Presentation on theme: "Case Studies in Afghanistan Health & Related Lessons Observed in EUCOM and PACOM 30 Jan 2012 Col John Mitchell The MHS: Healthcare to Health Defense Institute."— Presentation transcript:
Case Studies in Afghanistan Health & Related Lessons Observed in EUCOM and PACOM 30 Jan 2012 Col John Mitchell The MHS: Healthcare to Health Defense Institute for Medical Operations; Former CSTC-A SG
Has no real or apparent conflicts of interest to report. Conflict of Interest Disclosure John Mitchell, MD
MSO: Objectives Discuss direct medical stability operations efforts to include cooperation plans in past or ongoing CENTCOM operations. Evaluate specific cases of successes and failures related to USG efforts in Afghanistan Evaluate specific cases in EUCOM and PACOM
Agenda & Key Points Medical Stability Operations (MSO) –Worth Doing –Steep learning curve (MHS, DoD, USG, PN) –Goals are elusive (whose MoE, AMoE, MoP) –Getting Smarter (PN Civ/NGO/Mil linkages; USG) Origins of Health (Water, Food) Challenges of direction
MSO: Worth Doing “(The AFMS is involved in) GHE initiatives because health equates to security. When the people are healthy and prospering, economies grow, which furthers the goal of spreading democracy.” Major General (Dr.) Byron C. Hepburn, Commander, 59 th Medical Wing, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX
MSO: Worth Doing For Agile Combat Support (AGS),“GHE –Establishes “US access and influence with partner nations by building their health capabilities” –“Can serve as a model for success within the other ACS elements (airfield operations, logistics, security forces, maintenance, civil engineering, air traffic control, weather).” from pg 19 of Global Partnerships Strategy signed out Dec 2011 by CSAF and SECAF)
MSO: Worth Doing For Agile Combat Support (AGS),“GHE –“Without the various and specialized resources provided by the ACS community, sustained and successful air domain operations would not be possible….to achieve Joint effects.”
MSO: Steep Learning Curve Outset: Infrequently well versed in MSO –POCs, funding, documents, PN relationships? Stovepiped (MHS, DoD, USG, PN) Failures teach faster than successes; $ invested? Employment Training—MSOC (DMRTI), Non-Medical Cultural Orientations Crs, etc. Resources to teach PN—DIMO, DMRTI, Svc- specific
MSO: Goals Are Elusive Line Command MoEs—from GEF to IMO to PN (e.g., Access, Influence, Visibility; O,T,E) Health MoEs—World Bank, WHO –CDHAM/CoE (DMHA) project (next lecture) –BUMED, other Svcs, DIMO (29) measures –Planned synchronization –Require lots $, skill/time, focus; not easy “AMoEs”—”(Aligned MoEs)” Projects with direct alignment to Health MoE
MSO: Goals Are Elusive “AMoEs”—”(Aligned MoEs)” Projects with direct alignment to Health MoE –Procurement with Regional/Local importance Facility, Equipment, Personnel contract, etc –Training/Education with portability, flexibility DIMO (101: 26 Human med capabilities, 4 Policy, 5 Protocols, 66 Vet outcomes) MoPs “You get what you pay ($, time, etc) for!”
MSO: Goals Are Elusive Success in Sustainable New Capability: –CENTCOM wanted aerial capability for AFG, Iraq –Health Ldrshp pushed Air Evac Rotary wing (espec.) Fixed wing
MSO: AFG Success 12 CSTC-A Line MoE Trnd w/ANA Mi-17, Independent Rotary, 2008 Independent Fixed, w/cardioversion 2009 Not a World Bank MoE, but is AMoE
MSO: Iraq Success 13 MNF-I then USF-I MoE Trnd w/Iraqi Mi-17, & C-130 ( DIMO AE course 2008 ) Iraqi trnd Iraqis in 2009 Wks later saved 78 lives by fixed wing from Basrah to Baghdad Not a World Bank MoE, but is AMoE
Students From Country Course In-Country Both Global Reach : 212 msns, 124 countries, educated 7,346 students Defense Institute for Medical Operations (DIMO)
MSO: AFG, Goals Are Elusive AFG Mil-Mil –Facilities (clin, bed hosp, impr 400 bed) for direct care, trng, warehouses –Ambulances, AFAK, myriad equipment/supply –Education, trng, policies developed –Myriad of capabilities –Not WB MoE; AMoEs? or MoPs?
MSO: AFG, Goals Are Elusive AFG Mil-Civ (HA funds) w/o NGOs –CSTC-A Direct Care Facilities, inpatient equipment/supply Trng Facilities, equipment/supply –PRT’s x 12, ISAF units Same +, educ/trng, policies developed AFG Civ-Civ—USAID, DHHS/CDC, other USGs, orgs Not WB MoE; AMoEs? or MoPs?
