Page 116 - Journal of Special Operations Medicine - Spring 2015

Keeping these priorities in mind, we explored an evo­ teams executed classic MEDCAPs, dental civilian action
lution in medical engagements applicable to SOF that projects, and veterinary civilian action projects based on
are compatible and complementary to efforts of other local needs assessments. However, a review of the Over­
military components and government and nongovern­ seas Humanitarian Assistance Shared Information Sys­
ment agencies. tem revealed few projects with long­term sustainability
or capacity building scaled beyond local efforts. Assess­
Current US Department of Defense (DoD) guidance for ments in several partner nations revealed that access to
humanitarian assistance in Africa has several require­ medical care and resources was often compartmentalized,
ments. Projects cannot duplicate or replace the work with underdeveloped echelons of care through which to
of another agency and must be consistent with, and escalate patient care as needed. Critical infrastructure
complementary to, the strategic plans developed by the deficits contribute to barriers in healthcare delivery that
US Agency for International Development (USAID) and affect not only the people of the host nation but also the
the US Department of State. There must be a focus on SOF members who rely on local resources as an adjunct
knowledge and skills transfer rather than on supplies or to often sparse and remote US military medical presence.
equipment donations, coupled with a plan to provide for
sustainability, coordinated through USAID and the US SOF members in Africa have a vested interest in develop­
ambassador. The pathway for development, approval, ing local healthcare capacity. It may be necessary to use
9
and execution of health­sector engagements compliant local facilities in the event evacuation to a US provider
with these requirements can be arduous, and it is likely or facility is not a viable option in an emergent situation,
that a project will exchange hands from conception to due to scarce resources and long evacuation times. There­
execution as personnel and units rotate through a par­ fore, intimate familiarity with both military and civilian
ticular mission. This reality dictates a need for an endur­ healthcare resources and capabilities is a priority for SOF.
ing framework through which to approach assessments, Fortunately, many African partner nations have a mili­
project development, and subsequent application, with tary medical system that informally contains providers/
predetermined measures of effectiveness. Additionally, facilities that are dynamically linked to, or are part of,
due to the unique nature of SOF engagements, a model the local civilian healthcare network. This allows for a
that is scalable appropriate to SOF resources but also working relationship with the host­nation military that
translatable to larger echelon goals is necessary to en­ directly impacts the community, provides insight into lo­
sure unity of effort across the health sector and wise cal medical systems’ strengths and weaknesses, and high­
expenditure of medical resources. Because SOF units of­ lights the contributing factors pertinent to gaps in local/
ten operate remotely from robust support, health­sector regional medical capacity. Relationships forged in mili­
engagements are critical to understanding medical ca­ tary–military engagements can be used to reach the local
pabilities, limitations, key individuals, and stakeholder community and address healthcare sector needs.
organizations and their relationships on a local and a re­
gional level. Baseline assessments are the first step in the Based on these observations, the MEDCAN–GRO model
discovery of potential cooperative activities that provide was conceived with the following goals: (1) establish a
synergism between host­nation and US interests. progressive training plan that is scalable to partner­nation
needs/capabilities, (2) capitalize on civilian–military rela­
A model that is scalable, reproducible, and adaptable en­ tions to build security through medical capacity, (3) es­
sures applicability to the myriad environments and cir­ tablish infrastructure for sustainability and growth, (4)
cumstances in which SOF operate. The authors propose develop regional interoperability, and (5) operate within
the Medical Capacity for African Nations– Growing a framework that is reproducible and measurable.
Regional Operability (MEDCAN–GRO) model as a
framework to approach health­sector engagements that The MEDCAN–GRO Model
are sustainable and transferable in support of partner­
nation capacity building (Figure 1). The MEDCAN–GRO model capitalizes on SOF strengths
in relationship building. The model is a virtual buffet of
capacity­building activities and can serve as a means
Healthcare Sector Gaps in SOF Engagements
to negotiate a balance between US objectives and host­
MEDCAN–GRO was developed in response to a chal­ nation needs so all parties’ interests are represented. En­
lenging healthcare milieu faced by SOF while conduct­ gagements are designed to close immediate gaps in the
ing operations on the African continent. SOF healthcare healthcare sector while laying a foundation for more so­
engagements with African partner nations mainly con­ phisticated development as the host nation progresses.
sisted of individual skill­set training in the form of Tacti­ This continuum promotes a sustainable relationship
cal Combat Casualty Care (TCCC) modified to apply to while empowering the host nation to self­actualize ac­
partner­nation capabilities and resources. Concurrently, cording to its self­assessed needs. Additionally, the model

106 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015