Articles
Asia Pacific Military Medicine Conference XX
Jakarta 3-7 May 2010
The Surgeon General of the Indonesian Armed Forces, Major General Heridadi, welcomed the delegates and wished them “an unforgettably pleasant time learning about the development of the Republic of Indonesia and experiencing Indonesian culture.”
The steering committee of the Jackson Foundation and the Indonesian Armed Forces (TNI) together organised a congress that was specifically targeted at a consideration of the global and international issues of collaboration in the prevention and combating of the effects of disaster scenarios in today’s world. In his keynote speech, Rear Admiral Anderson, U.S. Pacific Command Surgeon, stressed the fact that the military medical services have now become internationally more prominent because of the increasingly frequent occurrence of complex disasters. The civilian aid agencies have become dependent on the support provided by the military medical services that, thanks to their level of training and quality of equipment, can be deployed on the spur of the moment to crisis regions. It is thus all the more necessary to promote closer mutual civilian-military cooperation in the future.
High ranking delegations from 23 nations of the Asia Pacific Region attended. The conference proved to be a resounding success for all who were present.
APMMC Keynote Address: RDML Michael H. Anderson, Monday, 3 May 2010
The U.S. Pacific Command is a Geographic Joint Command that covers 100 million square miles, representing 51% of the world’s surface, and even though much of it is ocean, it encompasses 36 independent Countries. USPACOM also serves a region that includes 60% of the world’s population, three of the world’s most populous countries (China, India, and Indonesia), and a multitude of diverse ethnic groups with many languages and dialects. Strategically the region includes six of the world’s largest militaries, 50% of the world’s oil supply, and 33% of US foreign trade. It is a truly impressive theater in which to work and presents a myriad of challenges and great rewards. Standing before this assembly today, is one of those great rewards.
As a physician executive it is a distinct professional pleasure to be here today during the opening of this prestigious gathering of medical professionals. It has also been an honor to be able to collaborate, support, and learn from many of you as together we faced last year’s challenges of a global economic crisis, the threat of an influenza pandemic, and the tragedy of multiple natural disasters. I am pleased to think that there are signs that the worst of the economic crisis may have passed and that there are indicators suggesting we are entering into a period of economic recovery. Additionally, the concerns that the 2009 novel H1N1 influenza strain could worsen in virulence have been lessened as global reports note a continued reduction in the rates of infection. It is clearly evident to me that the only way to persevere and recover from these challenging issues is through regional COOPERATION AND COLLABORATION." Based on our recent experiences hopefully you can envision how working together we can continue to develop resiliency within our military forces and among our at risk civilian populations.
This year’s APMMC theme is “Understanding Asia-Pacific Military Medical Issues through Regional Cooperation and Collaboration.” As you may have already surmised I take this to mean building resiliency through regional efforts. To clarify my point a useful medical model is psychological resiliency. Simply stated it is the ability of individuals to quickly return to a normal state of behavioral health by bouncing back from life’s challenges. Resilience is the capacity to adjust to high levels of stress while displaying minimal dysfunctional behavior and being able to recover quickly. In preparation for the psychological trauma that can occur in a combat environment, we can make our troops more resilient to Posttraumatic Stress Disorder (PTSD) through pre-exposure education and stigma reduction. Resiliency training can improve performance in combat and accelerate an individual’s return to psychological normalcy following traumatic exposure. Appropriate training can also prevent other significant mental health disorders that include depression, substance abuse disorders and suicide.
Similarly, we can make communities more resilient by developing capabilities that mitigate the social, economic, and political impact of natural and manmade disasters. Examples of this concept include the national and military Pandemic Influenza plans that each of our nations created and executed over the last year. Embedded within the plans were pre-determined strategies, responsibilities, and goals for future capability development that allowed for the most efficient use of available resources at the first sign of a potential pandemic. The plans allowed for the rapid but logical deployment of mitigation efforts that ranged from strategic communications to port of entry and debarkation screening. I am convinced that our current recovery from the pandemic owes its success in part to the community resiliency created by the development of these plans. But now is no time to rest. There is yet much work to be done. Think of how your Pandemic Influenza Plan might best be transformed into an emerging infectious disease plan in order to further develop your community resiliency. This is work that can be best achieved through REGIONAL COOPERATION AND COLLABORATION at conferences such as this one. The sessions this week are designed to share military lessons learned from our combat, peace keeping, and humanitarian assistance and disaster relief experiences. If our populations become more resilient we can better cope with the turmoil of a disaster, whether as a first responder or a victim, so that both personal and national recovery can proceed more rapidly.
