Page 123 - Journal of Special Operations Medicine - Winter 2014

An Ongoing Series

This Is Africa

Bites, Stings, and Rigors: Clinical Considerations in African Operations

James H. Lynch, MD, MS; April R. Verlo, MSPH, REHS/RS;
Melissa L. Givens, MD, MPH; Cesar E. Munoz, HMC

ABSTRACT
The natural health threats in Africa pose daunting clini- considerations for Special Operations Forces (SOF)
cal challenges for any provider, as evidenced by the cur- providers supporting operations in Africa. The natural
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rent Ebola epidemic in West Africa, but the threat is health threats in Africa pose daunting clinical challenges
multiplied for the Special Operations provider on the for any provider, but the threat is multiplied for the SOF
continent who faces these challenges with limited re- provider on the continent facing these challenges with
sources and the tyranny of distance. The majority of op- limited resources and the tyranny of distance. We hope
erationally significant health risks can be mitigated by to reinforce the importance of prevention by highlight-
strict adherence to a comprehensive force health protec- ing FHP measures critical to survival in Africa. We will
tion plan. The simplest, yet most effective, technique for then detail clinical considerations for some of the more
preventing mosquito-borne diseases is the prevention of likely or lethal infectious diseases encountered on the
mosquito bites with repellent, bed nets, and appropri- continent and conclude with special focus on the ven-
ate clothing in addition to chemoprophylaxis. Some of omous snake threat in Africa.
the more likely or lethal infectious diseases encountered
on the continent include malaria, Chikungunya, dengue,
human immunodeficiency virus, and Ebola. Venomous Force Health Protection
snakes pose a particular challenge since the treatment Numerous diseases, vectors, and environmental condi-
can be as deadly as the injury. Providers supporting Af- tions in Africa pose a very high health risk to deployed
rican operations should educate themselves on the clini- personnel. However, the majority of these operationally
cal characteristics of possible envenomations in their significant health risks can be mitigated by strict adher-
area while promoting snake avoidance as the primary ence to a comprehensive FHP plan. US Africa Command
mitigation measure. To succeed in Africa, the Special (AFRICOM) and Special Operations Command Africa
Operations provider must consider how to meet these (SOCAFRICA) have published recommendations that
challenges in an environment where there may not be re- detail such a multilayered FHP program. Disease pre-
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liable evacuation, hospitalization, or logistics channels. vention is a command responsibility. However, the im-
portance of accurate disease prevention education from
Keywords: Africa, tactical medicine, tropical infectious dis- SOF providers to unit command teams cannot be under-
ease, chemoprophylaxis, malaria, dengue, Chikungunya, HIV, stated. A formally trained Preventive Medicine Officer
Ebola, snake envenomation, antivenin, wilderness medicine (SSI 60C) or Preventive Medicine Non-Commissioned
Officer can be invaluable to assist with FHP risk assess-
ments and detailed unit level plans. Immunizations are
only one piece of a comprehensive unit health protec-
Introduction
tion plan. Table 1 lists the immunizations required for
This is Africa—TIA. This second part in the Journal military forces deploying to Africa. Additional FHP top-
of Special Operations Medicine “This is Africa” se- ics will be more fully addressed in a future JSOM article
ries will focus on some of the more pertinent clinical in the “This Is Africa” series.

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