Health Challenges of the Peacekeeper in Africa: A Practical Briefing Col(Ret) Lesley-Ann JacobsDefence AnalystDefence Decision Support Institute

Note: The opinions expressed herein are those of the presenter and do not in any way reflect the official standpoint of the Dept of Defence or any of it’s components. All material

used has been sourced, unless otherwise stated, from public domain sites.

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Scope

• The P of POSTEDFIT

• The soldier in a foreign physical environment• Physical health challenges• Psychological health challenges• Implications for force preparation

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Personnel Organisation Support Systems Training Equipment Doctrine Facilities Information

Technology

P O S T E D F I T

Functional Attributes of a Capability

FirepowerMobilityProtectionCommand and controlInformationSustainment

OPERATIONAL CAPABILITY

ARMOUR CAPABILITY

INFANTRY CAPABILITY

AIR CAPABILITY SUPPORT AND SUSTAINMENT

POSTEDFIT Capability Elements

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The Soldier in a Foreign Environment

Physical Factors– Immune system implications

• Immunity against foreign pathogens

• Change in climate

– Exposure to foreign physical environment• Hygiene and environment

• Living arrangements

Psychological Factors– Exposure to unfamiliar environment and culture– Exposure to circumstances beyond his/her control– Factors inherent to deployments

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Physical Factors

Disease

Injuries

Self Inflicted Disease

Environmental Factors

ZoonoticInsect/ Arthropod borneFood/ Water/ Soil borneHuman- Human Transmission

UnintentionalIntentional

Substance AbuseMalnutritionPoor Hygiene

Pollution and Contamination

Water/ Food/ Soil/ Air

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Diseases

Zoonotic Diseases

• Diseases that can be transmitted from animals, wild or domesticated, to humans.

• May be through direct contact with infected animals, or via the bites and scratches or indirect via vectors.

• May be bacterial, viral, fungal, parasitic, etc. Examples: Tuberculosis, Plague, Rabies, Anthrax, Yellow fever, Brucellosis.

• Important in African countries are the Viral Hemorrhagic Fevers such as Ebola, Lassa, Crimean Congo Fever

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Diseases Spread By Arthropods/ Insects

Diseases spread through insects which function as a vector, e.g malaria, plague, tick bite fever,. These may be bacterial, viral or parasitic. Vectors include fleas, lice, mosquitoes, ticks, bugs, etc.

Malaria (parasite) is more deadly than HIV in Africa.

Mosquitoes are the greatest menace carrying amongst others malaria, dengue, West Nile Virus and yellow fever

Diseases

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Fleas host encephalitis and diseases like plague

Ticks host various diseases e.g typhus, Lyme disease

Black flies carry river blindness

Lice can carry typhus

Tsetse flies transmit sleeping sickness

Elephantiasis is caused by a parasite

Diseases

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Diseases Spread Through Water/ Soil/ Food

Contaminated water, soil and food (as well as clothing and shoes that come into contact with it) can spread many diseases. These may be fungal, viral, bacterial, protozoa or parasitic. Helminthes like hookworms and tapeworms are spread in this manner. Other examples are cholera, polio, anthrax, Typhoid fever, Hepatitis A, diarrhoea caused by different organisms.

Diseases

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Parasites

Many parasites infect humans of which malaria and intestinal worms are extremely common.

Over 100 different types of parasitic worms can live in the human body- causing many symptoms. These organisms can be found everywhere such as in the air, water, soil or food humans eat.

WHO estimates that one quarter of the world’s population suffers from chronic intestinal parasitic infections

Hookworms lead to anaemia and malnutrition- with all consequences thereof

Tapeworm can become 6 m long in the human intestine

Diseases

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Contagious Diseases (Human To Human)

Diseases spread through contact with other infected humans- through touch, bodily fluids such as blood, saliva, droplets (sneezing), semen, vaginal fluid, or excreta

Examples: Measles; Tuberculosis; Polio; Sexually transmitted disease such as HIV, gonorrhea, syphilis; Influenza; Meningitis; Viral Hemorrhagic Fever (Ebola, Marburg, Yellow Fever, Lassa Fever, Crimean Congo Fever )

Diseases

Measles

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Not a New Phenomenon….

