For American troops who are wrapping up their mission to West Africa to combat the Ebola crisis, the deadly disease wasn’t their biggest worry.

“In general, the two biggest enemies service members face when going into any kind of conflict are never the shooting enemy. It is themselves or the environment,” said Army Col. James Czarnik, the command surgeon for U.S. Army Africa.  “So in the case of going to Liberia, everybody was widely worried about Ebola, or ‘Fear-bola’ as it came to be known. It was just crazy.” 

Not only were there gaps in the knowledge of the health threats but in the type of mission being conducted as well.  September 2014 represented the first time the Department of Defense (DoD), through the Army, had been asked to establish an initial position in Africa since World War II. The uncomfortable nature of this mission – both from the medical threat and the type of mission itself – required clear direction and leadership.  

The 26-year veteran Army doctor knew the real issues for the troops in Africa were the chances of contracting malaria, which can kill and is rampant in the region, and motor vehicle accidents, especially with the lack of trauma facilities in the West African nation. “There’s nobody shooting at me, but there’s no medical system here to speak of. The environment and the individual soldiers, who might hurt themselves or because of a lack of information would get harmed, were the real threats.”

Czarnik drew from his combat experience in Iraq and Afghanistan to implement the force protection measures needed, including making sure the troops took their malaria medicines and ensuring military doctors and medics could treat injuries in a field environment and evacuate patients, if needed. In addition, he had to help the people in his command get over their “Fear-bola” and assure them there is virtually no chance of them catching the deadly disease because they were not in direct contact with those infected. As a soldier who was among the first troops to jump into Afghanistan, Czarnik knew how to build a medical system from the ground up. It was that combat experience during early entry operations, and quite frankly, his somewhat intimidating physical presence that made it easier to “convince” the troops that his way was the best way to do things.

“I’m about 6’3”, 235 pounds, and I’ve got plenty of ‘scare badges’,” laughed Czarnik. “And [my troops] know I’ve jumped into Afghanistan with the Rangers, so my reassurance to them had credibility.” He added this type of experience is resident throughout the senior staff of the U.S. Army Africa (USARAF) command and in large part what makes this type of component command an effective tool to set the conditions to win in a complex world.

Czarnik said the military is well-suited to an environment like it faced in Africa, because of its ability to train personnel for a wide variety of situations and the logistics capability only the American military can bring. He said military medics are soldiers, sailors and airmen first, and that means they can train to the task, whether it is medical or military, and adapt better to surroundings than perhaps their civilian counterparts who are medical folks first. The military medics are able to train under conditions where their very lives are at risk.

“Their ability to train to standard is unlike many other systems,” said Czarnik. “Some people up front said, ‘You never worked in an Ebola treatment unit, so you don’t know how to train them.’  I told them I’m a U.S. Army jumpmaster, and we train people to jump out of air planes. They’ve got one shot to get it right, and if they don’t, they’ll die. This sounds a lot like the risks associated with the threat of Ebola.”

Ironically though, after more than a decade in Afghanistan and Iraq and a lot of the contracted infrastructure that much time brings, many troops don’t have the exposure to building up a bare-bones base environment. But, their ability to train to standards helped the U.S. military medics adapt quickly and successfully perform the mission. A few weeks after USARAF arrived in Liberia the Army published its new operating concept. The Army Operating Concept lists setting the theater as a core competency the Army must be able to accomplish as part of a joint force. 

“Going to Africa and taking care of a situation like Ebola prepares us for whatever other tasks might happen, even in the U.S.,” said Czarnik. “Military medicine needs to work in austere and unpredictable environments, so we can learn to think outside of the box. This will sustain the ability of the military medical people. We can’t outsource our requirement to do military medicine in a deployed setting. Africa represents a leadership laboratory unlike any other theater in the world today. Nowhere else will service members get these kinds of challenges and practice their profession and make a tangible, observable difference."

Another challenge for the troops deployed to Africa was to realize they were not there to directly treat the people with Ebola, said Czarnik.  He admitted that convincing troops to stay away from Ebola patients was a task.  “Our service members are trained to move toward the sounds of the guns, and as a result, it took some re-tooling to stop them from attempting to help patients directly.” 

The mission of the soldiers was to support the lead federal agency, the U.S. Agency for International Development, and the international aid agencies that were coming into the country. He said American troops had to realize that putting in the command and control systems, building the medical treatment facilities, educating about Ebola transmission and training approximately 500 health care workers each week were more important than treating just one Ebola patient.

“Service members needed to understand that if they got sick, they would not be able to help the thousands of others who need what our real mission was: providing the infrastructure and training so thousands can be saved,” said Czarnik.

Czarnik believes that these types of missions will likely become prime opportunities in the future for the DoD not only to leverage small numbers of service members with unique skill sets to make a big impact, but also help them maintain their unique skills during an interwar period. 

“Future engagements of the U.S. military will require unprecedented rates of innovation by junior leaders on the ground. The best way to develop this ability to innovate will be through continued daily engagement in complex environments, such as our deployment to Liberia.”