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File: 110796_aacki_02.txt6.. 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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