More than a dozen medical researchers from U.S. Army Medical Research and Materiel Command shared their experience and expertise on establishing programs, conducting research and delivering medical support in Africa at the second annual U.S. Army Africa Command Surgeon’s Forum Aug. 2 at Caserma Ederle in Vicenza, Italy.
U.S. Army Africa Commander, Maj. Gen. David R. Hogg, met with the principal participants to reiterate the command’s support for their wide range of activities and the positive impact they are having in promoting peace, prosperity and stability on the continent.
“The Army Africa Command Surgeon’s Office is acting as an intermediary, encouraging networking among U.S. Army medical researchers in Africa, AFRICOM’s service components and big Army, and developing lasting partnerships as we pursue our common interests in Africa,” said Col. Alfonso Alarcon, Army Africa Command Surgeon, and host of the conference.
MRMC researchers in Africa are establishing research centers, training personnel and conducting research relating to malaria, HIV, leishmaniasis, and a range of vector borne and bacterial diseases, while executing programs such as the President’s Emergency Plan for Aids Relief (PEPFAR) and the U.S. Military HIV Research Program, said Col. Kent Kester, commander, Walter Reed Army Institute of Research.
Presenters highlighted both the enormity of the problems facing societies and governments on the continent, and the impressive steps forward in both research and treatment that have become possible through building partnerships and establishing training programs.
“It’s a multi-pronged problem that requires multi-pronged approaches, and that’s just to get things started,” said Lt. Col. Shon Remich, director, U.S. Army Medical Research Unit-Kenya’s joint U.S. Army-Kenya Ministry of Defense PEPFAR program.
Col. Scott W. Gordon, USAMRU-K commander, described the infectious disease research and surveillance programs under way in Kenya and neighboring countries. USAMRU-K operates field research stations at Kisumu and Kericho, where staff partner with Kenyan government ministries, U.S. government agencies, nearly a dozen African and American universities, and a handful of nongovernmental agencies.
The U.S. military’s interest in African infectious diseases and their consequences began in the wake of worldwide awareness of the AIDS epidemic, a perceived interest in protecting blood banks and in not deploying HIV-infected personnel, said Merlin L. Robb, a retired U.S. Army lieutenant colonel and presently deputy director of clinical research for WRAIR’s U.S. Military HIV Research Program. Drawing on a range of funding sources, MHRP has helped establish significant elements of a base infrastructure to address HIV in several locations on the continent.
The program has helped establish an HIV maternal-child health center in Kericho, Kenya; a Centre for Infectious Diseases clinic and lab at the Mbeya Referral Hospital in Kihumbe, Tanzania; a research lab and clinical treatment support lab facilities in Mulago and Kayunga Provinces in Uganda; and a lab and surgical suite at the Kayunga District Hospital, also in Uganda, among other projects.
In Tanzania alone, MHRP has succeeded, with PEPFAR funding, to provide anti-retroviral treatment to more than 57,000 people, basic care services to more than 116,000 people, and counseling and testing to more than 228,000 pregnant women, he said.
“We establish a lab. We establish standards, and they have to meet those standards, and that’s very helpful,” Robb said.
MHRP is also active in Nigeria, where partnerships with the national government and the Nigerian Ministry of Defense are addressing the enormous toll that HIV and AIDS have taken on both the military and the society at large.
“I was there in the 1990s. Soldiers were dying by the boatload,” said Capt. Darrell Singer of the U.S. Public Health Service, who directs the operation in country for WRAIR. “We’d come in to train soldiers, then we’d come back six months later and they’d all be dead.”
At present MHRP-Nigeria and PEPFAR activities are supporting 20 military treatment facilities providing comprehensive services to tens of thousands, he said. More than 116,000 individuals have been tested for HIV and more than 9,500 patients have begun anti-retroviral drug treatment, he said.
“We rolled out treatment, now we’re getting the structure in place. We have a lot of structure, but it took us a long time to get that structure there. You have operational issues, issues of tracking, getting all your metrics in place,” said Singer.
“Getting necessary hires has been critical to getting care out there. It’s a lot of work. They have great bureaucracy and I think it will help improve their health care,” he said.
The Nigerian military has dedicated $9.6 million in funding to the program, Singer told the conference. “The plan is, they take over parts to keep the program going. Now they’re taking that part and we’re doing the ‘extra,’” he said.
Part of that “extra” at present is to teach forecasting, budgeting and related skills necessary for ensuring the long-term viability of programs that have been put in place, said Singer. The challenges are similar to those encountered by any developed country’s land forces: “They have to attract good people, they have to retain them,” he said.
The advent of AFRICOM has brought with it the benefit of sustained interest and support to programs on the continent, Singer said, who was in Africa in the 1990s when EUCOM had responsibility for large swathes of the continent.
“Back then they were dealing with the aftermath of the Cold War, the fall of the Berlin Wall . . . their engagement was elsewhere,” he said.
AFRICOM and Army Africa’s ability to focus on sustaining activities over an extended period of time is having a positive impact on MHRP-Nigeria’s operations, Singer said.
“The Nigerians depend on long-term history. Frequent and consistent engagement is key. One-offs actually become problems,” he said.
“This dialogue also helped our headquarters better assess how to support Medical Research and Materiel Command on the continent going forward,” Alarcon said.
“This second annual conference was by far more successful than last year’s, with an expanded agenda and twice the participation. I see this evolving into an annual event which will grow as our headquarters matures in its support role,” he said.
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