October 16 through October 24 saw units of the United States military assigned to Africa Command working with the militaries of five East African nations for Exercise Natural Fire 10. Burundi, Kenya, Rwanda, Tanzania, and Uganda contributed troops and resources, as well as civilians from various governmental ministries to this combined field and tabletop exercise.

East African Community military members line up to board a CH-47 Chinook for transport to a range, Kitgum, Uganda, Oct. 20, 2009. Combined forces from the East African Community and the United States are working together during Natural Fire 10 to learn from each other. (US Army photo by Spc. Jason Nolte)

The field exercise was held in northern Uganda, in the vicinity of the city of Kitgum. Various scenarios were practiced by the troops from the six nations. In addition, engineering assistance was provided by the militaries to several public buildings.

Cpl. David Bundi, Kenya, cuts the base off a door frame at Kitgum High School, Kitgum, Uganda, Oct. 17, 2009. Combined forces from the East African Community and the United States are working together to refurbish a building at the high school. (US Army photo by Spc. Jason Nolte)

Construction Electrician 3rd Class Mary Ward, Naval Mobile Construction Battalion 3, smiles for a photo while painting a wall at Kitgum High School, Kitgum, Uganda, Oct. 17, 2009. Combined forces from the East African Community and the United States are working together to refurbish a building at the high school. (US Army photo by Spc. Jason Nolte)

The various nations also participated in medical and dental clinics in Kitgum, seeing over 11,500 patients and helping to deliver 2 babies.

Rwandan Private Clemence Muramutsa prepares to draw blood on a Ugandan patient during Natural Fire 10 at Palabek Kal Health Clinic in Uganda, Oct 18, 2009. Natural Fire 10 is a humanitarian and disaster relief exercise that will enhance participants' capabilities to work together in response to complex humanitarian emergencies. This year's exercise is held 16 - 25 October 2009 and involves almost 1300 people from 5 East African countries and the United States. (U.S. Air Force photo by Staff Sgt. Samara Scott/Released)

Cpl. Charles Ntakiyirushamaboko, a Rwanda Defence Forces dentist works alongside Pvt. Michael Leti, a Uganda People’s Defence Force dentist to prepares young Agee Jostaka’s misaligned teeth for extraction. Photo by Capt. Ronald Kakurungu, Public Information Officer, Uganda People’s Defence Forces

More photos of this exercise may be found on Flickr.

The largest U.S. Defense Department-sponsored exercise in Africa this year yielded many important lessons, the commander of U.S. Army Africa said yesterday.

Army Maj. Gen. William B. Garrett III discussed Natural Fire 10 — a multi-national partnership that brought together troops from Burundi, Kenya, Rwanda, Tanzania, Uganda and the United States — during a “DoDLive” bloggers roundtable.

“We came together as friends and partners, and I’ve got to tell you, I’m absolutely amazed at the achievements that were accomplished there and the outcome and progress made during the month of October,” Garrett said. The 10-day exercise, held during October in Uganda, allowed multiple countries not only to achieve lasting partnerships, but also to help the people of Africa, he added.

“[The exercise] was a humanitarian and disaster-relief exercise that was designed to enhance our partner participating nations’ capabilities to work together to develop regional solutions to the complex humanitarian emergencies,” Garrett said. Medical and dental professionals treated more than 11,500 people, and even delivered two babies in northern Uganda, he said.

U.S. Army Africa missions are geared toward sustained security engagements with African land forces to promote security, stability and peace within Africa, Garrett explained. The command is the Army component of U.S. Africa Command.

In addition to the medical services provided, partner nations also tailored the exercise to focus on global health threats. Leaders and exercise participants came together in Kampala and Entebbe during a simulated natural disaster to learn how to address a global health threat that required international support and coordination.

“As we look at the future in Africa and other places in the world, [we're] making sure that we have the capacity to deal with that, which is frankly why we’re in Africa, [to help them achieve self-sustaining African security capacity," Garrett said.

The "tabletop exercise," he said, was the largest and most comprehensive pandemic response exercise conducted in Africa to date.

"It included not only the participating countries in the exercise, the six nations, but also a very large international contingent and U.S. government and interagency representatives," Garrett said.

The training provided for the global health threat was tailored toward logistic and medical support and security concerns. He added that the training targeted the procedures required to disseminate vaccines effectively during this type of threat.

"If a civilian health ministry needed trucks to move vaccines into an area, they needed to understand the procedures to reach out and gain those trucks and drivers and bring it all to bear and create a convoy, move the vaccines out, secure the vaccines, distribute the vaccines [and] administer the vaccines,” Garrett said.

Aside from medical and dental assistance, the exercise also allowed participants to complete three extensive construction projects as part of the community outreach. Although the exercise lasted for only about two weeks, many things were accomplished that can be used as prevention for future global health threats and pandemic outbreaks, Garrett said.

“I think the greatest accomplishments are the relationships that were fostered and created during the exercise and will continue as we go into the future and [the potential to] maintain these relationships as we work to achieve self-sustaining African security capacity,” the general said.