MSO: AFG, Dental Outreach PRT Identified Real need & Constraints PRT Developed to build capacity Equiped, Trained, Practiced Turned over to the Afghans Still running for yrs AMoE, MoP? 17
MSO: AFG, “Successes” CSTC-A, now NTM-A CSTC-A integrated approach –Vertical Ministerial Development Institutional Development Healthcare Provision Training –Horizontal 17 ofcr & enlisted specialties mentored
MSO: AFG, Failures Some AFG leaders Some AFG construction Some equipment (voltage, size, instructions, maintenance, etc.) Lost trainee ouput (espec. hundreds of combat medics) Less than full synchrony with CDC, ISAF, MoH, PRT, Univ, USAID
MSO: Getting Smarter Health NGOs partnering –Have been doing this well before MHS health ramped up role from DoS/USAID –Business model; sustainability-minded –In non-kinetic locales, partnering has benefits NGO/Civ/Mil is even better USG experience and interoperability growing
MSO: AFG, Getting Smarter AFG Mil-Civ (HA funds) with NGOs –Contributed to some MoEs (vs. AMoE’s) –CSTC-A--Direct Care Facilities (trauma clin, amputee/rehab clinic, maternity hosp ED), inpatient equipment/ supply MoEs: Life expectancy, maternal/child mortality –PRTs with USAID, USDA, etc– Sewers, Agri- culture, Roads to Healthcare, Vaccines, etc. MoEs: Mortality, Prenatal Care, Malnutrition, Clean Water
MSO: AFG, Getting … Strong Food PRT Identified –Real need, Constraints –Sustainable supply line PRT Developed, Tested & Implemented project Turned over to Afghans, NGOs Child wgts incr. Now MoE in 5 provinces 22
MSO: AFG, Getting … Clean Water PRT Identified –Real need & Constraints –Sustainable supply line PRT Developed, Tested & Implemented project Turned over to Afghans, NGOs Provided jobs MoE, AMoE? 23
MSO: EUCOM, Goals are….. Moldova Hospital School Croatia Incubators Georgia Nursing School Mil funded Successes of local/regional construction, renovation, equiping AMoE or MoP? Mil & USAID funded for trng output…. Govt goes pvt
EUCOM Croatia Hospital new incubators (x2) purchased with agreement to train both doctors and nurses on them and to use these as a teaching platform for future medical education which built intellectual capacity 25 Moldova Burn Hospital renovations, donated equipment, trained local staff saving local lives Moldova public school sustainable, functional renovation to "No Water" toilet system since water supply unreliable
EUCOM with NGO Mil-Mil: BPC in ISAF amputee care, Georgia (impt PN) Working with Georgia MoD and NGOs, WReed DoD Amputee SMEs, to treat their ISAF-WIA they cannot manage MoE: POTUS discussing it with PoG on 30 Jan at White House 26
EUCOM Integrated Approach Mil-Civ/Mil: BPC with National Amputee Care Ctr, Estonia (impt PN) With civ med ldrshp Line MoE Future, "simple" hospital renovation long-term med capacity (logic model) 27
PACOM Agri-business, Surveilance Mil-Civ/Mil/NGO: Mongolia, focus on survivability, economic growth (meat, wool, cashmere), animal health… Human health, proper nutrition, decreased parasite loads Surveillance of diseases MoE’s many 28
PACOM Agri-business, Health Mil-Civ/Mil: Timor Leste, (gold std?) is paying for TDYs & penning pigs Pigs increased litter size, weaned weights, # live pigs at weaning Goats and cattle production MoEs many 29
MSO: COCOMs Lsns Observed Linking COCOM medical efforts to Strategy Minimizing Random Acts of Engagement Ensure all Component medical activities support a common goal/objective Med may only be OPR for 1 of 50 Lines of Activities/ IMOs for PN, including mil deployability 31
Denial Depression Bargaining Anger Acceptance Avg Emotions of GHE Deployer AFG Arrival Thriving?
Agenda & Key Points Medical Stability Operations (MSO) –Worth Doing –Steep learning curve (MHS, DoD, USG, PN) –Goals are elusive (whose MoE, AMoE, MoP) –Getting Smarter (PN Civ/NGO/Mil linkages, USG) Origins of Health (Water, Food) Challenges of direction remain
The MHS Quadruple Aim Readiness Ensuring that the families and individuals that make up the total military force is medically ready to deploy and that the medical force is ready to deliver health care anytime, anywhere in support of the full range of military operations, including humanitarian missions. Population Health Reducing the generators of ill health by encouraging healthy behaviors and decreasing the likelihood of illness through focused prevention, chronic care management and the development of increased resilience. Experience of Care Providing a care experience that is patient- and family- centered, compassionate, convenient, equitable, safe, and always of the highest quality. Per Capita Cost Creating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total cost of care over time, not just the cost of an individual health care activity.
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