The old saying goes, if you give a man a fish, he eats for a day. But if you teach him how to fish, he eats for a lifetime. That’s the approach the Military Health System is using in terms of global health engagement. 

“In the past, when the U.S. military set up medical clinics and provided Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care to the local populations, initially there was a sense of goodwill and strong relationship building with host and partner nations,” said Air Force Maj. Dave Seelen, a physician assistant and international health specialist assigned to the command surgeon’s office for U.S. Africa Command. “But we found those medical civic action programs (better known as MEDCAPs) created a false sense of reliance on American military medical providers and missed the opportunity to support existing medical systems and infrastructure. Today, the goal is to develop sustainable programs and partnerships that leverage military health systems to enhance partner nation capacity.” 

Seelen said now instead of MEDCAPs, one of the tools used is the Medical Readiness Training Exercise (MEDRETE) program. In a MEDRETE, small teams of American service members work mostly with military medical leaders to identify local needs and find regional solutions. Working in nations with different resources helps foster innovation and strengthens the expeditionary mindset. In addition, working in Africa develops situational understanding and sustainable skill development for leaders across all military jobs. Working with partner nations also improves regional partnerships and increases professional development for American and host country medical staffs. 

“We try to go in and say, ‘What are the strategic goals? Will the objectives support current U.S. national priorities? Will efforts be actionable and sustainable? ’” said Seelen. “Sometimes we can help on the spot with sharing of best practices. Other times we need to return for a more formal assessment that prevents duplication of efforts and helps generate a sustainable solution.” 

Seelen said while the Americans think they might have the best idea with a quick fix, using a more deliberate and engaged approach helps find solutions that take into account what the local military medical leaders already know about their population and patients. “Our best solution to a problem might not be their best solution,” he said, adding there are also local laws about direct patient care that must be considered. 

Sharing U.S. military medicine best practices and concepts to help other developing countries indirectly helps American forces as well. 

“Disease knows no borders and doesn’t always follow the rule books,” said Seelen, pointing to recent efforts by the U.S. military medical system to help get the Ebola crisis in West Africa under control. “If there’s an outbreak that definitely can present a high risk to U.S. personnel working there. So if we can get into countries and help where there’s a need, developing or working on existing infrastructure in disease detection, prevention and even best practices for treatment, then overall, we’re also helping ourselves. By keeping local populations healthy, we’re keeping our troops healthy.” 

Seelen highlighted one recent example from Niger, where a four-member Air Force Special Operations Command mobile training team helped review that country’s current casualty evacuation (CASEVAC) system and exchanged ideas on the development of a national capability. Nigerien leaders discussed command and control, logistics, communication and operational issues related to development of a national CASEVAC organization. The Americans facilitated the discussion that worked with the assets already available to that country and how best to use them.

“Our first step was to assess the situation and then get buy-in from the local leadership,” said Seelen. “Then, working with those key leaders, we identified policy and training requirements. We also identified different platforms for use, including how to reconfigure a troop transport into an air ambulance equivalent. It was the Nigeriens’ idea, and we just helped make it happen. They have ownership.” 

Nigerien Deputy Chief of Air Force Staff, Lt. Col. Toure Seydou, said, “The development of a national CASEVAC system could enhance future operational roles and ability to save life as we ensure rapid access to definitive care.” 

In exchange, Seelen said the U.S. forces learned some new things about how troops should be trained and different patient movement techniques already being used by professional first responders in Niger. Moving forward, the Nigeriens are training their own people and adjusting that training as it best suits their needs. 

In the end, Seelen said his command wants to make sure the medical actions and programs initiated in developing countries strengthen existing institutions and are sustainable long after American forces go. 

“When we leave, there’s a program in place, instead of a one-time engagement,” said Seelen. “The real evaluation comes when we depart. In some instances, local leaders and providers implement policy and advance programs and knowledge gained even further than what we ever expected. That’s really the true measure of success.”