Health Challenges of the Peacekeeper in Africa: A Practical Briefing

1. Health Challenges of the Peacekeeper in Africa: A Practical Briefing Col(Ret) Lesley-Ann Jacobs Defence Analyst Defence Decision Support Institute Note: The opinions expressed herein are those of the presenter and do not in any way reflect the official standpoint of the Dept of Defence or any of it’s components. All material used has been sourced, unless otherwise stated, from public domain sites.

2. Scope • The P of POSTEDFIT • The soldier in a foreign physical environment • Physical health challenges • Psychological health challenges • Implications for force preparation

3. INFANTRY CAPABILITY SUPPORT AND SUSTAINMENT ARMOUR CAPABILITY AIR CAPABILITY POSTEDFIT Capability Elements OPERATIONAL CAPABILITY Personnel Organisation Support Systems Training Equipment Doctrine Facilities Information Technology Functional Attributes of a Capability Firepower Mobility Protection Command and control Information Sustainment S F P O T E D I T

4. The Soldier in a Foreign Environment Physical Factors • Immune system implications • Immunity against foreign pathogens • Change in climate • Exposure to foreign physical environment • Hygiene and environment • Living arrangements Psychological Factors • Exposure to unfamiliar environment and culture • Exposure to circumstances beyond his/her control • Factors inherent to deployments

5. Physical Factors Disease Injuries Self Inflicted Disease Environmental Factors • Zoonotic • Insect/ Arthropod borne • Food/ Water/ Soil borne • Human- Human Transmission • Unintentional • Intentional • Substance Abuse • Malnutrition • Poor Hygiene • Pollution and Contamination • Water/ Food/ Soil/ Air

6. Diseases • Diseases that can be transmitted from animals, wild or domesticated, to humans. • May be through direct contact with infected animals, or via the bites and scratches or indirect via vectors. • May be bacterial, viral, fungal, parasitic, etc. Examples: Tuberculosis, Plague, Rabies, Anthrax, Yellow fever, Brucellosis. • Important in African countries are the Viral Hemorrhagic Fevers such as Ebola, Lassa, Crimean Congo Fever Zoonotic Diseases

7. Diseases Spread By Arthropods/ Insects Diseases spread through insects which function as a vector, e.g malaria, plague, tick bite fever,. These may be bacterial, viral or parasitic. Vectors include fleas, lice, mosquitoes, ticks, bugs, etc. Malaria (parasite) is more deadly than HIV in Africa. Mosquitoes are the greatest menace carrying amongst others malaria, dengue, West Nile Virus and yellow fever Diseases

8. Fleas host encephalitis and diseases like plague Black flies carry river blindness Ticks host various diseases e.g typhus, Lyme disease Lice can carry typhus Tsetse flies transmit sleeping sickness Elephantiasis is caused by a parasite Diseases

9. Diseases Spread Through Water/ Soil/ Food Contaminated water, soil and food (as well as clothing and shoes that come into contact with it) can spread many diseases. These may be fungal, viral, bacterial, protozoa or parasitic. Helminthes like hookworms and tapeworms are spread in this manner. Other examples are cholera, polio, anthrax, Typhoid fever, Hepatitis A, diarrhoea caused by different organisms. Diseases

10. Parasites Many parasites infect humans of which malaria and intestinal worms are extremely common. Over 100 different types of parasitic worms can live in the human body- causing many symptoms. These organisms can be found everywhere such as in the air, water, soil or food humans eat. WHO estimates that one quarter of the world’s population suffers from chronic intestinal parasitic infections Tapeworm can become 6 m long in the human intestine Hookworms lead to anaemia and malnutrition- with all consequences thereof Diseases

11. Diseases Contagious Diseases (Human To Human) Diseases spread through contact with other infected humans- through touch, bodily fluids such as blood, saliva, droplets (sneezing), semen, vaginal fluid, or excreta Examples: Measles; Tuberculosis; Polio; Sexually transmitted disease such as HIV, gonorrhea, syphilis; Influenza; Meningitis; Viral Hemorrhagic Fever (Ebola, Marburg, Yellow Fever, Lassa Fever, Crimean Congo Fever ) Measles

