Paraguay Medical Exercise Aids Impoverished Citizens

By Army Sgt. 1st Class Alex Licea
U.S. Special Operations Command South

YASY CANY, Paraguay, June 6, 2013 – Life here in this small farming district in the Canindeyú Department is tough, and it shows on the faces of its 30,000 residents.

Located in the vast internal countryside 160 miles outside of Paraguay’s capital of Asuncion, the town lacks many basic services and its infrastructure needs to be revamped.

A Paraguayan military dental hygienist examines the teeth of a local man June 1, 2013, during a two-day Paraguayan-led medical civic action program conducted in the Canindeyú Department of Paraguay. DOD photo by Army Sgt. 1st Class Alex Licea   (Click photo for screen-resolution image);high-resolution image available.

Driving into town is quite a sight as poverty is truly visible, with small shops on one side of the road, and a few rundown houses, shacks and restaurants on the other side, the livestock running the grounds along the road.

Unemployment is high and most families live on $100 monthly to feed a family of six and in some cases up to 10 people. Every day is a struggle.

In towns like these, members of the Paraguayan military and its civil affairs elements thrive. After several months of planning and with support from the Office of Defense Cooperation at the U.S. Embassy in Paraguay and U.S. Special Operations Command South Civil Affairs, based in Homestead, Fla., a two-day Medical Civic Action Program, commonly referred to as a MEDCAP, was held June 1-2 in the area’s largest school.

More than 3,000 residents received social and medical services including pediatrics, gynecology general medicine, optometry, ophthalmology, dentistry, immunizations, identification registration and family planning. Laboratory and pharmacy services also were provided.

Paraguayan officials felt the Canindeyú Department, located in the northeastern part of Paraguay and bordering Brazil, was an important area to provide these services due to the poverty and in the wake of the massacres in nearby Marina Cue following a land dispute. That event shook the confidence and trust among many of the residents toward the nation’s security forces, a misperception they want to change.

“We plan and execute these missions because we understand the needs of the people in places like this and these services are important to their livelihood,” said Paraguayan Col. Leonardo Ibarrola, the operations officer for Paraguay’s civil affairs team. “This is a very poor area, and we understand our role as part of the government is to make sure our presence is felt and help those in the country who don’t have much and need our assistance.”

In order to provide these essential services to residents living in Paraguay’s rural districts, the Paraguayan military works closely with a number of different government agencies and civic groups to provide the support and personnel for a complex operation that reflects Paraguay’s whole-of-government approach.
Word of the event spread quickly. Some residents walked miles to arrive at the school and others packed themselves in pick-up trucks.

The Paraguayan military also provided transportation to the MEDCAP to ensure as many people as possible could benefit.

Sitting outside one of several classrooms used as makeshift clinics, 74-year-old Anadeto Furrez, a father of eight, patiently waited for his prescription for free medicine.Furrez, who suffers from cataracts was also given a new pair of glasses.

“This day is a miracle and a blessing,” said the grandfather of 35. “These are services we truly need, and I am very grateful to our military and the support from the U.S. We hope things start to get better and more jobs come to our town. This is a start!”

Along with support for the MEDCAP, the U.S. Embassy in Paraguay donated $15,000 worth of medical supplies to the town’s public clinic as well as supplies for two local schools.

“The United States is committed to assist Paraguay and help improve the quality of life for all Paraguayans and build a lasting friendship based of mutual respect and cooperation between our great nations,” Marine Corps Col. Michael D. Flynn, the senior defense official and defense attaché for the U.S. Embassy in Paraguay, said during a small ceremony celebrating the event and donation.

Since 2008, the Paraguayan Civil Affairs section, which teams up with the country’s national police for these events, has averaged four MEDCAPs a year in ungoverned and under-resourced areas across the country. This event marked the 22nd time this type of operation was accomplished.

