Pacific Health Mission Trudges On Despite Platform Change

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By Matt Pueschel,
FHP&R Staff Writer

As the four-month Navy hospital ship Comfort's ''Continuing Promise 2009'' humanitarian health care and disaster response training mission to Latin America concluded at the end of July, a counterpart civic assistance mission called ''Pacific Partnership 2009'' was beginning to stretch its sea legs on the other side of the globe.

Despite a small H1N1 influenza outbreak among crew members that forced the ship originally planned for the Pacific mission, the USS Dubuque, to be pulled on May 5 because of concerns the virus could be spread, a change in platform was made to the U.S. Naval Ship Richard E. Byrd that allowed the trip to proceed. The Byrd embarked in mid-June on the four-month medical mission to five Pacific countries, including Samoa, Tonga, the Solomon Islands, Kiribati, and the Republic of the Marshall Islands. Mission personnel will provide care and other services to the local populations.

''Pacific Partnership 2009 is providing a wide spectrum of medical and dental care ashore, including primary care examinations, dental exams, fillings and tooth extractions, subject matter expert exchange, eye exams and glasses, biomedical equipment repair and veterinary services,'' said Cdr. Jeff Bitterman, USN, the mission's Medical Contingent Commander. ''Public health education, preventive medicine, pest control, water quality evaluation and environmental engineering services also are offered. Pacific Partnership is designed to strengthen alliances, improve U.S. and partner capacity to deliver humanitarian assistance and disaster relief and improve security cooperation among partner nations.''

The ship will be at each stop for 10-14 days. Its U.S. uniformed medical team is comprised of members from the Army, Navy, Air Force and Public Health Service. Over the course of the deployment, medical partners from Australia, Canada, Chile, Japan, Korea, New Zealand, and Singapore will also be involved, as will professionals from the five host nations. The mission will further include medical partners from nongovernmental organizations (NGOs) such as Project HOPE, International Relief Teams, the University of California San Diego Pre-Dental Society, and World Vets. Specialties covered include optometry, dermatology, pediatrics, family practice, pharmacy, veterinary medicine, public health and dentistry, among others.

''We have a core of 50 medical personnel,'' said Cdr. Bitterman. ''The numbers and specialties vary by each country as not all partner nations and NGOs will travel with us to each port. Patients get to the care sites on their own. We choose multiple sites in our outreach efforts so we get as close to where the need is as possible. We triage the patients when they come in, they are assigned to medical, dental, optometry or pediatrics based on each individual's greatest need. Urgent cases are prioritized over routine. Otherwise, it is first-come, first-served. Depending upon how many patients show up, we may be able to see everyone. If the number of patients is larger than our staff can handle, unfortunately, in those cases, we cannot see everyone.''

USNS Richard Byrd July 3 in Samoa

Several improvements and changes are planned over previous Pacific Partnership MEDCAP (medical civic action program) ship missions, which began in 2006 and are conducted annually. ''One is to really hit into the high-capacity, high impact-type areas when we deliver the health care,'' advised Cdr. Bitterman.

The Dubuque was pulled ''due to an abundance of caution'' after a H1N1 outbreak onboard (about 50 sailors reported flu-like symptoms and the CDC confirmed at least one of the cases was H1N1). Although it was likely the crew would have been well enough by the time it reached the first mission port, Pacific Fleet Commander Adm. Robert F. Willard canceled Dubuque's participation May 5 so as not to cause concern of the spread of the virus in remote areas of the South Pacific. The switch to the Byrd forced several modifications by the ship's civil service mariners to make room for the mission¿s additional personnel. Overall Pacific Partnership 2009 mission commander Capt. Andrew Cully said a lot of people volunteered to go on administrative leave in order to increase the capacity of staterooms that they can provide for mission essential personnel. Although the number of personnel originally planned for the mission changed due to the switch to the Byrd, the Navy is tailoring the mission teams to the specific capabilities for each country, so team size will vary at the different stops.

''We're pretty excited that even though we've had to downsize this mission quite a bit as far as personnel goes, we're still being able to deliver in a lot of high-impact areas,'' Cdr. Bitterman said. "We've (had) to reduce our manning by almost 70 percent on the medical side due to the change in platform, but we're still going to be able to probably deliver in the neighborhood of 75 to 80 percent of the services we initially promised. That's because we're going to focus on the areas such as the veterinary, dental, optometry and public health. As an example, if you go into a MEDCAP, if you're seeing people as they come through, you'll help a few people. (But) when you work with somebody's sanitation or water supply and fix that system, that's something that sustains for a long period of time, long after we leave and go on to the next island.''

