LSSR medical respons..

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LSSR medical respons..

  1. 1. Liberia Security Sector Reform Team MEDICAL CONCERNS IN LIBERIA Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 To go through presentation either click on an item or use the down arrow key EXIT
  2. 2. Liberia Security Sector Reform Team MEDICAL Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 <ul><li>Malaria </li></ul><ul><li>Dysentery </li></ul><ul><li>Gastroenteritis </li></ul><ul><li>Cholera </li></ul><ul><li>Snake Bites and their treatments </li></ul><ul><li>Parasites – eaten from within </li></ul>Click on subject name for details <ul><ul><li>Typhoid </li></ul></ul><ul><li>Emergency Medical Procedures for </li></ul><ul><li>U.S. Military Personnel </li></ul><ul><li>Medical Supplies for U.S. Military personnel </li></ul><ul><li>Medical Personnel Recommendations </li></ul><ul><li>Medical Equipment Recommendations </li></ul>Return to Turnover Document <ul><li>Past Mentor Projects </li></ul>EXIT <ul><li>Required Medical Events Reports </li></ul><ul><li>Pocket Guide </li></ul><ul><li>Armed Forces of Liberia Medical Information </li></ul><ul><li>Medical Trend of LSSR personnel </li></ul>
  3. 3. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. Each year 350-500 million cases of malaria occur worldwide, and over one million people die, most of them young children in Africa south of the Sahara. This sometimes fatal disease can be prevented and cured. Bed nets, insecticides, and anti malaria drugs are effective tools to fight malaria in areas where it is transmitted. Travelers to a malaria-risk area should avoid mosquito bites and take a preventive ant malarial drug. Malaria Four species of malaria parasites can infect humans under natural conditions: Plasmodium falciparum , P. vivax , P. ovale and P. malariae . The first two species cause the most infections worldwide. Plasmodium falciparum is the agent of severe, potentially fatal malaria, causing an estimated 700,000 - 2.7 million deaths annually, most of them in young children in Africa. Plasmodium vivax and P. ovale have dormant liver stage parasites (&quot;hypnozoites&quot;) which can reactivate (&quot;relapse&quot;) and cause malaria several months or years after the infecting mosquito bite . Plasmodium malariae produces long-lasting infections and if left untreated can persist asymptomatically in the human host for years, even a lifetime. Return to Medical Table of Contents Return to Turnover Document EXIT
  4. 4. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of: > a cold stage (sensation of cold, shivering) > a hot stage (fever, headaches, vomiting; seizures in young children) > and finally a sweating stage (sweats, return to normal temperature, tiredness) Classically (but infrequently observed) the attacks occur every second day with the &quot;tertian&quot; parasites ( P. falciparum , P. vivax , and P. ovale ) and every third day with the &quot;quartan&quot; parasite (P. malariae). More commonly, the patient presents with a combination of the following symptoms: Fever Chills Sweats Headaches Nausea and vomiting Body aches General malaise. Return to Medical Table of Contents Return to Turnover Document EXIT
  5. 5. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents Return to Turnover Document EXIT
  6. 6. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Dysinteria Dysentery (formerly known as flux or the bloody flux ) is a disorder of the digestive system that results in severe diarrhea containing mucus and blood in the feces . [1] If left untreated, dysentery can and usually will be fatal. Dysentery is initially managed by maintaining fluid intake using oral rehydration therapy . If this treatment cannot be adequately maintained due to vomiting or the profuseness of diarrhea, hospital admission may be required for intravenous fluid replacement. When laboratory services are not available, it may be necessary to administer a combination of drugs, including an amoebicidal drug to kill the parasite and an antibiotic to treat any associated bacterial infection . Furthermore, Lewin (2001) reports that &quot;... consumption of fresh, warm camel feces has been recommended by Bedouins as a remedy for bacterial dysentery; its efficacy (probably attributable to the antibiotic subtilisin from Bacillus subtilis) was confirmed by German soldiers in Africa during World War II .&quot; [ citation needed ] In addition, sheep feces contain the same antibiotic as camel feces. There are numerous reports from German soldiers of the effectiveness of sheep and camel feces being effective cures for dysentery. Return to Medical Table of Contents Return to Turnover Document EXIT
  7. 7. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Gastrointeristis : Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract ). Diarrhea , crampy abdominal pain, nausea , and vomiting are the most common symptoms. Viral infection is the most common cause of gastroenteritis but bacteria , parasites, and food-borne illness (such as shellfish) can be the offending agent. Many people who experience the vomiting and diarrhea that develop from these types of infections or irritations think they have &quot; food poisoning ,&quot; and they may indeed have a food-borne illness. Many people also refer to gastroenteritis as &quot;stomach flu,&quot; although influenza has nothing to do with the condition. Travelers to foreign countries may experience &quot; traveler's diarrhea &quot; from contaminated food and unclean water. Return to Medical Table of Contents Return to Turnover Document EXIT
