“Outside the Wire” An Assessment of an Iraqi Clinic Laboratory

1. Lt Col Jody Noe And Capt Tracy Harrelson “Outside the Wire”An Assessment of an Iraqi Clinic Laboratory

2. Objectives • Understand the rationale behind counter-insurgency operations and what role the laboratory can play • Appreciate the current capabilities of one Iraqi medical clinic and the efforts that the 332d EMDG is making toward addressing its needs • Comprehend the challenges/ consequences of “helping” host country laboratories

3. Counter-insurgency Operations (COIN) • COIN, by definition is military, para-military, political, economic, psychological, and civic actions taken by a government to defeat insurgency. • In this instance the 332d EMDG sought to capitalize on the good will generated in the local community from medical care previously provided to local wounded Iraqi civilians.

4. History • Efforts were already underway to provide training and equipment to doctors and nurses • Recently, there has been a push to include ancillary medical services with the laboratory being the first service to be assessed • Came out of coincidental meeting with the mother of an Iraqi lab tech

5. Preparation • Mine Resistant Ambush Protected (MRAP) basic training • Rollover • Rollover in water • Rollover under fire

6. Assessment - Initial Assumptions • Intermittent power issues • Staff retainability/training – 4 lab staff • Reagent storage problems/refrigeration • Lack of reagents to perform spectrophotometric assays for Glucose, Bilirubin, Uric Acid, BUN, Cholesterol

7. Assessment Goal • Find areas for improvement where the Air Force could provide laboratory assistance which could in turn be sustained by the Iraqis.

8. Concerns • Cultural • Power and water supplies • Future sustainment capabilities • Security of donated equipment • Previous endeavors have resulted in equipment being sold on the black market.

9. Mission Brief

10. Convoy!

11. Clinic Findings

12. Clinic Findings

13. Findings - Laboratory • Basic laboratory requirements such as reliable power and clean water for reagents were woefully inadequate

14. Findings - Laboratory • Reagent supply issues were problematic

16. Findings - Laboratory • Equipment was antiquated and in disrepair

17. Findings- Laboratory

18. Findings • Operating instructions and reference material were non-existent.

19. Findings

20. Initial Response • Preliminary efforts to get the local Iraqi clinic laboratory staff to come to the 332d EMDG laboratory failed for cultural reasons. • Efforts are on-going to develop training aids and operating instructions in Arabic for use at local facilities and future visits to other clinics and hospitals are being considered.

21. Initial Training Aids

22. Initial Training Aids

23. Initial Supplies • Provided shovel, rake, trash bags and gloves so that the Iraqis could get the grounds cleaned up • Plan was to next bring painting supplies once outside was cleaned up

24. Challenges • Training • Initial training received, unable to assess adequacy • No evidence of ongoing training • Specifically concerned about microscopic urinalysis • Chemistry Testing • Manual methods require dangerous chemicals • Piccolo -pilferable, supply issues and cold storage issues

25. Challenges • Personal hygiene inadequate • Access to clean water • Education • No Microbiology testing capability • Only fecal wet preps • Cultural issues, all tests MUST have a result • “No stool pathogens” statement not seen in log

26. The Road Forward • Appealing to the female doctors to try to get an invite to their clinics and training for their techs. • Gathering intelligence on the Iraqi Health Care System and the Ministry of Health • Crossing our fingers!!!