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Full text of "DTIC ADA508948: Navy Medicine in Humanitarian Operations Force Projection or Diplomatic Debacle Waiting to Happen?"

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LT Prasad B. Diwadkar 


CG 13 

Cl Paper: "Navy Medicine in Humanitarian Operations" Force 
Projection or Diplomatic Debacle Waiting to Happen? 


19 Feb 08 



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19 FEB 2008 type 

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Navy Medicine in Humanitarian Operations Force Projection or 
Diplomatic Debacle Waiting to Happen? 

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United States Marine Corps,Command and Staff College, Marine Corps 
University,2076 South Street, Marine Corps Combat Development 
Command,Quantico,VA,22134-5068 

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standard Form 298 (Rev. 8-98) 

Prescribed by ANSI Std Z39-18 





Introduction 


Navy Medicine has conducted multiple humanitarian assistance 
(HA) missions such as the Tsunami Relief in 2004, advising of 
Afghani and Iraqi authorities in the development of their health 
care systems, and utilizing naval hospital ships to provide 
health care in developing nations. Some of the most positive 
results of the hospital ships were seen in the summer of 2006 on 
the MERCY. Relations were fostered with foreign military 
medical personnel from Canada, Australia, Singapore, India and 
Malaysia and 11 Non-governmental organizations who embarked 
aboard the ship. This crew's accomplishments include 60,081 
patients seen, 131,511 total services provided; 1,083 surgeries; 
19,375 Immunizations; 9,373 Dental Extractions. In an August 
2006 public opinion survey, conducted by Terror Eree Tomorrow, 
85% Indonesia aware of MERCY's visit had a favorable opinion, 
and in Bangladesh this figure was 95%.^ 

Focusing in the latter two types of missions Navy Medicine 
is taking on more than their current capability allows. 

Similar to Rwanda in 1996 where a UN force of 2,500 was 
overwhelmed; Belgian Peace keepers were murdered by Hutu backed 
military for assisting opposition factions.^ Operating in Asian 
and South American countries known to have instability, far from 
an embassy limits civil and cultural liaisons recognized the 
local government and Non Governmental Organization (NGO) to 


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provide guidance on culture; navy medicine may inadvertently 
agitate opposition factions to strike at our medical personnel 
as in the case of Belgian peace keepers. To mitigate negative 
outcomes Navy Medicine should adopt contemporary business 
organizational models that include decentralized cross¬ 
functional teams and training concepts to enhance humanitarian 
assistance operations (HAO). 

Back Ground 

The military brings security and logistics in support of 
HAO. In accordance with National Security Strategy, the 
military is called to intervene in hostile and chaotic 
environments where NGOs are having difficulty disseminating aid; 
examples of this are Operation Restore Hope in Somalia, OIF, OFF 
and Tsunami Relief. The goal of the national strategy is to 
promote democratic efforts, encourage human rights, alleviate 
human suffering, help establish democratic regimes and pursue 
economic development.^ 

Navy Medicine's assets, being expeditionary in nature, are 
increasingly utilized for humanitarian assistance missions. The 
hospital ship USHS MERCY's multiple port calls in predominantly 
Islamic countries, individual augmentees (lA) in Afghanistan, 
Djibouti and Iraq are operating independently with long-term 
health care missions, opposed to a traditional role as a 


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component of a task force responding to a crisis. The lA's 
deployment, which most often lasts six months, conflicts with 
the time-intensive mission. As a result, any knowledge of 
culture gained by experience leading to situational awareness 
(SA) and effective application is short lived.^ 

In defense of Navy Medicine, the current application of its 
assets are dictated by national policy. The hospital ships 
specifically have done wonders to develop positive relations as 
part of the post Tsunami relief task force in Asia.^ The task 
force in five months conducting biomedical equipment repairs, 
trained 254 people; restored 59 major and 177 minor medical 
systems to 100% operational capacity; and, 6,201 host nation 
students trained. Eighty seven percent of those polled in 
Bangladesh stated that MERCY's activities made their overall 
view of the United States more positive.® 

Yet, the short duration of medical assets in an area 
requiring HA operations events can go wrong due to lack of 
understanding on the part of medical personnel of politics and 
culture within the country.^ As an example of what can go wrong 
when people are not culturally aware a Marine/Navy task force 
that quickly steamed to Sri Lanka after the 2005 tsunami and 
began to off-load relief supplies to people on the beaches 
failed to realize they were giving the supplies to the Tamil 


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Tigers (a rebel insurgency group) and Sri Lanka's government 
obj ected.® 

Training Limitations 

In a Military Medicine study it was found that 50% of Army 
internists who had completed residency had been involved in 
humanitarian assistance.^ According to the study, "Their training 
lacked an internal medicine residency-training curriculum to 
address tropical disease management, sanitation, and 
interactions with civilian humanitarian workers and military 
civil affairs officials. The most prepared internists were those 
who graduated from the Uniform Service University (USU) medical 
school, but those graduates still felt unprepared for the 
administrative roles (e.g., interacting with NGOs and military 
civil affairs units) of humanitarian assistance medicine. 

