By Matt Pueschel,
FHP&R Staff Writer
For VIDEO, click here
Five years after a devastating 8.0-earthquake shook the southeastern coast of Peru, killing 540 people, injuring more than 15,000, destroying nearly 17,000 homes and displacing more than 40,000 people, U.S. military medics and civil engineers returned to the region this summer to provide follow-on health and civic assistance and disaster preparedness training.
“This project is what people here have been praying for,” said Jose Pepe Girao, of the Chincha municipal government for a Peruvian village where a reconstruction project took place as part of the recent mission. “It will improve the lives of many who have been suffering and it will bring them together.”
In addition to the recent mission, the Department of Defense had also played a prominent role in the immediate international relief response to the August 2007 earthquake, sending medical support teams to deliver aid, health assessments and urgent care in coordination with Peru’s National Institute of Civil Defense (INDECI), the State Department, USAID and NGOs. The quake had destroyed one of two hospitals that served the city of Pisco and severely damaged the other, as well as several referring clinics in the region. DoD helped fill gaps in the response effort that were not covered by other resources. “We were able to steer (our relief personnel) to where INDECI needed them to go,” said Dr. Lynn Lawry, who as a member of FHP&R’s International Health Division traveled to Peru in the quake’s direct aftermath to assist DoD leaders in conducting health needs assessments. “Some of the clinics were not functioning and they needed health care in some of the more remote areas. The interagency group on the ground and everybody cooperated -- DoD, the other agencies, NGOs, the U.N. It was not one person or one group.”
Some of the rural and mostly poor areas heavily affected by the earthquake’s epicenter in Pisco and Ica on the coast, and its reverberations felt in Huancavelica in the Andes mountains, are still recovering to this day, with reconstruction incomplete and people continuing to try to build back their lives. This summer, about 500 U.S. military health providers, engineers and support staff returned to the region over three months to provide medical relief and disaster response training. In a periodically recurring mission to the region called “New Horizons”, the U.S. Air Force, Army and Marines and NGO Project Hope worked collaboratively with Peruvian military medics and engineers to provide preventive, dental and minor surgical care to villagers in the region and rebuild clinics and clean water lines. The humanitarian civic assistance and training exercise, aimed at building an enduring partnership between the U.S., Latin America and the Caribbean, is about three months long and takes place in a different country each year. The last time it occurred in Peru was 2008 in Ayacucho.
This year’s $7.1 million New Horizon mission took place from the beginning of June thru August, with medical activities lasting six weeks, from June 19-July 31. The mission included medical readiness and humanitarian response training and medical assistance in Ica and Huancavelica, while engineering activities took place in two districts in the Ica province. Engineers from the 820th Expeditionary Red Horse Squadron collaborated with Peruvian military engineers on construction of a multi-use community center with a clinic, library, auditorium and playground in the town of Tambo de Mora, and an emergency room addition to a clinic in Independencia that will offer OB/GYN services and a 24-hour ER to some 15,000 local citizens. Both areas were hit hard by the 2007 earthquake. Girao said thousands of people were displaced in Tambo de Mora, which was struck by a tsunami that followed the earthquake. He said they will greatly benefit from the new center.
While these engineering projects took place, rotating groups of U.S. Air Force medics and Project Hope volunteers provided free medical and surgical care at 11 locations in the Ica region for 2-4 weeks at a time. Furthermore, in July some 40 U.S. Air Force medical personnel from an Expeditionary Medical Support (EMEDS) Health Response Team of the 633rd Medical Group set up a mobile field tent hospital on a soccer field in Huancavelica to treat several thousand patients over a month. Working at 13,500 feet above sea level in the frigid winter air of the Andes mountains under a strong sun that turns locals’ cheeks bright red, U.S. Air Force and Peruvian soldiers unloaded countless pallets from trucks that had driven 11 hours up winding roads to reach the field. Over a full day, the two countries’ military members worked tirelessly as a team, unpacking boxes and eventually assembling their contents into a 22-room, 6,300-square foot linked network of medical tents that comprised the EMEDS hospital.
“For us, it was something amazing because of all the containers and the rapid installation, the tents, and basically the immediate start of medical services,” said Dr. Jackson Sanchez Ponvalasa, a Peruvian surgeon and director of the regional hospital in Huancavelica, speaking in Spanish. “We saw that the first module took about an hour, and they were able to start seeing cases, like emergencies. We were really surprised because that module showed the first part of how the population responded. As the other modules are put in place, it shows the phases that they have and it is incredible because they don’t have to wait until the whole tent is built to start seeing patients. It’s immediate, fast and efficient. I think it’s brilliant.”
Medical care included both general and specialized care, as well as some orthopedic, cosmetic and other surgical procedures. Treatment was focused mainly on primary care, pediatrics, internal medicine, family medicine, gynecology, eye and dental care. Announcements went out in advance to the local communities to inform residents who might be interested in receiving dental, optometry and primary care, and Peru health officials made final determinations on which patients were selected for surgeries.