“These guys [Paraguayan Civil Affairs] are truly professional and have a passion for what they do,” said Army Sgt. 1st Class Hansel Delgadillo, who is the lead civil affairs planner for U.S. Special Operations Command South in support of the Office of Defense Cooperation in Paraguay.

Delgadillo has been working with his counterparts for the better part of three years and has seen the Paraguayan Civil Affairs unit develop each year.

“From planning to coordination and execution, they are really in control of each event, and the leadership demands nothing but the best to ensure every citizen is treated and cared for,” he said.

Paraguayan Civil Affairs planners, with support from SOCSOUTH, are already coordinating the concept of operations for another MEDCAP this September in another rural community.

There is no question that living here is tough, and will continue to be for the foreseeable future. However, during this most-recent MEDCAP, there were two expressions on people’s faces: pain and joy. Blame the pain on the dental work, but such pain produces a healthy smile.

Global Force’s Needs Shape DOD Biosurveillance

By Cheryl Pellerin
American Forces Press Service

WASHINGTON, June 5, 2013 – A new biosurveillance division at the Armed Forces Health Surveillance Center here -- home to a unique serum repository and database for service members and a global network of military laboratories -- is working to fill gaps at the convergence of battlefield biodefense and health surveillance.

Health surveillance involves monitoring human health to identify and prevent infectious and chronic diseases. Biosurveillance, at least for the Defense Department, is the process of gathering, integrating, analyzing and communicating a range of information that relates to health threats for people, animals and plants to help inform decisions and provide for increased global health security.

The Armed Forces Health Surveillance Center vision is to be the central epidemiological resource and global health surveillance proponent for the armed forces. Its mission is to provide timely, relevant and comprehensive health surveillance information to promote, maintain and enhance the health of military and associated populations.

Last year Dr. Rohit Chitale became director of the fledgling Division of Integrated Biosurveillance, which shares a building with the DOD Serum Repository, the world’s largest, with more than 55 million serial serum specimens dating back to the mid-1980s.

The specimens are linked to the Defense Medical Surveillance System, a database that can be used to answer questions at the patient level and in the aggregate about the health of the armed forces and beneficiaries.

Also part of AFHSC is the Global Emerging Infections Surveillance and Response System, called GEIS, whose 33 partners include military laboratories, academic institutions and nongovernmental organizations around the world that support service members and population-based surveillance and capacity building in 62 countries.

Leading the new biosurveillance division, Chitale has a doctorate in infectious disease epidemiology from the John Hopkins Bloomberg School of Public Health and a master’s of public health in epidemiology from the University of California, Los Angeles.

Before joining AFHSC last year, the 42-year-old scientist was senior analyst in the Global Disease Detection, operations center at the U.S. Centers for Disease Control and Prevention in Atlanta.

Soon after the severe acute respiratory syndrome, or SARS, epidemic in 2002-2003 sickened more than 8,000 people worldwide and killed 774, Congress funded the GDD program at CDC in 2004. The aim was to strengthen the global capacity to detect, identify and contain emerging infectious diseases and international bioterrorism threats.

In 2006, Chitale was one of the first analysts to help establish the GDD Operations Center at CDC. This epidemic intelligence and response operations unit uses many sources of information about disease events, including Internet-based media reports scanned for key words in more than 40 languages.

“What I came to AFHSC to do,” he told American Forces Press Service during a recent interview, “was to take the next step.”

The new division is part of a multiagency effort to implement the nation’s first U.S. National Strategy for Biosurveillance, released in 2012 by the White House to make sure federal agencies can quickly detect and respond to global health and security hazards.

It’s also part of a push to increase DOD diagnostics funding through the department’s biodefense program, Andrew C. Weber, assistant secretary of defense for nuclear, chemical and biological defense programs, told American Forces Press Service in an interview last year.

Some of the work is done by the Defense Threat Reduction Agency’s Joint Science and Technology Office of the Chemical and Biological Defense Program, as well as by the Joint Program Executive Office for Chemical and Biological Defense.

