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Public Health Command employees reflect on support to Iraq

June 20, 2012

By Compiled by Public Affairs Office U.S. Army Public Health Command

On a cold day in mid-December 2011, Capt. Mumtaz Ali stepped off an airplane and walked into the terminal of Baltimore Washington International Airport. Ali was returning from a deployment in Iraq, and his arrival at the airport marked the first time he had been on U.S. soil in six months.

"I was so grateful to be home safely," said Ali, who worked as an environmental science officer in Baghdad's Camp Liberty. "The day was special to me because I was home in time to spend Christmas with my family."

But Ali's arrival was significant in another way, too. He was the last Soldier from the U.S. Army Public Health Command to redeploy from Iraq.

USAPHC's participation in Operation Iraqi Freedom has been long and storied.

Over the 10-year course of the operation, 167 USAPHC personnel deployed. This number includes 143 military personnel, 24 civilians and seven Special Medical Augmentation Response Team--Preventive Medicine deployments.

"These deployments varied in length -- some being as short as two weeks, while others lasted for 14 months," said Brian Cashman, chief of USAPHC Current Operations.

Just as the length of deployments varied, the missions varied, too.

In the early days of the invasion, USAPHC personnel deployed ahead of troops to assess public health conditions.

"This work included conducting environmental assessments and performing preventive medicine (missions) to support the build-up of troops," said Jackie Howard, a section chief who was one of the initial civilians to deploy to Iraq.

The Deployment Environmental Surveillance Program served as the USAPHC organizational lead for activities in Iraq. Experts in this program provided reach-back support to deployed Soldiers on all occupational and environmental health-related matters.

"We communicated with deployed Soldiers and provided them with consultative and technical support to make their lives easier in the field," said Lt. Col. Sheryl Kennedy, DESP manager.

In addition, the USAPHC provided hands-on training to preventive medicine personnel on how to use specialized sampling equipment, said John Kolivosky, a DESP environmental engineer.

"We coordinated with our laboratory personnel to receive and analyze thousands of air, water and soil samples that were sent to us from deployed locations," said Jessie Brockmeyer, DESP's project manager for U.S. Central Command.

Another major initiative of the USAPHC was an assessment of the Tuwaitha Nuclear Research Center, located about 18 miles south of Baghdad. The TNRC was the crown jewel of Saddam Hussein's nuclear weapons research program. It contained dozens of buildings that housed nuclear reactors, multiple radiation research laboratories and numerous support facilities. A smaller secondary site at the facility was used for storing of processing uranium.

Sometime after the beginning of OIF, but before U.S. troops arrived at the outskirts of Baghdad, the Iraqi guards securing Tuwaitha abandoned their posts and fled, leaving the complex totally unprotected. In 2003, Army personnel arrived at the facility to secure it, allow a detailed search for weapons of mass destruction, and prevent looting.

In June 2003, a USAPHC team of nine people went to Baghdad, charged with performing a radiation safety survey of the TNRC to identify possible health risks to Soldiers and Marines who were guarding the facility. The team took air, soil, wipe and water samples, and those samples were analyzed. The results demonstrated that any radiation doses to Soldiers and Marines from the TNRC were safe, and chronic or long-term radiation health risks were low.

Scott Goodison, a health physicist who served as the technical lead for the radiation sampling team, said his work on this facility was one of his most fulfilling experiences.

"What I enjoyed most about the deployment was the sense of teamwork and being able to contribute as a civilian in some way following the events of 9/11 and at such an important time in our nation's history," said Goodison.

Teamwork was an important facet of many USAPHC deployments. USAPHC drew on the skill sets of all of its portfolios in providing occupational and environmental health assessments, preventive medicine guidance and direct support. Its laboratory capabilities supported these efforts by analyzing thousands of air, water, soil, chemical and other substances. The repercussions of this work are still being felt today.

Again in 2003, Army personnel were assigned to provide security for contract workers restoring an industrial facility at Qarmat Ali, Basra. The facility provided nonpotable water for injection into wells that maintained oil reservoir pressure. Work crews and safety personnel identified sodium dichromate, a corrosion-preventing chemical, as a potential occupational hazard. USAPHC did an onsite occupational and environmental health survey, and a health risk assessment. The survey included soil and air sampling and swipe tests in buildings, to determine levels of potential health hazards (including hexavalent chromium). Soldiers were medically surveyed, and medical testing was performed. The environmental testing showed no chemical hazards above Military Exposure Guidelines or Occupational Safety and Health Administration-permissible limits. No long-term health effects from these exposures were anticipated, although Soldier concerns continue today.

