The document discusses medical issues in Bolivia's Chapare region, a major cocaine production area. It notes endemic diseases like malaria, yellow fever, and diseases spread by insects or animals. Issues related to trauma from accidents or violence are also discussed. The document outlines collecting medical intelligence on the region including water sources, hospitals, and key personnel. It also discusses conducting humanitarian medical, dental, and veterinary missions to help the local population.

1. James Mitchell, M.D.

2. Background
 Bolivia – 40% of worldwide cocaine production
 American presence started in 1987
 United States Drug Enforcement Agency
 United States Army Special Forces Teams
 Chapare Region

9. WikiLeaks
3. (SBU) Morales’ broadening of a USAID-free zone to a
U.S.-free zone tracks with comments of cocalero leaders late
on June 25, who demanded all U.S. counter-narcotics personnel
be expelled from the Chapare. Although the rhetoric seems to
set the stage for a larger scale U.S. exodus from the
Chapare, it remains unclear whether plans to expel USAID will
be expanded to include our Narcotics Affairs Section (NAS) or
DEA presence in the Chapare. Chapare Cocalero leaders met
June 26 with Minister of Agriculture Susanna Rivero to ratify
the June 25 decision to expel USAID, but did not ask to
broaden the scope to include other USG personnel. However,
some cocalero leaders and journalists asked leading questions
about NAS’ activities.

10. Medical Issues in Chapare
 Medical Intelligence
 Endemic disease
 Identify water sources
 Identify hospitals/clinics
 Key personnel
 Evacuation
 Environmental issues

11. Medical Issues in Chapare
 Infectious Disease
 Water borne pathogens
 Vector borne
 Zoonosis

12. Medical Issues in Chapare
 Trauma
 Motor vehicle accidents (MVA)
 Gunshot/Blast
 Other

13. Medical Issues in Chapare
 Humanitarian missions
 Veterinary
 Dental
 Medical

15. Medical Intelligence
Endemic Disease
 Arthropod-borne illness
 Zoonotic disease
 Waterborne/foodborne pathogens
 Sexually transmitted disease
 Airborne pathogens

16. Medical Intelligence
 Water sources
 Potable
 Treatment
 Hospitals/clinics
 Capabilities/supplies
 Key Personnel
 Physicians/Dentists
 Evacuation
 Ground/air
 Environmental issues
 Chemicals/Pollution

17. Medical Intelligence

18. Infectious Diseases
 Arthropod-borne
 Malaria
 Yellow Fever
 Chagas’
 Dengue
 Leishmaniasis
 Zoonotic
 Bolivian Hemorrhagic Fever (Arenavirus)
 Rabies
 Waterborne/Foodborne
 Typhoid
 Hepatitis A
 Helminths (Ascaris, Strongyloides)
 Airborne
 MDR Tuberculosis

19. Infectious Diseases

20. Infectious Diseases

21. Trauma
 Motor Vehicle Accidents
 Most common
 Civilian
 Gunshot/Blast
 Military
 Booby traps
 Other
 Aircraft

22. Trauma
Case Study
 January 2000 C-130 transport crash on take-off in Chimore
 33 passengers including crew
 Six killed
 2000-1-14
 “Bolivian AF C-130B TAM60 c/n 3559, crashed at Chimorre
(sic) Airport, Bolivia. The aircraft departed the left side of
runway 35 and 600 meters from the approach end it ran
into a ditch and came to rest in a forested area off the left
side of the runway. The aircraft was a total loss with 7 crew
and 24 passengers dead.”

23. Case Study

24. Trauma
 Mass Casualty Situation
 “A mass casualty event overwhelms immediately available
medical capabilities to include personnel, supplies, and/or
equipment.”
 Triage
 “The system of sorting and prioritizing casualties based on
the tactical situation, mission, and available resources. It is
the best means to establish order in a chaotic environment
and the best hope to provide the greatest good to the greatest
number within the limitations of time, distance, and
capability. Triage is a constant and dynamic process as
casualties move within and through the system of care.”

25. Trauma
 Triage
 Immediate
 Delayed
 Minimal
 Expectant

26. Humanitarian Missions
 Veterinary
 Vaccination
 Dental
 Extractions
 Dental Care/Education
 Medical
 Acute/Chronic Issues
 Establish Wells
 Education