In October 2009, Weber himself ushered the Chemical and Biological Defense Program into the biosurveillance business by signing a memorandum to the military department secretaries announcing that emerging infectious diseases would become part of the chemical and biological defense mission.

Chitale, who says he’s spent the past 14 months building his division and learning about the many separate biosurveillance efforts underway across the department and the military services, is looking to better integrate these elements to create a coherent, global picture of biological threats -- and recommendations for action -- specific to the Defense Department.

“We now have a [memorandum of understanding] between Health Affairs, where AFHSC is, and Nuclear, Chemical and Biological Defense Programs,” Chitale said.

“Historically,” he explained, “NCB’s mission is global security -- combating weapons of mass destruction writ large -- and our mission is the medical care and surveillance of the forces and DOD populations.
They’re different missions, … [but] recently it has become increasingly clear that they are converging.”
The memo, signed last summer, describes how NCB and DOD Health Affairs will collaborate on cooperative activities that contribute to U.S. national security and to global health security.

“NCB and Health Affairs will cooperate on activities that help counter weapons of mass destruction, to include chemical, biological, or radiological events that impact various domains significant to U.S. forces,” Chitale said. “In effect, that’s the whole spectrum when it comes to health.”

His division helped to write a 50-page operational plan in December that lists 61 actions that the two organizations will accomplish together.

“They will be things like facilitating training for more preventive-medicine residents,” Chitale said. “We’re going to help create and implement better algorithms for syndromic surveillance. We’re working to create information management systems so we can all work more smartly -- for example, a system that can bring multiple high-quality information streams into one portal and refresh every 10 minutes, and be shared with trusted partners.”

The challenge for DOD is that the biosurveillance mission is complex, he noted. “There are three services that each do what we do here to some extent, but they do it for their own service,” he said. “What added value do we have? One thing, at least, is that we can bring it all together to get a complete picture.”

Such an augmented system would use information from the DOD agencies, the rest of the U.S. interagency including the CDC, the World Health Organization, the World Organisation for Animal Health, the AFHSC-GEIS network, the Internet-based Program for Monitoring Emerging Diseases, or ProMED, and even more informal sources, such as Twitter.

Ultimately, Chitale said, he envisions being able to do for DOD what he and his CDC colleagues did for global public health, but even more -- collect a broad range of data and information relating to human, animal and plant health, work with partners and analyze it according to DOD needs, and provide guidance, recommendations and reach back support to the department’s leadership and DOD customers such as the six geographic combatant commands, and especially their surgeons’ offices.

Chitale has initially organized his small division into teams that include alert and response operations, coordination and engagement, and innovation and evaluation.

“We haven’t said that we’re actually creating an operations center,” he said. “But the Alert and Response Operations team, ARO, is a term modeled after WHO’s Global Alert and Response Operations [established in 2000], probably the world’s first strategic health operations center. Others were since stood up around the world, and under the vision and leadership of Dr. Ray Arthur, we established one at CDC in 2006. In some ways, and based on the needs, I’m trying to model several of our key activities after that.”

Already the AFHSC and the new division have relationships broadly across the interagency, including the State Department, the Department of Health and Human Services and the intelligence community, particularly through the Defense Intelligence Agency’s National Center for Medical Intelligence in Maryland.

NCMI is an intelligence organization, while AFHSC is a preventive medicine and public health organization. Yet, there is some overlap in methods and certainly in goals. “Importantly,” Chitale said, “we are working with NCMI closer than ever before, and are formalizing a MOU with them as well.”

Key areas in which AFHSC and the new division can provide value for DOD biosurveillance is in disease detection, preventive medicine guidance and coordination with the interagency, he added. “We’re trusted across the DOD and also domestic and international medical and public health communities – a real value add in this new paradigm, this new normal,” Chitale said.

