U.S. Medics Support Botswana HIV Prevention Efforts

By Donna Miles

American Forces Press Service

THEBEPHATSHWA AIR BASE, Botswana, Aug. 14, 2012 – A U.S. military medical team here for the Southern Accord 12 exercise is helping the Botswana Defense Force confront its country’s most pressing health crisis one circumcision surgery at a time.

The U.S. team is working side by side with its military hosts to promote Botswana’s national program of education, HIV screening and male circumcision surgeries to stem what’s become a national epidemic, explained Army Col. (Dr.) Michael Kelly, an Army Reserve surgeon deployed here from the Army Reserve Medical Command in Washington.

The Botswana Ministry of Health’s goal, Kelly said, is to bring the number of new HIV diagnoses to zero by 2016. That’s an ambitious plan, in light of an HIV rate that has skyrocketed since the first case of AIDS was diagnosed in Botswana in 1985.

Today, 17.6 percent of the general population is infected with HIV, and the rate continues to climb by 2.2 percent per year, Maj. Mooketsi Ditsela, the Botswana Defense Force’s HIV coordinator, told American Forces Press Service. Men ages 30 to 45 suffer the highest infection rates, topping 40 percent, according to Health Ministry statistics.

As the Botswana government adopted an aggressive national prevention strategy, it teamed the Health Ministry with the Botswana Defense Force, which was showing signs of progress in reducing infections within its ranks.

In addition to education about the risks of unprotected sex and multiple partners and the importance of proper condom use, the national program includes a “safe male circumcision” strategy, Ditsela said. Unlike in the United States, circumcision is not a cultural norm in Botswana, Kelly explained. Yet research shows that the simple procedure can reduce HIV infections among males by as much as 60 percent.

So in meetings to plan humanitarian civic assistance projects for Southern Accord 12, Air Force Capt. Francis Obuseh wasn’t completely surprised by the Botswanans’ request for help in conducting male circumcisions.

Working with a partner-nation military to conduct male circumcisions during those clinics would be a first for the U.S. military, Obuseh said. Few U.S. medical doctors are experienced in the procedure. Kelly, for example, said he hadn’t performed one in about 30 years, when he was undergoing his surgery residency.

But as an epidemiologist who grew up in Nigeria and has studied HIV around the African continent, Obuseh welcomed the opportunity to teach U.S. medics new skills, strengthen the partnership between the two militaries’ medical teams and to make a valuable contribution to the Botswanan people.

“This is excellent way for them to partner together in an area of great importance that can make a lasting difference,” he said.

Obuseh emphasized that the circumcisions were just one part of a comprehensive HIV program for the local villagers, funded in part by the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, program.

Members of the Botswana Defense Force provide HIV counseling, screening and education about the safe male circumcision procedure. Meanwhile, the U.S. medical personnel are working side by side with them, performing the surgeries. To prepare the U.S. surgeons, nurses and surgical technicians who arrived here earlier this month for Southern Accord 12, Botswana Defense Force medical personnel conducted two days of classes to teach them the techniques.

They put them to practice yesterday for the third medical clinic since they arrived, performing circumcisions on 28 men ranging in age from 14 to 49 not far from the base in the tiny village of Monwane.

Army Spc. Chris Kepler, a medic with the 396th Combat Support Hospital, said he “begged and pleaded” for the chance to serve as circulating nurse for the clinic. He scurried among five operating areas sectioned off within a generator-powered tent, preparing rooms, drawing medications and applying dressings once the surgeries were completed.

“This is a lot of work, but it’s exciting to be a part of a humanitarian mission like this,” Kepler said. “I feel that we are serving a bigger purpose and getting a chance to give back. … I wouldn’t trade this experience for the world.”

Army Spc. Christina Shoemaker, a 396th CSH surgical technician, acknowledged the challenges of working in an austere environment with limited instruments and a steady flow of patients. But just as she knows she is helping to change their lives, she said, her experience here is changing her own.

“This has been a really big influence on me that I will take home,” she said, expressing interest in working with HIV-positive patients at a local veterans hospital as a volunteer. “It’s a great feeling knowing that we have helped these people,” she said.

Army Capt. Julie Karpinski, a registered nurse with the 396th CSH, said she enjoyed learning a new skill while making a contribution she knows will benefit the people of Botswana long after Southern Accord 12 ends.

“If you can’t change the fact that HIV is here, at least this procedure is minimizing the transmission rate. And that is huge,” she said. “Being a part of it is wonderful.”

Southern Accord is a joint, combined training exercise led by U.S. Army Africa to expand capabilities between the U.S. military and Botswana Defense Force and enhance their interoperability. In addition to training activities relevant to peace support operations, it includes engineering projects and four medical and dental clinics in local communities.

Law Allows VA Health Benefits for Camp Lejeune Water Victims

By Lisa Daniel

American Forces Press Service

WASHINGTON, Aug. 6, 2012 – President Barack Obama today signed into law a bill enabling the Department of Veterans Affairs to provide health benefits to veterans and families diagnosed with diseases related to water contamination at Camp Lejeune, N.C.

“I think all Americans feel we have a moral, sacred duty toward our men and women in uniform,” Obama said before signing the "Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012" in the Oval Office. The law covers those with conditions linked to water contamination that occurred on Camp Lejeune between 1957 and 1987.

“They protect our freedom, and it’s our obligation to do right by them,” he said. “This bill takes another important step in fulfilling that commitment.”