Cooperation and collaboration also advances regional security, promotes positive relations among militaries, improves civilian-military dialog, reduces the likelihood of disputes and when disputes arise, promotes the likelihood of negotiated settlements. Militaries can then come together rapidly in peace keeping operations, rendering medical care to partners and allies, and supporting regional activities that counter transnational threats like infectious diseases, piracy, narcotics and terrorism. However, the need for cooperation is never greater than during natural disasters. These natural disasters come in the form of earthquakes, volcanoes, tropical storms, droughts, famines, and health crises.
Regional partners working together to build capacity, capabilities and resiliency during peacetime pays tremendous dividends during times of natural disasters. In the US we are fond of saying that in the midst of a crisis, it is not the time to be exchanging business cards for the first time. Establishing relationships ahead of time, developing inter-operability in our capabilities and equipment, following evidence-based medicine protocols, sharing lessons learned from our deployments, and building trust and confidence in one-another are the goals of international military medical meetings and joint exercises.
At the same time in this region, we face immense challenges which are obvious in looking at statistics compiled by the United Nation’s Economic and Social Commission for Asia and the Pacific. 2009 was a particularly disastrous year in Asia and the Pacific, with the greatest damage caused by storms and earthquakes. By November 2009, disasters had affected more than 6.8 million people, left more than 150 thousand homeless, and caused more than $227 million USD in economic damage. While the military is typically not a country’s first responders, they are often heavily involved in support of civilian authorities and can offer resources not found in the civilian sector.
We in medicine are privileged in a myriad of ways. Medical practitioners are most fortunate in that medicine transcends politics and is philosophically seen as a higher good. However, we may sometimes be underappreciated by our operational commanders who may regard us as just medical professionals in uniform. Yet, medicine is increasingly a means for bringing countries together when they may agree on little else.
Countries certainly readily support each other in times of urgent need by providing life-saving measures to victims and the most vulnerable populations. This is especially critical in today’s interconnected world where we have sometimes painfully learned that infectious diseases know no boundaries and diseases have the potential to rapidly spread worldwide. Examples that readily come to mind are the Influenza A 2009-novel H1N1 virus, the H5N1 virus, and earlier in this decade, the SARS virus. The World Health Organization has issued guidance to address such public health emergencies of international concern. The WHO International Health Regulations – 2005 was ratified by 194 countries in order to enhance international medical surveillance for early detection and rapid response. Similarly, medical innovation and modern discoveries are shared worldwide in the international medical literature for the betterment of all mankind and knowledge freely shared at conferences such as APMMC.
When a nation experiences a disaster, we as allies and partners responded with real world humanitarian assistance and disaster relief. In late 2007, following a tropical cyclone in Bangladesh, USPACOM supported the relief efforts of the 3rd Marine Expeditionary Brigade as they delivered over 327 tons of supplies, 14,000 gallons of water, and 4,334 patient encounters. In May 2008, USPACOM assisted in southwestern China in the aftermath of their earthquake with C-17’s transporting relief supplies. Also during May 2008, US military C-130 aircraft brought emergency relief supplies to Rangoon International Airport, Burma in support of national disaster relief efforts following a tropical cyclone. Bringing in thousands of bottles of water, pallets of mosquito nets and pallets of blankets, the US was just one of many countries that responded when these nations were in crisis. What is more important is that prior planning allowed for rapid assessments of what was needed in the form of relief supplies, significantly contributing to the resiliency of these nations.
Through USPACOM there is an extensive list of opportunities that assist in the building of additional capabilities and resiliency. From blood safety workshops, to blast injury symposiums, and emerging infectious disease conferences my staff is available to coordinate professional development opportunities. The Center for Excellence in Disaster Management & Humanitarian Assistance provides a catalog of options that includes their popular Health Emergencies in Large Populations (HELP) course. The Asia Pacific Center for Strategic Studies conducts many security cooperation courses throughout the year in Honolulu with distinguished alumni. The Pacific Air Forces sponsors a flight safety exchange, a Joint Medical Attendant Transport Team (JMATT) hands-on course and an Asia-Pacific Military Nursing subject matter expert exchange. US Army Pacific, represented by their surgeon, General Steve Jones conducts first responder combat lifesaver training that builds upon the capabilities of the individual Soldier and combat medic. The US Pacific Fleet welcomes partner nations when it conducts its annual Pacific Partnership humanitarian assistance missions. Over the past four years, Pacific Partnership has provided a variety of medical, dental, educational and preventive medicine services to more than 150,000 patients in 10 countries. More than 70 engineering projects have included school refurbishment and construction of entirely new clinics for remote villages.