“When it comes to something like disease detection,” he added, “you need the ability, which we have, to pick up the phone and call someone in Uganda who you trust -- a medical person, U.S. government staff working in the host nation, even someone in the Ministry of Health or WHO staff -- and ask them what’s going on. They can talk to their people in the country, and you get high-quality information back within minutes to hours.

“You get real, hard information,” he continued, “and those are your boots on the ground -- those are your listening posts across the globe.”

Patriots, F-16s May Remain in Jordan After Eager Lion Exercise

By Jim Garamone
American Forces Press Service

WASHINGTON, June 5, 2013 – The United States could leave Patriot anti-missile batteries and F-16 fighter jets in Jordan following the end of Exercise Eager Lion, a Pentagon spokesman said here today.
Jordan has requested the batteries, but Defense Secretary Chuck Hagel has not yet reviewed it, Army Col. Steve Warren told reporters. Hagel is returning from NATO meetings in Brussels today.

“When the secretary receives the request, he will favorably consider it,” Warren said. “Jordan is a strong partner with us. We have a longstanding and strong relationship with the Jordanians, and we want to do what we can to support their security requirements.”

The fighting in neighboring Syria has raised concerns in Jordan. The Patriot batteries and F-16s are going to Jordan to take part in Eager Lion – an annual exercise that this year encompasses 19 nations and about 8,000 service members. It is scheduled to start June 9 and to run through June 20.

About 200 U.S. soldiers of the 1st Armored Division based at Fort Bliss, Texas, deployed to Jordan in April to provide a nucleus of command and control capabilities if the fighting in Syria spills over into Jordan. About 120,000 Syrians have fled to Jordan to escape the country’s civil war.

T-1 Jayhawk mod ushers in new era in CSO training, first for AF

by Capt. Ashley Walker
12th Flying Training Wing Public Affairs

6/5/2013 - NAVAL AIR STATION PENSACOLA, Fla.  -- The 451st Flying Training Squadron completed the final step of a long journey when a T-1A Jayhawk modified for electronic warfare training took flight on an undergraduate syllabus sortie June 4.

This is the first time in Air Force history an undergraduate aviation program has formally incorporated the fundamentals of electronic warfare in flight into their syllabus.

"Incorporating a formalized, airborne electronic warfare training platform is a first for flying training at the undergraduate CSO level," said Lt. Col. Timothy Moser, 451st FTS commander. "Eleven years after the original CSAF vision and after four years of testing, the first official student training flight is a significant accomplishment for the unit and the Air Force."

According to Gen. Edward Rice, Commander of Air Education and Training Command, "The 451st FTS has embraced innovation. Rather than rest on their laurels, the unit strived to find better ways of doing business, while embracing a culture of cost consciousness. Advances like these enable our nation's airpower advantage while helping us meet today's fiscal challenges."

While the 451st FTS, which executes the advanced phase of undergraduate CSO training, has employed the T-1 since 2009, the newest modifications usher in a new era in CSO training.

Previously, the electronic warfare portion of CSO training was taught only in a simulator with basic flying skills taught in the aircraft. With the new modification, the electronic warfare skills are now integrated into the flying where the concepts initially taught exclusively in the simulator are reinforced airborne.

The modifications allow the T-1 to hold an additional student and instructor station in the aft section of the aircraft. The aft training stations receive flight information from the aircraft's avionics, global positioning system, flight instruments and simulated threats are introduced to provide a virtual threat environment to students. The modifications also include new touchscreen consoles that allow instructors to interact with students and set up different threat scenarios to better teach students how to identify and react to notional threats while in flight.

The addition of the second training station and instructor station allow twice as many student training events to take place in the same amount of sorties according to Moser.

"Basic electronic warfare training has never been formally conducted airborne until now," he said. "And because of the modifications, we're able to do so without adding any additional sorties, which saves resources and Airmen's time while enhancing the quality of our training."

