2nd Quarter 2008

   

Forty eight military medical personnel from Australia, Cambodia, Indonesia, Malaysia, the Philippines, Singapore, Thailand, and the United States met in Jogjakarta, Central Java, Indonesia, in June 2007 to participate in Exercise TENDON VALIANT V, a medical readiness exercise for training and education (MEDRETE). The Indonesian government and military (TNI) hosted the exercise along with the U.S. Army, Pacific (USARPAC) Surgeon’s Office.

Against the backdrop of Mount Merapi, an active volcano, delegates met in Hotel Melia Purosani, in the culture rich provincial capital. This was the fifth USARPAC MEDRETE, but the first for the Central Java location, site of an 8.6 earthquake in 2006. The Indonesian Government, in coordination with the U.S. Embassy, selected Jogjakarta province for humanitarian medical operations, one of the exercise goals. Other exercise goals and objectives included improving security cooperation and medical interoperability among participating nations, and promoting a positive image for the militaries of each participating country.

Planning for TENDON VALIANT V began in the summer of 2006 when U.S. Army Maj. Kinsey J. McFadden submitted a humanitarian assistance proposal for approval and funding. Under the auspices of the U.S. Pacific Command Theater Security Cooperation Program, Maj. McFadden secured funding and received approval for TNI-based security during the entire mission. Employing TNI limited the number of U.S. forces requiring travel – a significant cost savings – while maximizing host-nation capability along with local populace acceptance.

The MEDRETE concept assumes each nation’s delegates take an active part in scientific exchanges and medical/dental care delivery. During the first two exercise days, physicians, nurses, dentists, and other medical specialists presented medical briefings on a wide range of topics including tropical disease identification and treatment, the Indonesian National Family Planning Program, dental emergencies, and partners’ international humanitarian responses.

Attendees shared their knowledge and experiences. Their talents included surgical skills, doctoral degrees and combat medical experience. All delegates – officer and enlisted – were major contributors to this effort. Indonesian Army surgeon Lt. Col. (Dr,) Victor Wullur, Royal Thai Air Force cardiologist Col. (Dr,) Taksin Jiemthong, Singapore Navy psychiatrist Capt. Teck Hwee Soh, and Philippine Army pharmacist Capt. Marlon Bayhon recounted their individual military experiences in such countries as the Congo, Kosovo and Iraq.

Learning happened everywhere. In the dining room, Thai delegates discussed their experiences with Cambodians and Malaysians. Americans worked out in the gym and field with Australians and Indonesians, and Filipinos and Singaporeans exchanged medical information while journeying to villages. Indonesian military medics pointed out local sights to delegates, described Indonesian customs, and shared medical practices with an eager-to-learn multinational group of medical colleagues.

The Exercise Commander, U.S. Army Col. Dwight Shen, determined Medical Team A and B composition based on members’ talents and experience. U.S. Public Health Service Capt. Fritz Craft split the dental expertise into two multinational teams of specialists and technicians. The teams focused on learning each other’s individual and collective strengths so that an asset on Team A could be leveraged against a need on Team B.

On the afternoon of the second day, teams visited their pre-selected sites, met local government officials and medical staff, assessed capabilities, and coordinated on the population’s expectations for care. Planning and sharing continued into the evening as teams projected their ideas for patient reception, registration, examination and treatment stations, and pharmacy set-up and dispensing. Members identified potential choke points and problems; others proposed alternate courses of action and solutions.

On the third day, volunteers assembled to pick up and load medications and supplies packed the day before. Teams A and B arrived at selected villages and the day began in earnest as every delegate worked the plan. Once opening ceremonies concluded, patient care began and work continued until the last villager received treatment. Each evening delegates met for after-action reporting. In a large conference room, teams lauded successes, talked out problems, and discussed the next day’s plans. And so it went on subsequent days at appointed village sites.

At the TNI Army Hospital in Jogjakarta, U.S. Navy Capt. (Dr.) Karl Holzinger, an ophthalmologist, working in consultation with a civilian Indonesian eye specialist and TNI physician, screened 80 blind citizens. They successfully performed cataract surgeries, giving 27 candidates back their eyesight on the first day. Capt. Holzinger’s 18-year-old son, Gregory, along as a volunteer, saw his dad with new eyes, too. “Wow, I’m really proud of him,” Gregory commented. “My dad is amazing!” (Gregory is a high school student who paid his own way to volunteer his help, observe his dad, and decide whether medicine should be his study field.)

“I’ve never done so many cataracts in one day,” said Capt. Holzinger. “What a great day!” He did the same for 50 more patients. “These doctors are so good to work with, and the patients so grateful for anything you do to help,” he said. “USARPAC is doing a tremendous service in getting us out here to share techniques and knowledge. I never want to stop doing this.”

For many delegates, Exercise TENDON VALIANT V ended far too soon. But not before 4,300 residents of Central Java received MEDRETE assistance. Musculoskeletal complaints were the most common reasons patients sought care, likely due to the hard work of tending rice paddies and harvesting crops. Respiratory illnesses were the second most frequently reported health problem.

Teeth decay was another common problem. In Jogjakarta, children receive sugar cane as a treat, and without any naturally occurring fluoride to help counteract harmful side effects, bacteria thrive and cause tooth decay. Consequently, delegates seized every opportunity for teaching health care and collaborating with local physicians, midwives, and health-care workers.

Delegates were as eager to learn about local treatment approaches as local providers were for a Thai or Filipino remedy. Side by side, hour by hour, day by day, physicians and nurses conferred about, with, and for patients. Even the casual observer could appreciate interoperability as the quiet Cambodian Army physician explained a new use for a simple drug to Australian Navy cardiologist Capt. Edwin Barin, or as an Indonesian midwife supervised Royal Thai Air Force Col.(Dr.) Wutichai Isara, a surgeon, as he carefully treated a young woman.

Most delegates experienced “firsts.” It was their first time seeing the ravages of Hansen’s disease, also known as leprosy. A first glimpse of a government-owned mobile family planning van, where midwives provided family planning services, while a noisy air conditioner droned on to keep both practitioners and patients cool. A first time to witness the effects of fractures not fixed, wounds not healed, and cantaloupe-sized thyroid goiters. For many, a first time experiencing deep frustration at an inability to do more to help.

TENDON VALIANT V did not end with a closing ceremony as collaboration among delegates continues. Nurses from Australia, the Philippines, Singapore, Thailand and the U.S. are preparing a combined presentation for the Asian Pacific Military Medicine Conference in 2008. E-mails fly daily to and from delegates following up on questions and discussions during their week together in Indonesia. U.S. delegates from Hawaii plan to meet their Thai counterparts in Honolulu in August 2008.

Judging by the gratitude of the local population, the delegates likely won the hearts and minds of many in the local population. Moreover, the positive responses from delegates’ post-exercise surveys highlight the success of participating nations to improve security cooperation and medical interoperability between their armed forces. Each of the 48 MEDRETE delegates could now walk into a multinational crisis far more prepared, rendering TENDON VALIANT V a resounding success.