The president was joined at the signing by Jerry Ensminger, a retired Marine Corps master sergeant who served at Camp Lejeune and advocated on behalf of affected veterans and families. The first title of the law was named after his daughter, Janey, who died of leukemia at age 9. Mike Partain also attended. The son and grandson of Marine officers, Partain was born at Camp Lejeune and developed breast cancer at age 39. He serves as a community representative for the Agency of Toxic Substances and Disease Registry.

“This bill ends a decade-long struggle for those who serve at Camp Lejeune,” Obama said. “Some of the veterans and their families who were based in Camp Lejeune in the years when the water was contaminated will now have access to extended medical care. And, sadly, this act alone will not bring back those we’ve lost, including Jane Ensminger, but it will honor their memory by making a real difference for those who are still suffering.”

The bill has several other provisions to improve VA health care coverage, housing, education and burial benefits, White House officials said. An initiative on preventing homelessness among veterans renews VA’s authority to work with community organizations and make use of previously underutilized VA properties, they said.

“It is going to have an immediate impact,” Obama said. “It is going to improve access to health care, streamline services in the VA, and it expands support for veterans who are homeless.”

The law also restricts protests at military funerals by prohibiting demonstrations from within 300 feet for two hours before and after services. “I am very pleased to be signing this bill into law,” the president said. “The graves of our veterans are hallowed ground. And, obviously, we all defend our Constitution and the First Amendment and free speech, but we also believe that when men and women die in the service of their country and are laid to rest, it should be done with the utmost honor and respect.”

New Malaria Task Forces Will Address Top Africa Killer

By Donna Miles

American Forces Press Service

STUTTGART, Germany, June 13, 2012 – Two new task forces being stood up by U.S. Africa Command have set their sights on one of the biggest killers on the continent: the mosquito.

Malaria -- that same affliction that decimated Roman legions, Revolutionary War and Civil War soldiers and was a scourge in the South Pacific during World War II -- continues to plague Africa, particularly the sub-Saharan region. Ninety percent of the world’s malaria-related deaths are reported in Africa, and the disease kills some 600,000 African children each year.

The toll is so devastating that it overshadows Africa’s other medical challenges, including HIV/AIDS and tuberculosis, Army Col. (Dr.) John Andrus, Africom’s deputy surgeon and medical logistics division chief, told American Forces Press Service.

And beyond the pure humanitarian toll, there’s an operational one, too. Last year, during Africom’s World Malaria Day observance, a soldier from an African partner nation told Andrus malaria is one of the biggest concerns among his troops deploying for peacekeeping operations across the continent. “This was a real eye opener to us,” he said.

Africom incorporates malaria prevention into much of its theater engagement, distributing mosquito nets and teaching new diagnostic techniques during training events throughout Africa.

But at the African soldier’s suggestion, Africom went to work to establish regional task forces to help partner nations create a unified front against the problem. The command stood up the East African Malaria Task Force in December with plans to form a similar task force in West Africa by the year’s end, Andrus reported.

The East African task force includes Burundi, Kenya, Uganda, South Sudan, Rwanda and Tanzania. The United States is a member, but has no leadership role, Andrus said. “The task force is led by the African partners who are members,” he said.

The task force plans to meet in Dar es Salaam, Tanzania, in late July to discuss their battle plan for combating the disease, Andrus said. They’re expected to identify ways to encourage self-protection while promoting improved surveillance, diagnosis and treatment.

“This will give them an opportunity to move forward against a very challenging disease in a very positive way,” he said.

Meanwhile, the first meeting of the new West Africa Malaria Task Force is scheduled for November.

Andrus called the task forces an example of the command’s goal of helping African nations confront African problems.

“This is a wonderful example of what it means to work with our partners, assist them in coming up with solutions to their own challenges, and then to be a partner with them as we move toward addressing those challenges,” he said.

Ultimately, this supports the concept of “stability through health,” Andrus said. Helping partner nations protect their military forces against disease supports the bigger goal of establishing professional militaries that are trusted by their populations and able to respond to crises, he explained.

It also builds confidence within partner-nation militaries that they will be taken care of when they are called on to carry out their missions, he said. “If they can deploy forward, knowing that they are able to receive the health care they need, it gives them confidence they need to be able to perform in a way that promotes stability on the continent,” he said.

While helping partner nations confront malaria, Africom also ensures U.S. service members who deploy to Africa are protected, Andrus said.

The Kelley Health Clinic here recently celebrated its one-year anniversary as a one-stop shop for Africom members traveling to the continent. It provides health screenings, immunizations, malaria prophylaxis and mosquito repellents.

"The first step is to get to know who you're fighting," said Lt. Col. (Dr.) Steven Baty, a veterinary epidemiologist for Public Health Command Region -- Europe. “If we can identify the mosquitoes in the area that are going to carry malaria, then we can look at prevention programs.”

Because Africom personnel often travel in small groups to the continent, officials recognize the importance of keeping them healthy.

“Each person is critical," said Army Lt. Col Jose Nunez, chief of the command’s health protection branch. “If you have one person go down, that person can't do his or her job.”

(Jan Wesner Childs of U.S. Africa Command headquarters contributed to this article.)

DoD Studies PTSD, TBI Methods

A recent study funded by the Department of Defense compared methods of assessing and diagnosing traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The study found that current practices for assessment and diagnosis of these mental health conditions are hindered by biases and complications, but they remain the most effective tools to study and assess brain injuries. The study was conducted in part by researchers from the Defense and Veterans Brain Injury Center (DVBIC) and was published in the journal Rehabilitation Psychology. An abstract of the study is available on the APA PsycNET website.