By Doctor (Colonel) Schuyler Geller, command surgeon of U.S. Africa Command
U.S. AFRICOM Public Affairs  Print     Share  

WASHINGTON, D.C., 

Jan 6, 2009 — Improving the health infrastructure in African nations is a "productive and non-threatening" way to build stability on the continent, says Doctor (Colonel) Schuyler Geller, command surgeon of U.S. Africa Command.

U.S. Africa Command works with African militaries to develop force health protection strategies for military members and support defense health programs in Africa through medical exercises such as MEDCAP, VETCAP, and DENTCAP, Geller said in a recent interview.

Geller was interviewed by Lieutenant Jennifer Cragg, New Media Directorate of the American Forces Information Service, on January 6, 2009. The interview was featured on "DOTMILDOCS," a weekly show from the Military Health System (MHS), leading up to MHS's U.S. Africa Command health Symposium, January 8-9, in Washington, D.C.

During the interview, Geller discussed how his division supports U.S. Africa Command's mission from a medical standpoint and describes how the command works in concert with government agencies, such as USAID, Centers for Disease Control, and the World Health Organization, to combat disease and make healthcare more accessible to Africans.

Geller explained that in countries with high rates of infectious diseases, such as malaria and HIV/AIDS, it is extremely difficult for development to occur.

"Individual nations that are unable to provide essential services to their people have legitimacy issues. And those issues lead to instability. As public health infrastructures are developed and are supportedddÃ?the stability, and therefore, the less likelihood of radicalization of populations occurs," he explained.

For more information on healthcare in Africa, read Dr. (Colonel) Geller's blog at http://www.africom.mil/africomDialogue.asp?entry=440&lang=0.

Following is the complete transcript of Dr. (Colonel) Schuyler Geller's interview:


(Music.)

OPERATOR: You're listening to "DotMilDocs," a product of the Office of the Assistant Secretary for Health Affairs. This show is designed to discuss the topics that concern you most when it comes to military health. We welcome your input, your questions and your thoughts. We're glad you joined us.

LIEUTENANT JENNIFER CRAGG: Welcome. You're listening to episode 38 of "DotMilDocs" for Tuesday, January 6, 2009. "DotMilDocs" is a weekly show from the Military Health System and I'm your host, Lieutenant Jennifer Cragg. Our guest today is Africa Command Sergeant Colonel Schuyler Geller, who will be discussing the Military Health System's humanitarian effort to increase healthcare capacity in African nations.

This discussion with Colonel Geller is being held leading up to the January 8th and 9th, MHS' U.S. Africa Command health symposium. It's called "Health as a Bridge to Peace and Stability" and it's being held in Washington, D.C. Also, Colonel Geller will be discussing topics including groundbreaking public-private partnerships in Africa, the role of research and developing-nation capabilities and best-practice sharing for building strong partnerships.

With that, welcome to the show, sir.

COLONEL SCHUYLER GELLER: Thank you very much. I appreciate your having me.

CRAGG: And, with this, a note to our listeners: If you have any questions for Colonel Geller, please go to episode 38 and you can list them in the comments section. We'll make sure we get back to you.

So, with that, I'm going to just going to go ahead and go into some questions. My first question, tell our listening audience, tell us a little bit about your career in the military medicine and what does being a U.S. Africa Command surgeon mean?

GELLER: Well, I come to the military medical system through a little bit of a circuitous route, this being a second career for me. I was 10 years in private practice in Indiana and came in as a reserve officer during Desert Shield/Desert Storm and have stayed with military medicine since.

I've been--I'm internist and a pediatrician in clinics, hospitals, and medical centers and the chief--the medical staff at a couple of medical centers in the United States Air Force and came to Africa Command. My last assignment was the commander of Malcolm Grow Medical Center at Andrews Air Force Base in Washington, D.C. The job of the command surgeon is certainly different than my clinical background, which has been the vast majority of the last 35-plus years that I've been a physician.

The command surgeon advises the commander of U.S. AFRICOM on all matters relating to health and in Africa there are numerous health issues and in many places, somewhat less than ideal public health infrastructure to support those many demands. My staff supporting me is made up of a medical planning division and an operations division, an international health specialist branch and a force health protection branch, which includes the command veterinarian and an infectious disease specialist. And you can imagine that my infectious disease specialist is quite busy in Africa.

