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May/June 2012

US Military Medical Missions in Iraq and Southeast Asia

Author Affiliations

Author Affiliation: Department of Otolaryngology–Head and Neck Surgery, The University of Texas Health Science Center, San Antonio.

Arch Facial Plast Surg. 2012;14(3):219. doi:10.1001/archfacial.2012.394

Following the liberation of Iraq in 2003, the Coalition Provisional Authority and the US Department of Defense convened a group of 24 American consultants, one from each of the medical and surgical specialty societies, to assist in the reconstruction and modernization of the Iraqi medical profession. The Department of Defense, through the direct effort of US Army Surgeon General LTG James Peake, MC USA, was an important collaborator in this effort, for there was still an urgent need to provide security and protection to both the Iraqi and the American physicians in their collegial efforts. I was fortunate to represent the specialty of otolaryngology–head and neck surgery in this alliance, which was headed by a former president of the American Academy of Ophthalmology, Michael Brennan, MD. The initial meeting with Iraqi physicians was in the so-called Green Zone of central Baghdad, where plans for the reconstitution of the Iraqi Society of Physicians and the specialty societies were discussed, along with issues of the development of an effective emergency medical transport system; modernization of emergency centers, operating rooms, and surgical suites; and the improvement of public health in the country. Efforts by this group, known as the Medical Alliance for Iraq (MAI), have been widely successful, resulting in an improvement of emergency patient care, introduction of contemporary therapeutics, and the development of 2 continuing medical education centers in the country, which were initially staffed by MAI physicians (including a team of facial plastic, general plastic, and oculoplastic surgeons) but are now staffed by Iraqi physicians for their own self-education. The country's medical education and residency training programs are now more regulated and consistent. It has been a successful program for all of the specialties, but particularly for otolaryngology–head and neck surgery, since we now have new colleagues who were previously isolated.

In December 2004, an earthquake-generated tsunami of tremendous magnitude hit Southeast Asia, resulting in the deaths of more than 200 000 individuals. In particular, the coastal Indonesian city of Banda Aceh was nearly obliterated by the tsunami. Because of the tremendous need for humanitarian support, the US Navy Hospital Ship Mercy was readied from its berth in San Diego, California, to provide disaster relief and humanitarian aid to victims of this tsunami. The Chief of Naval Operations, ADM Vern Clark, USN, and the CEO of Project HOPE, John P. Howe III, MD, forged a unique and innovative arrangement where civilian physician and nurse volunteers would augment the limited medical staff of the Mercy's medical task force to provide a joint military-civilian disaster relief effort to Banda Aceh. This was the first time this concept had been tested in an actual relief effort and, if successful, would provide the pilot study for future efforts. I was asked to lead one of the 2 Project HOPE volunteer forces, the other led by retired MG Harold Timboe, MC USA, former commander of Walter Reed Medical Center.1 Each volunteer civilian group numbered approximately 100, consisting of a blend of surgeons and operating room personnel, intensive care physicians and nurses, pediatricians, and other specialized care providers thought to be critical to disaster relief efforts.

Initially, 2 challenges faced both the military cadre and the civilian volunteers—one, ensuring that the civilians understood the complexities of life onboard ship and conducted themselves safely and effectively, and two, that both groups were able to integrate into a single effort to provide high-quality medical and surgical care to the victims. Because the civilian leaders also had extensive past military experience, the transition and integration was facilitated and was successful. There was considerable professional interchange of information and the spirit of the effort was collegial. Local hospitals were cleaned and assisted in their efforts to again treat patients. The Mercy–Project Hope team also worked with the International Red Cross, the International Red Crescent, and the US Public Health Service to provide longer-term follow-up care for the patients treated on the hospital ship. A new form of pan-pneumonia, called “tsunami lung,” was identified and subsequently discussed in the medical literature.2,3 In addition to the acute care of victims, patients presented with long-standing, untreated problems such as huge thyroid tumors, periorbital masses, mandibular tumors, and pediatric neck masses, which required surgical excision and reconstruction by the head and neck surgery and pediatric surgery teams. This new paradigm of military-civilian disaster relief and humanitarian care was deemed highly successful and has been ongoing in the Pacific Rim, as well during US hurricane relief efforts since 2005.

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Article Information

Correspondence: Dr Holt, Department of Otolaryngology–Head and Neck Surgery, The University of Texas Health Science Center, 325 E Sonterra Blvd, Ste 210, San Antonio, TX 78258 (holtg@uthscsa.edu).

Published Online: May 15, 2012. doi:10.1001/archfacial.2012.394.

Financial Disclosure: None reported.

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