An argument can be made that the impact of individuals 
lacking training on medical units can be mitigated during HA 
missions by supplementing their intelligence and staffs with 
that of NGOs, who could also be designated as the lead agency. 

In HA operations such as Restore Hope, Tsunami relief, and 
hospital ship cruises, NGOs have been in the AOR long before the 
military deployed to the area. The presence of NGOs in country 
is reinforced by Col. Rutherford at the Army War College by his 
statement that, "Many humanitarian NGOs have a commitment to 


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long term projects in support of economic and social 
development. NGOs can sometimes identify the status of a 
conflict early, provide warning indicators and make reports 
available to governments, the United Nations and the media. 

They have achieved situational awareness through the 
relationships built amongst the people and governments. When 
the military exits and hands over operations to the host 
government; it is the NGO who sustains operations; hence, it is 
in their best interest to have optimal relations. 

The success of NGOs such as CARE, UNICEF, and International 
Medical Corps can be attributed to recruitment of qualified and 
motivated staff with experience abroad.This has allowed NGOs 
to have a great deal of accumulated experience. 

Diplomatic Pitfalls 

The USHS MERCY operating independent of a task force in 
2006, treated up to 60,000 patients over five months during HAOs 
in Philippines, Bangladesh, Indonesia, and East Timor. 

Five hundred out of thousand medical crew (doctors, nurses, 
medical planners and corpsmen) lacked essential HA training 
(applying the percentage from the Military Medicine study^^) ; 
potentially handicapping any operational and tactical planning 
process. 

A large component of planning entails coordination with 
NGOs to gain situational awareness of political dynamics. 


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culture, cultural taboos and sociology of those being treated^®. 
The lack of situational awareness can lead to manipulation by 
political factions; naively lead to treatment of one faction 
over an adversarial faction validating its political agenda over 
the other and potentially introducing a destabilizing factor 
within the country.As in a case mentioned earlier when a 
Marine/Navy task force that quickly steamed to Sri Lanka after 
the 2005 tsunami and began to off-load relief supplies to people 
on the beaches failed to realize they were giving the supplies 
to the Tamil Tigers (a rebel insurgency group) and Sri Lanka's 
government objected.^® 

Cross-functional Teams 

Navy medicine's versatile missions require updated 
delegation of authority and placement of human capital rather 
than its current rigid processes. To mitigate negative outcomes 
Navy Medicine should adopt decentralized cross-functional teams. 
Dr. Weiner, Professor at Haifa University states, "New team 
based organizational forms should be developed. Their design 
should be functional, project oriented, and short-lived, with 
team composition that may change over the life of the project. 
Those that have been successful have been non-hierarchical in 
nature, flexible, and interdependent. In addition these 
organizations have an ability to solve problems be responsive to 
a situation utilizing free information flow made possible by 


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advanced technology and authority grounded in knowledge, not 
position.NGOs are successful for they operate in cross¬ 
functional and decentralized groups.^® Human capital can be 
organized as Virtual Teams, Cross Functional, Product 
Development Teams, and Self-directed teams. 

Conversely, Navy Medicine accepting the new concepts in a 
vacuum is of no good. A process not synchronized with military 
counterparts within Navy Medicine and outside would only 
increase friction and uncertainty. However in lieu of the 
deficit in HA trained medical staff. Navy Medicine should 
utilize Medical Service Corps Officers (MSC), specifically 
Medical Planners (MP) with operational experience in Patient 
Administration (PAD), Plans Operations and Medical Intelligence 
(POMI), and graduates of Expeditionary Warfare School (EWS) to 
be a part of Cross functional teams with the implementation and 
management functionalities of a self directed team. 

The MP, as a Cross-functional and product development team 
member, would be the medical functional expert amongst various 
departments, and organizations. This group, through meetings 
and multi-media, would develop, adapt and resolve dilemmas.A 
self directed team member one would be part of the 
implementation and management of the mission similar to the role 
of 5^*^ MEB in Relief Activities Coordination and Monitoring Cell 
(RACMC) in OPERATION SEA ANGEL. Here the Joint Task Eorce J-3, 


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the Embassy, NGO coordination cell and host nation government 
met to track information and to gather requests. The cell kept 
track of all relief efforts and served as a liaison to the 
decision making body of the RACMC.^^ 

Another application would be similar to having a Patient 
Evacuation Team (PET) within the DASC to coordinate inter¬ 
theater patient movement analogous to having a Medical Planner 
as a cross functional team member with NGO, and or indigenous 
governmental organizations coordinating the planning and 
utilization of the hospital ships. This would allow for advance 
party in the form of a liaison from medical to be factored in 
during the initial planning process resolving any communication 
and process concerns in advance. 

