A Model for CivilMilitary Cooperation on Global Health: Integrating the Response to Humanitarian Ass

1
A Model for Civil-Military Cooperation on Global
Health Integrating the Response to
Humanitarian Assistance Crises

• Kenneth Schor, DO, MPH
• CAPT MC USN
• Assistant Professor, Preventive Medicine
  Biometrics
• Associate Program Director, General Preventive
• Medicine Residency
• USUHS, Bethesda, MD
• Email kschor_at_usuhs.mil

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Disclaimer

• The views and opinions expressed are mine and do
  not necessarily represent DoD, US Navy, or USUHS
  policy or positions.

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Objectives

• This presentation will look at how to better
  integrate global health efforts across multiple
  civilian agencies and the military.
• Identify components of an effective integrated
  strategy.
• Describe the key partners in such and effort and
  their roles.
• (Ref page 91, 2008 USPHS Scientific and Training
  Symposium)

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Objectives

• This presentation will look at how to better
  integrate global health efforts across multiple
  civilian agencies and the military.
• Identify components of an effective integrated
  strategy.
• Describe the key partners in such and effort and
  their roles.
• (Ref page 91, 2008 USPHS Scientific and Training
  Symposium)

5
The Real Objectives

• Discuss emerging directives and initiatives among
  U.S. government, military, and civilian agencies.
• Articulate key aspects of improving cooperation.
• Describe potential future opportunities for
  enhancing civil-military cooperation in global
  health.
• (Ref Email dated
  08 April 2008)

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PACOM LAYDOWNCurrent as of 0600W, 11 Jan 2005
CHINA
Logistics Ships CONCORD (T-AFS) SAN JOSE
(T-AFS) NIAGARA FALLS (T-AFS) TIPPECANOE
(T-AO) NOTE USNS RANIER w/ALCSG
BHR ESG BONHOMME RICHARD (LHD) (18 Helos) DULUTH
(LPD) (3 X CH-46) RUSHMORE (LSD) BUNKER HILL (CG)
(2 X SH-60) MILIUS (DDG) THACH (FFG) (2 X
SH-60) MUNRO (WHEC)
Futenma 2 KC130
Kadena 2 KC135 on alert
INDIA
Personnel 15,250 Air Assets 4 C-17
(USTRANSCOM) 6 C-5 (USTRANSCOM) 14 C-130 2
KC-130 5 MC-130 6 P-3 4 C-2 41 fixed-
wing (52 TACAIR ALSG, 6 AV-8B TACAIR
BHRESG) 51 Helos (4 AH-1W BHRESG) Ships 11
USN 6 MPS 5 USNS Logistics 1 USCG Cutter 1 Survey
Ship 1 HSV
3 P-3, 8 C-130, 2 KC 130 1 C-12, 1 UC-35, 1 C-21
CSF-536
WESTPAC EXPRESS (HSV)
THAILAND
FORT MCHENRY (LSD) ETA Banda Aceh 11 Jan 4 x
CH-46
Utapao
BONNYMAN (MPS) ETA SRI LANKA 12 JAN
PHILIPPINES
5 MC-130
SRI LANKA
MARTIN, HAUGE ANDERSON,
Phuket
Colombo
Langkawi
PLESS (MPS)
CONCORD (T-AFS)
Medan
MCDONNELL (T-AGS) ETA Singapore 13 Jan
A LINCOLN CSG
6 x HH-60
4 CH-46, 4 X C-2 2 C-130 (USCG)
Singapore
B RICHARD ESG
From CONUS MERCY (T-AH) ETA 29 Jan SWIFT
(HSV) ETA 26 Jan
DULUTH (LPD) 3 X CH-46 MV LUMMUS (MPS)
INDONESIA
3 x P-3
SAN JOSE (T-AFS) NIAGARA FALLS (T-AFS)(2 x
MH-60s) TIPPECANOE (T-AO)
Jakarta
4 C-130
Diego Garcia
ALCSG LINCOLN (CVN) (10 x SH-60) SHILOH (CG) (2 X
SH-60) SHOUP (DDG) (2 X SH-60) BENFOLD
(DDG) RAINIER (T-AOE) (2 x MH-60)
Maritime Prepo Ships MARTIN, ANDERSON, HAUGE IVO
Gulf of ThailandPLESS IVO Banda Aceh LUMMUS,
BONNYMAN ETA IVO Sri Lanka 11/12 Jan
As of 110600W
UNCLASSIFIED
ON STATION ENROUTE
CSG AIRFIELDS
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UN Other Civilian Relief Operations

