case studies in afghanistan health & related lessons observed in eucom and pacom 30 jan 2012 col...
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Case Studies in Afghanistan Health & Related Lessons Observed in EUCOM and PACOM
30 Jan 2012
Col John Mitchell
The MHS: Healthcare to Health
Defense Institute for Medical Operations; Former CSTC-A SG
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Has no real or apparent
conflicts of interest to report.
Conflict of Interest DisclosureJohn Mitchell, MD
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MSO: Objectives
Discuss direct medical stability operations efforts to include cooperation plans in past or ongoing CENTCOM operations.
Evaluate specific cases of successes and failures related to USG efforts in Afghanistan
Evaluate specific cases in EUCOM and PACOM
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Agenda & Key Points
Medical Stability Operations (MSO)– Worth Doing – Steep learning curve (MHS, DoD, USG, PN)– Goals are elusive (whose MoE, AMoE, MoP)– Getting Smarter
• (PN Civ/NGO/Mil linkages; USG)• Origins of Health (Water, Food)
Challenges of direction
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MSO: Worth Doing
For Agile Combat Support (AGS),“GHE – Establishes “US access and influence with
partner nations by building their health capabilities”
– “Can serve as a model for success within the other ACS elements (airfield operations, logistics, security forces, maintenance, civil engineering, air traffic control, weather).” • from pg 19 of Global Partnerships Strategy signed
out Dec 2011 by CSAF and SECAF)
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MSO: Worth Doing
For Agile Combat Support (AGS),“GHE – “Without the various and specialized
resources provided by the ACS community, sustained and successful air domain operations would not be possible….to achieve Joint effects.”
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MSO: Steep Learning Curve
Outset: Infrequently well versed in MSO – POCs, funding, documents, PN relationships?
Stovepiped (MHS, DoD, USG, PN) Failures teach faster than successes; $
invested? Employment Training—MSOC (DMRTI), Non-
Medical Cultural Orientations Crs, etc. Resources to teach PN—DIMO, DMRTI, Svc-
specific
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MSO: Goals Are Elusive
Line Command MoEs—from GEF to IMO to PN (e.g., Access, Influence, Visibility; O,T,E)
Health MoEs—World Bank, WHO– CDHAM/CoE (DMHA) project (next lecture)– BUMED, other Svcs, DIMO (29) measures– Planned synchronization– Require lots $, skill/time, focus; not easy
“AMoEs”—”(Aligned MoEs)” Projects with direct alignment to Health MoE
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MSO: Goals Are Elusive
“AMoEs”—”(Aligned MoEs)” Projects with direct alignment to Health MoE– Procurement with Regional/Local importance
• Facility, Equipment, Personnel contract, etc
– Training/Education with portability, flexibility• DIMO (101: 26 Human med capabilities, 4 Policy,
5 Protocols, 66 Vet outcomes)
MoPs “You get what you pay ($, time, etc) for!”
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MSO: Goals Are Elusive
Success in Sustainable New Capability:– CENTCOM wanted aerial capability for AFG,
Iraq– Health Ldrshp pushed Air Evac
• Rotary wing (espec.)• Fixed wing
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MSO: AFG Success
12
CSTC-A Line MoE Trnd w/ANA Mi-17,
2007-8 Independent Rotary,
2008 Independent Fixed,
w/cardioversion 2009 Not a World Bank
MoE, but is AMoE
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MSO: Iraq Success
13
MNF-I then USF-I MoE Trnd w/Iraqi Mi-17, &
C-130 (DIMO AE course 2008 )
Iraqi trnd Iraqis in 2009 Wks later saved 78
lives by fixed wing from Basrah to Baghdad
Not a World Bank MoE, but is AMoE
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Students From Country Course In-Country Both
Global Reach 2002-11: 212 msns, 124 countries, educated 7,346 students
Defense Institute for Medical Operations (DIMO)
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MSO: AFG, Goals Are Elusive
AFG Mil-Mil– Facilities (clin, 50-100 bed hosp, impr 400
bed) for direct care, trng, warehouses– Ambulances, AFAK, myriad equipment/supply– Education, trng, policies developed– Myriad of capabilities– Not WB MoE; AMoEs? or MoPs?
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MSO: AFG, Goals Are Elusive
AFG Mil-Civ (HA funds) w/o NGOs– CSTC-A
• Direct Care Facilities, inpatient equipment/supply• Trng Facilities, equipment/supply
– PRT’s x 12, ISAF units• Same +, educ/trng, policies developed
AFG Civ-Civ—USAID, DHHS/CDC, other USGs, orgs
Not WB MoE; AMoEs? or MoPs?
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MSO: AFG, Dental Outreach
PRT Identified Real need & Constraints
PRT Developed to build capacity
Equiped, Trained, Practiced
Turned over to the Afghans
Still running for yrs AMoE, MoP?
