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Medics Protect U.S. Troops in Balkans

By Jim Garamone
American Forces Press Service

WASHINGTON, July 2, 1999 – From Macedonia to Kosovo to Albania, U.S. medical teams are busy protecting the health of U.S. peacekeeping forces against infectious diseases and unsanitary conditions.

While the most recognized mission of U.S. medics is to care for combat casualties, their role in force protection through preventive medicine is also vital, said Dr. Sue Bailey, assistant secretary of defense for health affairs.

Bailey, who just returned from an inspection of U.S. facilities in Albania, said medical teams are placing countermeasures to provide a safe, healthy environment for service members. She also went to ensure teams have all they need to do their jobs.

Before entering the Balkans, medics looked at the available medical literature. This pointed to problem areas. "We know the environment itself is a concern," she said. "There are endemic diseases and environmental pollutants that may affect one's health." "Endemic" means native or constantly present.

"One of the concerns is tick-borne encephalitis. We need to be thinking about clothing service members should wear and what pesticides and insecticides will provide a safe environment," she said. Preventing tick bites is better, and easier, than treating encephalitis, she remarked.

Dust is another concern. In Tirana, Albania, medical teams supported about 5,000 U.S. troops based at the city's primitive, dusty airport. The custom would have been to spray oil on the tarmac and the area to keep the dust down, but dust and oil fumes both cause respiratory problems, she noted. In Tirana, medics recommended using water.

Prior to deployment, service members were educated about how to stay safe and healthy in Kosovo, Bailey said. They received packages providing information on medical risks and endemic diseases in the area and providing practical tips on how to dress, control pests and more. Medics also briefed service members on the need for good sanitation.

Joint Staff officials pointed out the Balkan infrastructure has never been robust but conditions are especially bad in Kosovo today. Contaminated water and poor sewage sanitation were common problems there before the Serb invasion, and are worse now. One of the officials called Kosovo a potential public health disaster.

A number of diseases pose threats to service members in Kosovo. In February, the Armed Forces Medical Intelligence Center at Fort Detrick, Md., produced a disease risk assessment for the area. Here are some of the diseases that bear watching:

  • Diarrheal diseases -- The assessment says the risk to service members is moderate to high. Diarrheal diseases are year-round problems everywhere in the province. They are transmitted by ingesting contaminated water or food. Symptoms usually appear six hours to 10 days after exposure.
  • Typhoid and paratyphoid fevers -- The risks are moderate according to the assessment. Typhoid is an endemic, year- round threat, though more prevalent in summer. These diseases are spread by ingesting food or water contaminated by the feces or urine of infected humans. Fever and flu- like symptoms appear one to three weeks after exposure. The infection in the blood and various organs can be fatal if not treated with antibiotics. Service members can be immunized against these diseases.
  • Hantaviral diseases -- The risk of getting these diseases hinges on the presence of rodents, and the report puts their population on the rise. Hantaviral diseases are spread through aerosol transmission of dried droppings and saliva of infected rodents. Symptoms usually appear 14 to 28 days after exposure and include fever and headaches; complications include bleeding and kidney failure. Four hantaviruses have been found in the former Yugoslavia -- 120 cases and seven deaths were reported in 1995. Small outbreaks occurred in Kosovo in 1996. Most cases occur from June through August.
  • Arboviral diseases -- These viral diseases are transmitted by the bites of ticks, mosquitoes or other blood-sucking insects. Five arboviral diseases identified in the Balkan region are Crimean-Congo hemorrhagic fever, tick-borne encephalitis, sandfly fever, West Nile fever and Bhanja virus fever. The disease risk is tied to the Balkans tick and insect season of March through September. Symptoms range from a fever and flu-like illness to encephalitis, a rare, potentially fatal brain inflammation.
  • Sexually transmitted diseases endemic to the Balkans include gonorrhea and chlamydia. The occurrence of HIV/AIDS infections is increasing in the region.
  • Viral and bacterial meningitis -- The bacterial variety is more serious, but both are an inflammation of lining of the brain characterized by fever, intense headaches, nausea and vomiting. They are transmitted by direct contact with or inhalation of nasal and throat discharges of infected persons. The disease is more prevalent in the winter months. The most recent outbreak in Kosovo was in 1994, when 250 schoolchildren came down with the disease. Symptoms usually appear three to four days after exposure.

Other diseases endemic to the Balkans include hepatitis, leishmaniasis, Lyme disease, tuberculosis and leprosy.

Bailey found that U.S. medical forces now in the Balkans have received strong support from military commanders. The medical teams are doing a superior job, she said.

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Click photo for screen-resolution imageMedics brief Dr. Sue Bailey, assistant secretary of defense for health affairs, during a visit to Tirana, Albania. Bailey was checking out medical protection efforts of U.S. forces in the Balkans. Photo by Master Chief Petty Officer Karen Sayers, USN.  
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Click photo for screen-resolution imageDr. Sue Bailey listens to medics in a field hospital in Tirana, Albania, as they describe the challenges of providing force health protection in the Balkans. Bailey is assistant secretary of defense for health affairs. Photo by Master Chief Petty Officer Karen Sayers, USN.  
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