"The configurability of this system allows for flexibility in training we've never had before - it's nearly limitless," said Moser of the system. "All an instructor needs to do is change the configurations in the system and the student can train for practically any scenario in any operational airframe they are eligible for assignment to later. Not only are we getting twice as much accomplished in one sortie, we're also saving future resources because we won't have to update the aircraft as frequently to adapt to changing requirements."

According to Maj. J.D. Shell, 451st FTS director of staff, "the new modifications prepare students for operational responsibilities in a threat environment, while fostering crew coordination and the ability to problem solve during actual flight. Through innovation, we've changed the way the Air Force conducts undergraduate electronic warfare training."

"The training is now more modern and incorporates advances in GPS technology and electronic flight displays, similar to operational aircraft. The result is a better prepared aviator for the operational Air Force," said Shell.

In addition to navigation duties, in operational aircraft CSOs inform aircrew members of threats, provide systems management, verify target identity and release munitions. The new T-1 modification helps teach students those responsibilities by providing simulated synthetic radar with a virtual target. Instructors aboard the aircraft have the ability to dynamically control threats in real time. The modified T-1 system also has the capability to record and play back the flight data for further evaluation and enhanced flight debriefs.

The modified T-1 development and test team, affectionately known as 'the Mod Squad,' worked to improve system reliability to make the system more user-friendly for instructors and students. The team, comprised of civilian engineers and 451st FTS instructors, worked to automate unnecessary and cumbersome procedures, lowering the chance for instructor-induced errors, securing valuable training.

Following the 2005 Base Realignment and Closure Commission, the Air Force was tasked to consolidate specialized undergraduate navigator, electronic warfare officer and weapons system officer training into one course. The result was the creation of Undergraduate Combat Systems Officer training and the stand up of the 479th Flying Training Group at Naval Air Station Pensacola, Fla., in 2010. The group is now the sole provider of Air Force CSO training, graduating approximately 350 students a year. Once they've completed the program, each graduate is universally assignable, meaning they can be assigned to any aircraft with a CSO crew position in the U.S. Air Force fleet.

Desert Challenge competitors train at Luke

by Senior Airman David Owsianka
56th Fighter Wing Public Affairs

5/31/2013 - LUKE AIR FORCE BASE, Ariz. -- What thoughts come to mind when hearing that a person has any of the following: vision impairment, traumatic brain injury, amputation, cerebral palsy, muscular dystrophy or spinal cord injury?

Probably not an athletic competitor.

Fourteen U.S. Paralympic competitors trained at the Luke Air Force Base Fitness Center May 13-17 to prepare for the Desert Challenge that took place May 18 in Mesa, Ariz.

"This is important because it allows service members an opportunity to compete and realize that getting back into sports or finding sports can be a huge lift in their lives," said Harrison Ruzicka, retired Army corporal and Desert Challenge Games competitor.

The Desert Challenge Games is a regional competition for individuals with physical disabilities. The event is open to U.S. and international male and female athletes with permanent physical disabilities age 6 through adulthood who are interested in competitive athletics.

The participants training at Luke AFB competed in shot put, discus, javelin; 100-, 200-, and 400-meter wheelchair and ambulatory sprints; and a 1,500- and 5,000-meter ambulatory run.

"We brought the athletes into the environment they will compete in to help them acclimate and get a week of training with national team coaches," said Kallie Quinn, U.S. Olympic Committee Paralympic Division associate emerging sports program director. "It's great for our athletes (who are prior military) to train here, because they are able to re-engage with a military community."

The athletes received guidance from four national team coaches.

"It's been great to have the paralympic coaches instruct us with their level of training," Ruzicka said. "It gets better each time I go to camp, and I improve because of the coaches brought in."

For Ruzicka, participating in events like the Desert Challenge isn't just about competing.

"I've gotten in much better shape since getting involved in these events, as well as meeting others who have gone through similar circumstances," he said. "We share stories. It makes it easier on me, and I'm sure for some of the others as well to find that community (brotherhood) again that is such a big part of the military."