Author Affiliation: Department of Plastic Surgery, Hawaii Permanente Medical Group, Honolulu.
The US military is a lead actor on the global stage of humanitarian assistance. It was not always this way. It took a number of supporting roles and even some miscast productions to secure this preeminent position. Like it or not, and there are many in both camps, the US Department of Defense (DoD) is now a go-to player for not only logistical might but also for far more nuanced development efforts around the world.
From the Berlin Airlift in 1948 to the support of the Kurds in Operation Provide Comfort in 1991, DoD humanitarian assistance was often an exercise in brute airlift capacity. How many tons of food can you get to point X? Today's efforts are increasingly held to a different standard. How did you interact with others already involved in the area? Was capacity increased? Did your efforts help produce a better health system? Is the work you invest in a place sustainable? Is the society better off, more resilient, because we were there? In disaster relief work the focus is still on saving lives, limbs, and property, but with nonemergent humanitarian assistance the rules have changed. Dropping in, doing a few cases, taking a few pictures does not cut it anymore.
In my 30-plus years of active duty and now civilian advisory roles I have had the true pleasure of participating in this evolution and seeing the DoD mature from a gangly, noncoordinated albeit powerful adolescent participant to an elegant, reflective, and insightful elder and leader. As physicians and citizens, we should be proud of the humanitarian assistance work our uniformed colleagues provide. It is unmatched in scope and increasingly critically evaluated. Engagements are staffed, sequenced, and deployed with an eye to what works, what does not, and why. Would that all our government efforts were so. Let me give you 3 recent examples of the DoD's ever-maturing role in humanitarian assistance.
In the active war zones of Iraq and Afghanistan, sometimes a single small unit can accomplish something divisions cannot. The roads are critical supply lifelines in war. In Iraq I was fortunate enough to work with a Forward Surgical Team that could handle anything. We had a recurring “Desert Clinic” that we held out in the middle of nowhere, but through that nowhere passed a very important highway. The road was riddled with improvised explosive devices. One day a 2-year-old child with an unrepaired bilateral cleft lip was brought to the clinic. We were able to call on Operation Smile and get some additional pediatric airway equipment just to be safe and performed an uncomplicated repair. Days later the child came for follow-up with an entourage. This entourage included an elderly man of regal bearing who identified himself as the local sheik and grandfather to the child. He said he understood there had been some “problems” on the road in the past. He said those problems have ended. They did. Countless millions of dollars and more importantly dozens of lives were saved because of a grandfather's gratitude. Our uniformed physician colleagues and the young men and women working with them replicate this sort of small-scale assistance with positive blowback countless times a week in the war theaters. We will never know the collective benefit of these actions, but in remote places unreachable by any group save the US military there are patients who consider the individual benefit priceless.
Department of Defense humanitarian efforts are also played out on a countrywide scale. Our now increasingly mutually beneficial relations with Vietnam were kick-started by a focused effort of US military members who first went to Vietnam in the late 1990s to help the military health system there improve their ability to treat severe burns. All manner of specialty and primary care assistance followed. Academic and nongovernmental organization (NGO) partners came on board. Today, an entire nursing corps is being built in the Vietnamese military with the help of this civil military collaboration. On an even larger scale the US President's Emergency Plan for AIDS Relief (PEPFAR) program provided the laboratory capacity and clinical expertise to assist Vietnam in combating human immunodeficiency virus. Though PEPFAR is primarily a US Department of State program, it needed the DoD to access the Vietnamese military and the roughly 20% of the population served through their health care system. A whole-of-society approach requires the participation of the uniformed military. Without access there is no success. This and the next example are emblematic of the nascent but growing level of cooperation between the military, academic, NGO, and international organization communities.
On a global scale the US military evaluates its efforts through detailed assessments that embrace the opinions and findings of our Department of State and NGO colleagues and most importantly our partner nations. When the hospital ships USNS Mercy and Comfort deploy for humanitarian assistance missions, exactly what should be done? In the summer of 2012, USNS Mercy will sail for 4½ months, visiting the Philippines, Vietnam, Cambodia, and Indonesia. The ship's capability rivals that of a major metropolitan trauma center. Will her crew, NGO, and academic and military medical staff just hand out a few pills for chronic diseases and build clinics that will never be staffed or supplied long term? I will argue they will not. That may have been a fair criticism of past missions, but it is no longer a justified critique. The journey from the gangly adolescent player of untold logistical might to the mature insightful stakeholder the DoD is today has not been without missteps. But those mistakes were the classic opportunity for improvement. Today, readers can be proud of our uniformed colleagues' humanitarian dedication and disaster expertise. It is a national treasure exercised on our behalf for the benefit of all.
Correspondence: Dr Crabtree, Kaiser Permanente Moanalua Medical Center and Clinic, 3288 Moanalua Rd, Honolulu, HI 96819 (firstname.lastname@example.org).
Published Online: May 15, 2012. doi:10.1001/archfacial.2012.397.
Financial Disclosure: None reported.
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