health.mil

Matt Pueschel  |  FHP&R Staff Writer

June 25, 2010

Since the recent release of a newly approved DoD instruction that calls for the U.S. military to integrate medical stability operations (MSOs) across Military Health System training, planning and resourcing activities, the policy seems to be catching on not only within DoD but among its allies across the ocean.

FHP&R’s International Health Division (IHD), which wrote the instruction (DoDI 6000.16), hosted a visit on June 10 in its Falls Church, Va., offices from Brig. Gen. Patrick Godart, M.D., medical advisor of the Chairman of the French Chiefs of Staff, to discuss approaches to global humanitarian health missions. Godart said he realizes the importance of the policy and how it relates to a change in the way humanitarian assistance and disaster relief (HA/DR) can be delivered to countries in need.

In addition to assigning specific DoD responsibilities in Military Health System (MHS) education, research and preparation for MSOs, the policy requires the ASD/HA to collect best practices and establish health standards of care and technical supervision over the MHS in stability operations, as well as measures of effectiveness that evaluate the long-term impacts and progress toward achieving the goals of medical relief and health infrastructure reconstruction or capacity building projects in other countries.

DoD health care personnel must further practice within their scope of medical privileges when treating other populations and consider what sustainable sources of follow-up care are available through local doctors and nongovernmental organizations (NGOs). When engaging in humanitarian relief efforts in conflict, disaster or non-combat areas to reestablish health sector capabilities when local providers are unable to do so, the MHS, according to the policy, must also support and collaborate closely with other relevant U.S. departments, foreign governments and security forces, international organizations, NGOs and the private sector.

Godart, who began his career as a tropical medicine physician, said France is searching for something new like this policy for its own medical relief or cooperative missions in regions such as Afghanistan, former Yugoslavia countries, some African states and conflict areas like South Lebanon, that utilizes a long-term vision to support and assist other nations build their own health capacity and thereby help themselves improve.

Godart said France is trying to better its own military’s relationships with NGOs in medical relief efforts that it embarks on in impoverished countries. The relationships have been improving, as France has started to look more closely at developing long-term strategies for such missions. “It’s not just your typical humanitarian assistance/disaster relief,” he said, adding that providing trainers to teach local medical personnel how to use donated radiological equipment and supplies, for example, over a six-month to one-year period instead of a short-term relief operation may have a greater long-term impact. “We should do that in doctrine.”

Likewise, IHD Director Dr. Warner Anderson said the U.S. military has international obligations to care for injured civilians in conflict zones in an ethical manner and does so, but it is not something that is always planned for from the beginning with civilian agency and NGO counterparts to ensure the hand-off of care and reconstruction from DoD to local systems is ideally transitioned. “Maybe we should do civilian casualty estimates beforehand and plan it out (further),” he advised.

Brig. Gen. Godart agreed that the number of unintended civilian casualties is often much higher than military casualties in conflicts, so increased civil-military medical planning would help. “Our other concern is natural disasters, like in Haiti, because their local medical infrastructure was flattened, so we have to be there a long time because we can’t hand off to anyone,” he said.

IHD humanitarian assistance specialist Dr. Lynn Lawry said the civil-military coordinated medical response to the Jan. 12 Haiti earthquake, as well as the collaborative health assistance provided after the 2004 Indonesia tsunami, were successful joint efforts and are good starting points to work from in other health stability missions. MSO efforts in conflict areas are more complicated and require even more delicate joint planning efforts, she added.

Considering what sustainable medical resources are available to the host country after a medical relief operation ends, as well as understanding the cultural and social aspects of the population and their traditions is very important in MSOs, as well. This will help DoD and its allies develop basic, inexpensive solutions that the culture can sustain. Recognizing that local patients may be accustomed to a different manner of medical care is crucial, also. For example, Godart said in Africa local physicians may work more closely with patients and try to put them at ease by patting them on the arm or back as they examine them, so international providers should consider such customs when they arrive to help provide care.

Godart, who also visited U.S. Navy medical facilities in Portsmouth, Va., during his four-day visit to the area, and Anderson exchanged items emblematic of their countries to commemorate the visit, and promised to make themselves and their staffs available to learn from one another in the continued effort to improve how HA/DR is delivered around the world. “It was a great honor to be here this morning,” Godart said. “I promise we are very, very interested in what you are doing. It’s the future.”

For more information, please visit http://www.fhpr.osd.mil/intlhealth.

Leadership & Policy [News]  |  FHP&R   international health   humanitarian relief