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Health Facility Team Improves Care in Combat Zone

By Karen Fleming-Michael
Special to American Forces Press Service

FORT DETRICK, Md., May 4, 2004 – As a nurse helping to design a medical center for Fort Bragg, N.C., in 1995, Lt. Col. Sharon Steele never envisioned she'd be taking that expertise into a combat zone. But after joining the Health Facility Planning Agency in 1999 and leading trips overseas to help create or improve health facilities, she's hooked.

Click photo for screen-resolution image
Health Facility team members at the Balad Hospital in Iraq are, from left, Lt. Col. Robert Rhodes, Lt. Col. Sharon Steele, Chief Warrant Officer John Burgess, and Chief Warrant Officer Chris Phillips. (Courtesy Photo)

(Click photo for screen-resolution image);high-resolution image available.

"Everybody is motivated to make these new facilities the best possible, given the resources, for the soldier," she said. As a clinical planner on the agency's Special Medical Augmentation Response Team, she and other team members visited Iraq, Afghanistan and Kuwait last year to share their expertise in planning health care facilities.

"We figure out what is needed: all the utilities, equipment, what services, where the rooms go and what type of construction, where it should be placed on the site, where the helipad should be, what climactic conditions will influence the design, the geographical and the combat conditions," Steele said.

She and the team also have to consider the local population's needs as well, because more than half of the care provided in U.S. and coalition hospitals in Afghanistan or Iraq is for the local people.

"We have a lot of clinical problems in taking care of the local populations in Afghanistan and Iraq, because there are so many cases of tuberculosis and other infectious diseases," Steele said. "Our DEPMEDS (deployable medical systems) hospitals are designed to be big wards in a tent. If we have someone who's infectious, that's a real issue." The team also takes into account local cultural norms. For example, men in both Afghanistan and Iraq don't want to be in the same wards as the women and children being treated.

Steele said the team will take on any task to help improve medical care. In her most recent trip to Kuwait, for example, her team offered advice to the staff of a medical and dental facility built by the Kuwaitis for the team's use, because its work wasn't flowing well.

"It was occupied before it was finished, so it hasn't been occupied the way it was designed," she said. "There were dental rooms in three places in the clinic and logistics rooms in two. It was all over the lot."

After analyzing the situation, the team left recommendations to the staff on possible fixes, which are based on the team members' expertise in working on brick-and-mortar hospitals and consulting with a team of architects, mechanical engineers and health facility and equipment planners at the Health Facility Planning Agency's headquarters in Falls Church, Va.

In Iraq, though, both the work and the working conditions were tough as the team tackled designing a hospital for a prison located inside a warehouse. Planners decided on building a concrete box inside the warehouse for two reasons: detainees can't climb out through the ceiling, and it protects the patients and equipment from dust, a real problem for health care workers in Afghanistan, Iraq and Kuwait.

Another job the team took on in Iraq was replacing DEPMEDS currently on the ground. "Those tents are not meant to stand more than a year to 18 months in the kinds of conditions they're in now, with 140 degrees in the summer, the sand and mud in the winter," she said. "They are beaten up, and it's very difficult to keep the surfaces clean, at this point, and to get the air changes that are needed in the critical clinical rooms in the building."

The team employs the lessons it learned in Kosovo, such as bringing in semi- permanent modular medical units, like trailers, that can be moved by truck, plane or ship to Iraq.

"It's a pretty inexpensive type of construction that is good for our clinical function," Steele said. "And if we decide that we're ready to move on to another place, we can pick it up and move it."

Steele's introduction to Iraq was bumpy at best. Upon its arrival in Baghdad, the C-130 transporting her and her team detected incoming fire and did "an awful lot of exciting maneuvers," and the pilot shot off flares, she said.

"At all times, you're well aware you're in a war zone," she said. "I really have a lot of empathy for the people who are there for long periods of time. You must kind of get used to it, but I can't imagine you ever would."

Steele said she breathed a "sigh of relief" when she left Iraq, but said visiting a patient ward in Balad, one hour north of Baghdad, reminded her of why she loves her job. "We don't spend much time on the wards," she said. "To see who we're working for makes it worthwhile."

Lt. Col. John Michael Olson, an architect with expertise in engineering and facilities management, spent nearly six months in Baghdad as part of a Special Medical Augmentation Response Team working as a member of the Coalition Provisional Authority. He and other facility planners from HFPA spent their days working with the Iraqi Ministry of Health to help establish health care processes and the system.

"The goal is to help the Iraqis improve and sustain the condition of health care facilities so the health care system will work better and the health of the population will get better -- not to put an American system in Iraq," he said. What made his job tough at first, he said, was that Iraqi planning and engineering staffs he worked with didn't use decision-making processes when it came to the health care system.

"They were more accustomed to a dictatorial, just-do-it type of process," Olson said. "They didn't know how to establish criteria or evaluate options to determine the best course of action. It's all new to them, because in the past it appears that most decisions were made for them and all they did was execute them."

Though the words "rebuilding" and "Iraq" often seem to be used together, Olson said rebuilding wasn't a top agenda item for the team.

"There were some facilities that do need rebuilding, but we had the philosophy that we need to establish a system and let the system solve the problems rather than try to deal with the facilities individually," he said. "We tried to balance the political tendency to get it done fast, which runs counter to good planning, and focus on the process, not the products."

The entire experience, Olson said, was "fascinating," and gave him an opportunity to see that what he does "really matters in a bigger role than just having a health care system be more efficient or effective."

"What we really were doing was helping a whole country and society have hope for a better life," he said.

(Karen Fleming-Michael is assigned to the Fort Detrick, Md., public affairs office.)

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Related Sites:
Health Facility Planning Agency
Coalition Provisional Authority

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