Page 68 - Journal of Special Operations Medicine - Fall 2015

tropical settings, increase the public health and infec- licensed practical nurses. There were also three FARDC
tious disease capabilities of the host hospital, update clinical laboratory officers, one pharmacist, one radiogra-
the FARDC physicians on national policies and interna- phy technician, a physical therapist, and a dentist.
tional standards of care, and build good working rela-
tionships between the two militaries.
Results
The US Army medical team included adult and pediatric
infectious diseases subspecialists, a preventive medicine Health Statistics of Kitona Health Zone
physician, a public-health nurse, and a clinical laboratory Throughout Kitona Health Zone, there were a total of
officer. In addition, six senior-ranking physician officers in 28,594 cases of malaria in 2012, which was 24.9% of
the FARDC, all of whom were program directors within the population of the health zone. This number may
the medical department, traveled from the capital in Kin- be artificially high; because of the high prevalence of
shasa to participate. The MEDRETE was executed in the malaria in the area, clinicians tended to diagnose any
paradigm of collaborative medical engagement (CME), syndrome that included fever as “malaria,” regardless
the details of which have been described previously. The of confirmation from blood smear or rapid diagnos-
8
members of the US Army medical team paired with their tic tests. In addition, persistent parasitemia results in
FARDC counterparts. The mornings were spent working a moderate level of immunity; because of this, there is
side by side in normal clinical activities. Afternoons were always a percentage of the population that has parasit-
dedicated to didactic activities, with participation by both emia but is asymptomatic. Eighty-one confirmed cases
US Army and FARDC medical professionals. In all, there of malaria resulted in death. There were also 139 new
were 20 didactic sessions, with 14 given by FARDC medi- cases of tuberculosis, of which 36 were co-infected with
cal officers and the remaining six by US Army officers. HIV. The Military Referral Hospital of Kitona has been
Topics covered included HIV/AIDS, malaria, tuberculosis, offering HIV counseling and testing since August 2005;
cholera, sexually transmitted infections, antibiotic stew- since that time, 9,280 patients have been counseled and
ardship, and measles. Health statistics for the hospital and screened, with 1,606 positive, or 17% of the screened
the Kitona Health Zone were obtained from briefs and pre- population. There have been 631 patients started on
sentations by FARDC hospital staff. The MEDRETE 13-3 antiretroviral therapy since that time. Overall, the
team conducted needs assessments by asking every avail- prevalence of HIV in the Health Zone is estimated to
able physician and healthcare worker what they identified be 1.8%. In February 2013, the Health Zone saw the
as the top three needs for the hospital. Data on patients end to a cholera epidemic that lasted 12 months, with a
seen were collected prospectively during the MEDRETE. total of 226 patients and four deaths. From 2011 to the
present, there were laboratory-confirmed outbreaks of
Military Referral Hospital of Kitona yellow fever and Ebola virus in the DRC, but none were
The Military Referral Hospital of Kitona is the tertiary reported from the Kitona Health Zone.
care center for both the Ministry of Defense Health Zone
of Kitona and the Rural Health Zone of Kitona. It also Needs Assessment
functions as the primary-care community hospital for that Responses to the needs assessment varied and can be
region. The health zone, one of six military health zones broken into categories of equipment, training, and in-
and one of 515 operational health zones, consists of a frastructure. Equipment needs included nebulizers, up-
population of 90,024 people in an area of 180km . An dated ultrasound and radiograph machines, computed
2
operational health zone can be defined as the area served tomography scanner, better beds, stethoscopes for the
by a referral hospital, with 10–15 smaller health centers providers, updated books in French for the medical li-
that offer the basic package of health services under this brary, new dental chair and tools, cameras, educational
umbrella. The operational health zone level is where na- materials, and hemoculture capability. Training needs
tional and provincial health strategies are implemented. identified included opportunities to train abroad, how
The Kitona health zone is made up of six health areas: to maintain and repair existing equipment, and “bet-
four military (Banana, Baki-Ville, Troupe, and Camp ter training,” which was stated by many but without
Permanent) and two civilian (Nteva and Kibamba). The specific ideas of how to go about doing that. Finally,
Military Referral Hospital of Kitona is staffed by four infrastructure needs identified included stable electric-
FARDC physicians as well as six civilian physicians seek- ity, generators, running water, computers with Internet
ing advanced training in their first year out of medical access, increased laboratory capabilities, and more fre-
school. There are a total of 50 nurses; 15 are “university quent insecticide treatment on the hospital grounds.
trained,” with responsibilities equivalent to nurse practi-
tioners or physician assistants; 23 are trained to a “high Patients Evaluated
school level,” with responsibilities equivalent to registered According to hospital records from the seven days of
nurses; and 12 are lower-level nurses, the equivalent of MEDRETE 13-3, 343 patients were seen in outpatient

56 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015