"Even so, the Environmental Medicine Program just supported the implementation of a long-term surveillance project for Soldiers and civilians who were on the site," said Coleen Baird, physician and program manager for the Environmental Medicine Program. "The Veterans Administration has the same program for veterans."

In addition to evaluating the Qarmat Ali water treatment plant, USAPHC experts also evaluated the health consequences that might have resulted from a 2003 sulfur fire that occurred in Mosul and from the operation of burn pits in multiple locations.

In the sulfur fire study, USAPHC attempted to assess potential exposure to a plume of chemicals released during the fire. The fire burned for almost a month, emitting dense clouds of sulfur dioxide, a combustion byproduct. The plume also contained other pollutants. Firefighters experienced the greatest exposure, but many others also may have been exposed. For a number of reasons, individual exposures could not be accurately determined; however USAPHC conducted a study of post-deployment health effects of the potentially exposed. The study demonstrated that there was not an increase in health effects in those potentially exposed to the fire as compared with deployed personnel who were not exposed.

Burn pit smoke continues to be an issue of Soldier concern. During the initial years of OIF, commanders were not able to avoid using burn pits for waste disposal. In response to concerns of Soldiers who saw and smelled burn pit smoke, the CENTCOM surgeon asked USAPHC to participate in a special assessment of air quality at Balad Air Base. Four rounds of specialized air sampling from 2007--2010 supplemented routine deployment occupational and environmental health surveillance efforts.

Results from the assessments showed that chemicals found in the smoke from burn pit operations at Balad were similar to those found from open-pit burning of solid waste throughout the world. Results also showed the chemicals detected in the smoke were below levels that were likely to cause long-term disease to service members. Airborne particulate matter in the Balad samples was measured at similar (elevated) levels to those found throughout Iraq.
In these efforts, the current Health Risk Management and Occupational and Environmental Medicine portfolios were leading players.

Baird was one of the experts who reviewed the samples that came in and determined if the levels of a contaminant posed a risk to Army personnel.

"Our studies did not identify any long-term health effects associated with the measured levels of contaminants," said Baird. "This finding was confirmed by a recent Institute of Medicine report, but we continue to study this issue."

USAPHC teams also performed industrial hygiene assessments, ergonomic assessments and epidemiological investigations.

USAPHC epidemiologists reviewed the disease and injury threats that can adversely impact the readiness and mission of deploying personnel, and provided preventive measures to minimize them.

Surveillance in a nation very different from much of the U.S. in indigenous disease threats pointed to the need for medical personnel to become more expert in conditions that do not occur with frequency or at all in the U.S. These diseases included malaria, leishmaniasis and rabies, to name only a few.

USAPHC injury prevention experts noted that non-battle injuries were the leading cause of medical evacuation from theater, and that injuries due to sports, falls and motor vehicles topped reasons for the NBI evacuations.

Epidemiologists and behavioral health personnel reacted to high Soldier suicide rates thought to be related to deployments. As a result of increasing suicide rates, the Epidemiology and Disease Surveillance Portfolio added the Behavioral and Social Health Outcomes Program. In redeploying populations where negative behaviors seem to be occurring, the program tries to understand those behaviors in the context of individual, unit and community factors. It also maintains Department of Defense repository of suicide and behavioral health data.

To further assist in suicide prevention during the Iraq war, USAPHC behavioral health personnel from the Health and Wellness Portfolio created the Army's suicide prevention training for Soldiers and leaders. In partnership with the Army G-1 and Army chaplains, they also developed the Ask, Care, Escort, or "ACE," card, which gives tips on how to intervene to prevent the death of a Soldier from suicide.

USAPHC also had a role in ensuring that those deployed had safe water and food.
Water supply experts responding to Soldier needs conducted a comprehensive analysis of individual water purification systems that could be purchased from commercial vendors. USAPHC personnel also conducted water system vulnerability assessments in deployed locations and served as consultants on drinking water monitoring.

