Working together toward the same end--strengthening the health care capacity and crisis response capabilities of African nations to ultimately empower Africans to improve their health and security--was the theme of a conference in Washington, D.C., hosted by the Military Health System that introduced the new U.S. Africa Command surgeon to an array of partners from the military, Department of State, U.S. Agency for International Development (USAID), and the African Union.

Developing the best ways to work more closely together to achieve the same goal was one of the underlying topics throughout the "Africa Command Health Symposium: Health as a Bridge to Peace and Stability," held January 8-9, 2009 at the Institute of Medicine.

The work of Africa Command Surgeon Colonel Schuyler K. Geller, Africa Command surgeon, and his medical team consists of helping African militaries develop their health-care capacity, such as assisting with the training of military medics in Liberia, placing their medics on Navy ships in the Africa Partnership Station off West Africa to engage host nation militaries with CPR, pre-hospital life support and battlefield medicine triage training, helping the Moroccan military with rotary wing medical evacuation techniques, and developing more realistic exercises for the Mali military on triage and disaster response techniques through the use of moulage (simulated wounds) in patient simulations. The Africa Command surgeon also supports humanitarian aid and disaster response missions, as needed and when requested.

"When you do little things like a local vaccination program or a local nutrition program, what people are thinking is that their lives are worth your attention and it gives them hope," said Dr. S. Ward Casscells, Assistant Secretary of Defense for Health Affairs, at the symposium. "People begin to [think] they are going to be around when things get better. [They] begin to think longer-term and invest in themselves, because their health will carry them through."

Casscells encouraged the symposium's speakers and attendees to introduce their best ideas for low-cost public health solutions in Africa, such as "training the medical trainers" and developing better health surveys.

Geller cited four civil affairs projects in Mali in which Africa Command medics successfully worked with host-nation military medics and the Ministry of Public Health to deliver health care to the local population, as well as veterinary care to help sustain their farming capacity. This included entering one village that had previously been fearful of rebel forces. "We have to have buy-in from the community," Geller advised. "We always engage their elders. On the first visit, no one would come out of their homes. The Malian military escorted us to the village and translated. It took three or four visits, but health is [such] a huge need."

Furthermore, through the Defense HIV/AIDS Prevention Program, DoD is assisting host nation militaries with voluntary HIV testing and treatment. The Walter Reed Army Institute of Research (WRAIR) has a lengthy record of supporting disease surveillance and the prevention and treatment of malaria and Rift Valley fever in Kenya, and the U.S. Army Medical Research Institute of Infectious Diseases carries out research on such diseases as Monkey Pox in the Congo. The U.S. Naval Medical Research Unit No. 3 in Cairo, Egypt, established since 1946 and a WHO Collaborating Center for HIV and Cholera, also conducts surveillance for emerging infectious diseases in military populations.

The mission of U.S. Africa Command, which was launched in October, 2008 to consolidate parts of three existing commands and better focus the military's work in Africa in concert with other U.S. government agencies and international partners, is to conduct sustained security engagement through military-to-military programs, military-sponsored activities, and other military operations as directed to promote a stable and secure African environment. Geller cited the command's unique interagency aspect in that it was established with a complementary mix of military members and civilians. Agencies such as USAID, the Departments of Homeland Security, State, Treasury, Commerce and Agriculture, the FBI and the U.S. Coast Guard all have embedded leadership positions within Africa Command.

Geller said Africa is the highest medical risk continent on which the U.S. military operates, with high rates of HIV/AIDS, maternal and childhood mortality, diarrheal disease, TB, malaria, hemorrhagic fever, malnutrition and parasitic diseases.

"Africa Command is all about increasing security and stability on the continent," Geller said. "I believe that health is one of those ways we can build a bridge to peace and security."

One of the military's strategic objectives is to protect the American population from deadly contagions emanating from Africa, so another goal of the Africa Command surgeon is to work with the host nation military medical infrastructure to develop surveillance and response plans for avian or pandemic influenza, and other emerging infectious diseases.

"Our goal is to enhance coordination and create more sustainable medical programs within our military to military engagement efforts, fully mindful of the many positive externalities on civilian public health infrastructure and capacity that might ensue," Geller advised. "We're supporting other people do what needs to be done and health is something that makes people stand up and say yes to."

A panel of experts from USAID spoke at the symposium about improving stability in Africa by addressing drivers of conflict through community-based programs, developing host nation capacity to respond to secondary illnesses during a pandemic, strengthening supply chain systems to improve continuity of care, and developing partnerships with DoD in areas where security is an issue.

"At USAID, we really are committed to the importance of this relationship with DoD in Africa and other parts of the world," said Dr. Kent Hill, USAID's Assistant Administrator for the Bureau of Global Health. "No one agency can accomplish everything. The increased importance of this cooperation is evidenced by the fact that we now have an Office of Military Affairs at USAID."

"The link between security and development is clear throughout Sub Saharan Africa," added Franklin Moore, USAID's Deputy Assistant Administrator for the Africa Bureau. "A whole government approach is more successful and sustainable, ultimately."

Other symposium presenters included the U.S. Health Attache to the African Union, and experts from the Department of State, Walter Reed Institute of Research, the Telemedicine and Advanced Technology Research Center, the Defense Centers of Excellence for Psychological Health and TBI, the AMAR International Charitable Foundation, the OSD/HA International Health Division (which organized the conference), and the World Bank, which expressed interest in possible future collaborations through its Program on Health, Nutrition and Population.

Other topics discussed included China's investment in Africa; mental health care for providers of humanitarian aid; partnerships with NGOs in distressed areas to recover and sustain professional health services; and the arrival of a "perfect storm" to utilize emerging technologies to help meet health needs in the developing world through the use of mobile phones. For example, HIV prevention and health education messages or patient appointment and medication reminders can be sent at low cost to African host nation military members in remote peacekeeping areas. Low literacy rates and the large number of languages spoken in Africa remain challenges, but DoD is exploring ways to leverage picture and text messages or video/audio clips to improve health communication.

Dr. Chinua Akukwe, Executive Chairman of the African Union Africa Diaspora Health Initiative, spoke of the AU's strategy to strengthen its health systems. With thousands of African physicians now living outside the continent, Dr. Akukwe said the diaspora initiative was launched to enhance the continent's health workforce and support best practices by bringing in professionals for short-term appointments. "Africa accounts for 10 percent of the global population, but represents 24 percent of the global burden of disease, and only one percent of all health spending worldwide," he said. "Ultimately the AU wants to be free of the burden of disease and disabilities and premature deaths."

Geller said the best care is not always about the number of patients seen or dollars dispersed for prescriptions, and he plans to develop a set of measures of effectiveness that his medics can utilize to be more successful.

"This is about a lot of possibilities and about hope, and it's time to translate that into action, as we work together to find ways to partner," said Ms. Ellen Embrey, Deputy Assistant Secretary of Defense for Force Health Protection and Readiness, at the symposium.

Full symposium coverage and materials are available at http://fhp.osd.mil/intlhealth/africomConf/

Read Colonel (Dr.) Schuyler K. Geller's blog on the conference at http://www.africom.mil/africomDialogue.asp?entry=440.