In all, more than 26,300 patients were attended to during the overall mission in two regions of Peru with tremendous needs. The mission’s Facebook page included several likes and comments expressing gratitude. “I like that our soldiers are doing an amazing job with the people here and they are providing the quality care that they need,” said Lt. Veronica Perez, Operations Officer for the 228th Combat Support Hospital. “(Peruvian) dentists are working with (the U.S.) Army and Air Force and they’ve been able to learn from each other’s experiences in what they do. I think that the locals really like us here. A lot of them came up and said, ‘thank you so much for coming out here and doing this for us’.”
Educational Exchange Strikes Chord, Builds Mission Harmony
Perhaps the most impactful component of the mission was a disaster preparedness and response management exercise and subject matter expert exchange (SMEE) that included several training activities at various sites in Pisco from Aug. 1-10, after U.S. and Peruvian military personnel had set up and operated the mobile field hospital. The exchange was coordinated between INDECI, the U.S. Air Force, the U.N. Office for the Coordination of Humanitarian Assistance, USAID’s Office of Foreign Disaster Assistance and the U.S. embassy’s Military Group. It included a training course on emergency communications systems, an exchange of lessons learned from previous natural disasters that had occurred in Peru and West Virginia, a basic light structural collapse search and rescue operation, first responder and basic and intermediate first aid courses, with a practical live exercise on the last day. The first aid course was so popular that a second course was held. Even after that, more locals expressed interest in participating. So, U.S. Air Force medical personnel taught a train-the-trainer course in basic first aid to Peruvian military medics, who then taught two classes to 230 participants with U.S. medics just observing and assisting where needed.
“There was such a high demand, we had to launch a second session of the first responder basic first aid course to meet the desires of the community,” said Rolando Benavides, Peru INDECI Disaster Risk Management Specialist and Disaster SMEE Liaison Coordinator for the New Horizons events, describing the exchange as a “pebble thrown into a lake”. “Ripples of preparedness will spread out wider through the region as people teach each other the skills they’ve learned. Each time they pass on the information, they will expand the ripple until all of Peru’s first responders share in the knowledge and are more prepared to respond to future disasters. The people of Pisco were greatly affected by the 2007 earthquake and still feel the importance of staying prepared. They know it’s important to be ready and they want to know what to do.”
Speaking in Spanish through an interpreter at Pisco Air Base, which served as one of the training sites, Maj. Gen. Fermin Vera Flores, Sanition Section Chief of Peru's Air Force, praised the value of a two-day basic flight medicine expert exchange exercise that was held on the base and suggested establishing a regular program where more Peruvian flight doctors and surgeons could receive basic flight medicine training in the U.S. He said it would assist Peru in retaining and recruiting flight medics to address a current shortage they have. “Today I’ve had the opportunity to participate in this exchange between flight doctors both from the U.S., as well as Peru,” he said. “The experience is very motivating. It’s permitted us to learn about certain situations that you encounter that we’ll be able to utilize, too. The human factor is very important, and the pilot should be completely ready and in optimal condition to be able to fly. We’ve learned about ophthalmology problems, spatial disorientation, which will serve us later on. Knowing the power that the U.S. Air Force has, for us as the Peruvian Air Force a training class in the U.S. for our flight medics would have a tremendous value because we only have the basics here.”
Maj. Gen. Vera Flores also mentioned that the U.S. Air Force donated two aircraft to the Peruvian Air Force recently. “We will be able to refurbish them and it will help us a lot,” he said. “Also, the support you are giving us to combat illicit drug trafficking is highly important. Illegal drug trafficking is not only a national problem in Peru, but a problem at the international level and it affects the U.S. a lot. We have to be strict in combating it, for the youth in your country, as well as in ours.”
Dr. Ponvalasa said the New Horizons mission was preceded by a lot of coordination and produced excellent results. “We were committed to help with this campaign from the beginning,” he said. “The Peruvian doctors were very eager to learn the experiences from the U.S. doctors. People who have always been involved with this campaign have made this not a services campaign, nor a donation campaign, and not a campaign of help, but a knowledge exchange campaign. The U.S. doctors are bringing back very grateful experiences, as well as the Peruvian doctors.”
Alonso Navarro, Ica Regional President, agreed, saying the disaster response SMEE has helped both Peru and the U.S. become richer in knowledge. “Knowledge is a wealth that doesn’t end once transmitted, unlike a transaction of money,” he said.
Officials from INDECI, which is the Peru equivalent to the U.S.’s Federal Emergency Management Agency, were really excited about the turnout and want to hold similar courses in the future in the Pisco region and throughout other regions of Peru to increase first responder preparedness. The training was a great success in partner nation capacity building, particularly since there is a desire by Peru to continue this course in the future.