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An Injury is: “the physical damage that results when a human body is suddenly or briefly subjected to intolerable levels of energy”

Two broad categories: Unintentional (not associated with violence) and Intentional (associated with violence)

Injuries in Africa are mainly caused by:

Unintentional Injuries•Road Accidents- high incidence in Africa

•Drowning

•Falls

Source: Bowman, B, et al. Violence and Injuries. Disease and Mortality in Sub-Saharan Africa. World Bank. 2006

Injuries

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Intentional InjuriesConflict

• Bullets• Machetes/ sharp edged instruments• Landmines• Arrows• Beating/ blunt instruments• Sexual violence including rape and

genital traumatic injury or mutilation (predominantly in women)

• Homicide • Suicide

Exacerbated by infections

Injuries

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• Self Inflicted Disease– Substance abuse– Malnutrition– Poor personal hygiene

Self Inflicted Disease

Athlete’s FootAlcohol is widely available, cheap and consumed in copious amounts

Poor food choices

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Environmental Factors

Pollution and Contamination• Water

• Air

• Soil

• Food

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Psychological Factors

• Stressors– Away from home– Increase in disposable income– Reduced supervision and control – Higher status in poor communities– Boredom

• All contributes to following behaviour manifestation:– Alcohol abuse– Prostitution– Abuse of power– Visits to nightclubs– Vehicle abuse– Violence and misbehaviour

Stress associated with armed conflict is less common in SA Soldiers deployed in current operations

Source: Col A Neale (Directorate Psych, SAMHS, SANDF)

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Maslow’s Hierarchy of Needs

Operationally deployed soldiers tend to regress with needs becoming increasingly basic

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Implications for Force Preparation

Training:– Training in and awareness of prevention of communicable diseases

– Knowledge of preventative measures re zoonotic, insect, water, soil and food borne diseases (pets!)

– Proper training in general and field hygiene for individual soldiers- washing of hands!

– Proper training for all soldiers in nutrition to maintain optimum immune systems

– Awareness of purchasing of local foodstuffs

– Substance abuse awareness and monitoring for prevention thereof. Buddy systems to prevent violence and indiscriminate behaviour when drinking alcohol

– Resilience training for own forces to withstand psychological trauma due to witnessing of violence, atrocities, etc.

– Training in self management and control, money and boredom management

– Training of supervisory personnel in management of own power

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Prevention through:– Prophylaxis where possible through immunisation, chemical measures such

as malaria tablets and physical barriers such as condoms and mosquito nets

– Enforced use of insect repellents

– Screening for soldiers likely to develop asthma in areas with air pollution. Ensuring that these soldiers are adequately prepared for such events

– Enforced rules about keeping of exotic pets in the operational area

– Proper waste management systems in military bases as well as in the field

– Physical inspections for presence of skin disease, especially parasitic infections

– Regular inspections of living areas to ensure adequate hygienic circumstances

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• The effective utilisation of environmental health officers for field and base sanitation services, including collaboration with engineers to determine correct placing of latrines, food service units, water service points and waste management systems.

• Reducing of boredom and satisfying of higher needs through:

– Opportunities and motivation to use time to improve self with skills training

– Provision of library services

– Physical training facilities

Implications for Force Employment

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Acknowledgements and Additional Sources

• My colleagues at DDSI and SANDF, especially Col Tertius van Zyl and Col Anton Grundling from J Operations Division

• Col Arthur Neale, Directorate Psychology, SAMHS, SANDF for providing information

• Col Hennie Venter, previous Director Environmental Health, SAMHS, SANDF who taught me the importance of environmental health in the military

• J R Army Med Corps- several issues• UA Army Medical Department Journal (especially the Jan-

Mar 2009 and April – June 2009 issues)• Medical textbooks and professional journals (large variety)

were consulted in presenter’s professional training and contributed to domain knowledge

Thank You

Questions?