Training Concepts 

To mitigate negative outcomes. Navy Medicine should adopt 
planning and training to enhance humanitarian assistance 
operations. Providers (doctors and nurses), similar to junior/ 
mid-level infantry officers who operate at the tactical level 
are at the forefront of incurring dynamic issues with indigenous 
peoples / patients during HA port calls. Until HA training on 
the medical staff can become part of their training pipeline 
utilization of experienced medical planners while developing 
DUINs and cultural exchange opportunities could be an answer. 


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DUINS internships with NGOs similar to the FEMA LNO 
internship would develop experience. Currently the IMG has 
internships with Uniformed Services Health Sciences University 

o A 

for medical physicians. This internship should be a model to 
develop similar arrangements with other NGOs, allowing junior 
medical officers an alternative venue for experience. 

The reality is that Navy Medicine in HA ops is acting as a 
diplomatic vehicle to influence foreign perception of the U.S. 

It would be wise to ensure medical staffs are culturally 
sensitive. An option would be to open the overseas experience 
and immersion that the Olmstead Foundation provides to line 
officers. Its mission: 

"To provide... military leaders an unsurpassed opportunity to 
achieve fluency in a foreign language, pursue graduate study at 
an overseas university, and acquire an in depth understanding 
of foreign cultures, thereby further equipping them to serve in 
positions of great responsibility as senior leaders in the 
United States Armed Forces” 

In many cases where Navy Medicine is operating alone and 
unafraid, decisions made by medical staff officers in sole 
billets overseas could greatly benefit from the cultural 
experiences gleaned from the types of exchange and training 
opportunities. 


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Conclusion 


The lack of training has been identified as the Achilles 
Heel for medical staff to avoid the cultural pitfalls of a 
diplomatic incident during HA. Contemporary business 
organizational models of Cross-functional product development 
and decentralized Direct teams to develop strategy and 
implementation will allow for increased efficacy of 
communication and skills to augment the lack of training. 
Alternative sources as Medical Planners, DUINs opportunities 
with NCOS and cultural immersion opportunities with the Olmstead 
foundation will increase exposure to a foreign culture and 
awareness which will enhance capabilities of Naval Medical 
Officers during humanitarian assistance operations. 


^Statement of Admiral Michael G. Mullen Chief of Naval Operations 
Before the Senate Armed Services Committee, 29 MAR 2007, 
http://WWW.jag.navy.mil/documents/testSASC_CNO_FY08_Posture_Hear 
ing_final.pdf. Accessed 19 Feb 2008, 13. 

2 

Guimond, Marie-France, Noah S. Philip, Usman Sheikh, "Health 
concerns of peacekeeping: a survey of the current situation", 
McGill University, 2001, www.jha.ac/articles/a067. htm . Accessed 
19 Feb 2008, 2. 

^ Chaplain Donald L. Rutherford, (COL) (USAR), "The Strategic 
Implementation and Employment of Non-Governmental Organizations 
in Contingency Operations", U.S. Army War College, Carlisle 
Barracks PA, 2000, 1. 

^ Department of the Navy, BUMEDINST 644.5C, Health Service 
Augmentation Program (HSAP), 24 JAN 2007, 
http://www.nme.mar.med.navy.mil/POMI-Docs/BUMEDINST- 
6440_5C_Health-Services-Augmentation-Program.pdf, Accessed 18 
Dec 2007, 4-1. 


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5 


The White House, Ask The White House, Karen Hughes, 24 AUG 
2007, http://WWW.whitehouse.gov/ask/20070824.html. 

® Statement of Admiral Mullen, 1. 

^ Jeff Drifmeyer, Craig Llewellyn, "Toward More Effective 
Humanitarian Assistance", Military Medicine, Mar 2004, 
http://findartides.com/p/articles/mi_qa3 912/is_2 004 03/ai_n93 97 9 
15/pg_l, 1. 

® Fisher-Thompson, Jim, "Study of Culture Increasingly Important 
to the Military", America.gov, 23 April 2007, 
http://WWW.america.gov/st/washfile- 

english/2007/April/200704231042231EJrehsiFO.7528803.html , 1. 

^ DeZee, d 
DeZee, 5. 

