READY FOR TODAY – EVOLVING FOR TOMORROW
In recent memory there have been
successes and some forgettable
moments. During the Vietnam War, some
units suffered 50 per cent attack rates of
malaria. The British force in Sierra Leone
in 2000 sustained 82 malaria cases in
six weeks and a US Marine contingent
in Liberia in 2003 had a similarly bad
experience. Force Health Protection
(FHP) was noted to be poor in both
cases. However, a company commander
at that time in the Sierra Leone operation
would later be the joint force commander
of a small operation in the Democratic
Republic of the Congo where the risk
of malaria was high. Remembering the
experiences of 2000, he briefed his
component commanders that he would
hold them responsible for lapses in force
health protection discipline. The result?
No cases of malaria.
It is arguably Field
Marshall Slim who was
the first commander
who understood
the importance
of maintaining
the force through
health protection.
He changed the
approach to malaria
management through
prevention and
treatment.
Bringing the story to very recent memory,
the joint force commander on the first
rotation of Operation GRITROCK made
it known that he would hold commanders
responsible for lapses in force
protection discipline. The result? Four
cases of malaria (each one rigorously
investigated for failure to adhere to force
health protection policies) and the lowest
recorded incidence of gastro enteritis
in a deployed military population ever
published; this in a country where gastro
enteritis amongst travellers is almost
universal.
As part of the
propaganda campaign
against malaria in
the Pacific Theatre
during World War II,
the US Army produced
a series of posters,
calendars and comic
strip, “Malaria Moe,”
reminding soldiers
to follow various
protocols in order to
prevent contracting
malaria.
What does this mean for a
NATO HRF(L)?
We may have to fight in places where
disease is endemic and FHP will be
critical to maintaining force levels. Force
Health Protection is not about being
risk averse, on the contrary; it should
be seen as enabling, not constraining.
Military operations are invariably a risky
business; FHP therefore provides a
function that assesses the health threats
then recommends pragmatic achievable
mitigation measures to reduce the risk
and give the commander freedom of
movement. While medical professionals
will provide specialist advice (and we do
have a FHP expert within the OLRT), it
will be for commanders to ensure that
discipline is maintained.
Key considerations
• Lack of commitment to FHP will result
in higher rates of diseases, such as
malaria or gastro enteritis.
• Medical SMEs can advise, produce
guidance/instructions and even deliver
pre-deployment briefs. However, the
effective implementation of control
measures to prevent malaria is down
to good leadership and command at all
levels.
• Commanders must lead on enforcing
FHP discipline. As Slim so succinctly
put it in his memoir Defeat Into Victory,
“I only had to sack three [commanding
officers], by then the rest had got my
meaning.”
ABOUT THE AUTHORS
Colonel Jeremy Tuck is an officer with
the British Army’s Royal Army Medical
Corps and is a consultant in public
health medicine and a former general
practitioner. He currently serves as the
ARRC’s medical director. Col. Tuck
has extensive operational experience
in clinical delivery, command and staff
roles, and has worked at every level
from the tactical front line to operational
2- and 3-star level headquarters, as well
as on the strategic stage at Ministry and
international levels.
Major Glen Bullivant is a 22-year veteran
of the British Army and currently serves
in the ARRC’s Preventative Medicine
cell. In his previous assignment he
served as the Commander of the Joint
Services Health Unit for British Forces
in Akrotiri, Cyprus. Maj. Bullivant
has provided environmental health
support across an array of combat,
peacekeeping and peace enforcement
operations in Bosnia, Kosovo, Northern
Ireland, Afghanistan and Iraq. A native
of Nottingham, England, Maj. Bullivant
holds a Master’s Degree in Occupational
and Environmental Health and Safety
Management from the University of
Portsmouth, a Bachelor’s Degree in
Environmental Health from Middlesex
University, a Post Graduate Diploma in
Strategic Leadership and Management
from Stratford Business School and a
Post Graduate Certificate in Education
from the University of Greenwich.
ALLIED RAPID REACTION CORPS
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