  8. 8. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 The mainstay of home treatment of gastroenteritis is hydration. Dehydration will make the symptoms of nausea and vomiting worse and compound symptoms. Clear fluids should be consumed for the first 24 hours, then gradually progress the diet as tolerated. Clear fluids are anything you can see through. Popsicles and jell-o work well, since they are ingested slowly. Drinking too much fluid too quickly will distend the stomach and worsen the nausea. Return to Medical Table of Contents EXIT
  9. 9. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Gastrointeristis : Treatment Self-Care at Home The mainstay of home treatment of gastroenteritis is hydration. Dehydration will make the symptoms of nausea and vomiting worse and compound symptoms. Clear fluids should be consumed for the first 24 hours, then gradually progress the diet as tolerated. Clear fluids are anything you can see through. Popsicles and jell-o work well, since they are ingested slowly. Drinking too much fluid too quickly will distend the stomach and worsen the nausea. Return to Medical Table of Contents EXIT
  10. 10. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Cholrea Cholera , sometimes known as Asiatic or epidemic cholera , is an infectious gastroenteritis caused by enterotoxin -producing strains of the bacterium Vibrio cholerae . [1] [2] Transmission to humans occurs through eating food or drinking water contaminated with cholera vibrios from other cholera patients. The major reservoir for cholera was long assumed to be humans themselves, but considerable evidence exists that aquatic environments can serve as reservoirs of the bacteria. Vibrio cholerae is a Gram-negative bacterium that produces cholera toxin , an enterotoxin , whose action on the mucosal epithelium lining of the small intestine is responsible for the disease's infamous characteristic, exhaustive diarrhea . [1] In its most severe forms, cholera is one of the most rapidly fatal illnesses known, and a healthy person's blood pressure may drop to hypotensive levels within an hour of the onset of symptoms; infected patients may die within three hours if medical treatment is not provided. [1] In a common scenario, the disease progresses from the first liquid stool to shock in 4 to 12 hours, with death following in 18 hours to several days, Return to Medical Table of Contents EXIT
  11. 11. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Can cholera be treated? Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die. Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly. Return to Medical Table of Contents Return to Turnover Document EXIT
  12. 12. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Parasites eaten from within Nicknamed “the African eye worm”, Loa loa is one of those tropical parasites that myths and legends are made of.  A medically important parasite from Africa, this is commonly a disease of local people but can effect travelers and adventurers in the endemic areas. Return to Medical Table of Contents Return to Turnover Document EXIT
  13. 13. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents Return to Turnover Document EXIT
  14. 14. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 How common are parasites in the world? Estimates of current numbers of human helminth infections Helminth species Numbers (millions) Distribution Ancylostoma duodenale and Necator americanus 1,298.00 Worldwide; developing countries Ascaris lumbricoides 1,472.00 Worldwide; developing countries Brugia malayi and Brugia timori 13.00 E. Indonesia islands; Philippines; S.E. Asia; Southern China; India. Clonorchis sinensis 7.01 China; Korea; Taiwan; Vietnam Diphyllobothrium latum 9.00 Worldwide where certain raw fish is eaten . Dracnunculus medinensis 0.08 Sub-Sahara Africa; Yemen Echinococcus granulosus and Echinococcus multilocularis 2.70 Worldwide Echinostoma spp. 0.15 Philippines; Thailand Fasciola hepatica and Fasciola gigantica 2.40 China; Egypt; Europe; Iran; South America Fasciolopsis buski 0.21 Bangladesh; Cambodia; China; India; Indonesia; Laos; Thailand; Vietnam. Heterophyes heterophyes (and related species) 0.24 Egypt; Iran; Korea Hymenolepis nana 75.00 Americas; Australia; developing countries Loa loa 13.00 West and central Sub-Saharan Africa Metagonimus yokogawai (and related species) 0.66 Korea; S.E. Asia. Onchocerca volvulus 17.66 Central and South America; Sub-Saharan Africa; Yemen Opisthorchis viverrini and Opisthorchis felineus 10.33 Kazakhastan; Laos; Thailand; Ukraine Paragonimus westermani (and related species) 20.68 China; Laos; Korea; Ecuador; Peru Schistosoma haematobium 113.88 Africa; E. Mediterranean region Schistosoma intercalatum 1.73 Sub-Saharan Africa Schistosoma japonicum 1.55 China; Western Pacific region Schistosoma mansoni 83.31 Africa ; Caribbean; E. Mediterranean region Schistosoma mekongi 0.91 Cambodia; Laos Strongyloides stercoralis 70.00 Worldwide (warmer countries) Taenia saginata 77.00 Worldwide (related to beef consumption) Taenia solium 10.00 Worldwide (related to raising pigs for pork) Trichuris trichiura 1,049.00 Worldwide; developing countries Wuchereria bancrofti 107.00 Asia; Central and South America; Sub-Saharan Africa; West Pacific countries Return to Medical Table of Contents EXIT
