Page 135 - Journal of Special Operations Medicine - Winter 2015

conducted across the CJSOTF-A made it impossible for can also be helpful in dealing with infestations of fleas,
the small PM team to research each one, but it was pos- lice, and bed bugs. Unfortunately for our team, fleas were
sible to quickly prioritize mission support to a medic not the only PM challenge they would face. The unex-
who requested information for a specific area. pected duration of the mission then presented additional
challenges related to the handling of human waste when
A common concern associated with flea exposure in enemy activity significantly limited movement.
some countries is plague. However, of equal concern for
operators in remote regions is the biting behavior of fleas The Poop Conundrum
and the large numbers of insects which are likely to be
encountered in situations of infestation. Fleas, like many Preventive medicine personnel most commonly face
insects, have evolutionary adaptations that help to en- challenges related to what I refer to as “the big 5”: food,
sure their survival. Flea pupae can remain dormant in the water, poop, garbage, and bugs. Of these five, poop,
ground for upwards of a year and they respond to both also known as “human waste,” is by far the most un-
vibration and CO in the atmosphere, which is indicative pleasant and frequently left out of the logistics planning
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of a potential blood meal. The team in NE AFG just hap- process as a result. Unfortunately, ignoring the fact that
pened to move into a former barn (with no current ani- we must defecate does not stop it from happening, and
mal habitation) which was still infested with flea pupae in the case of our team, stranded with a large number
dormant in the ground until a blood meal became avail- of Afghans in a small barn, it became a significant issue.
able. Once the team arrived and settled into the barn the
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adult fleas emerged and began feeding (Figure 4). There are numerous viral, bacterial, and parasitic infec-
tions spread through the fecal-oral route. This is why
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Figure 4 SF Operators with hundreds of flea bites. care must be taken in washing hands, foodstuffs, utensils,
etc. to decrease the likelihood of disease transmission.
The risk of contracting fecal-orally transmitted infections
increases in environments where we live or work with
indigenous forces who do not necessarily exercise sanita-
tion and hygiene measures comparable to US standards.
In addition, US personnel do not possess the same level
of immunity to many fecal-orally transmitted pathogens
meaning their impact on us is typically more significant.
Our team in NE AFG was sharing very close quarters
with numerous Afghan soldiers and had periods of lim-
While plague would have been a concern in this situation, ited movement due to effective enemy sniper activity in
the more immediate issue was the itching and potential the area. As the 72-hour mark approached with no ex-
infection associated with the hundreds of bites the opera- traction in site the waste problem grew and put every-
tors endured. Also a concern was each individual’s con- one at great risk of illness. A resupply had been dropped
tinued ability to do his job effectively while covered with to the team, which contained a significant number of
flea bites. This situation could have been easily avoided garbage bags to help deal with the flea problem. These
or at least minimized through the spraying of canned garbage bags also provided a temporary solution to the
permethrin on uniforms prior to the mission (to allevi- solid human waste problem. Instead of trying to bury the
ate the need to carry anything extra). The impact of the waste in the limited space inside the barn, the garbage
bites could also have been minimized with oral and topi- bags could be used to “capture” the waste and seal it.
cal antihistamines. Unfortunately, the medic did not have While defecating into a garbage bag is not something that
either of these on hand. Finally, if the mission had actu- anyone would look forward to, it is a preferred alterna-
ally only lasted for 72 hours, personnel would not have tive to digging cat holes inside a shelter, especially when
had to endure the situation long; unfortunately, again, the your Afghan partners frequently suffer from diarrhea.
mission did not go as planned and the team was stuck for The PM team put together another resupply containing
8 days. Another bit of field craft that may have been use- additional garbage bags, plastic buckets, and even toilet
ful in this situation is the use of garbage bags to control seats and sent these north with a quickly prepared set of
insect infestations in clothing and bedding. Many insects instructions for creating a “field toilet” (Figure 5). None
desiccate easily, so creating a hot, dry environment can be of these solutions are ideal, but they are effective in miti-
deadly for them. Putting infested clothing or bedding into gating the risk of diarrheal disease transmission.
a tightly closed garbage bag for several hours (longer if
you do not have the benefit of sunshine) will kill the adult Considering the likelihood of waste issues on the aus-
insects and can even leave eggs, larvae, and pupae nonvi- tere missions the SOF community is executing with in-
able. A garbage bag is great for keeping gear dry, but it creased frequency, planning for effective management
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Medical Intelligence Prep of the Environment 123