Towards a Better Approach to Medical Humanitarian Assistance in Iraq and Future Counterinsurgency Operations

Lesho, Emil; Jawad, Naseer Kadhim; Hameed, Husam Majeed

doi:10.7205/milmed-d-09-00156

Cited by 32 publications

(7 citation statements)

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“…by prescription) including Middle Eastern countries such as Saudi Arabia [4] and Iraq [28] could be an important factor for high community MDR bacterial colonization and community dissemination. Since the majority of the MDR bacteria in our study were isolated from local Iraqi patients, and this facility was their first point of entry into the healthcare system, these events /findings might reflect the baseline or ambient colonization in the local community [16].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Plasmids in Multi-Drug-Resistant Enterobacteriaceae Isolated during Prospective Surveillance of a Newly Opened Hospital in Iraq

et al. 2012

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Background Gram-negative multidrug-resistant (MDR) bacteria are major causes of nosocomial infections, and antibiotic resistance in these organisms is often plasmid mediated. Data are scarce pertaining to molecular mechanisms of antibiotic resistance in resource constrained areas such as Iraq. Methodology/Principal Findings In this study, all MDR Enterobacteriaceae (n = 38) and randomly selected non-MDR counterparts (n = 41) isolated from patients, healthcare workers and environmental surfaces in a newly opened hospital in Iraq were investigated to characterize plasmids found in these isolates and determine their contribution to antibiotic resistance. Our results demonstrated that MDR E. coli and K. pneumoniae isolates harbored significantly more (≥3) plasmids compared to their non-MDR counterparts, which carried ≤2 plasmids (p<0.01). Various large plasmids (∼52 to 100 kb) from representative isolates were confirmed to contain multiple resistance genes by DNA microarray analysis. Aminoglycoside ( acc, aadA, aph, strA/B, and ksgA ), β-lactam ( bla TEM1 , bla AMPC , bla CTX-M-15 , bla OXA-1 , bla VIM-2 and bla SHV ), sulfamethoxazole/trimethoprim ( sul / dfr ), tetracycline ( tet ) and chloramphenicol ( cat ) resistance genes were detected on these plasmids. Additionally, multiple plasmids carrying multiple antibiotic resistance genes were found in the same host strain. Genetic transfer-associated genes were identified on the plasmids from both MDR and non-MDR isolates. Seven plasmid replicon types (FII, FIA, FIB, B/O, K, I1 and N) were detected in the isolates, while globally disseminated IncA/C and IncHI1 plasmids were not detected in these isolates. Conclusions/Significance This is the first report of the characteristics of the plasmids found in Enterobacteriaceae isolated following the opening of a new hospital in Iraq. The information provided here furthers our understanding of the mechanisms of drug resistance in this specific region and their evolutionary relationship with other parts of world. The large plasmids, carrying resistance genes and transfer-associated genes, may be potential factors for regional dissemination of antibiotic resistance.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Plasmids in Multi-Drug-Resistant Enterobacteriaceae Isolated during Prospective Surveillance of a Newly Opened Hospital in Iraq

et al. 2012

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“…Often called "parachute medicine" training operations because teams dropped in and provided care for a short time and then left, this short-term model prevented long-term and follow up care for patients with chronic conditions [33]. Many participants recognized the need for long-term projects, and re-occurring MEDRETEs [34].…”

Section: The Promise and Pitfalls Of Medretesmentioning

confidence: 99%

The complicated life of a physician-soldier: Medical readiness training exercises & the problem of dual loyalties

Eagan¹

2013

JBiSE

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While physicians are generally understood as owing moral obligation to the health and well being of their individual patients, military health professionals can face ethical tensions between responsibilities to individual patients and responsibilities to the military mission. The conflicting obligations of the two roles held by the physician-soldier are often referred to as the problem of dual loyalties and have long been a topic of debate. This paper seeks to enrich the dualloyalties debate by examining the embedded case study of medical civilian assistance programs. These programs represent the use of medicine within the military for strategic goals. Thus, a physician is expected to meet his obligation to his role as a soldier while also practicing medicine. These programs involve obligations inherent in both roles of the physician-soldier and thusly they serve as excellent exemplars for the problem of dual loyalties at an institutional level. This paper focuses on Medical Readiness Training Exercises (MEDRETEs). These programs are short-term, generally taking place in low-income nations in order to accomplish strategic goals including training opportunities for military medical professionals that are not possible on the home front. This form of temporary program raises ethical concerns regarding the exploitation of vulnerable populations and the value of what is termed "parachute medicine". The short-term nature of these interventions makes long-term treatment and follow-up impossible, begging the question as to whether this peak and trough approach to foreign civilian aid is of any use. Physicians are generally understood as having obligations towards the well being of the patient, which these programs do not necessarily prioritize. Rather, the programmatic intent is military, with political and strategic aims of furthering international relations, increasing US military global presence and providing austere and tropical training opportunities for military healthcare providers. This can be morally problematic for the physician-soldier.

