US, Burundian medical teams impact over 600 patients during a medical readiness exercise

BUJUMBURA, Burundi – Twenty-four U.S. Army medical professionals treated patients alongside Burundian counterparts at Kamenge Military Hospital, improving the lives of more than 600 patients in just two weeks.

The 30th Medical Brigade and the Burundi National Defence Force executed a medical readiness exercise that placed U.S. providers inside a partner-nation hospital, Aug. 17-28. During this MEDREX, they treated trauma, surgical and infectious disease cases in numbers they do not see at their home stations, and without the equipment they normally have.

That combination of real patients in an unfamiliar and resource-constrained clinical environment increases shared medical readiness. Part of the difference is who walks through the door.

“The facility here is primarily military led, but the patient population is more civilian than we see at my home base,” said U.S. Army Lt. Col. Nate Boyer, a pulmonary and critical care physician with the 30th Medical Brigade.

In Germany, Boyer's caseload centers on U.S. Soldiers and their families. In Bujumbura, it presented tropical diseases his team rarely sees.

U.S. medical experts spanned seven specialty areas: the emergency room, the intensive care unit, anesthesia, the operating room, dental, biomedical maintenance, and obstetrics and gynecology.

They worked the hospital's schedule, not a training schedule.

“Day to day, we arrive at the hospital and join rounds for our respective departments, so we can see what every patient is going through and how we can help,” said U.S. Army 1st Lt. Ashley Duke, a medical-surgical nurse with 30th Medical Brigade.

Duke said her team scrubbed in on several surgeries while encountering trauma cases and diseases rarely seen at military hospitals in the United States, but the caseload looked different for each specialty.

The dental section repaired a patient’s fractured jaw, treated a jaw tumor and performed 19 extractions and 16 fillings among more than 100 patients, 11 of them children.

In the intensive care unit, personnel managed patients with sepsis, a life-threatening reaction to infection. They inserted breathing tubes in several patients, responded to adult cardiac arrests and provided burn and other chronic wound care.

Emergency room experts assessed multiple patients transferred after vehicle crashes to treat wounds, fractures and lacerations, along with tropical and infectious diseases including malaria, rheumatic fever and tuberculosis.

Anesthesia providers traded techniques with their Burundian counterparts on intubation, patient positioning, preoxygenation, intrathecal dosing, difficult intravenous placement and pediatric care under anesthesia, while supporting numerous surgical cases.

Biomedical maintenance technicians restored a dialysis machine, an operating room light and a ventilator and exchanged preventive maintenance procedures for patient monitors and defibrillators.

Nearly all equipment used during the exercise belonged to Kamenge Military Hospital. Providers delivered care with the tools available instead of the ones they train on — a condition that mirrors deployed medical operations.

Boyer said that constraint is what makes the training valuable, and that the Burundian staff have already made it routine.

“The Burundian medical staff really do stretch what they have to care for as many patients as possible, while still providing great medical care compared to anything I’ve seen anywhere in the world,” Boyer said.

Boyer framed the two weeks as preparation for a scenario in which U.S. forces do not manage the hospital.

“It's the sharing between two different military facilities, two different military medicine departments,” Boyer said, describing the exchange that ran from medications to the ventilators used in the intensive care unit.

Boyer explained that U.S. forces could face such a situation in potential future large-scale combat operations, where they need to use other countries' medical facilities and medical equipment just like they did during the exercise.

A few U.S. medical-surgical nurses, combat medics and practical nursing specialists rotated across nearly all departments. In two weeks, they trained individual critical tasks, gaining a wide range of case exposure that would take far longer to accumulate at a single home station. Duke emphasized that adaptability was the most significant lesson she took away from the exercise.

“A lot of things are different here — but just because they’re different, doesn’t mean they’re wrong,” Duke said.

The U.S. team learned to navigate language barriers as the Burundi's medical staff speak primarily French and Kirundi.

“We relied on interpreters to help us communicate,” said U.S. Army Sgt. Charles Dubin, a licensed practical nurse with the 30th Medical Brigade. “We made it work because medicine is not just about talking. It’s about working side by side, showing what you know.”

For Dubin, the clinical gains were only part of what the team carried out of Burundi.

“The doctors, the nurses and the hospital opened their doors to us, allowed us to use their facilities and their medications,” Dubin said. “In the mornings when we’re working in the hospital, hearing people say, ‘bonjour’ and 'merci’ has been amazing. What I’ll take away from this is the relationships we’ve been able to foster being here.”

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