12. Not a New Phenomenon….

13. Injuries • An Injury is: “the physical damage that results when a human body is suddenly or briefly subjected to intolerable levels of energy” • Two broad categories: Unintentional (not associated with violence) and Intentional (associated with violence) • Injuries in Africa are mainly caused by: • Unintentional Injuries • Road Accidents- high incidence in Africa • Drowning • Falls Source:Bowman, B, et al. Violence and Injuries. Disease and Mortality in Sub-Saharan Africa. World Bank. 2006

14. Injuries Intentional Injuries Conflict • Bullets • Machetes/ sharp edged instruments • Landmines • Arrows • Beating/ blunt instruments • Sexual violence including rape and genital traumatic injury or mutilation (predominantly in women) • Homicide • Suicide Exacerbated by infections

15. Self Inflicted Disease • Self Inflicted Disease • Substance abuse • Malnutrition • Poor personal hygiene Poor food choices Alcohol is widely available, cheap and consumed in copious amounts Athlete’sFoot

17. Environmental Factors Pollution and Contamination • Water • Air • Soil • Food

18. Psychological Factors • Stressors • Away from home • Increase in disposable income • Reduced supervision and control • Higher status in poor communities • Boredom • All contributes to following behaviour manifestation: • Alcohol abuse • Prostitution • Abuse of power • Visits to nightclubs • Vehicle abuse • Violence and misbehaviour Stress associated with armed conflict is less common in SA Soldiers deployed in current operations Source: Col A Neale (Directorate Psych, SAMHS, SANDF)

19. Maslow’s Hierarchy of Needs Operationally deployed soldiers tend to regress with needs becoming increasingly basic

20. Implications for Force Preparation Training: • Training in and awareness of prevention of communicable diseases • Knowledge of preventative measures re zoonotic, insect, water, soil and food borne diseases (pets!) • Proper training in general and field hygiene for individual soldiers- washing of hands! • Proper training for all soldiers in nutrition to maintain optimum immune systems • Awareness of purchasing of local foodstuffs • Substance abuse awareness and monitoring for prevention thereof. Buddy systems to prevent violence and indiscriminate behaviour when drinking alcohol • Resilience training for own forces to withstand psychological trauma due to witnessing of violence, atrocities, etc. • Training in self management and control, money and boredom management • Training of supervisory personnel in management of own power

21. Prevention through: • Prophylaxis where possible through immunisation, chemical measures such as malaria tablets and physical barriers such as condoms and mosquito nets • Enforced use of insect repellents • Screening for soldiers likely to develop asthma in areas with air pollution. Ensuring that these soldiers are adequately prepared for such events • Enforced rules about keeping of exotic pets in the operational area • Proper waste management systems in military bases as well as in the field • Physical inspections for presence of skin disease, especially parasitic infections • Regular inspections of living areas to ensure adequate hygienic circumstances

22. Implications for Force Employment • The effective utilisation of environmental health officers for field and base sanitation services, including collaboration with engineers to determine correct placing of latrines, food service units, water service points and waste management systems. • Reducing of boredom and satisfying of higher needs through: • Opportunities and motivation to use time to improve self with skills training • Provision of library services • Physical training facilities

23. Acknowledgements and Additional Sources • My colleagues at DDSI and SANDF, especially Col Tertius van Zyl and Col Anton Grundling from J Operations Division • Col Arthur Neale, Directorate Psychology, SAMHS, SANDF for providing information • Col Hennie Venter, previous Director Environmental Health, SAMHS, SANDF who taught me the importance of environmental health in the military • J R Army Med Corps- several issues • UA Army Medical Department Journal (especially the Jan- Mar 2009 and April – June 2009 issues) • Medical textbooks and professional journals (large variety) were consulted in presenter’s professional training and contributed to domain knowledge

24. Thank You Questions?