^^Rutherf ord, 2 
^^Ibid. 

^^Ibid. 

Department of the Navy, Naval Attache NewsLetter, U.S. NAVY 
FOREIGN LIAISON OFFICE, 2000 NAVY PENTAGON, WASHINGTON, DC 20350 
Captain John T. Segura, Director, OPNAV N2L, 
http://www.navalattaches.com/NAN061005.doc 
DeZee, 5. 

^®DeZee 1. 

^^Christopher Seiple, The U.S. Military/NGO Relationship in 
Humanitarian Interventions, Peace Keeping Institute, Center for 
Strategic Leadership, U.S. Army War College, 1996, 68. 

Fisher-Thompson, Jim, "Study of Culture Increasingly Important 
to the Military", America.gov, 23 April 2007, 
http://WWW.america.gov/st/washfile- 

english/2007/April/20070423104223IEJrehsiFO.7528803 .html , 1. 
^^Eugene Weiner, The Handbook of Interethnic Coexistence, Antonia 
Handler, Chayes Handler and Abram Chayes, " International 
Organizations and Conflict Preventions: Lessons from Business", 
The Continuum Publishing Company, New York, NY, 1998, 281. 
^“Seiple, 81. 

^^Weiner, 2 81. 

^^Weiner, 2 81. 

^^Seiple, 77. 

^^Rahib Torbay, CMO Luncheon, 28 November 2007. 

^^http://WWW.olmstedfoundation.org/o1msted/web/index.cfm. The 

George and Carol Olmstead Foundation, the Olmstead Scholar 
program. 

The White House, Ask The White House, Karen Hughes, 24 AUG 2007, 
http://WWW.whitehouse.gov/ask/20070824.html. 


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BIBLIOGRAPHY 


Department of the Navy, BUMEDINST 6440.5C, Health Service 
Augmentation Program (HSAP), 24 AN 2007, 
http://www.nme.mar.med.navy.mil/POMI-Docs/BUMEDINST- 
6440_5C_Health-Services-Augmentation-Program.pdf, Accessed 
18 Dec 2007. 

Department of the Navy, Naval Attache NewsLetter, U.S. NAVY 

FOREIGN LIAISON OFFICE, 2000 NAVY PENTAGON, WASHINGTON, DC 
20350 Captain John T. Segura, Director, OPNAV N2L, 
http://www.navalattaches.com/NAN061005.doc 

Guimond, Marie-France, Noah S. Philip, Usman Sheikh, "Health 
concerns of peacekeeping: a survey of the current 
situation", McGill University, 2001, 

www.jha.ac/articles/a067.htm. Accessed 19 Feb 2008, 2. 

DeZee, Kent Jr., Elizabeth P. Berbano, Ramey L. Wilson, 

Jean E Rinaldo, "Humanitarian Assistance Medicine: 
Perceptions of Preparedness: A Survey-Based Needs 
Assessment of Recent U.S. Army Internal Medicine Residency 
Graduates", Military Medicine, Sept 2006, 

http://findartides.com/p/articles/mi_qa3912/is_200609/ai_n 
16756208/pg_l. 

Drifmeyer, Jeff, Craig Llewellyn, "Toward More Effective 

Humanitarian Assistance", Military Medicine, Mar 2004, 
http://findartides.com/p/articles/mi_qa3912/is_200403/ai_n 
9397915/pg_8. 

Eugene Weiner, The Handbook of Interethnic Coexistence, Antonia 
Handler, Chayes Handler and Abram Chayes, " International 
Organizations and Conflict Preventions: Lessons from 
Business", The Continuum Publishing Company, New York, NY, 
1998 . 

Rutherford, Donald L. Chaplain, (COL) (USAR), "The Strategic 
Implementation and Employment of Non-Governmental 
Organizations in Contingency Operations", U.S. Army War 
College, Carlisle Barracks PA, 2000. 

Seiple, Christopher, The U.S. Military/NGO Relationship in 

Humanitarian Interventions, Peace Keeping Institute, Center 
for Strategic Leadership, U.S. Army War College, 1996. 

Statement of Admiral Michael G. Mullen Chief of Naval 


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Operations Before the Senate Armed Services Committee, 29 MAR 

2007,http://WWW.jag.navy.mil/documents/testSASC_CNO_FY08_Po 
sture_Hearing_final.pdf, Accessed 19 Feb 2008, 13. 

Interview with Robih Torbay, interview by Prasad B. Diwadkar, 

28 February 2007. 

The George and Carol Olmstead Foundation, the Olmstead Scholar 
program, http://www.olmstedfoundation.org/o1msted/web 
/index.cfm. 


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