Safety of bottled water and food was the responsibility of the Army veterinary services personnel, who were also important components to preserving public health during OIF. As well, Army veterinarians provided clinical care for the DOD's four-footed warriors.

"Army veterinary service personnel were responsible for assessing the safety of food and bottled water for use by U.S. forces and for ensuring comprehensive veterinary care for hundreds of military working dogs, whose explosive detection capabilities were a first line of defense to protect U.S. service members and personnel deployed to Iraq," said Col. Erik Torring, USAPHC deputy commander for Veterinary Services. "These personnel effectively promoted stability in Iraq through veterinary operations."

Army veterinarians provided animal care assistance to local populations and zoonotic disease surveillance in support of nation-building missions for DOD.

To ensure Soldiers could see and hear well enough to win, two USAPHC programs improved those capabilities through their efforts at protecting vision and hearing.

USAPHC's Tri-Service Vision Conservation and Readiness Program was directly involved with keeping Soldiers' vision intact. During the conflict, the program promoted the Military Combat Eye Protection Program and Authorized Protective Eyewear List, which identified approved eyewear for protecting Soldiers from sustaining an eye injury. Experts in the program were also able to help develop the "G-Eyes" initiative, which allows Soldiers (as well as other deployed service members) to order approved eye protection via the Web, instead of visiting a clinic for these items.

Col. David Hilber, a board-certified optometrist at USAPHC, said one of the most significant things to come out of the Iraq conflict was the widespread acceptance by troops and officers of the benefits of wearing eye protection.

"This conflict is the one where the rest of the Army noted that eye protection is effective and should be used by the troops," said Hilber.

The Army Hearing Program was also instrumental in supporting contingency operations in Iraq. Lt. Col. Marjorie Grantham, program manager, said that one of the key advancements in the Iraq conflict was the development of the Combat Arms Earplug, which has two settings to protect Soldiers' hearing.

The AHP also assisted with developing the Army's Tactical Communication and Protective Systems.

"This gives Soldiers the ability to hear in high levels of background noise, while also protecting their hearing," said Grantham.

The USAPHC uses the Defense Occupational and Environmental Health Readiness System to manage environmental health surveillance samples and associated laboratory results. The DOEHRS is a DOD Web-based data collection and analysis system that is the foundation for the service members' longitudinal exposure record.

"We still frequently support Soldiers who redeploy from Iraq by responding to requests for information on environmental sampling efforts and results," said Nikki Perazzoli, the Operation New Dawn project manager for the USAPHC. (OND is the successor operation to OIF, focused on stability operations and training Iraqi forces.) "We collaborate internally to provide pertinent information and point Soldiers in the right direction when they have health concerns as a result of their deployment."

All of the work performed by USAPHC during OIF and OND was important to the overall safety of deployed forces, according to James Sheehy, who served as the USAPHC CENTCOM project manager from 2003 to 2011.

"The USAPHC remained a leader in assessing health risks during deployments and offering solutions to mitigate those risks," said Sheehy. "Our ultimate goal was to enable our forces to complete their mission in a safe and healthy environment."

Iraq was not the only country where USAPHC personnel deployed during Operation Iraqi Freedom. Members of the command also served vital missions in Bahrain, Jordan, Kuwait, Qatar, Saudi Arabia and Turkey.

"We missed many family events, birthdays, holidays, anniversaries and graduations," said Command Sgt. Maj. Gerald Ecker, who deployed three times during the course of OIF/OND. "Our military and civilian personnel have shown incredible service and sacrifice."

Despite the imminent danger, long hours, family separation and environmental challenges that accompanied working in a war zone, many of the military and civilian personnel who deployed in support of OIF said it was humbling to play a role in such a mission.

"I am proud of our service in Iraq," said Ecker. "We did a terrific job showcasing the ability and discipline of our military force. As this war comes to an end, we need to pause and reflect on our accomplishments, yet remain ready to face new challenges."

For now, many USAPHC personnel feel a sense of mission accomplishment.

"People are constantly thanking me for my service, and it is certainly uplifting to see that most Americans appreciate the sacrifices that were made for them," said Ali, USAPHC's last redeploying Soldier. "It feels good to know that I have done my part in serving my country."

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