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MSO: AFG, “Successes”
CSTC-A, now NTM-A CSTC-A integrated approach– Vertical
• Ministerial Development• Institutional Development• Healthcare Provision • Training
– Horizontal• 17 ofcr & enlisted specialties mentored
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MSO: AFG, Failures
Some AFG leaders Some AFG construction Some equipment (voltage, size, instructions,
maintenance, etc.) Lost trainee ouput (espec. hundreds of combat
medics)
Less than full synchrony with CDC, ISAF, MoH, PRT, Univ, USAID
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MSO: Getting Smarter
Health NGOs partnering– Have been doing this well before MHS health
ramped up role from DoS/USAID– Business model; sustainability-minded– In non-kinetic locales, partnering has benefits
• NGO/Civ/Mil is even better
USG experience and interoperability growing
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MSO: AFG, Getting Smarter
AFG Mil-Civ (HA funds) with NGOs– Contributed to some MoEs (vs. AMoE’s)– CSTC-A--Direct Care Facilities (trauma clin,
amputee/rehab clinic, maternity hosp ED), inpatient equipment/ supply• MoEs: Life expectancy, maternal/child mortality
– PRTs with USAID, USDA, etc– Sewers, Agri-culture, Roads to Healthcare, Vaccines, etc.• MoEs: Mortality, Prenatal Care, Malnutrition, Clean
Water
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MSO: AFG, Getting … Strong Food
PRT Identified– Real need, Constraints– Sustainable supply line
PRT Developed, Tested & Implemented project
Turned over to
Afghans, NGOs Child wgts incr. Now MoE in 5
provinces
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MSO: AFG, Getting … Clean Water
PRT Identified– Real need &
Constraints– Sustainable supply line
PRT Developed, Tested & Implemented project
Turned over to Afghans, NGOs
Provided jobs MoE, AMoE?
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MSO: EUCOM, Goals are….
.• Moldova Hospital School
• Croatia Incubators
• Georgia Nursing School
Mil funded Successes of local/regional construction, renovation, equipingAMoE or MoP?
Mil & USAID funded for trng output….
Govt goes pvt
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EUCOM with NGO
Mil-Mil: BPC in ISAF amputee care, Georgia (impt PN)
Working with Georgia MoD and NGOs, WReed DoD Amputee SMEs, to treat their ISAF-WIA they cannot manage
MoE: POTUS discussing it with PoG on 30 Jan at White House
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EUCOM Integrated Approach
Mil-Civ/Mil: BPC with National Amputee Care Ctr, Estonia (impt PN)
With civ med ldrshp Line MoE Future, "simple" hospital
renovation long-term med capacity (logic model)
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PACOM Agri-business, Surveilance
Mil-Civ/Mil/NGO: Mongolia, focus on survivability, economic growth (meat, wool, cashmere), animal health…
Human health, proper nutrition, decreased parasite loads
Surveillance of diseases MoE’s many
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PACOM Agri-business, Health
Mil-Civ/Mil: Timor Leste, (gold std?) is paying for TDYs & penning pigs
Pigs increased litter size, weaned weights, # live pigs at weaning
Goats and cattle production
MoEs many
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PACOM
Training – Gray Hull activities (NAVPAC)– Disease Surveil. (CDC, DoD, Lao, USAID)– Blast Injury Survival (DMRTI, CoE (DMHA))– Infection Control Workshop (DIMO Vietnam)– Asia Pacific Military Nursing Symposium (12
countries) Lives Saved = MoEs
– Nepal events (DIMO trauma & Disaster crs)
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MSO: COCOMs Lsns Observed
Linking COCOM medical efforts to Strategy
Minimizing Random Acts of Engagement
Ensure all Component medical activities support a common goal/objective
Med may only be OPR for 1 of 50 Lines of Activities/ IMOs for PN, including mil deployability
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Denial
Depression
Bargaining
Anger Acceptance
Avg Emotions of GHE Deployer AFG
Arrival
Thriving?
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Agenda & Key Points
Medical Stability Operations (MSO)– Worth Doing – Steep learning curve (MHS, DoD, USG, PN)– Goals are elusive (whose MoE, AMoE, MoP)– Getting Smarter
• (PN Civ/NGO/Mil linkages, USG)• Origins of Health (Water, Food)
Challenges of direction remain
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Questions?
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The MHS Quadruple Aim
ReadinessEnsuring that the families and
individuals that make up the total military force is medically ready to deploy and that the medical force is ready to deliver health
care anytime, anywhere in support of the full range of
military operations, including humanitarian missions.
Population HealthReducing the generators of ill health by encouraging healthy behaviors and decreasing the
likelihood of illness through focused prevention, chronic care
management and the development of increased
resilience.
Experience of CareProviding a care experience that is
patient- and family- centered, compassionate, convenient,
equitable, safe, and always of the highest quality.
Per Capita CostCreating value by focusing on quality, eliminating waste, and
reducing unwarranted variation; considering the total cost of care over time, not just the cost of an individual health
care activity.
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Videos
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How to Embed Videos
Open the slide where you want to place the video On the INSERT menu, point to MOVIES AND SOUNDS
and then click MOVIE FROM FILE Locate the file and click OK A box will pop up to ask “How do you want the movie to
start in the slide show?” Click on the “when clicked” option. Your video is now embedded.
To test the video, go to SLIDE SHOW > VIEW SHOW and locate to the slide where the video is placed. Click on the video.
Note: A separate copy of the video must be submitted with the presentation.
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Locate the slide containing the video and right click on it. Click on EDIT MOVIE OBJECT Click on the “SOUND VOLUME” button and adjust as
necessary Click OK when finished
How to Change Video Volume
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Select the movie in the slide and then drag the sizing handles (sizing handle: One of the small circles or squares that appears at the corners and sides of a selected object. You drag these handles to change the size of the object.) that are displayed around the video.– To maintain the video’s original proportions, drag one of
the corner sizing handles.– To change the original proportions, drag one of the sizing
handles in the center of a border.– To change the video’s size without displacing the center of
the image (that is, to resize it symmetrically about the center), press CTRL while you drag a sizing handle.
– To move the video, drag it to a new location.
How to Change Video Size