• SRI LANKA
• Air
• 1 x UN IL-76 WFP
• 2 x UN IL-76 UNJLC
• 1 x OFDA / USAID King Air
• 1 x OFDA / USAID Helo
• Maritime
• - NSTR
• Ground
• 30 x WFP 10MT Trucks
• 17 x FP 20 MT Trucks
• 22 x UN Warehouses
• IOM Jaffna
• UNICEF Batticaloa
• UNHCR Kuchachaveli
• UNDP
• SLRC
• DRN Galle
• IFRC

• INDONESIA
• Air
• 2 x IL-76 UNJLC
• 3 x EU Helo at B-A
• 6 x Garuda JKT- B-A flts daily
• 25 x Garuda JKT- Medan flts daily
• Dutch ATC to Medan
• Maritime
• 1 x AUS Ferry used by WFP
• 1 x Maersk Sealand 200 Container Ship
• ETA Jakarta 13 Jan
• Ground
• 1 x DRN Log Mgt Team at B-A
• 17 x WFP Trucks at Medan
• IOM HQ at Jakarta / Halim Apt
• IOM Ops at Medan B-A
• IHP Camp at B-A for UN Ops
• IFRC Fact Team at Meulaboh
• UNFPA, CARDI, CARE, ICMC at B-A

• THAILAND
• Thai Red Cross
• WFP at Phuket
• 1 x Urban SAR Tm - Taiwan
• 1 x Urban SAR Tm - Germany
• 20 x Forensic Tms
• from Various Countries

ANDAMAN / NICOBAR 1 x IRC Team UNICEF
MALDIVES 1 x WFP VAM Mission 2 x WHO
Engineers UNICEF, USAID
MALAYSIA (Near KL) Subang Humanitarian Relief Hub
SINGAPORE Changi APT Alternate Civil Stratlift
Hub ICRC Regional Hub
As of 10/2045W
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Range of Military Operations
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Aspects of National Power

• US National Security Strategy emphasizes
  integration among 3 Ds
• Defense
• Diplomacy
• Development
• US Government lacks
• Robust interagency planning capability
• Expeditionary capability in civilian agencies
• Military truly trained, manned, and equipped to
  support integrated responses
• domestically
• internationally
• A key to success Championing Need to share
  over Need to know

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• DoD thinks in terms of effects-based operations
• Classic Kinetic Operations (Warfighting)
• Integrated operations value Non-Kinetic (Soft
  Power) concepts--requires new skills,
  capabilities, approaches

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Soft vs. Hard Power USS
Peleliu passes battleship USS Missouri and USS
Arizona memorial
Pacific Partnership 2007 4 month HA mission with
NGOs, Army, Air Force, USPHS
12
MHS Mission Overview
13
DOD Directive 3000.05Policy on Stabilization,
Security, Transition, Reconstruction Operations
(SSTRO)

• Gives direction from Secretary of Defense on DoD
  activities leading to sustainable peace while
  advancing US interests
• Key Points
• Equal mission Winning the peace as important as
  winning wars
• shall ensure DoD medical personnel and
  capabilities are prepared...

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Central Idea of Conducting SSTR Operations
SSTR Stability, Security, Transition, and
Reconstruction
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HSPD-21 Public Health Medical Preparedness
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HSPD-21 Public Health Medical Preparedness

• Primarily homeland defense and preparedness in
  focus
• Education training specifics
• Para. 36 Est. mechanism to coordinate federal
  grants for public health preparedness
• Para. 37 Est. mechanism to develop disaster
  medicine public health core curricula
  (FETIG)
• Para. 38 Est. academic joint program for
  disaster medicine public health at USUHS
  National Center for Disaster Medicine Public
  Health
• center of excellence
• co-locate education and research
• Includes domestic, international, and military
  aspects

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HSPD-21 Public Health Medical Preparedness

• Para. 43 DHHS leads the interagency development
  of first ever National Health Security Strategy
  as decreed by PAHPA legistlation

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• Thus, various initiatives are demanding
  interagency and civil-military cooperation and
  integration.
• What does this mean culturally?

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• DoD is from Mars,
• State Dept. is from Venus,
• HHS is from ___________?
• Civil Society is from.
• .a galaxy far, far away?

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Possible mechanisms for improving
civilian-military cooperation?

• Personnel Exchange
• Liaison Officer billets in headquarters
• Policy, Procedure, Guideline Development
• Interagency education and training
• Chart course
• USUHS graduate public health degree
• Sphere training
• (www.sphereproject.org )

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Possible mechanisms for improving
civilian-military cooperation?