These examples are just a short synopsis of the security strengthening and community resiliency building didactic and hands-on training opportunities that are available each year.
In closing, I would like to acknowledge that USPACOM and USARPAC have close ties with Northeast Asia, South Asia, Southeast Asia and Oceania. Many of our engagements are in the realms of humanitarian assistance and disaster relief, and enhancing military professionalism. Our collaborative work takes the form of both direct bilateral engagement and often multilateral engagements, in which we join with friends, partners and allies to work towards common purposes. Venues like APMMC promote these goals.
On a personal note, this will most likely be my last APMMC as the USPACOM Surgeon. After two years of enjoyable engagements with the military medical leadership throughout the Pacific, I will be relieved by Rear Admiral Michael Mittelman in August 2010. Some of you my already know Rear Admiral Mittelman through his current assignment as the U.S. Joint Forces Command Surgeon and Senior U.S. Medical representative to NATO. He therefore brings with him a wealth of experience developing joint medical doctrine.
Welcome Address
General Djoko Santoso, Commander-In-Chief of Indonesian National Defense Forces (TNI)
In his welcome address General Djoko Santoso highlights some inputs and prominent matters to be further considered as the insights which – so General Djoko Santoso - will help pinpoint the discussion regarding various prominent issues on military health in particular and on public health in general.
Firstly:
The 20th Asia-Pacific Military Medicine Conference (APMMC) of 2010 can serve as the vehicle which discusses various urgent and prominent issues whose results will become a‘benchmark’ in implementing the medical treatment and service on the ground when a pandemic or infectious disease occurs, for example HIV/AIDS, in the national, regional and global level.
Secondly:
Enhance, broaden and develop the cooperative level of humanitarian assistance as well as how to tackle a disaster by shifting a bilateral into multilateral level in order to gain the effectiveness and the best result of military medical operation in any circumstances, both in emergency situation and when a disaster takes place. The countries that have more capabilities will undoubtedly have to assist those considered to have lack of capabilities.
Thirdly:
Try to find more new innovations in tackling pandemics or infectious diseases by keeping up with the technological development and progress for the mastery of technology. It is aimed to gain the success of military medical mission in improving the soldiers’ health
condition and their families as well as its surrounding community, most particularly in area of humanitarian assistance when a disaster occurs.
Fourth:
An annual or a 2-year workplan on military medical activities is worth setting up for
anticipating an unpredictable disaster in the national, regional or global level for the purpose of capacity building.
Fifth:
A training with stages and continuously carried out is worth conducting as a constructive measure. It is done in the form war-gaming activities on humanitarian assistance when a disaster takes place, beginning from the planning, implementing, mitigating and in the postdisaster in order to create interoperability.
Sixth:
An inventory on the use of capacity and asset of military medical organizations available in each country in the Asia-Pacific region should be set up for the best effectiveness. With such preparedness, this is ready for the deployment to all areas affected by a disaster.
Operational communities in each country in the Asia-Pacific region can serve as the leading-sector fully backed up by the military medical communities from respective countries.
Seventh:
In a humanitarian operation, a military medical team works for human’s life. Therefore access from the affected country should be provided to any regional donor country in order to make it easier for them to send any medical team or other forms of assistance to the affected areas.
Australia hosts 21st APMM Conference
The 21st Annual Asia Pacific Military Medicine Conference will be held in Australia in 2011.
At the closing ceremony of the congress in Jakarta, the congress flag was formally presented to Major General Paul Alexander, Surgeon General Australian Armed Forces, by BrigGen Steven L. Jones. The flag had previously been returned by Major General Heridadi to BrigGen Jones in a special ceremony.
Major General Alexander invited the nations to visit Australia next year and undertook to provide for a fascinating and stimulating programme.
Further details of schedules and the conference programme will be published in the next issue of MCIF.
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