Lt Col Jody NoeAndCapt Tracy Harrelson
Objectives
Understand the rationale behind counter-insurgency operations and what role the laboratory can play
Appreciate the current capabilities of one Iraqi medical clinic and the efforts that the 332d EMDG is making toward addressing its needs
Comprehend the challenges/ consequences of “helping” host country laboratories
Counter-insurgency Operations (COIN)
COIN, by definition is military, para-military, political, economic, psychological, and civic actions taken by a government to defeat insurgency.
In this instance the 332d EMDG sought to capitalize on the good will generated in the local community from medical care previously provided to local wounded Iraqi civilians.
History Efforts were already underway to provide
training and equipment to doctors and nurses
Recently, there has been a push to include ancillary medical services with the laboratory being the first service to be assessed
Came out of coincidental meeting with the mother of an Iraqi lab tech
Preparation
Mine Resistant Ambush Protected (MRAP) basic training
Rollover
Rollover in
water
Rollover
under fire
Assessment - Initial Assumptions Intermittent power issues
Staff retainability/training – 4 lab staff
Reagent storage problems/refrigeration
Lack of reagents to perform spectrophotometric assays for Glucose, Bilirubin, Uric Acid, BUN, Cholesterol
Assessment Goal
Find areas for improvement where the Air Force could provide laboratory assistance which could in turn be sustained by the Iraqis.
Concerns
Cultural
Power and water supplies
Future sustainment capabilities
Security of donated equipment
Previous endeavors have resulted in equipment being sold on the black market.
Mission Brief
Convoy!
Clinic Findings
Clinic Findings
Findings - Laboratory
Basic laboratory requirements such as reliable power and clean water for reagents were woefully inadequate
Findings - Laboratory
Reagent supply issues were problematic
Findings - Laboratory
Equipment was antiquated and in disrepair
Findings- Laboratory
Findings
Operating instructions and reference material were non-existent.
Findings
Initial Response
Preliminary efforts to get the local Iraqi clinic laboratory staff to come to the 332d
EMDG laboratory failed for cultural reasons.
Efforts are on-going to develop training aids and operating instructions in Arabic for use at local facilities and future visits to other clinics and hospitals are being considered.
Initial Training Aids
Initial Training Aids
Initial Supplies Provided shovel, rake, trash bags and gloves so
that the Iraqis could get the grounds cleaned up
Plan was to next bring painting supplies once outside was cleaned up
Challenges Training
Initial training received, unable to assess adequacy
No evidence of ongoing trainingSpecifically concerned about microscopic
urinalysis
Chemistry TestingManual methods require dangerous chemicalsPiccolo -pilferable, supply issues and cold
storage issues
Challenges
Personal hygiene inadequateAccess to clean waterEducation
No Microbiology testing capabilityOnly fecal wet preps
Cultural issues, all tests MUST have a result“No stool pathogens” statement not seen in log
The Road Forward
Appealing to the female doctors to try to get an invite to their clinics and training for their techs.
Gathering intelligence on the Iraqi Health Care System and the Ministry of Health
Crossing our fingers!!!