• Simulation and Exercise
• Joint civilian-military education and
  trainingfight as you train
• USUHS
• UNOCHA Civil Military Coordination Section
  (UN-CMCoord)--http//ochaonline.un.org/AboutOCHA/O
  rganigramme/EmergencyServicesBranchESB/CivilMilita
  ryCoordinationSectionCMCS/tabid/1274/Default.aspx
  
• Various courses (ex. ICRC HELP)
• Hospital shipsUSNS COMFORT MERCY

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Integrated Operations

• How will civilian and military actors learn to
  dance better together?

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MHS Stability Operations Joint Capabilities
Document, vers. 1
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Another Way to Dance
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PACIFIC PARTNERSHIP 08Concept of Operations
This brief is UNCLASSIFIED
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PACIFIC PARTNERSHIP 2008Approved Transit Plan
San Diego DEP - 01 MAY ARR - 25 SEP
Manila, RP 15 - 17 Jun (14-16 Jun US)
Guam 23 - 25 May (22-24 May US) 03 06 Sep (02
- 05 Sep US)
Samar, RP 14 Jun (13 Jun US)
Nha Trang, VM 11 Day Mission 19 - 29 Jun (18-28
Jun US)
Cotabato, RP 14 Day Mission 29 May - 12 Jun (28
May-11 Jun US)
Pearl Harbor Westbound 8-12 May Eastbound
15-18 Sep
Chuuk State, FM 10 Day Mission 22 Aug - 01
Sep (21-31 Aug US)
Singapore 02 -07Jul (01 - 06 Jul US)
148 Day Deployment TSCP/HCA
65 days U/W 56
days LOG/QOL PVST 27 days Dates are
Arrival-Departure days Calculated using 14 kts
SOA
Port Moresby, PP 13 Day Mission 04 - 17
Aug (03-16 Aug US)
Dili, TL 13 Day Mission 12 - 25 Jul (11-24 Jul
US)
Darwin, AS 27 - 31 Jul (26-30 Jul US)
As of 04 APR 08
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Pacific Partnership Mission Team
Host Nation Government Agencies
Host Nation Military Forces
Partner Nation Military Forces
Humanitarian Community
Other U.S. Government Agencies
U.S. Army
U.S. Air Force
U.S. Marines
U.S. Navy
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Health Services Concept of Operations

• MERCY Provides Health Service Core Capacity
• 3 x OR and 1 x Shore Team
• Integrated US Military, Partner Nation Military,
• and Civilian Partners
• Shipboard Capabilities Ashore
  Outreach Capabilities
• 3 Operating Rooms (8 hrs/day) 2-3 Medical
  Site/Day
• 1 Emergency OR -basic dental care, optometry
  
• 4 ICU beds Isolation Ward -primary care,
  internal medicine
• 5-7 PACU Beds -pharmacy, lab
• 62 Ward beds 22 hotel beds 2 Non-medical
  Sites/Day
• Lab/Pharmacy/Radiology/Sterile Processing
  -Vet/EHO/Preventive Medicine
• SMEE/Training as
  requested by Host Nation
• Other Services
• Public Health
• Preventive Medicine
• Bio-Medical Repair

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Humanitarian Organizations

• U.S.-based Humanitarian Organizations will embark
  aboard MERCY to expand capabilities
• Aloha Medical Mission
• International Relief Teams
• Operation Smile
• Project HOPE
• University of California at San Diego
• Additionally, USAID and AMEMB in each country
  have identified international and local NGOs to
  participate
• CARE
• Catholic Relief Services
• Rotary Club
• World Vision
• and numerous local NGOs

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USUHS Hospital Ship Humanitarian Health Care
Course

• Provide CHE to all aboard USNS Mercy
• CME
• CNE
• Up to 35.5 credits
• Organic staff conduct training
• Underway in port
• Integral Program Feasibility Assessment
• Consider hospital ships as floating global health
  education and training labs!

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USUHS Hospital Ship Humanitarian Health Care
Course

• 4 Modules
• Global Health
• Collaborative Patient Care
• Colloquium Ethical Psychological Challenges
• Culturally Competent Care Provision in the
  Developing World

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USUHS Hospital Ship Humanitarian Health Care
Course

• Other considerations pending program assessment
• CHART Lite
• Sphere Guideline Training
• Incident Command Training
• Maternal Child Health

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The Real Objectives

• Discuss emerging directives and initiatives among
  U.S. government, military, and civilian agencies.
• Articulate key aspects of improving cooperation.
• Describe potential future opportunities for
  enhancing civil-military cooperation in global
  health.
• (Ref Email dated
  08 April 2008)

34

• Shall we dance?
• Shall we learn together?