  15. 15. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 What are the symptoms of internal parasites? Feel tired most of the time (Chronic Fatigue)? Have digestive problems? (gas, bloating, constipation or diarrhea that come and go but never really clear up) Have gastrointestinal symptoms and bulky stools with excess fat in feces? Suffer with food sensitivities and environmental intolerance? Developed allergic-like reactions and can’t understand why? Have joint and muscle pains and inflammation often assumed to be arthritis? Suffer with anemia or iron deficiency (pernicious anemia)? Have hives, rashes, weeping eczema, cutaneous ulcers, swelling, sores, papular lesions, itchy dermatitis? Suffer with restlessness and anxiety? Experience multiple awakenings during the night particularly between 2 and 3 am? Grind your teeth? Have an excessive amount of bacterial or viral infections? Depressed? Difficulty gaining or losing weight no matter what you do? Did a Candida program which either didn’t help at all or helped somewhat but you still can’t stay away from bread, alcohol, fruit, or fruit juices? Just can’t figure out why you don’t feel really great and neither can your doctor? itchy ears, nose, anus forgetfulness , slow reflexes, gas and bloating, unclear thinking ; loss of appetite, yellowish face fast heartbeat, heart pain, pain in the navel; eating more than normal but still feeling hungry; pain in the back, thighs, shoulders; lethargy; numb hands; burning sensation in the stomach; drooling while sleeping; damp lips at night, dry lips during the day, grinding teeth while asleep; bed wetting; women: problems with the menstrual cycle; men: sexual dysfunction; Return to Medical Table of Contents
  16. 16. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Parasites Cleanse Parasites could be a cofactor in almost every illness, and that is why we have many pages on CureZone dedicated to parasites. (parasitic animals) How can I get rid of parasites? Hulda Clark says: &quot;Getting rid of all parasites would be absolutely impossible using clinical medicines that can kill only one or two parasites each. Such medicines also tend to make you quite ill. Imagine taking 10 such drugs to kill a dozen of your parasites! Good news, perhaps, for the drug makers but not for you. Yet three herbs can rid you of over 100 types of parasites! And without so much as a headache! Without nausea! Without any interference with any drug that you are already on! Does this sound too fantastic? Just too good to be true? They are natures gift to us. The herbs are: Black Walnut Hulls (from the black walnut tree) Wormwood (from the Artemisia shrub) Common Cloves (from the clove tree) These three herbs must be used together . Black walnut hull and wormwood kill adults and developmental stages of at least 100 parasites. Cloves kill the eggs. Only if you use them together will you rid yourself of parasites. If you kill only the adults, the tiny stages and eggs will soon grow into new adults. If you kill only the eggs, the million stages already loose in your body will soon grow into adults and make more eggs. They must be used together as a single treatment .&quot; Return to Medical Table of Contents
  17. 17. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Parasites Cleanse Return to Medical Table of Contents EXIT Nasty, YES! Serious YES! Hand Washing Required ? What do you think?
  18. 18. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents EXIT
  19. 19. Liberia Security Sector Reform Team MEDICAL PERSONNEL RECOMMENDATIONS Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 At the time this presentation was produced the U.S. military mentors had one medical (Army medic or Navy corpsman) with them. Neither were P.A.s or Independent Duty Corpsmen. However, DynCorps Contractor had a physician on hand 24/7 at Camp Ware with a lab tech, that was available at no charge to U.S. Active duty personnel. Once civilian contractors leave the area it is paramount to have either an Army P.A. medical officer or Navy Independent Corpsman . The U.S. Embassy has a Register Nurse Practioner available, however due to the embassy’s location/ travel time use of this resource would not be acceptable on a daily basis. 60 U.S. Military Personnel – for a 6 to 12 month deployment should be covered by a minimum staff of : > One Army P.A. medical officer or Navy Independent Corpsman. > three army medics or navy corpsmen > one laboratory Technician > one dentist <ul><li>- Army P.A. medical officer or Navy Independent Corpsman. Will be the chief medical person </li></ul><ul><li>- three army medics or navy corpsmen, this will allow for one medical person to be at AFL </li></ul><ul><li>EBK medical clinic, one to be in the field, and one to cover sick call/ aid station at berthing location. </li></ul><ul><li>- Laboratory Technician is required because of the environment. Typhoid, Malaria, Yellow fever, </li></ul><ul><li>all start off the same however the treatment is different for each. The rule of thumb is for </li></ul><ul><li>a blood test to be taken, to determine the cause. There are also other parasites, water and food </li></ul><ul><li>inspections to be covered. </li></ul><ul><li>- Due to the remoteness of the area and lack of dental coverage for the AFL, a dentist would be both a </li></ul><ul><li>U.S. military medical asset for in country personnel and a great PR person for some AFL care. </li></ul>Return to Medical Table of Contents EXIT
