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Global health engagements save lives and build partnerships

  • Published
  • By Kevin M. Hymel
  • Air Force Surgeon General Public Affairs
FALLS CHURCH, Va. --  There’s an old proverb: “You give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.” That’s the philosophy behind the Air Force Medical Service’s (AFMS) role in Global Health Engagement (GHE). Instead of just aiding countries in a disaster or teaching them a brief lesson in basic aid, Air Force medical teams help stand up foreign medical teams and teach procedures through a program that can last years.

“The key to the entire process is sustainability,” said Maj. (Dr.) Paul Tilton, chief of the Air Force Special Operations Air Warfare Center’s Medical Operations Division at Duke Field, Fla. “We provide a country with a sustainable program that will live on.” Tilton speaks from lesson’s learned in other countries where short-term programs did not take root. “We left a host country and in a few weeks nothing had changed,” he said.

This program has already yielded success. Niger, where teams have completed the program, has used casualty evacuations (CASEVAC) in the fight against Boko Haram. The country has also helped its allies who do not have an institutionalized CASEVAC system, by flying critically injured allied troops to higher levels of care. “Global Health Engagement improves regional stability and cooperation,” said Tilton. “Helping our partners build successful programs is one way we build stronger relationships between the U.S. and our partner nations.” 

The program relies on a six phase structure that ensures a professional, well-trained medical team. The first two phases lay the foundation for a successful program. Once a U.S. embassy receives a training request from a country, the embassy contacts international health specialists from U.S. Africa Command, U.S. Air Forces Africa, and Special Operations Command Africa, who in turn develop a program. “In the beginning we take a strategic approach and engage with the country’s high-level civilian and military leadership to assist them in drawing up a policy, including logistics, lines of funding, and who is going to be involved,” Tilton explained. 

Leaders discovered through experience the importance of signed documentation from the host country. “We learned that if you don’t have something in writing it doesn’t exist,” said Tilton. “If we don’t have a policy written by the country at that higher level, these programs are not going to persist.”

Phase 2 involves assessing the host country’s infrastructure and the state of its healthcare, taking its constraints into consideration, and then developing a patient movement system. Teaching medical teams to operate equipment outside their healthcare system can be fruitless. “We can upgrade their equipment, but we must be mindful that upgrades mean we might have to help bolster their infrastructure,” said Tilton. “Without addressing these critical items, expensive equipment could be left sitting in a closet unused.”

The GHE teams then assist their partners in developing standard operating procedures. “We don’t do it based on how we wish it were,” said Tilton. “We don’t template an American system.”

In Phase 3, the training begins. Keeping to the theory of relying on the country’s system, the GHE teams usually provide some basic CASEVAC equipment, funded thought the State Department, the Secretary of the Air Force’s Department of International Affairs or other government departments. “If we are able to assist by providing a few basic items, that is great,” said Tilton, “but it is more about laying a strong foundation of policies, procedures and concepts which will keep the program going long after we have left.”

Part of the training is teaching tactical combat casualty care and inflight patient care. Medical teams in training learn to deal with noise, vibration and the confined space of an airplane. Instructors stress keeping the patient alive during the critical Golden Hour. “We’re trying to get that patient back to a surgeon in an hour or less,” said Tilton. “Sure the plane flies fast, but if the teams do not possess the skills to sustain a patient’s life during the flight or if it takes six hours to get the airplane off the ground, you’ve missed the point.”

In Phase 4, which occurs a few months later, the GHE team checks the trainees’ progress through several exercises. The trainees complete a great deal of homework during Phase 3, and in Phase 4, the GHE team sees if the trainees have honed their skills.

Phase 4 can be repeated a number of times until the trainers are satisfied that the trainees have developed a strong foundation in evacuations skills.

During Phase 5 the GHE teams identify qualified students who show the leadership skills to become instructors. “We look for people with instructor potential and help them put together a training program,” said Tilton. “We actually train the trainers.”

Phase 5 also looks at the big picture. While the GHE teams help develop training curriculums and provide a framework for the host nation’s CASEVAC teams, they step back and let their former students take the initiative. “We tell them, ‘It’s your system, you need to make it sustainable within your constraints,’” explained Tilton. “They own the program now.” 

After years of teaching and training, the GHE teams hand off their former students to the host country’s conventional forces. At this point the trainees have conducted a few of their own classes and have developed their own course material.

Currently, there are two AFSOC GHE teams in the field in West Africa teaching and watching their students teach CASEVAC. One country is in Phase 2, while the other is in Phase 6. “They’re hard at work,” said Tilton. “I’m constantly in contact with them.”

AFSOC’s success has had broad-reaching effects. “You have an Air Force component command working with AFSOC to achieve mutual goals, and success between the host country’s military and civilian communities,” said Col. James Chambers, director of the Air Force International Health Specialist Program. “There have been a number of incidents where these flights have saved civilians from losing a limb.” 

Chambers is pleased with the results these teams have achieved. “It is very gratifying to see individuals work together in to meeting a number of objectives.” And he knows his teams are ready to help any partner nation anywhere. “We have 60 personnel around the globe seeking to achieve global health-related security cooperation goals in each area of operations.”

Tilton considers the Air Force’s role in GHE noble work and sees it as an excellent opportunity to build good relations with America’s global partners. “No one is going to scoff at moving your injured soldiers off the battlefield,” he said. “The host countries are very appreciative because GHE teaches a man how to fish.”