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        6.. Patient Workload: See attached summary sheets formatted to comply with
CENTAF/SG theater requirements.  Summary of these tables for 17 Sep 90 - 21
Mar 91:
          Outpatient visits:  3658
          Admissions: 6
          Aerovacs: 3
          DNIFs: 335
          URTIs: 444
          Gastroenteritis: 152
          Dermatological: 254
          Opthamological: 13
          Non-Battle Injury: 75
          Battle Injury: None

       7. Professional Intelligence:
          a. Community Environment and Sanitation:

              (1) Health Services - Host country military medica1 facilities were
                 available for Tertiary referral on an individual case basis. 

       (2) Water Supply - City of Riyadh water was a mixture of 2/3
       desalinated and 1/3 aquifer, with adequate free chlorine residual, Local
       policy of using bottled water for drinking persisted more due to theater
       practice than need.

       (3) Sewage disposal - City wide sewage system with occasional
       exuberant odors in certain downtown areas. Local, porcelain, floor elevation,
       pit style toilets were cbe norm except at Eskan Vlllage where European style
       fixtures were installed.

       (4) Local Restaurants - Good city wide health code. No restaurants
       were off limits. No gastroenteritis cases implicated any commercial eating
       establishment from Schwarma Shops to Indian Restaurants, Kentucky Fried
       Chicken, Pizzarias, to Wendy' s.

       (5) Insects and animals affecting beaIth - No Significant problems
       noted in urban environment. However, local housefly populations were heavy
       in warmer weather and, in fact, are the anticipaced vectors for annual
       shigella outbreaks wbich occur every early fall. Domestic cats and especially
       dogs are culturally considered unclean and generally shuned but a large stray
       cat and much smaller stray dog papulation exists and could potentially present
       a significant zoonotic reservoir.

      (6) Between 6 and 10 Oct an estimated 400 cases of debilitating
      diarrhea, nausea, vomiting and chills developed in the Eskan population.
      Within our AWACS community, there were 85 cases including 49 DNIFs.  Eleven of
      20 stool cultures of initial patients resulted in Shigella sonnei pure
      cultures The absence of positive cultures within our AWACS community is
      attributed to our early suspicion of bacterial gastroenteritis due to the
      severity of symptoms and rapid spiking above the normal background of one or
      two AGS daily which prompted our early use of antibiotics.  Despite these 
      positive patient stool cultures, an exact source was never identified (all
      contract food handlers were rectally swabbed without a source) a single
      positlve salmonella culture was derived from an Oasis mess tent beverage

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