1640 TAW (P) CLINIC LESSONS LEARNED

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SUBJECT: 1640 TAW (P) CLINIC LESSONS LEARNED

CLINIC: Lessons Learned

The initial deployment and first six months of operation were under the
supervision of Capt (Dr.) Chris Budny. Uunfortunately, he took almost all of the
pertinent information concerning that period of time with him back to Pope AFB.
He is preparing an after-actton report for HQ TAC/SG with it. This report is
prepared based on a medical Intelligence Report (attach #1) and Summary of
Activities (attach #2), both prepared by Dr. Budny, the collective knowledge of
the remaining technicians and my own observations since early February.

CLIMATE: Masirah is a desert island with temperatures, while mild by Persian
Gulf standards, that range from highs in the 80's during the winter to the 90's
in the summer. Vigorous education and enforcement of water discipline kept heat
casualties minimal. One individual, a repeat kidney stone former, was airevaced
out of the AOR, He continued to pass stones despite his best efforts at
hydration. He should not have been given medical clearance for deployment here.
This environment is also very dusty which aggravated asthmatics. One individual
required air evacuation out of the AOR. Again, this individual should not have
been given medical clearance.

FOOD BORNE ILLNESS: Early in the deployment, there was one epidemic of 68 cases
of gastroenteritis. Diet histories pointed toward locally purchased fresh fruits
and vegetables as the most likely source, consistent with the low level of local
sanitation off-base. Proper preparation and chlorination of fresh fruits and
vegetables was restressed. There have been no subsequent out- breaks.

ANIMAL THREAT: There are a number of diseases borne by arthropods and insect
vectors on the mainland. These have not been seen by either American or local
medical personnel. No case of malaria has been seen on Masirah in nearly five
years. The Omani military officials do spray in the camp.

Rodents are present but have not been a factor when proper sanitation
procedures are followed. An isolated incident of rodents nesting in the dining
hall storage room was quickly resolved after proper storage practices were
resumed.

Poisonous snakes, scorpions and camel spiders are in the local area. There
have not been a factor and have only been seen on a few isolated occasions.

There is a beach accessible to base personnel. Sharks, poisonous sea snakes
and sea wasps are in the local waters. However, there has been only one incident
of a jellyfish sting, one individual who was knocked down by a wave, and several
cases of 2nd degree sunburn. This is actually less than what is given on a
typical day in an BR near Waikiki Beach (personal experience).

Overall, the camp has been kept orderly and no consumable items have been
left out. The lack of proper shelter and food sources has kept pests to a
minimal level.

LOCAL MEDICAL ASSETS: There is a local military (RAFO) clinic and civilian
hospital. Both are staffed with Indian trained physicians. Neither meets
western standards for either capability or cleanliness. Turn around time for
routine lab procedures is lengthy, XR quality is suboptimal and blood products,
like all of the AOR, are of questionable quality. While there is surgical backup
at the civilian hospital, it is strongly recommended that emergency and
potentially urgent patients be evacuated to either the nearest American military
hospital (ATM) or western staffed civilian hospital (such as exists in Riyadh).

AEROVAC: Initially, there was a significant capability here with the presence
of both C-130's and an air evacuation squadron. This has gone with the drawdown
of forces and an emergency air evacuation could take as much as 5-6 hours to
complete. We have made free use of opportune airlift for any potentially
unstable patient. All commanders are aware of this policy and that their troops