Mutual Healthcare Activities Produce Sustainable Results
“We are encouraging these types of DoD humanitarian medical outreach missions that have a focus on local capacity building and exchanging medical education with the partner country’s military health leaders and civilian organizations so that we contribute to a sustaining, public health impact that assists the host nation in improving their medical and crisis response capabilities over time,” said Dr. Warner Anderson, Director of the International Health Division in the U.S. Department of Defense Office of Force Health Protection and Readiness in Falls Church, Va. “When done correctly like this, these missions enhance our partnerships and collective preparedness with the host nations in the region so that we can respond effectively together should a future crisis occur. Through emerging pre-deployment U.S. Military Health System international training programs on cultural customs, health terminology in foreign languages, local standards of care and medical ethics, we are also developing useful guidance to help MHS providers successfully carry out these important global health engagements.”
Dr. Ponvalasa said the U.S. doctors likewise learned from the exchange by seeing Peruvian patients at the Huancavelica hospital, offering opinions about treatment, monitoring and follow-up care, while the Peruvian doctors asked questions and gathered knowledge about U.S. procedures for the same pathologies. “The sharing of experiences in more than two weeks of presence of the American doctors have made us seen the U.S. not only as a country where there is technology, development and a lot of movement, but it is also a country that shows humanity, support, and interest in exchanging knowledge,” he said. “We’ve won not only companions, but friends. In the future we wish that these campaigns not only happen in Huancavelica, but also in different regions because that way we can reach the people that need it the most and also share knowledge with doctors of distant communities.”
In the initial stages of the mission, Dr. Ponvalasa said his perception was that it was going to be “external help,” but that quickly changed as a few days went by and he became more closely involved and the close collaborations developed. For example, one initiative between a Peruvian doctor and an American doctor involved a surgery of a parasitic ‘hydatid’ cyst, which is very common in Peru but not usually seen in the U.S. Maj. Brian Neese, an International Health Specialist assigned to the 12th U.S. Air Force (Air Forces Southern), attended the procedure to watch the Peruvian doctor perform it and see how it is done. Afterward Maj. Neese wrote an article about it for the local newspaper, El Correo, in which he said he will remember his friend from Peru if he encounters such a cyst in the U.S. and will know how to treat it. “This is a very beautiful article and very special that definitely shows that the U.S. doctors are taking grateful experiences, and so are the Peruvian doctors,” Dr. Ponvalasa said. “I am convinced that this can continue forward and be the beginning of a series of campaigns across Peru.”
In the Huancavelica medical exchange, doctors saw up to 350 people a day in the various specialty clinics inside the mobile tents with those in critical condition being referred to the local hospital for Peruvians to perform procedures and necessary follow-up care. “The population is convinced that the treatments they’ve received here in this camp have been quality services given with kindness and love,” said Dr. Ponvalasa. “They are definitely convinced that they will get better and heal.”
U.S. Air Force Capt. James Small said the time he spent with each local patient allowed him to develop important connections with Peruvians while providing them with invaluable reassurances about their health and lives. “I’m going to come away from here with a deeper level of compassion and appreciation of what I can do for my patients,” he said.
The mission also illustrated the value of interagency cooperation in medical relief missions. The U.S.-based NGO, Project Hope, sent three two-week rotations of various medical specialists to assist the Air Force with the mission. Dr. Alan Jamison, of Project Hope, said that the NGO’s volunteers worked side by side with U.S. and Peruvian military medics and physicians to provide care to the local population, which lined up to wait to be seen in droves. He said the NGO enjoyed the interactions, and each component provided valuable contributions. “The military through DoD provides the infrastructure for us to function,” he said. “Our Project Hope team comes in with just the volunteerism and desire to be helpful and provide humanitarian aid. The military provides all the structure and supplies and equipment and all the pharmaceuticals for us to work with, plus we have some considerable guidance (from DoD) in transportation services. The military knows how to get things done in a large manner and how to move people and how to move equipment, so it’s very important. We would not be here without the military on this program.”
U.S. Air Force Maj. Brad Cogswell, a 12th Air Force (Air Forces Southern) planner, said a lot of host nation military medical and civil medical participation was requested for the mission. The included focus on local capacity building and sustainability could be a potential catalyst for more organized and thorough whole of government approaches in comprehensive planning for future such missions. The disaster readiness training exercises produced transfers of skills both ways between the two countries, and the mission helped the U.S. maintain a valuable partnership in the region. “They help ensure operational readiness to respond to crises, promote security interests of both the U.S. and the Partner Nation (Peru), enhance operational skills, and help local communities where the events are conducted,” he advised.
[Capt. Candace N. Park, U.S. Southern Command Public Affairs Director for the New Horizons mission, provided information from the mission site that was used in this story]
For more information, please visit U.S. Southern Command New Horizon News.