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!!!