Page 66 - Journal of Special Operations Medicine - Fall 2015

Kitona 2013
A Medical Readiness Training Exercise in the
Democratic Republic of the Congo Leading to Lion Rouge

Elisabeth Hesse, MD, MTM&H; Edmond Amisi Okito, MD;
Kelly Mann, MD, MPH; Michael McCullough; Emil Lesho, DO

ABSTRACT

Background: Health initiatives support regional stability that have been called MEDCAPS include vaccination
and are a priority for US and African partners. We pres- clinics, one-time surgical engagements, and donations
ent data and experience from the Democratic Republic of of medical supplies. 2
Congo (DRC), a strategically and epidemiologically ideal
location for collaborative medical engagement (CME). Historically, these quick MEDCAPs have been popular
Our objectives included relationship building, exposure with both medical staff and line commanders. They are
of US military medical personnel to uncommon tropi- short term but with high visibility, providing media-
cal diseases, bolstering a referral hospital, and updating friendly projects. In addition, they have been used, espe-
Congolese physicians on new treatment or preventive cially in the Special Operations community, to provide
standards of care. Methods: We conducted a CME- access to areas otherwise restricted to friendly forces
styled medical readiness training exercise ( MEDRETE) or to gain favor with local populations. However,
3,4
at the Military Referral Hospital of Kitona in June 2013. in recent years, the unintended consequences of such
US and Congolese healthcare providers presented 20 lec- short-term encounters, both of the healthcare and in
tures and evaluated 158 patients collaboratively; 132 for counterinsurgency operations, have been more clearly
infections. Results: The CME led to Lion Rouge, the first described. 2,4–7 They are typically limited in scope of both
joint military, multidisciplinary engagement between the diagnostics and therapeutics, and the inability to treat
respective militaries. Equally noteworthy is that some of a patient may be interpreted as an unwillingness to do
the same participants returned to the same location for so. In addition, a MEDCAP performed in one village or
the follow-on exercise, providing continuity. Conclusion: to one group of people may create a perception of one
These outcomes suggest the MEDRETE and CME ap- group being favored over another, and adverse reactions
proaches were successful. to therapy may be interpreted as intentional harm done
to the local people. Finally, MEDCAPs do not increase
Keywords: exercise, medical; MEDRETE; needs assessment; local healthcare capacity and provide little or no sus-
Democratic Republic of the Congo tained benefits, may actually compete with local provid-
ers and undermine their ability to earn a living, and have
the potential to create a sense of dependency on the US
military for healthcare. 2,8
Background
Transnational security issues have the potential to create The evidence of the long-term negative impacts of
widespread regional instability. Increased international MEDCAPs has led to the publishing of guidelines for
cooperation enhances mutual understanding, stability, implementation of medical operations in military engage-
and security across the African continent. Health initia- ments, with emphasis to the Special Operations commu-
tives and strengthened relationships are a priority for US nity. In addition, the International Security Assistance
7
government and African partners, as the United States Force has discouraged the provision of MEDCAPs in
strives to be a partner of choice throughout Africa. US Afghanistan. Instead, the recommendation is for sup-
military medical engagements in the developing world porting the development of the health sector as a whole
have traditionally taken the form of Medical Civil Ac- to include human capacity building, medical workshops,
tion Programs, or MEDCAPs. Although there are vari- public health and preventive medicine training, improv-
ous definitions of the term MEDCAP, for the purposes ing public health and sanitation, and community health
of this article, we are referring to short-term primary awareness and education. Although this guidance ap-
2
medical care missions to provide treatment for minor plies only to Afghanistan, the principles behind this pol-
illnesses and injuries for local nationals. Other missions icy pertain to any setting in the developing world. For
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