Military Medical Stability Operations from a Navy Hospital Platform: Veterinary Service Perspective Jeremiah Nelson DVM, MPH Battalion Veterinarian 81 st Civil Affairs, Fort Hood, TX

Disclosures The presenter has no financial relationships to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS. Neither PESG,AMSUS, nor any accrediting organization support or endorse any product or service mentioned in this activity. PESG and AMSUS staff has no financial interest to disclose. Commercial support was not received for this activity.

Learning Objectives: At the conclusion of this activity, the participant will be able to: 1. Define Veterinary Civic Action Programs (VETCAPS) 2. Understand the changing roles of veterinary programs in global health engagement 3. Explain the complexities and challenges for the delivery of one-health humanitarian civic assistance programs from a naval hospital platform

5 6 months, 11 country stops in US Southern Command area VETCAPs: 52 Continued to re-define and broaden veterinary civic action programs SMEEs: 51 From hands-on anesthesia workshops to multiday seminars Most sites were split operations (2 teams doing different projects) Total patients: 7,291 (cattle and buffalo to working dogs and monkeys) Surgical patients: 700 Augmented significantly by local surgeons (Panama, Colombia) Donations and used items total: $124, Continuing Promise VS Team

Not black and white, mislabeled at all levels VETCAP: Veterinary Civil Action Program Short-, intermediate- and long-term projects or programs designed to improve host nation veterinary or agricultural infrastructure Host nation (HN) professionals are involved at maximum extent VETRETE: Veterinary Readiness and Training Exercises Support humanitarian and civic assistance operations designed to enhance US and HN relations. Supports and conducts veterinary training with HN military, government and civilian agencies Training US forces is the primary objective; HN professionals may/may not be involved SMEE: Subject Matter Expert Exchange Educational outreach to professional and para-professional local nationals Veterinary and Agricultural Programs

7 VETCAPs are not going away… But they can change: veterinary civic action programs can not be US Forces popping shots (not suitable, sustainable) or isoflurane-anesthesia surgeries for stray animals in a rural village (why?) Continue to redefine VETCAPs by seeking indigenous and other partner SMEs, HN execution, and link target-donations to specific VETCAP themes SMEEs wedded to kits Select topics (e.g. rabies clinic and outreach, anesthesia and nociception, necropsy, parasitology) are best supplemented with ready-to-use, appropriate kits Improve formulary and develop basic kits with a "menu” of SMEE topics Create engagements centered around: organize, train, and equip followed by plan, execute, and evaluate Right top to bottom: “VETCAPs” in Panama included training in, and donations of, surgical supplies with 2 local NGOs to complete 341 surgeries; surgical and veterinary donation “kit” after 3 days of side-by-side surgery with HN in Puerto Cabezas Nicaragua; and, community animal health worker “kits” were donated after a 3-day course in Tuapi (pictured) and Bethania village in Nicaragua. Changing Roles of Programs

8 USNS Comfort is not suited for veterinary public health surveillance or veterinary herd health diagnostic capability Many low-come partners would benefit from initial surveillance e.g. serology, studies for Brucellosis, Anthrax, WNV, VEE, Tuberculosis, etc. End State: A one-health platform that can accommodate larger volumes and greater capability for surveillance research and diagnostics capacity-building, relevant to the host nation first, and the mission second Above: herd health including brucellosis and VEE serology accounted for many engagements but execution of population studies could not be met by the current laboratory capacity of USNS Comfort Veterinary Public Health Platform

9 “One-health” planners are necessary but not sufficient – Regionally focused veterinarian(s) for planning OR a well informed, culturally competent public health planner – In ALL cases the planner must be tasked for the mission first, and tasked for planning second; they must understand the capability (including limits) of a VS team, the ship laboratory, public health department, and other assets of the mission Evaluation must be built into the planning and execution phases From planning to execution, left to right: the PDSS planner CPT Watson in Guatemala; movement at the final planning conference; and SPC Maza demonstrating injections to farmers in Tuapi, Nicaragua. Veterinary Public Health Platform

10 Continue to redefine all civic action programs to re-align with GHE Longer is better; short missions can be successful engagements Require: 1 part PDSS, 3 parts near-term planning (1 month to 1 day), 3 parts expeditionary mind-set, language, and technical skill set and 2 parts follow-up and evaluation A better platform for the delivery of Military Medical Stability Operations includes more collaborative teaching and cooperative research and less “doing” Questions, Comments, Concerns? Military Medical Stability Operations from a Navy Hospital Platform: Veterinary Service Perspective

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