Observations From Embedded Health Engagement Team Members
Introduction: A joint embedded health engagement team (EHET) was created and executed as a test of an alternative health engagement method during Operation Continuing Promise 2011. This article relates the personal observations of team members.
Materials and Methods: The EHET was integrated into the host nation’s public health system to collaborate in direct patient care, contribute to comprehensive preventive health, and achieve intellectual exchange between professionals of similar disciplines. Team members recorded their personal observations, noting particularly how they worked with the partners and how the EHET differed from other methods of health engagement.
Results: EHET resulted in greater satisfaction on behalf of the host nation and US health professionals, detailed insight into local operations and health system understanding, deeper empathy and respect for similar challenges despite differences from US and US Department of Defense health system practices.
Conclusions: The EHET afforded deep insight by team members into ways to partner with hosts to target better health outcomes and meaningful partnership for potential long-term geopolitical impact. EHETs of longer duration, or recurrent insertion, in a single location will achieve greater long-term benefits because of greater health system and cultural understanding that can be attained. EHETs will be a more effective health engagement tool in building partnerships, building capacity, increased security cooperation, and enhance medical readiness while using US military resources to support legitimate health needs either in a military to military or military to civilian setting.
Medical Technician (MSgt, E-7, Independent Duty Medical Technician, USAF)
“The first day I was assigned to work with the ‘auxiliaries,’ nurses working in the urgent care area at the clinic. Their urgent care area had limited equipment and supplies and included equipment such as mercury thermometers, a few stethoscopes and 1 blood pressure cuff. Their duties consisted of screening patients, starting IVs, giving injections and breathing treatments. They also had a minor surgery room where the nurses helped.
“During the observation of the placement of an IV catheter, I noticed that they were using a port and attaching a needle to the IV tubing and leaving the needle attached to the patient. I asked them about their procedure and incidents with needlesticks since they had to be pretty accurate in getting the needle through the port. The nurse stated there were a significant number of cases of needlesticks. The following day, we brought 18-g, 20-g, and 23-g IV catheters, saline locks, syringes, and our team’s junior physician and I instructed the nurses how to set up an IV without using the needle port.
“The third day at the clinic, I assisted in checking in patients (blood pressure, weight, interviews). I also helped run the immunizations clinic, assisting in giving both pediatric and adult immunizations. Since there was only 1 nurse on shift that day, we multitasked and also gave injections prescribed by the providers, such as medroxyprogesterone and dexamethasone. By far, this was the most rewarding part of the mission. I really felt as though we were part of the team and believe we truly made a difference.”
Administrator (LTC, Medical Service Corps, USN)
“I learned many items from our visit to Clinica Dr. Francisco Quintanas Area de Salud 4 Chacarita. I reviewed the business plan contained in two 1.5-inch hardbound books. Their business plan outlined the population served, projections for upcoming year, and contracts. Area 4 served 21,344 people (11,197 men and 10,147 women). The business plan reviewed historical encounter information (ie, average patient is seen 2.6 times annually, 203,285 laboratory tests were performed in 2010, no radiology capabilities) and contained metrics for key programs for upcoming year (eg, vaccinations, women wellness) that seemed similar to US Healthcare Effectiveness Data and Information Set (HEDIS) measures.
“Our partners discussed financing of the health care they provide, including money flows to and from the government, the work center, and the employees. The business plan contains contract information and costs for maintenance, utilities, personnel, and other issues that would be typical for US-based operations as well. Housekeeping, some of the secretaries, and security staff are not employees—they are contracted personnel. Money is shifted to meet unexpected needs (ie, in 2009/2010–H1N1 influenza was unanticipated). Money was taken from other programs to meet the need.
“Within the Area 4 clinics there are 94 personnel, including 15 physicians. They have a document that is similar to our Activity Manning Document, which outlines personnel billet code, name, and specialty. The Asistentes Técnicos de Atención Primaria are the personnel who conduct home visits and are a unique capability—we do not have an exact equivalent in most US health care systems. Pregnant workers are released from work 1 month prior to the due date and are expected to return to work 3 months postdelivery.”
