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On 2/3/2009 10:05:14 AM Dr. (Col) Schuyler Geller wrote
During a recent trip to Madagascar and the Union of the Comoros with Gen Ward, I was able to meet with a number of individuals engaged in the important work of decreasing the disease burden that afflicts so many in Africa. This included the U.S. Agency for International Development (USAID) health representative and Centers for Disease Control (CDC) physician engaged in U.S. government development efforts on Madagascar and with the major civilian hospital director in Maroni, Comoros, as well as senior medical staff within the militaries of both island nations.
I was specifically briefed on the major efforts supporting the President's Malaria Initiative on Madagascar and the progress being made with the use of interior residual spraying and insecticide treated bed nets as well as the identification and treatment of active cases. This multi-pronged approach not only reduces the number of mosquitoes near populated areas but also reduces the number of active carriers of malaria to infect the remaining mosquitoes.
Although HIV/AIDS has become the number one killer of Africans, malaria continues to be the number one killer of children age 1-5 in these island nations and is the major admission diagnoses for all of their medical facilities. I was able to see the malaria wards in both civilian and military hospitals on both islands. The number of beds filled with small children and pregnant women is a serious reminder that this ancient scourge remains a serious threat to personal, societal, and economic security and prosperity in these nations and Africa, in general.
The fact that the Madagasy and Comoronia military hospitals, like so many all over Africa, serve a largely civilian population (80 percent of admissions are non-active duty) further defines the impact of any deficient facilities in these military facilities to the overall public health infrastructure and disease burden response of the entire nation.
Moreover, malaria is a clear force health protection issue for both U.S. and partner nation militaries. I was able to meet with the senior physicians from both Madagasy and Comoronian militaries during the course of our trip and see their hospitals and diagnostic laboratory facilities.
Both had similar concerns, a relative lack of trained laboratory technicians and diagnostic equipment and supplies for the enormous numbers of patients they encounter. It decreases the effectiveness of their important militaries in a key region of the world. Microscopy is the "gold standard" for malaria diagnosis and must be used to support any other diagnostics such as rapid testing kits to minimize the over-utilization of anti-malarials with resultant increases in resistance patterns so deleterious to world-wide eradication efforts.
Although there are a number of training opportunities by partnering institutions in support of PMI on Madagascar, these opportunities are not available yet to our military medical partners. Although the DoD has been actively involved in training malaria diagnostic microscopy in Africa through our Walter Reed Institute of Research (WRAIR) Microscopy Center of Excellence (MCOE) in Kenya to both military and civilian lab technicians, building African diagnostic capacity for many years, it has heretofore focused exclusively on English-speakers.
Both the Madagasy and Comoronian military medical departments requested assistance with such training but would need that support in French and Gen Ward recently on his return from Madagascar and the Union of the Comoros said, "What you say matters to us." True to his words and in support of these important partners, the Command Surgeons' office is currently working with the commander of WRAIR, an unit of US Army Medical Research and Materials Command at Ft Dietrick, MD, to develop a complete microscopy course in French at the MCOE for our francophone partner military medics. As an additional capacity building effort each graduate of the MCOE will take home a brand new microscope to immediately begin to use the newly acquired skills.
Even more importantly, a sustainment program will then be instituted with quarterly unknowns sent by both the MCOE and the trainee to each other to reinforce and further develop these important diagnostic skills to assist in the detection and treatment of malaria in Madagascar and the Union of the Comoros. The Africa Command Surgeon's office will continue to listen to our partner nations' military medical departments needs to improve their capacity to provide vigorous force health protection to their military personnel and all the civilians entrusted to them.
I think it is fitting that U.S. Africa Command, headquartered in Stuttgart should so take to heart and put into practice the wisdom captured in the words of one of Germany's greatest thinkers, Goethe: " We do not learn from men coming to us, we learn by going to them." We will continue to go to our military partners in Africa and learn from them how we best can add value to what they are already doing, assisting their efforts to improve the security and stability of their nations.
On 2/5/2009 9:49:56 PM Jack in Berlin wrote I just read an article in the Final Call—Is Africom a U.S. military maneuver or real help for the Motherland?—and am appalled that such a debate about this exists. To oppose Africom is to oppose the years and years of tremendous U.S. military support to African nations regardless of what command has point. The U.S. military, and many others' militaries, too have for decades been there to help African nations with their security, help them build and professionalize their militaries, help them understand rule of law and running a military under civilian leadership. If it weren't for the Europeans cutting them off and providing no method of teaching them how to care for their own resources—well, that's a whole different matter. It's just a shame that many countries came into Africa to take out the natural resources that rightfully belong to Africans, versus teaching Africans how to harvest their own stocks and mentor them on becoming prosperous. Look at Kenya, look at Botswana, look at Uganda. The article is looking at this through a very small bubble. And by the way ... will Final Call write articles on China's work in Africa and be derogatory? Just as the U.S. is building schools and clinics and pumping billions of dollars into hiv aids prevention, what about China? I'd like to see a Final call article bad mouthing China's and others' impact in Africa? Uh huh. Thought so.
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