medical department in military operations other than war. Part II: Medical Civic Assistance Program in Southeast Asis, The

Military Medicine, Sep 1999 by Baker, Michael S

It is a short trip by air from Bangkok, Thailand, to Phnom Penh, Cambodia, but a dramatic contrast. A Medical Civic Assistance Program (MEDCAP) visit was conducted in conjunction with Exercise Flash Canoe 97, the first U.S. Navy mission to Cambodia in more than 22 years. Nearly 3,000 patients were seen by the MEDCAP team members. Medical and dental care, medications, educational materials, and training were provided. The mission was an exceptional training opportunity for U.S. Medical Department personnel, who learned to function outside of the hospital and clinic environment and to deal with limited logistic backup, austere field conditions, a hostile environment, and an overwhelming number of patients, many of them with infectious diseases. Cambodia lacks public health infrastructure and has uncertain communications, difficult travel conditions, and an unstable political climate. Using the planning checklists described in Part I, the team completed the "in-country" part of the mission with minimal logistic and support problems, maximizing the effectiveness of the health care providers. The MEDCAP is an important instrument of U.S. foreign policy and friendship with other peoples.

Introduction

The U.S. Navy conducted its first official mission to Cambodia in more than 22 years in 1997. Exercise Flash Canoe was a combined mission involving personnel under the command of Special Warfare Group One and Special Boat Squadron One working with and training members of the Royal Cambodian Navy. The goal of the exercise was to provide training in riverine operations, coastal patrol, boat maintenance, navigation, communications, and medical care. In conjunction with this exercise, a Medical Civic Assistance Program (MEDCAP) was requested and carried out in areas near the military training sites.

The MEDCAP team was composed of two physicians, two dental officers, and five corpsmen-all reserve personnel-and two active duty corpsmen, one of whom did all of the preplanning visits, logistics arrangements, and contracting. The MEDCAP team worked with members of the Royal Cambodian Navy and rural regional providers to provide hands-on medical and dental care, medications, training for health care professionals, and preventive medicine in needy communities.

Nearly 3,000 patients were evaluated on the MEDCAP visits, and many of them had never been treated by a physician or dentist before. Cambodia is emerging from a dark period of the "killing fields," when the Khmer Rouge executed all educated, business, and professional people-perhaps as many as 3 million in a nation of 10 million. The Cambodian medical system was virtually wiped out during the Khmer Rouge period, has very limited resources, and is now slowly being rebuilt. Medical facilities are not widely available and do not meet U.S. standards of technology, hygiene, and care (see Fig. 1, Part I).1-3

We have divided this paper into discreet areas to facilitate understanding the challenges of this mission. The "Trip Preparation" includes sections on "Immunizations and Prophylaxis," "Passport and Country Clearance," "Logistics," "Equipment and Supplies," "Profile of Cambodia," "Medical Intelligence and Networking," and "Travel Planning and Personal Security." The remainder of the paper recounts the "Actual Mission," 'MEDCAP Accomplishments," "Contrasts with Cobra Gold 96," and "Training Accomplishments and Lessons Learned."

Trip Preparation

Immunizations and Prophylaxis

This MEDCAP mission required a significant number of vaccinations to be obtained and verified before departure. The State Department advisory lists the routine and specific vaccinations for travel in Cambodia. Common immunizations such as diphtheria, pertussis, and tetanus or tetanus alone, Hemophilus influenzae type B, measles, mumps, and rubella, polio, varicella, and influenza should be current. Personnel working and eating in rural areas should also consider immunization against hepatitis A and B, Japanese encephalitis, typhoid, and a polio booster.3-5

We found this somewhat difficult to arrange via the reserve military system, especially with time being short. The hepatitis A vaccines are a series given 6 months apart, and Japanese encephalitis requires three vaccinations on days 0, 7, and 28. These vaccines are also quite expensive and require cold storage and special handling. Major military treatment facilities will usually provide these vaccinations if presented orders showing need. There are travel clinics and health department clinics where one can obtain appropriate immunizations commercially.

The most common health threat to military mission effectiveness is diarrheal illness. Many types abound, including Shigella, Salmonella, Giardia, and amebiasis. Cholera is reported, and this vaccination should be considered by personnel who will be exposed to less sanitary conditions or who have impaired gastric defenses.3,4

Malaria remains a significant risk, and personal protective measures and prophylaxis were essential. Very high rates of malaria infection are reported in northern forest villages along the Vietnam and Laos borders. Personal protective measures include the use of insect repellents such as DEET applied to skin and clothing, wearing long sleeves and long pants whenever possible, and sleeping under mosquito netting. Spraying pyrethrins into closets and room corners will decrease mosquito populations in working areas and living quarters.