Medicine for the Masses

A Humanitarian Event Offers Free Medical Care to Civilians and Training for Soldiers

From a distance, the crowd ringing the cricket stadium near Bhisho, South Africa, looked like fans queuing up for a big match. The festive atmosphere was amplified by Cynthia Bhadikazi Mnyande, an occupational health and safety supervisor from nearby Grey Hospital, who wore a multicolored cap and shouted words of encouragement through a megaphone.

“Everyone will get in,” said Mnyande, who alternated between English and Xhosa.

But these people, many of whom showed up as early as 6 a.m., were not there for sports; they were there for their health. From July 29 to August 2, 2013, the stadium was transformed into a huge outdoor health clinic. In what was called a humanitarian civic action (HCA), U.S. and South African military doctors, nurses, dentists, optometrists and mental health professionals treated about 3,000 people from the surrounding region, seeing more than 500 patients per day. If you are in need of a professional dentist, then check out this experienced dentist at Colorado Healthy Smiles.

“For the people, this is like manna,” Mnyande said. “They never expected this service from the military. They thought the military is for shooting, for wars.”

Often paired with a military exercise, an HCA is a good-will gesture to civilians in the host community. It also allows military doctors to work with governmental agencies and NGOs to train for mass casualties that could follow a natural disaster or conflict. The Bhisho HCA was advertised in newspapers, on the radio and through fliers in the Eastern Cape province. There are many health clinics in the region, but patients said they came to the event hoping for a second opinion on an illness or to receive specialized care. They also jumped at the chance to get care for multiple ailments in one place.

“You normally would go [into town] for dental, come back, go for your eyes, come back, then go for your flu or whatever,” said Lt. Col. Kwena Mabotja, a South African National Defence Force (SANDF) dentist. “Here, it’s one stop. All services that you can think of are being rendered.”

In this event, held as part of the military exercise Shared Accord 13, organizers recorded patient information, including names, addresses, ages and next of kin. Local health officials plan to use the data to study health trends in the region. After registering, patients moved on to a tent where nurses checked their vital signs and referred them to specialists depending on their needs. Special care included tuberculosis tests, dental treatment, optometry tests, mental health services and a pharmacy. The most common untreated illnesses doctors saw were hypertension, diabetes and bone problems. HIV testing also was important in a country where the infection rate, though dropping, is still nearly 18 percent. Patients with conditions too serious or complex to be treated at the HCA were referred to local hospitals.

The HCA offered a unique opportunity for various South African and American agencies to work together. The South African Military Health Service worked alongside the country’s Department of Health and an NGO. The U.S. military sent doctors and other specialists from the Washington, D.C., Army National Guard; Soldiers from the 82nd Civil Affairs Battalion of Fort Stewart, Georgia; and specialized medical detachments from across the United States.

“There is so much camaraderie between the U.S. and the SANDF, and also interdepartmental collaboration that we don’t see on a daily basis,” Mabotja said. “Department of Health will do their thing there, DOD [Department of Defence] will do their thing there, so when we do it together, there’s opportunity to learn, opportunity to teach, opportunity to develop new skills.”

Another unique aspect is that the event had military and civilian psychologists and social workers. They counseled people who had a range of issues, including marital and money troubles. Psychologists offered pre- and post-test counseling for people who took HIV tests.

“As military social workers, we work with Soldiers and their families. So we’re not actually used to coming to the civilians and offering these kinds of services. It’s something new,” said Capt. Mthobisi Nene of the SANDF. “This is important because it just takes away the perspective that civilians have of Soldiers, so when we come to the community offering them social services, they look at us differently.”

Patients expressed gratitude for the free care. Daily crowds grew as the week went on, and news of the event appeared to spread by word of mouth. Although the final days of the event coincided with payday for most in the area, patients decided to spend the day at the HCA instead of heading to the banks to cash their checks. “Health first, pay later” was a phrase heard around town.