DoD
Story by Petty Officer 2nd Class Molly Burgess

Spc. Samantha Greeninger, an Army Reserve medic from Cincinnati, Ohio, assigned to the 629th Forward Surgical Team of Columbus, Ohio, and a Ugandan medic named Edwin entertain Ugandan children waiting for treatment at the Pajimo Clinic in rural Uganda.

For the past week, about 60 Army Reserve medical personnel assigned to the 629th Forward Surgical Team of Columbus, Ohio, and the 7225th Medical Support Unit from Greenville, S.C., have been providing medical care to rural Ugandans, seeing about 700 people a day.

“We’re sort of an emergency room for anyone who shows up,” said 1st. Lt. Matthew Boyer, a Thornville, Ohio, resident and RN with the 629th FST. “As a nurse, it’s great when we can see that many people.”

When the two buses of medical personnel arrived at Pajimo Clinic around 8 a.m., there was already a long line at the gate. Some people had traveled from miles away, including an 11-year-old girl who walked seven miles by herself to be treated for a skinned knee. Many of the people had dressed themselves and their children in their finest clothing: colorful dresses, robes, and formal jackets.

The local residents filed in through the gate to a triage station, where U.S., Ugandan and Tanzanian medical professionals inquired about their illness or injury. Some were given medicine and released, while others were referred to one or more of the other four stations: medical, dental, optometry and pharmacy.

“There is a difference in disease patterns and how they present in Africa as compared to the U.S.,” said Lt. Col. Ronald Januchoski, a physician and commander of the 7225th MSU.

“With the tropical disease spectrum here, you see things you’d never see in the U.S. It’s really helped me grow as a physician.”

Januchoski and Maj. Phillip Cummings, a physician from Fayetteville, N.C., also assigned to the 7225th MSU, treated patients at the medical station for such complaints as malaria, skin infection, pleurisy, broken bones and minor wounds, such as an infected cut on a little girl who caught her foot in her bicycle spokes.

“We’re primarily providing Level I care, which is general medical care,” said Col. William Myers, an orthopedic surgeon assigned to the 7225th MSU. “I did have the opportunity to examine some X- rays and provide some consultations to the local doctors on orthopedic problems.”

U.S. Navy and Ugandan personnel provided dental services, which included multiple extractions due to lack of dental hygiene. Patients were provided with toothbrushes, toothpaste, and instructions on how to care for their teeth.

Pfc. Kendra Hinds, a medic from Lubbock, Texas, deployed with the 7225th Medical Support Unit out of Greenville, S.C., examines a child in the optometry section of Pajimo Clnic.

In optometry, Dr. Francisco Cordera, an optometrist from Puerto Rico deployed with the 7225th, examined patients while other Soldiers conducted vision tests. The vision tests were pieces of paper on which was drawn the capital letter “E,” facing different ways and sized differently as the rows descended across the paper. Many patients could not read the English alphabet, but this test allowed them to indicate which direction the “E” was facing. Patients were issued prescription eyeglasses, some for the first time in their lives.

U.S. Navy pharmacist Lt. Cdr. Brett English and U.S. Army Reserve 1st. Lt. Jon Schuller were assisted in the pharmacy by Morris, a Ugandan pharmacist whose guidance was instrumental in prescribing the medicines.

“Getting local national input on designing formulary is crucial,” said English. “They know the people. Also, we see predominantly pediatric patients, but a lot of our medicines are adult-strength.”

English explained that the dosing can be difficult not just in scaling down adult doses for children, but because some patients are malnourished, and their digestive systems cannot handle a large dose such an 800 mg ibuprofen. Morris’ expertise was critically important in assigning the correct doses. He also knew how to provide quinine for malaria, a treatment that–though effective–is no longer used in the United States.

Patients were not limited to how many stations they could visit, and the team worked diligently throughout the day to treat as many as possible.

The medical personnel also provided for some unexpected contingencies. For instance, though they had not brought maternity capabilities or equipment, when a 19-year-old woman named Linda went into labor at the gate, 1st. Lt. Victoria Lynn Watson, a labor and delivery nurse at Abilene (Texas) Regional Medical Center in her civilian occupation, rushed in to help. Watson, the Pajimo Clinic’s certified midwife Stella Betty Lamono, and Pfc. Kendra Hinds, a medic from Lubbock, Texas, worked together to deliver a healthy, 5.5 lb. baby boy.

[Lt. Watson later delivered a second baby, to be named 'Victoria'.]

“It’s neat to see their skills and what they do to deliver a baby as compared to what we do in the states,” Watson said.

By 4:30 p.m., the team had treated 714 patients –715 counting the newborn. They boarded the buses and returned to the camp to prepare for the next day.

The medical outreach continued every day for a week, part of a U.S. Army Africa exercise, Natural Fire 10, in which the United States and five East African nations (Uganda, Kenya, Tanzania, Rwanda and Burundi) practice disaster relief and medical outreach. The intent was to learn each other’s skills and procedures so that they will be able to operate more effectively in the event of an actual disaster.

“What we’ve started doing in Africa with the different countries we’re working with is going to go a long way to stabilizing the region, even when we’re not here,” Boyer said.

DVIDS
Story and photos by Major Corey Schultz

For more on Natural Fire 10