Page 70 - Journal of Special Operations Medicine - Fall 2015

physicians and staff of Military Referral Hospital of has already guided future engagements and donations,
Kitona. This allowed the directors of the national and should continue to do so. These are actions that
FARDC programs for HIV/AIDS, malaria, and tuber- will likely increase the public health and infectious dis-
culosis to ensure that the medical staff of Kitona was ease capabilities of the Military Referral Hospital of
aware of these programs, helping them achieve compli- Kitona. Third, the exercise achieved the objective of
ance. It also allowed the staff of Kitona to demonstrate educating the local physicians on national policies and
their experiences, successes, and challenges with these international standards of care, which was done mostly
diseases and program interventions. They also presented through the afternoon academic sessions. Through the
their final data and lessons learned from the cholera participation of the senior-level FARDC medical of-
outbreak that ended in February 2013. This would not ficers, the medical staff at Kitona was educated on its
have been possible in a model in which the US team military programs for HIV/AIDS, malaria, and tuber-
gave all academic presentations. Finally, the US Army culosis. Discussions were immediately initiated among
team was able to educate the FARDC personnel on US military staff at Kitona to correct identified deficiencies
Army policies and procedures, as well as US Centers for in the implementation of those programs. Finally, the
Disease Control and Prevention and World Health Or- objective of establishing good working relationships be-
ganization standards of care. tween the two militaries was met, as this engagement
set the stage for Lion Rouge and future engagements
The most notable strength of this exercise was the success- that are already in planning. It is unlikely that a tradi-
ful collaboration between the US Army and the FARDC. tional MEDCAP-type mission, where primary medical
This achieved the overall goal of the US Embassy in Kin- care was provided without further education or train-
shasa of doing things with the Congolese, instead of for ing, would have achieved these same aims.
the Congolese (J.F. Entwistle, personal communication).
This also stands in contrast to a traditional MEDCAP, The MEDRETE made possible the opening of relations
which is focused on the provision of primary medical in a region that had not hosted the US Military in de-
care, an activity that may or may not involve partners cades. The exercise advanced the US policy objective of
from the host nation. MEDCAPs are also single-time en- institutionalizing our training via engagement at DRC
gagements, whereas the conduced MEDRETE and needs military education centers, with Kitona being the larg-
assessment was used as a foundation for future activities est. The MEDRETE provided a precedence of medical
between the United States and the DRC. engagement that led to the development of the largest
US interagency, joint military engagement event in US
One limitation of the exercise was the scheduling. With and DRC history: Lion Rouge, which took place in Sep-
clinical activities in the mornings and academics in the tember 2013. This engagement incorporated legal, civil
afternoons, many Congolese physicians were not able military operations, airfield defense, military agricul-
to participate in academics, especially on days with a ture, and medical engagements.
high-patient volume. In addition, the US physicians did
not often learn the final diagnoses on the patients seen Conclusion
in the mornings, as laboratory results were typically not
available until the afternoon. One suggestion for future The MEDRETE After Action Review provided a tem-
MEDRETEs of this type is to have clinical and academic plate for USARAF and Naval Forces Africa to provide
activities on separate weeks, although this would require additional engagement with the hospital and nursing
back-filling the hospital staff during the academic week school. The fact that such a complex follow-on event
to allow the hospital to continue treating patients. Due like Lion Rouge could be coordinated and linked to the
to the transportation issues involved with the poor in- MEDRETE in such a short time is evidence that Kitona
frastructure in DRC, this may not be possible in remote is and remains a key security assistance engagement venue,
areas such as Kitona. and that the MEDRETE was both beneficial and effective.

MEDRETE 13-3 in the DRC had four specific objectives Disclosure
that were determined prior to the mission. The exercise
met the objective of familiarizing US Army personnel The authors have nothing to disclose.
with providing medical care in resource-limited tropical
settings, as US personnel performed clinical activities to- References
gether with FARDC personnel. Not only did the US per-
sonnel obtain greater exposure to patients with ailments 1. Bryan E. Standard operating procedure, Medical Civil Assis-
tance Program. Task Force Falcon, Kosovo 2000.
not often seen in the United States, but it also allowed 2. International Security Assistance Force. Standard operating
the FARDC personnel to explain their differential diag- procedure HQ-01154: ISAF guidance on military medical en -
noses and diagnostic pathways. The needs assessment gagement in health sector reconstruction and development.

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