Medical Care during Recovery Operations in Laos

Craig P. Dobson, MD

LTC, MC

Jeffrey C. Ransom, DNP, FNP

CPT, AN

Objectives• Understand tailoring military medical supplies to meet civilian needs.• Understand need for after action review of unmet medical needs each mission

in order to adapt future missions.• Understand evolution of humanitarian relationship to develop improved local

medical expertise and capacity.

The views expressed in this presentation are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

Introduction• Beginning in 1985, U.S. Defense POW/MIA Accounting Agency (DPAA,

formerly JPAC) conducts four missions per year in Laos searching for remains of U.S. Service Members from the Vietnam War.

Introduction

• In a joint agreement with the Lao government, the U.S. Recovery Teams provide a clinician to perform medical care to villagers near the recovery sites.

• Three teams established five recovery “dig” sites at aircraft crash locations near Xepon, Laos. The medical team rotated between dig sites.

Methods

• Humanitarian engagement clinics were conducted approximately every four days throughout the thirty five day mission.

• Access to sites for the medical team involved helicopter flight, hiking or canoe transport.

• No sites were accessible by vehicle nor within 45 minute access of established Lao medical facilities.

Methods

• Consent for clinics was conducted in coordination with regional government health officials of Savanaket Province and Xepon health clinic.

• The joint medical team consisted of one physician, one medic or nurse practitioner, one Lao government linguist, and a village chief (as a translator from Lao to local dialect).

Methods

• Depending on the location of the site, access to humanitarian care from the villages varied widely between five minutes to five hours walk.

• All Lao locals who journeyed to the sites were eligible to be receive care.

Results

• Over a one month period, seven humanitarian clinics were held in Savanaket Province.

• A total of 235 individual patient encounters

• Patients ages 3-65 years • 260 diagnoses • No medical diagnosis in 14. • These consisted of patients

with no medical issues who were seeking vitamins or patients with non-current complaints.

Results

Insufficient Supplies/Facilities to Treat:

Parasitic 20 47.6% Insufficient albendazole Dental 13 31.0% No dentist, needed tooth

extraction Eye 3 7.1% Blindness, dry eyes GI 4 9.5% Constipation, Diverticulosis Derm 2 4.8% Acne

total 42 16.2% as percentage of total diagnoses

Results• Trauma, wound care and minor surgical procedures (abscess

incision and drainage) accounted for a small percentage of overall diagnoses (5, 1.9%).

Results

• Additionally, may of the cases were related to chronic medical conditions that presented with multiple long-standing and/or recurrent symptoms.

Conclusions

• Supplying missions for humanitarian engagement should target dermatologic, gastrointestinal, musculoskeletal complaints.

• Military planners created the supply list for missions.

• One-fifth of supplies were trauma-related, yet trauma accounted for a small percentage of visits.

• Humanitarian engagement packing lists must change from a wartime emphasis to a peacetime focus.

Conclusions• Increased supplies of anti-parasitic agents should be stocked to meet population need.

• There is some controversy recently as to whether de-worming improves school performance. (Davey, et al. Int J. Epid.)

• Adding a dentist to the mission or training team members on dental extraction would be beneficial.

• Prevention efforts should target dental hygiene (toothbrushes, fluoridated toothpaste, children’s vitamins with fluoride).

Conclusions

• To address the a large portion of the patient population with chronic illness symptoms, the relationship in the future should evolve towards establishing dialogue and training sessions including U.S. medical personnel, Lao government officials, and Lao medical system representatives.

Conclusions

• The future of cooperation should develop increased medical expertise and capacity addressing these essential needs.