One patient, Hamilton Makom, 68, arrived before daybreak hoping to have a doctor look at his back and waist to explain shooting pains that kept him up at night. He also was having difficulty seeing, but he never had seen an eye doctor. After nearly six hours, he grinned widely as he clutched medication for his pain and a document that entitled him to a free pair of glasses.

“I came here because I wanted to get help; I knew I needed medication, and I got the service that I expected,” Makom said through a translator. “I’m happy because I’m getting the eyeglasses and medication. I don’t know whether it will help yet, but I’m very grateful.”

At the end of the fourth day, Lt. Col. Phumla Ngqakamba, chief medical officer for SANDF, stood outside her tent with a stethoscope slung around her neck. Typically, she works in a hospital in Pretoria where she might see a couple of dozen patients in a day. Today she had seen more than 100. “Exhaustion is there,” she said. “But psychologically you feel great that you’ve given back to the community. Some are even asking us why don’t we extend the event. It’s very sad for them that we are only left with one day.”

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Military Veterinarians Treat Livestock at Shared Accord 13

ADF STAFF

It was an unusual farm scene. Three Soldiers crouched inside a wire holding pen in a cloud of dust and wool. The men were trying to corral a flock of sheep that emphatically did not want to be contained. The sheep were even more resistant to being picked up and injected with a syringe containing an anti-parasite drug.

But these Soldiers –– two Americans and one South African –– were persistent. Two teamed up to corner and grab one of the fearful sheep. A third stood ready with the syringe to administer a vaccine that protects against roundworm.

In all, it took less than seven minutes to vaccinate 14 sheep. The veterinary team members then piled back into their truck and visited the next smallholder farm where another grateful farmer had dogs, pigs and sheep to be vaccinated.

“I wish we could do this more and more,” said Cpl. Abel Mhlambi, a veterinary orderly with the South African National Defence Force. “Because you can see the people here appreciate what we are doing.”

The team was part of a veterinary civic action program (VETCAP) held in conjunction with military exercise Shared Accord 13 near Bhisho, South Africa. In five days in July and August 2013, veterinarians treated 5,913 animals, including 3,112 sheep, 2,392 cattle, and a handful of pigs, horses, donkeys, dogs and cats in Eastern Cape province. Soldiers from the 82nd Civil Affairs Battalion of Fort Stewart, Georgia, in the United States worked alongside U.S. and South African military veterinarians and representatives from the Eastern Cape provincial department of veterinary services. The teams rotated their clinics among five villages as farmers brought in cattle and other livestock each day. They also sent a mobile veterinary unit to farmers unable to transport their animals.

SANDF Capt. Francois van Huyssteen and Capt. Lelanie van Huyssteen, a husband-and-wife team of military veterinarians, supervised the event. They work at South Africa’s Military Veterinary Institute in Free State province, where they typically treat horses from the SANDF cavalry and military dogs trained for bomb detection and tracking.

Francois van Huyssteen said military veterinarians rarely have time to do this type of outreach, but it is greatly appreciated in regions like Eastern Cape where, for many people, livestock is their livelihood.

“This is their wealth,” he said, gesturing to a line of cattle moving through a narrow corral. “They don’t have cars, they don’t have houses and stuff like that. If you want to determine their wealth, you look at how many cattle they have.”

In addition to benefiting the community, the event helped the provincial government take an accurate census of the animals in the region. The local department of veterinary services also took blood and tissue samples from livestock to look for signs of disease.

Lt. Col. Dickie Vest, a U.S. Army veterinarian with the 176th Medical Brigade, said he has participated in VETCAPs all over the world and came away particularly impressed by the South Africans’ veterinary expertise and facilities.

“The biggest goal is just to back them up,” Vest said. “They have the finances, they have the equipment –– a super-impressive facility –– they have emergency response trailers where they can totally quarantine off this whole area in 48 to 72 hours if there’s an outbreak. What they lack is the people, the labor. That’s where we can help.”