Training for Disaster

by U.S. Medicine

April 19, 2010

From the Editor-in-Chief, Chester ‘Trip’ Buckenmaier III, MD, COL, MC, USA

Every surgical patient at Cho Ray Hospital, Ho Chi Minh, Vietnam, underwent a chest X-ray. It is not my typical practice to review chest X-rays prior to beginning a regional anesthetic, but this was not my typical practice. My Vietnamese physician hosts insisted I review the X-rays of each patient prior to assisting them with the block procedure. This I did diligently without incident until I saw the film of my next patient, an elderly female with a perfectly formed M-16 slug in the right lower lobe of her lung. She was about to undergo a thoracotomy and a right lung lower lobe lobectomy for the complications this spent bullet was now causing her some forty years after she was shot as a girl during the Vietnam War. I was training her Vietnamese anesthesia providers in paravertebral continuous peripheral nerve catheter infusions for enhanced perioperative analgesia.

I was leading a team of military doctors and nurses on a medical training and teaching mission to Vietnam, when I encountered this thoracotomy patient. Medical training rotations of this type are extremely popular with resident military physicians and for many it is their first experience at austere environment medicine before deployment to Iraq orAfghanistan. This mission was our fourth to Vietnam as part of the Walter Reed Army Medical Center, Anesthesiology Residency, Operational Anesthesia Rotation (OAR) program. The program consists of planning and deployment for a two week operational anesthesia mission to medically underserved areas of the world.

The benefits of this medical exchange truly go both ways. Our host country patients and providers benefit from exposure to, and training in, new medical technologies and techniques. Team members gain valuable experience in austere environment anesthesia and teaching skills. These missions also provide ideal environments to exercise field medical equipment to evaluate efficacy or identify areas for improvement. Personally, these missions have been some of the most fulfilling professional experiences of my career. Many of my physician trainees have noted that their OAR experience was the single most important rotation in preparing them for eventual duty in Iraq or Afghanistan. Missions of this type are one of the reasons many healthcare providers stay in the federal system.

Recent events in Haiti underscore the value of medical training in austere environments. As events in New Orleans so painfully underscored, the United States is not immune to natural disaster and must have a corps of medical professionals trained and ready for these disasters at all times. Who better to fulfill this role than federal medicine?

While military medical missions to austere environments are not uncommon, they are not an integral part of many training programs. Funding for these missions can be difficult to obtain and medical commands do not necessarily see the missions as valuable to their local operations. Notwithstanding the educational benefits of missions to medically underserved regions, I would contend that there are many other tangible advantages that should stimulate more investment in this type of training initiative. Medical missions showcase the finest attributes of the United States in host countries such as our willingness to help, our medical expertise, and our compassion for people regardless of race, politics, or religion. Influence in strategically important countries can be gained through academic medical exchange rather than force, sometimes termed the ‘soft side of the spear.’ Certainly greater cultural understanding and appreciation of cultural similarities and differences is gained by all involved. In short, few graduate medical education activities can provide so much return on every dollar spent. I would encourage fellow federal medicine providers to seek out medical mission opportunities, and our leadership to expand and resource these efforts.

I recall the following day after my encounter with the girl, now woman, Vietnam War casualty. Our team of Vietnamese and American doctors performed acute pain rounds (perhaps the first time in this institution) on our post-surgical patients. We found our thoracotomy patient sitting upright, breathing comfortably, and smiling. The interpreter introduced the American members of the team who had helped her. She frowned briefly and whispered something to the interpreter. Sheepishly, the interpreter reported that she was pleased with the pain control but noted that it had been an American who had shot her so many years ago. I quickly lightened the moment my assuring her I had not fired the shot since I was also a child at the time, but I was grateful for the opportunity to help her now. This seemed to satisfy the patient and please the team, other patients in the packed patient room listening to the exchange smiled. When I reflect on that incident, I often think the healing provided by our team that day went far beyond that one patient.

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