Repatriation for diseases or non-battle injuries (DNBI): long-term impact on quality of life

INTRODUCTION

Throughout history, diseases and non-battle injuries (DNBI) have threatened deployed forces more than battlefield injuries. During the Dutch involvement in Afghanistan, the amount of DNBI that needed medical evacuation out of theatre (60%) exceeded the number of battle injuries (40%). The aim of this study is to explore the long-term quality of life (QoL) of Dutch service members that acquired a DNBI, warranting repatriation during their deployment to Afghanistan between 2003 and 2014.

METHODS

Observational cross-sectional cohort study in a selected group of Dutch service members who deployed to Afghanistan 2003-2014 and were repatriated due to DNBI. Using the 36-item Short Form, EuroQol-6D, Symptom Checklist 90 and Post Deployment Reintegration Scale questionnaires, their outcomes were compared with a control group of deployed service members who did not sustain injuries or illnesses.

RESULTS

Groups were comparable in age, rank, number of deployments and social status. There were significant differences found in terms of physical functioning, pain and health perspective. No differences were seen in emotional or psychological outcomes.

CONCLUSION

The amount of military service members who contract a DNBI is significant and imposes a burden on the capacity of the medical support, readiness of deployed units and sustainability of ongoing operations. However, regarding QoL, being forced to leave their units and to be repatriated to their home country due to a DNBI seems to have no significant impact on reported psychological symptoms of distress and reintegration experiences. Future research should focus on more in-depth registration of illnesses and not combat related diseases and injuries and even longer-term outcomes.

Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital

BACKGROUND

Surgery is an indivisible, indispensable part of healthcare. In Africa, surgery may be thought of as the neglected stepchild of global public health. We describe our experience over a 3-year period of intensive collaboration between specialized teams from a Dutch hospital and local teams of an orthopaedic hospital in Effiduase-Koforidua, Ghana.

INTERVENTION

During 2010-2012, medical teams from our hospital were deployed to St. Joseph's Hospital. These teams were completely self-supporting. They were encouraged to work together with the local-staff. Apart from clinical work, effort was also spent on education/ teaching operation techniques/ regional anaesthesia techniques/ scrubbing techniques/ and principles around sterility.

RESULTS

Knowledge and quality of care has improved. Nevertheless, the overall level of quality of care still lags behind compared to what we see in the Western world. This is mainly due to financial constraints; restricting the capacity to purchase good equipment, maintaining it, and providing regular education.

CONCLUSION

The relief provided by institutions like Care-to-Move is very valuable and essential to improve the level of healthcare. The hospital has evolved to such a high level that general European teams have become redundant. Focused and dedicated teams should be the next step of support within the nearby future.

Cross-sectional analysis of Dutch repatriated service members from southern Afghanistan (2003-2014)

BACKGROUND

A systematic analysis of the complete medical support organization of the Dutch Armed Forces regarding repatriated service members from Afghanistan has not been performed so far.

METHODS

All information were collated in a specifically designed electronic database and gathered from the archive of the Central Military Hospital for all Dutch service members receiving treatment for wounds or diseases sustained in the Afghan theater from July 2003 till January 2014.

RESULTS

Traumatic injuries were the main cause (63%, 141/223) of repatriation, and improvised explosive devices the major (67%, 60/89) mechanism of injury in the battle casualty group. The mean time between injury and medical evacuation from Afghanistan was 8 days, and this was reduced to 3.6 days in case of polytrauma casualties (ISS > 15).

CONCLUSIONS

Sixty percent of all Dutch medical evacuations from Afghanistan were not directly related to combat operations. A standard medical examination/endurance test in the predeployment phase could be useful as screening tool in reduction of the disease nonbattle injury casualty rate. Shorter transport intervals might improve morbidity and mortality of casualties, a timeframe of 48 to 72 hours for receiving definitive treatment seems feasible. Further research is necessary to identify delay factors and possible improvements in the medical support organization.