Mission engineers will also refurbish schools and clinics. Another goal is to work more closely with each host country. ''The other lesson learned we really wanted to latch onto and work with very early on from the get-go is working by, with and through the host nation and our subject matter expert exchange or educational training opportunities and tailoring those to what the host nation would like us to bring to the table, but also to work collaboratively and have an opportunity to benefit from their areas of expertise, as well,'' advised Cdr. Bitterman.

Pacific Partnership 2009 will not be performing any surgeries, but has arrangements in place with several NGOs, including Interplast, the Shriners and Loloma Foundation, that are willing to take surgical referrals from the ship¿s medical team.

For patients treated by the ship's team who may need follow-up care, the mission leaders have made plans with each host nation's medical system to address that through a couple of venues. ''We have a standardized patient care and patient tracking form that includes a documentation of the entire patient encounter, in a standardized format that's been developed over the last couple of Pacific Partnerships, as well as a pharmacy form (in triplicate),'' Cdr. Bitterman advised. ''One copy will go to the patient, one will go to the host nation, one will go back with us for documentation of patient care. We attempt to work very closely with the host nation medical team, as well as the host nation NGOs in support so that we're working by, with and through them and have them integrally a part of our MEDCAP mission and any area where we're delivering health care so that they can have a successful hand-off from us and actually by working with us, are already kind of involved with the care from the starting point. That's how we attempt to achieve continuity of care and not have things fall through the cracks. We also provide written documentation for their medical records, as well.''

The same kind of planning went into the types of medicines that will be distributed to the local populations. ''Prior to deployment, we tailor our pharmacy to the formulary of the host nations, so we only use medicines that can be obtained in the host nations,'' said Cdr. Bitterman. ''So, they sustain care after Pacific Partnership departs.''

Cdr. Bitterman said there are also Measures of Effectiveness in place for the mission that are focused on sustainability and capacity building. For example, according to a spokesperson for mission partner Project HOPE, the education the NGO provides to local health care workers lasts beyond the two weeks spent in each port and raises their capacity to provide better care to the population over the long-term. The spokesperson added that they are working with the Navy to try to partner more with local NGOs that already have a presence in certain countries to plan ahead and improve opportunities for follow-up care.

The fourth mission in a series of annual U.S. Pacific Fleet humanitarian civic assistance missions, Pacific Partnership 2009 also contributes to the new Maritime Strategy of promoting U.S. security, strengthening partnerships with allies and being prepared to conduct more humanitarian missions. Cdr. Bitterman cited the words of Capt. Cully from his remarks at the opening ceremony in Tonga: ''Our goal is to grow in friendship, learn from one another, and build skills that will allow us all to respond in the event of any future humanitarian crisis. As our doctors and nurses treat the sick, our engineers build, and our people interact, we hope for a long-lasting impact and a deepening of the bonds of friendship.''

The mission can even save some lives along the way. A two-year old Samoan child was saved by mission medical personnel July 3 in Lalomanu. According to a U.S. Navy doctor who treated him, the child suffered from severe gastroenteritis and 10 attempts to provide intravenous (IV) therapy failed due to his extreme dehydration. An emergency surgery to gain IV access was finally successful and the boy was resuscitated, transferred to a local hospital and later released in good condition.

Since 2006 the Navy has been leading two 4-month interagency hospital ship missions a year to the Southern and Pacific Command regions. The Navy will further send the high speed USS Swift on a humanitarian civic assistance mission to the Africa Partnership Station (APS) this fall and West African countries such as Liberia, Ghana and Cameroon. A portion of the mission is health-related. The Navy also supports a fourth standing humanitarian civic assistance mission to the Global Maritime Partnership. There furthermore may be an additional Navy gray hull ship sent to the East Africa coast, as well, within the next couple of years if funding is approved. ''I personally think we can get more done for less money with smaller, less draft ships that can provide maritime security training opportunities at the same time without escorts or helicopter squadrons for required support,'' advised Africa Command Surgeon Col. Schuyler Geller, USAF, MC.