, and so- is endemic throughout most of the continent, and other
cioeconomics are far too complex to capture within one vector-borne illness such as leishmaniasis and dengue
textbook, let alone within an article. Suffice to say, it fever are very common. Absent and ineffective vaccine
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is crucial to recognize that the political and economic therapies for diseases such as malaria and dengue em-
climates are as deterministic in healthcare delivery and phasize the need for an aggressive prophylaxis regimen
public health concerns as is the geographic climate. with bite exposure prevention as the foundation and
chemoprophylaxis as a supplement.
Further crowding the stage are the multitude of actors
engaged in the healthcare sector: nongovernment orga-
nizations (NGOs), foreign governments, and interna- Human Threats
tional health organizations, among others, rendering the Human-transmitted diseases represent some of the more
medical milieu a test to the most seasoned health care frightening and virulent pathogens. Africa has the du-
professionals within Special Operations Forces (SOF). bious distinction of hosting almost half of all countries
worldwide with the highest disease burden, and Central
4
Understanding dynamic force health protection issues, Africa is the epicenter of the most potent and feared hem-
logistical challenges, socioeconomic dynamics, and orrhagic fevers. Ebola virus, Marburg virus, and other
working relationships of interested parties is tantamount hemorrhagic fevers spread quickly via human contact,
in African medical operations. These factors must be especially in the absence of appropriate control measures.
thoroughly researched, duly Even one case of hemor-
considered in all levels of rhagic fever can overwhelm
planning, and potentially medical resources, and safe,
mitigated within a paradigm reliable blood transfusion
that maintains a posture of products are likely unavail-
flexibility and adaptabil- able for resuscitation.
ity. Most of all, one must
ensure plans are tempered Transit and travels through
with healthy doses of human regions of outbreaks pres-
compassion, practicality, and ent a significant threat to
a sense of humor and ad- deployed forces; cognizance
venture, lest the mission be of these disease patterns is
clouded by frustration. essential in operational plan-
ning. For example, multi-
drug-resistant tuberculosis is
Primary Threats
on the rise in Sub-Saharan Africa. Operations-essential
5,6
Those unfamiliar with Africa might assume that force community interactions may be necessary, but the risk–
health protection principles are universal, until encoun- benefit balance of possible disease transmission must be
tering unique African threats requiring special attention critically considered.
and departures from previously held beliefs. The greatest
short-term health risks to personnel deployed to Africa Evacuating infected and exposed personnel requires
are associated with the ingestion of contaminated food exceptional consideration. The US Army Medical Re-
and/or water. Common contaminants include human search Institute of Infectious Diseases (USAMRIID) con-
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and animal waste, but chemical contaminants must also siders using a patient isolation unit (PIU) from the BSL-4
be considered due to unregulated industrial waste, pes- containment unit the standard for evacuation protocols.
ticide, and fertilizer use and misuse or improper storage However, an American-based capability might not be
and handling of toxic products. Food and water should the most timely response. Collaborating with countries
be procured through approved sources or prepared in a such as Italy that possess PIU assets may provide a more
manner that minimizes exposure to contaminants. Wa- responsive and rapid evacuation timeline. 7
ter is a threat when ingested, but simple direct contact
can also result in diseases due to parasites such as schis- The human immunodeficiency virus (HIV) bears special
tosomiasis and onchocercosis. These health threats war- mention in any discussion of human-borne communi-
rant consideration when designing operations that may cable diseases. Sexually transmitted diseases (STDs) are
transit through bodies of water, resulting in potential very prevalent across the continent, but HIV rates are
skin, ocular, and mucous membrane exposures. Water is orders of magnitude higher in Africa than in any other
both an indirect and a direct threat because it serves as a location worldwide, representing 69% of the global
reservoir for vector-borne illnesses. Africa is the highest HIV burden. Regimented STD prevention is imperative,
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108 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014