1640 TAW (P) CLINIC LESSONS LEARNED

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48 see figure one). Most cases responded to supportive care, however severe or
protracted cases were managed utilizing the treatment algorithm for Traveller's
Diarrhea in Sanford's Guide to Antimicrobial therapy 1989. No cultures were
available. Although proper chlorination of water to sanitize vegetables was
stressed, fresh vegetables were the suspected source based on diet histories.
Also, after the temporary discontinuation of all fresh fruits and vegatables
(except peeable fruit), the outbreak stopped. No significant outbreaks have been
seen since, and frequent mess hall inspections are ongoing. Base personnel also
have access to host nation NCO and Offers club; I have accompained the host
nation medical staff on sanitation inspections and have been favorably impressed.
Gamma Globulin was re-administered to camp personnel (over (90%) and is
ongoing.

5. OTHER COMMUNICABLE DISEASES
Arthropod - borne diseases such as Cutaneouis Leishmaniasis, Dengue Fever,
and Onchocerciasis exist on the mainland, but their incidence on Masirah is
unknown. According to the local medical authority, these illnesses do not pose a
significant threat, no do other communicable diseases endemnic to the Middle East,
such as Chlamydia conjunctivitis. In 5 1/2 months several patients have had
self-limited febrile illness presumed viral in etiology. None, however, have been
serious or protracted and therefore no exotic artbropod-borne illness have been
suspected. Whether or not endemic ticks represent disease vectors is not known
the present time, however several have been found and are preserved for
future identification.

6. ANIMAL ANDARTHROPOD THREAT
Rodents have been noted in tents. This has not been a significant
problem, however, and the current level of camp santitation is very good. Several
(less than five) snakes have been noted in the rocky area around tent city. One
small (30cm) snake was captured and is preserved for future identification. (it
may be a Saw Scale Viper). One scorpion and one camel spider were found early
in the deployment but were not preserved. Viper and scorpion antivnin are
available at the local hospital. During peacetime, a beach was available for use.
Host Nationals report sharks and sea snakes, although none were observed over
4 1/2 months of beach use. Only minor pufferfish and jellyfish stings were
observed.

7. LOCAL MEDICAL ASSETS
A RAFO Medical and Dental Clinic is on station, and is staffed by an India -
trained General Medical Officer and General Dentist, as well as several locally
trained medics. They have approximately 10 inpatient beds although an additional
20 beds have been prepositioned at other camp locations in case more extensive
patient holding capability is required. There is also a local civil hospital with
approximately 30 inpatient beds. The hospital staff is alos India - trained and
includes 2 General Practioners (one of whom focuses on obstetrics), one surgeon,
and one anesthetist. An operating suite, plain x-rays, and basic laboratory tests
are available on site. More sophisticated laboratories can be drawn at the RAFO
clinic and shipped to the Military Hospital at Muscat. Blood products are
available at the civil hospital, however in the our hemorrhagic shock patient seen
to date, crystalloid was used for stabilization was used for stabilization prior to
and during air-evacuation. The local civil hospital's level of sanitation is not at
a level observed at Western hospitals.