Page 118 - Journal of Special Operations Medicine - Fall 2014

difficult to identify independently and can augment de- provide operational pearls from recent lessons learned
tecting deviations from standards of care that may be or within the SOF community in order to best prepare
become more problematic. Of note, “standard of care” for future operations on the continent. Armed with in-
is a relative concept of varying perspectives when faced formation, providers should take any opportunity to
with extremely meager resources. Sophisticated health- walk the ground to gain firsthand experience in counter
care facilities should only be expected in well-developed “TIA” tactics.
urban centers, and prehospital care or en route care from
more remote health care facilities is scare to nonexistent. Disclosures
The authors have nothing to disclose and no funding to
Patient evacuation is fraught with tribulation. Evacua- report.
tion times are often defined in terms of days, not min-
utes or hours. The immense time–distance variables are
confounded by a severely underdeveloped road network References
and minimal access to aviation assets. Even when air- 1. WHO/UNICEF Joint Monitoring Programme for Water
craft is available, supporting aviation services may not Supply and Sanitation. Progress on Sanitation and Drink-
be. This is usually attributed to the inability to support ing Water 2010. www.wssinfo.org/.
night operations, inadequate fuel supplies, or lack of 2. World Health Organization. The Health and Environ-
personnel to support unscheduled flights. Many of the ment Linkages Initiative (HELI). http://www.who.int/heli
/risks/vectors/vector/en/index.html.
airfields are unable to support typical aircraft platforms 3. World Health Organization. World Malaria Report 2013.
used for medical evacuation operations. Communica- http://www.who.int/malaria/publications/world_malaria
tion systems for prehospital coordination are virtually _report_2013/en/.
nonexistent. Evacuation and patient movement may 4. Institute for Health Metrics and Evaluation. Global Burden
necessitate cross-border transportation, which requires of Disease Study 2013. http://www.healthdata.org/gbd.
time-sensitive synchronization of necessary clearances. 5. World Health Organization. Tuberculosis fact sheet. http://
www.who.int/mediacentre/factsheets/fs104/en/.
6. World Health Organization. Tuberculosis country profiles.
Conclusion and Recommendations http://www.who.int/tb/publications/global_report/gtbr
Medical operations in Africa require dynamic and sys- 13_annex_2_country_profiles.pdf?ua=1.
tematic approaches that consider the myriad challenges, 7. Ippolito G, Nicastri E, Capobianchi M, et al. Hospital
preparedness and management of patients affected by vi-
yet offer flexible solutions ral haemorrhagic fever or smallpox at the Lazzaro Spall-
applied as situations and en- anzani Institute, Italy. Euro Surveill. 2005;10:523.
vironments dictate. Fortu- 8. World Health Organization. Global HIV/AIDS response:
nately, it is within this milieu epidemic update and health sector progress towards uni-
that SOF are taught to oper- versal access, progress report 2011. http://www.afro.who
ate. While risk tolerance is a .int/en/clusters-a-programmes/dpc/acquired-immune
realistic necessity, risk miti- -deficiency-syndrome/overview.html.
gation is an integral factor 9. Centers for Disease Control and Prevention. Preventing
in ensuring mission success. new HIV infections. http://www.cdc.gov/hiv/guidelines/
Predicting medical threats preventing.html.
and discerning where and 10. Kuhar DT, Henderson DK, Struble KA, et al. Updated US
Public Health Service guidelines for the management of
when available resources occupational exposures to human immunodeficiency vi-
should be acquired and ap- rus and recommendations for postexposure prophylaxis.
plied can only be achieved Infect Control Hosp Epidemiol. 2013;34:875–892.
by understanding the unique 11. Hang’ombe, MB, Mwansa, JC, Muwowo S, et al. Human–
operational environment of animal anthrax outbreak in the Luangwa valley of Zam-
the African continent and bia in 2011. Tropical Doctor. 2012;42:136–139.
the diversity of issues the 12. World Health Organization. Venomous snakes distribu-
continent represents. Open tion and species risk categories. http://apps.who.int/blood
dialogue regarding challenges and lessons learned can products/snakeantivenoms/database.
provide a framework for addressing the medical conun-
drum of African operations to ensure future success.
LTC(P) Givens is affiliated with the Uniformed Services Uni-
In a follow-up series to this introductory article, infor- versity of the Health Sciences E-mail: Melissa.l.givens2.mil@
mation as outlined in Table 1 is intended to provide a mail.mil.
frame of reference for the healthcare challenges faced LTC(P) Lynch is the command surgeon with Special Opera-
on the African continent. The intent of each article is to tions Command Africa, Stuttgart, Germany.

110 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014