CRAGG: I can imagine. And thanks for going into that. And I have a couple of more questions, kind of in the same line of what you just explained. Why are medicine and health important areas of focus for U.S. Africa Command?

GELLER: Well, the mission of United States Africa Command is in concert with other U.S. government agencies and international partners to conduct sustained security engagement through military-to-military programs, military-sponsored activities and other military operations as directed to promote a stable and secure African environment in support of U.S. foreign policy.

Any place where we would have a need to send members of the United States government, specifically members of the Department of Defense, we must develop a force health-protection strategy for those individuals. The continent of Africa includes nations that are very high risk from a medical standpoint. And this becomes a particular important area for the commander of U.S. AFRICOM in support of any military operation or any disaster response, humanitarian assistance where we would send personnel.

We have developed a force health-protection strategy for our military members, and when we go to the various African nations and meet with our health counterparts in the ministries of defense and provide support to our embassy teams that lead the humanitarian assistance or disaster response to any nation on the African continent that might request assistance, we are providing our military medical intelligence information to them and we are sharing with those very important members of the ministry of defense, ministry of health and our government teams the medical information required for supporting our defense health programs on the continent.

CRAGG: And the second part to my question that I was going to ask is, what are your top three areas of concentration? Can you explain?

GELLER: Yes, ma'am. The areas that we are most interested in for--in support of U.S. Africa Command's mission from a medicine and health standpoint is to provide a medical interface for the various exercises and interactions from a mil-to-mil standpoint. A number of major exercises take place every year in Africa, and we support that by interacting with the medical components of those militaries and provide, in support of the host-nation, medical--what we call MEDCAP and VETCAP and DENTCAP, which are exercises that provide direct support to the population in conjunction with our military partners, and it's an opportunity for training of our personnel, as well as getting the host-nation militaries an opportunity to see our medical deployed capability as we help to increase their capacity to be able to provide the same support to their own militaries.

We provide, in addition, a very long-term and persistent effort in Africa in the form of medical laboratories that have been operating since the late 1960s. These laboratories are engaged in research on malaria, tripanasomiasis, leishmaniasis, tuberculosis, the very debilitating diarrheal diseases as well as the hemorrhagic fevers that are a plague to that continent.

The large army medical research facility is U.S. Army Medical Research Unit Kenya in Nairobi with a number of field units at Kisumu and Kericho as well as the Center of Excellence for Malaria Microscopy, which has developed capacity in many East African nations, particularly, but also expanding into Nigeria. And this is a particularly important DOD engagement on the continent. In the area of interagency, there was an outbreak of Rift Valley fever in the northern part of Kenya a couple of years ago and the CDC asked the research lab Kenya to assist them in the surveillance and in supporting the host-nation ministry of health's response to that outbreak. And there was a significant opportunity for this joint effort to assist the people of Kenya and to develop the capacity of the ministry of health of Kenya to do that for their people in the future. We'd certainly like to see that kind of capacity building expand.

And then, thirdly, there is an enormous brain-drain in Africa. Africa actually has a number of training facilities, medical schools, professional schools. Many of their graduates do not stay within those nations. And we have been approached by ministries of defense as they seek to fill their medical officer billets to assist them with developing some paraprofessional training. And we're looking very hard at that, at how we can develop that from a regional approach. And I think there are numerous universities in Africa that offer opportunities for partnering as we support our host nation military health training endeavors.

So those are some of the things that I'm looking at as we move forward in this next year or two. Certainly there are more ambitious projects from eradicating malaria and HIV where the host-nation militaries would be supporting ministries of health and how we would assist with that and providing surveillance for pandemics in support of the larger ministry of health activities. Those are important areas as well.

CRAGG: And that goes to my next question--is what role do U.S. service members play in the health missions in Africa? You kind of alluded to that when you talked about the MEDCAPs and what you just said a couple of minutes ago, but can you explain or elaborate, please?

GELLER: Sure. We, of course, are not contemplating new basing on the continent of Africa, but with the standup of U.S. Africa Command as the most recent unified command, we inherited an already existing presence on the continent of numerous military operations. There are ongoing activities, as I've already described, in the labs that is a small military component, large civilian contractor. Most of the laboratories are supported by host-nation individuals that are hired, and that builds the capacity.