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“…6 That same three-part approach was followed here. In brief, initial meet-and-greet planning sessions, during which mutual objectives and capabilities were discussed, were followed by collaborative patient evaluations and consultations, and then by bi-lateral didactic sessions.…”

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“…5,6 This effort often requires a combination of relief and health system strengthening from governmental and nongovernmental partners. To direct relief in a timely and relevant manner, needs assessments must be performed before any decision to provide aid had been made.…”

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“…3,4 These fragile states are often far from achieving health-related Millennium Development Goals, and improving health in these settings is a high priority. 5,6 This effort often requires a combination of relief and health system strengthening from governmental and nongovernmental partners. To direct relief in a timely and relevant manner, needs assessments must be performed before any decision to provide aid had been made.…”

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Collaborative Medical Engagement and Needs Assessment in the Democratic Republic of the Congo: A Preliminary Report from Muanda

Lesho

Okito²,

Mann

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. The Democratic Republic of the Congo is the second largest and fourth most populous country in Africa. More than two decades of ongoing conflicts have degraded its healthcare system. A broad range of tropical diseases, along with opportunities for collaborative medical engagements (CMEs), are prevalent. However, reports from such events in this country are sparse. In June 2013, a CME was conducted in the western town of Muanda. Twenty-two hours of didactic sessions were collaboratively presented, and 158 patients were collaboratively evaluated. Durable dental and respiratory equipment, infrastructure improvements, and training opportunities were the top needs identified by the providers. Whether the regional referral hospital received sustainable benefit remains under investigation. However, the approach and needs assessment described herein provide a framework for future engagements or assistance. This CME established a precedence of medical partnership in the region because it led to the largest multidisciplinary joint collaboration in the history of the Democratic Republic of the Congo.With a population of more than 65 million persons, the Democratic Republic of the Congo is the fourth most populous nation in Africa and nineteenth most populous nation in the world. It is the second largest country in Africa and eleventh largest in the world, but a lack of infrastructure, including roads, makes travel throughout the country difficult.1 For much of the past two decades, this country has been torn by conflict. The Second Congo War left almost six million people dead in one of the most violent conflicts in the world and prompted security sector reform and professionalization of the military in the Democratic Republic of the Congo.2 Even today, conflicts continue in the eastern provinces of the country. 3As in all nascent states engaged in or recovering from conflict, access to healthcare had been limited throughout the Democratic Republic of the Congo in areas free from conflict, as well as those still engaged in it.3,4 These fragile states are often far from achieving health-related Millennium Development Goals, and improving health in these settings is a high priority. 5,6 This effort often requires a combination of relief and health system strengthening from governmental and nongovernmental partners. To direct relief in a timely and relevant manner, needs assessments must be performed before any decision to provide aid had been made. However, in these unstable states, needs assessments are often difficult to complete. 5Opportunities in the Democratic Republic of the Congo for assistance and collaborative engagement are plentiful, but because of difficulties inherent in performing these engagements, data and reports from such are sparse. In June 2013, we conducted a collaborative medical engagement (CME) type event outside the western town of Muanda. Muanda was chosen because, compared with Kinshasha or eastern Democratic Republic of the Congo, it provided a low risk/high yield opportunity because of ...

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Towards a Better Approach to Medical Humanitarian Assistance in Iraq and Future Counterinsurgency Operations

Cited by 32 publications

References 0 publications

Characteristics of Plasmids in Multi-Drug-Resistant Enterobacteriaceae Isolated during Prospective Surveillance of a Newly Opened Hospital in Iraq

Characteristics of Plasmids in Multi-Drug-Resistant Enterobacteriaceae Isolated during Prospective Surveillance of a Newly Opened Hospital in Iraq

The complicated life of a physician-soldier: Medical readiness training exercises & the problem of dual loyalties

Collaborative Medical Engagement and Needs Assessment in the Democratic Republic of the Congo: A Preliminary Report from Muanda

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Towards a Better Approach to Medical Humanitarian Assistance in Iraq and Future Counterinsurgency Operations

Cited by 32 publications

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Characteristics of Plasmids in Multi-Drug-Resistant Enterobacteriaceae Isolated during Prospective Surveillance of a Newly Opened Hospital in Iraq

Characteristics of Plasmids in Multi-Drug-Resistant Enterobacteriaceae Isolated during Prospective Surveillance of a Newly Opened Hospital in Iraq

The complicated life of a physician-soldier: Medical readiness training exercises &amp; the problem of dual loyalties

Collaborative Medical Engagement and Needs Assessment in the Democratic Republic of the Congo: A Preliminary Report from Muanda

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The complicated life of a physician-soldier: Medical readiness training exercises & the problem of dual loyalties