  20. 20. Liberia Security Sector Reform Team MEDICAL EQUIPMENT RECOMMENDATIONS Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents Due to the remoteness of the area, the environment, and lack of high standard medical care. It is recommended that a complete Sick Call Amal be issued for the 60 personnel. There is no medical supply system present in the country available to U.S. Military personnel. However, local pharmacies/ medical suppliers will sell medical supplies and medications to medical professionals. At this time it is unknown if the pharmacies check medical professional credentials. It is also recommended that a field lab with at least one microscope, slide processing capabilities using various stains, centrifuge, quick tests packages for major theater diseases and complications. There is no power plant in the country of Liberia at this time. Medical requires dependable electricity at all time. For this reason, it is recommended that the Medical Department be issued a minimum of a 5,000 watt generator. EXIT
  21. 21. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents TYPHOID Salmonella typhi or commonly just typhoid Common worldwide, it is transmitted by the ingestion of food or water contaminated with feces from an infected person epidemics and less wealthy countries, after excluding malaria , dysentery or pneumonia , a therapeutic trial time with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures Typhoid fever in most cases is not fatal. Antibiotics , such as ampicillin , chloramphenicol , trimethoprim-sulfamethoxazole , Amoxicillin and ciprofloxacin , have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%. Typhoid fever is characterized by a sustained fever as high as 40 °C (104 °F), profuse sweating, gastroenteritis , and nonbloody diarrhea . Less commonly a rash of flat, rose-colored spots may appear When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. Though in some communities case-fatality rates may be as high as 47%. EXIT
  22. 22. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents Emergency Medical Procedures for U.S. Military Personnel EXIT In case of medical emergency of life, limb, or eye sight transport U.S. Military member immediately to Star Base, also know as the Jordanian Military Hospital. After close observation it was determine that this facility has the highest trained personnel and is the cleanest in the country. Do not wait for
  23. 23. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents Medical Supplies for U.S. Military personnel EXIT
  24. 24. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents Area Hospitals Hospital Phone numbers – > John F. Kennedy Medical Center - Photos > Redemption Hospital – > Eternal Love Winning Africa Hospital > St. Joseph Catholic Hospital- > EXIT
  25. 25. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF)(FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents EXIT Medical Events Reports In a joint service environment it is important to have a full understanding of how and who sends Medical Event reports to. Medical personnel need To verify this procedure a quickly as possible when deploying. U.S. Navy Reportable Medical Event list U.S. Navy Reportable Medical Event report format DOD Tri-Service Guidelines to Reportable Medical Events Malaria Pocket Guide 2007 Joint Task Force Liberia 2003 Malaria History
  26. 26. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents EXIT Armed Forces of Liberia Medical Information <ul><li>AFL Medical Department Organizational </li></ul><ul><li>Chart </li></ul><ul><li>Photos of AFL Clinic and AFTC Clinic </li></ul><ul><li>AFL Medical Personnel Recall list </li></ul><ul><li>AFL Medical Collateral Duties </li></ul><ul><li>AFL Medical Proposed documents </li></ul><ul><li>Directions to Area hospitals </li></ul><ul><li>Medical illness trends with AFL-EBK </li></ul><ul><li>Medical illness trends with AFL-AFTC </li></ul><ul><li>AFL Medical Standard Operating Procedures </li></ul>HMC(FMF) Mendenhall’s personal assessment of AFL Medical Division
  27. 27. Liberia Security Sector Reform Team Complied and Presented by HMC (FMF) Thomas Mendenhall October 15, 2009 Return to Medical Table of Contents EXIT This is a break down of medical issues with Personnel on the Marine/ Navy/ Army LSSR Team from June to December 2009 <ul><li>This was out of a team of : </li></ul><ul><li>7 MARINES </li></ul><ul><li>1 SAILOR </li></ul><ul><li>5 SOLDIERS </li></ul><ul><li>6 PUERTO RICO NATIONAL GUARD </li></ul><ul><li>19 PERSONNEL TOTAL </li></ul>Service Rank Medical Diagnosis 1 USMC LtCol Malaria (lab diagnosis) 2 USMC Captain Typhoid (lab diagnosis) 3 USMC GySgt Typhoid (lab diagnosis) 4 USMC Gysgt Typhoid (Clinic diagnosis) 5 USMC SSgt Typhoid (lab diagnosis) twice 6 USMC SSgt Malaria (lab diagnosis) 7 USN HMC Typhoid (lab diagnosis) 8 USA SFC Malaria (lab diagnosis)

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