But as we have expanded the defense health, HIV/AIDS prevention program, those individuals are--those programs are led by military individuals and hired host-nation contractors as well. The interaction with each one of these exercises, whether they're the large Joint Chief of Staff exercises called MEDFLAGs, which we had last year in Bamako, Mali, and next year is slated to be in Swaziland, where the entire exercise is devoted to medical interaction with the host nation, that's a large military contingent, depending on which component--Army, Air Force or Navy-- medics will directly support those.

The individual exercises that are more support and training of military such as peacekeeping operations and developing professional militaries, we, as the command surgeon's office, are very strong advocates for the interjection of military medical engagements with each one of these exercises and those involve opportunities for training of host-nation medics, but usually are also associated with these medical civil-affairs projects, MEDCAPs, DENTCAPs and VETCAPS that go out into the communities and are military medics from various components are providing direct care and direct training to the host-nation military in those kinds of engagements.

CRAGG: And thank you for going into that. And right now what we're going to do is take a quick break to learn or to rather listen to General William "Kip" Ward. He's AFRICOM commander and Sergeant Major Mark Ripka, AFRICOM's senior enlisted advisor. And they will convey the commander's focus to promote security, stability and development.

Let's go ahead and listen.

(Begin audio clip.)

GENERAL WILLIAM WARD: On the 1st of October, 2008, the United States Africa Command became the sixth geographic command in the Department of Defense's unified command structure. My focus and vision is that this command will be a contributing factor for global security as we work with others to help bring stability to the African continent and its island nations.

SERGEANT MAJOR MARK RIPKA: To that end, our command's military and civilians will cooperate with U.S. agencies, African nations, and organizations, as well as the international community. Our actions will assist in promoting security, preventing conflict and, where appropriate, supporting African development.

WARD: I am confident that in the years to come, people will see an Africa that is secure, stable and developed in ways meaningful to its people and our global society. The United States Africa Command will make positive contributions in this important endeavor.

(End audio clip.)

CRAGG: We're back and we're listening to episode 38 of "DotMilDocs" for Tuesday, January 6, 2009 and our guest today is Dr.--command surgeon, Dr. Colonel Schuyler Geller. Sir, I have a few more questions, if I can go ahead.

GELLER: Sure, please.

CRAGG: What organizations do you work with to accomplish your health mission? Can you explain for our audience?

GELLER: Certainly. The organizations that are in direct support of United States AFRICOM are first and foremost our specific component. And each one of those components--the Army component in Vicenza, SETAF; and the Navy component in Naples, which is NAVEUR-NAVAF; and our Air Force component, the 17th Air Force at Ramstein, all have command surgeons working in those organizations. And I work directly with them as we plan for support to the African nations.

As I've alluded to, our labs have worked with our interagency partners, certainly the Centers for Disease Control, CDC. That I think becomes a particularly important area of collaboration when you consider the large number of deaths from malaria. What many of your listeners may recall about the Centers for Disease Control, it was established in the United States for the specific purpose of eradicating malaria in the U.S. And so that collaboration takes on particular import and meaning, both current and historical, as we assist with malaria research in Africa.

We have an opportunity to interact in support of the whole of government approach to African development, humanitarian assistance and disaster response. The specific agency of the United States government that has the lead for disaster response is the Office of Foreign Disaster Assistance, OFDA, which works under USAID and the Department of State. We have a specific representative on our staff at headquarters, U.S. Africa Command, from OFDA and we are in constant collaboration with that individual with reach-back to her organization, Ms. Angela Sherbenou .

The interaction as we go to meet with country teams and meet with the offices of security and cooperation, part of that inherited presence on the continent and the defense attaches, in the embassies, we are as health providers, at the U.S. AFRICOM public-health office, we interact with USAID and their health representatives on the continent. We provide support for TRICARE reach-back, which is, of course, our healthcare plan, to all of those COD and TRICARE dependent members on the continent.

We work with organizations that have been contracted with through the TRICARE global overseas organization that supports air evacuations and is the contractor for healthcare delivery for TRICARE on the continent of Africa. And that currently is international SOS, a very important asset for us for air evacuation as they have fixed assets on the continent. And, as you are aware, the biggest challenge for healthcare reach-back in Africa is the distance issue, this tyranny of distance that would create such delays in delivery of a member back to Europe or certainly back to the United States. And our ability to reach them with appropriate medical assets makes it very important for us to partner with organizations that are already on the continent and have developed networks there.

