Operation Iraqi Freedom

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OperationIraqi Freedom

• Public Health Perspectives
• A Personal Journey

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TimelineMarch August, 2003

• Initial shock and preparation
• Pre-deployment at Fort Benning
• Camp Wolf (APOD)
• Camp Arifjan
• Post-deployment process
• Home again

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Camp Wolf (APOD)

• Departure
• Arrival You are not in Kansas anymore

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Camp Wolf
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Inescapable Reality
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Camp Wolf (APOD)

• Departure
• Arrival You are not in Kansas anymore
• A surreal routine awaiting a mission
• Opportunity knocks My world gets bigger

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The Scenario

• Congressional complaints about Camp Bucca

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Camp BuccaCharacteristics

• EPW camp in southeastern Iraq
• Established rapidly without planning
• Initially managed by Britain
• Previously an Iraqi facility of some kind
• Concerns
• Persistent problems with GI illness
• Insufficient medical resources

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Camp Bucca
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A typical desert scene
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Camp Bucca Assessment

• The initial journey
• Arrival A plethora of issues to explore

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Camp Bucca Assessment

• The initial journey
• Arrival A plethora of issues to explore
• Negotiations with the Spanish

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Negotiations with SpanishSome Accomplishments

• Mental health support
• Additional primary care capacity
• Dental care established

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Camp Bucca Assessment

• The initial journey
• Arrival A plethora of issues to explore
• Negotiations with the Spanish
• A well-received report actions taken
• Environmental Health staff on site
• Sanitation improvements
• Additional medical resources
• Personnel
• Supplies

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Camp Wolf (APOD)

• Departure
• Arrival You are not in Kansas anymore
• A surreal routine awaiting a mission
• Opportunity knocks My world gets bigger
• I get a mission! surveillance

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Surveillance Activities

• Scope
• Land forces Army and Marines
• Geographic areas

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Surveillance Activities

• Scope
• Defined Categories
• Syndromic surveillance
• Traditional DNBI (Disease and Non-Battle Injury)

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Syndromic SurveillancePurpose

• Primary
• Early identification of conditions, outbreaks or
  diseases which threaten operational readiness
• Secondary
• Establish syndromic surveillance thresholds for
  implementation of strategic medical capabilities

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Surveillance Activities

• Scope
• Defined Categories
• A new software system - JMEWS

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Timeline

• Initial shock and preparation
• Pre-deployment at Fort Benning
• Camp Wolf (APOD)
• Camp Arifjan
• Post-deployment process
• Home again

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Camp Wolf
Camp Arifjan
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Surveillance SystemInitial Assessment

• Many sites not reporting
• Considerable confusion/anger about software
  system
• Surveillance categories perceived differently
• Communication capabilities severely limited
• DoD system (JMEWS) not utilized properly

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Camp Arifjan

• A developing, permanent facility
• Initial assessment of surveillance system
• Surveillance system - possible solutions

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Surveillance SystemPossible Solutions

• Site visits
• Training
• IT assessments
• Communication
• Data transfer
• Ensure appropriate use of JMEWS
• Data entry
• Data reporting

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Camp Arifjan

• A developing, permanent facility
• Initial assessment of surveillance system
• Surveillance system solutions
• Travels in Kuwait

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Other camps
Camp Wolf
Camp Arifjan
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Surveillance System KuwaitStatus after Site
Visits

• Education provided
• Data processes/communication mechanisms
  established
• Secure
• Nonsecure
• IT needs noted and requested
• Establish centralized data entry

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CDC cooperation in Kuwait
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Camp Arifjan

• A developing, permanent facility
• Initial assessment of surveillance system
• Surveillance system solutions
• Travels in Kuwait
• Functioning surveillance system reveals problems

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SurveillanceSome Potential Problems

• Heat Injuries

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Weekly DNBIHeat Injuries CFLCC Total
Above Threshold
Reference rate 0.5
Below Threshold
CFLCC total does not include V Corps data
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SurveillanceSome Potential Problems

• Heat Injuries
• Air quality concerns at SPOE

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SurveillanceSome Potential Problems

• Heat Injuries
• Air quality concerns at SPOE
• Other areas of note
• Dermatologic presentations
• Other types of injuries
• Gyn concerns

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Camp Arifjan

• A developing, permanent facility
• Initial assessment of surveillance system
• Surveillance system solutions
• Travels in Kuwait
• Functioning surveillance system reveals problems
• Tasking - assess surveillance in Iraq

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IraqSurveillance Assessment

• IT capabilities
• Geographic boundaries
• Appropriate matching of numerator and denominator
  data
• Capturing information from roving clinics

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IraqSurveillance Assessment

• Day 1
• Camp Wolf, Kuwait
• Camp Udairi, Kuwait
• Navistar (border check area in Kuwait)
• Tallil AFB (near An Nasiriyah, Iraq)

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Camp Udairi
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IraqSurveillance Assessment

• Day 1
• Day 2
• Assess surveillance capabilities at AF and Army
  facilities
• Visit an ancient site

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IraqSurveillance Assessment

• Day 1
• Day 2
• Day 3
• Missed convoy
• Completed further assessment of heat injuries at
  Tallil

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IraqSurveillance Assessment

• Day 1
• Day 2
• Day 3
• Day 4
• Catch a ride with a large truck convoy
• Go from Tallil to BIAP (Baghdad airport)
• Begin assessing surveillance in BIAP area

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IraqSurveillance Assessment

• Day 5
• Developed a new convoy with ambulance company
  (565th)
• Traveled to Balad (Camp Anaconda)
• Assessed surveillance capability
• Visit with 30th MED BDE

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IraqSurveillance Assessment

• Day 5
• Day 6
• Continued with 565th convoy
• Traveled to airfield near Tikrit
• Assessed surveillance capability
• Visited with 1st MED BDE

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IraqSurveillance Assessment

• Day 5
• Day 6
• Day 7
• Continued with 565th convoy
• Travel back to BIAP

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IraqSurveillance Assessment

• Day 5
• Day 6
• Day 7
• Day 8
• Brief V Corps Surgeons office
• Visit a nearby palace
• Catch an MP convoy to Scania

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Surveillance in IraqFindings

• Information grouped from disparate geographic
  locations
• Very little information coming from battalion aid
  stations (BAS)
• V Corps has made some modifications that make
  comparisons difficult
• IT capabilities need to be enhanced

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Surveillance in IraqV Corps Feedback

• Majority of sick call information is missing as
  most care is provided at BAS in division settings
• As division assets are quite mobile, appropriate
  technology is essential
• The process must not interfere with critical work
• Please come back to assess BAS and make
  recommendations

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IraqSurveillance Assessment

• Day 5
• Day 6
• Day 7
• Day 8
• Day 9
• Travel from Scania to Tallil with the 161st
• Helicopter ride back to Camp Arifjan

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Iraq Surveillance TripFollow-up

• Brigade commander will not allow further
  assessment of battalion aid stations in Iraq due
  to safety concerns
• Begin plans to return home!

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Timeline

• Initial shock and preparation
• Pre-deployment at Fort Benning
• Camp Wolf (APOD)
• Camp Arifjan
• Post-deployment process
• Home again

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Post-deployment Process

• Visit to Kuwait City

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Timeline

• Initial shock and preparation
• Pre-deployment at Fort Benning
• Camp Wolf (APOD)
• Camp Arifjan
• Post-deployment process
• Home again

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The Adventure Ends