The World Health Organization provides direction and is a great resource. We currently have been in contact with the U.S. military infectious disease specialist that has been stationed there with the World Health Organization for the last several years working in conjunction with that organization currently to develop a specific protocol for infectious-disease outbreak response that would be applicable across the continent is a very large project and can only be undertaken with the support and oversight of such an organization as the World Health Organization. And they've been--they have entered discussions and the U.S. military is one of those members of those discussions. So we're very excited about that as outbreak surveillance for pandemics is pretty high on the list of our theater's strategic objectives for U.S. Africa Command, not just the pandemic influenza that is currently the large issue, particularly for USAID and they are actually going to speak a little bit about that threat at the conference this Thursday and Friday.

CRAGG: And that's what I was going to ask you. For our listening audience, maybe some folks that are in the D.C. area who might be interested in this conference--I don't know if it's open to the public--but can you tell me a little bit about this symposium that's happening on January 8th and 9th and explain to the audience what it's about?

GELLER: Yes, I would love to. This--I'm very excited about the Africa Command health symposium that is being hosted by the assistant secdef of health affairs, Dr. Casscell, at the Institute of Medicine this Thursday and Friday, the 8th and 9th of January. The theme of the conference is "Health as a Bridge to Peace and Stability." You just heard, on the public service announcement, General Ward's concerns about the security and how stability operations are an important part of what we will be about, as U.S. Africa Command. The opportunity to engage, from a health standpoint, is going to be, in my opinion, a very non-threatening and particularly productive way to build stability from the standpoint of U.S. Africa Command on the continent.

Individual nations that are unable to provide essential services to their people have legitimacy issues. And those issues lead to instability. As public health infrastructures are developed and are supported and are seen as being delivered by host nations, the stability and, therefore, the less likelihood of radicalization of populations occurs. It's very difficult to develop if the infant mortality rate, the maternal mortality rate, the disability due to HIV, malaria and other chronic diseases--particularly infectious diseases--is high. And as we are able to assist those organizations of U.S. government that have the lead for development--that would be USAID--we will be able to bring more peace and stability to the continent of Africa.

And this conference on Thursday and Friday will have a large component of USAID speakers. We will be able to talk about how Africa Command can support those ongoing whole-of-government efforts in Africa. In addition, there is going to be a discussion about evolving technologies that can help transform health in Africa, particularly mobile health technologies utilizing cell phones, which there has just been a recent conference, in December, that the results will be presented in a way that programmatics for Africa Command could be a low-hanging fruit kind of outcome.

There'll be a working lunch on the first day that will have speakers from the Center of Excellence for PTSD and TBI, the problem with concussive brain injury that has been somewhat of a signature of our current engagements. There will be a discussion about mental health and humanitarian crises. There's new information from a recent study that was just published in JAMA that I'm looking forward to hearing some results about, as it directly impacts the mental health needs of our partner nations who have particularly had issues with child soldier conflicts in the recent past. And then there'll be discussion about the barefoot health professionals that have been working in Africa for many years.

CRAGG: Well, thank you for going over all the details of the symposium. If people are interested in finding out more about it, is there a Web site or something that people can go to?

GELLER: Well, yes. The military health Web site is www.health.mil and that's Dr. Casscell's Web site for the military health service and there'll be information there. In addition, a blog is being published today on the African dialogue section of the U.S. Africa Command Web site, which is www.africom.mil.

CRAGG: Thank you for going over that; I really do appreciate it. And our time is up for today, but with that, I thank you, sir, for joining us and explaining to the audience about AFRICOM. And with that, I want to remind our audience: We have another show this week, on Thursday. We're going to be speaking with Dr. Roger Tsien. He's from the University of California, San Diego, and he's a researcher and 2008 Nobel Prize winner for chemistry. He received this award for his development of the green fluorescent protein which serves as a fluorescent tag that can track movement through cells. So we'll get a lot of good information from him this Thursday at 3:00 p.m. Again, sir, thank you for joining us and good luck at your symposium this week.

GELLER: Thank you so much. Appreciate it.

CRAGG: Thank you.

(END)