UNDERSTANDING AND PREVENTING DISEASES OF POVERTY IN MILITARY TROPICAL MEDICINE

Photo By Chief Petty Officer Emilio Velez | Military Tropical Medicine Course Director, CAPT Todd Gleason, MC (center) with HM1 Norbert Owusu (left), and LCDR David Wolfe, MSC (right).  

BETHESDA, MARYLAND, UNITED STATES

05.19.2022

Story by Chief Petty Officer Emilio Velez 

Naval Medical Forces Development Command

The Navy Medical Leader and Professional Development Command (NMLPDC) located at Naval Support Activity (NSA) in Bethesda, Maryland offers several vital training platforms that fosters Navy Medicines goal of maintaining state of the art medical and operational readiness. One of those platforms is the Military Tropical Medicine (MTM) course. This course emphasizes some of the most debilitating and dangerous diseases that have had a global impact affecting the development of human civilization throughout history. Many of these morbidities are far too common afflictions in impoverished nations whose poor populations are caught up in a never-ending cycle of disease that is often coupled with malnutrition. Currently over 1.5 billion people live below the World Bank poverty level (<$1.25 U.S. Dollars per day). However, you don’t have to live in the tropics to be affected. Even people residing in wealthy countries above the equatorial zone can also be infected and especially those that live in poverty. Some diseases such as cysticercosis (tapeworm larvae encystation), Dengue fever (mosquito borne virus), Chagas Disease (or American Trypanosomiasis spread by Triatome bugs), toxocariasis (dog/ cat roundworm larval infections of humans) and West Nile Virus (mosquito borne) have become widespread.
Across the globe one or more tropical disease pathogens affect poverty ridden peoples often contributing to their inability to escape it. Many of these diseases continue to increase (emerging infectious diseases) and a good portion of these are vector borne or spread by blood seeking arthropods (especially ticks and insects). It’s often that anthropogenic (human induced) changes will provide vectors and the parasites they carry the ability to expand their ranges and to even evolve into more virulent forms that can be drug resistant or pesticide resistant. In the equatorial zone, temperature and rainfall have always been primary mitigating factors affecting rates of parasite development inside the host (whether vertebrate or arthropod) and the abundance of hosts over time.
Like the World Health Organization (WHO), one of the goals of the DOD is to eliminate as many diseases of poverty as possible in the developing world. Training medical professionals in MTM is one way of contributing to this goal, but also to educate health care providers in the U.S. that are not often exposed to patients that have contracted one of these diseases. Its important for U.S. providers to acquire knowledge in how these diseases are transmitted but also how they can be treated, often under very primitive conditions. In March 2022, the Combined Joint Task Force-Horn of Africa surgeon cell hosted an MTM course for U.S. providers and other partners in Djibouti, an East African nation with a host of infectious diseases, particularly human malaria. Providers from various nations as well as those native to Djibouti, were able to collaborate and work together in such an important training course. Opportunities such as this is the first step to providing the guidance that leads to disease prevention and ultimately to disease eradication.
In 2003, 35% of 225 U.S. Marines had to be evacuated from their ships after a short deployment in Liberia due to the contraction of malignant tertian malaria (Plasmodium falciparum) (Whitman et al. 2010). These marines worked and slept in an abandoned airport warehouse, after spending only 10 days in Liberia. Within the first day after returning to their ships, several developed a mysterious febrile illness. This rather broad diagnosis was narrowed quickly after shipboard physicians, who had been trained in an MTM course, diagnosed P. falciparum from peripheral blood smears (Gleeson personal communication, 12 May, 2022).
Besides recognizing and diagnosing disease agents like Plasmodium falciparum, an additional goal of MTM is to unify all the concepts from the various investigative methods in tropical disease biology to understand the strategies necessary to control disease transmission. For instance, first being able to diagnose that a specific parasite is the culprit of disease, then identifying its mode of transmission and finally monitoring and implementing control measures. Diseases that are vector borne require a combination of field and lab methods that must be used so vectors can be identified and their abundance determined so control measures can be implemented.
NMLPDC offers the MTM course twice per year beginning in July. Students can enroll in a virtual platform or select an in-seat version. In 2021, 432 students were trained both virtually and in-person. As a result of Covid restrictions, the in-seat version of the course has limited seats but in July 2022, 44 students had enrolled including 11 reservists (9 from National Guard). While the in-seat version lasts 4 weeks, students enrolling in the virtual platform are given until March 2023 to complete all modules of the course. The director of the MTM course is CAPT Todd Gleeson, an infectious disease physician.
For additional MTM course information, go to https://www.med.navy.mil/Naval-Medical-Leader-and-Professional-Development-Command/

Article written by CDR Michael D. Bay, MSC and LCDR Rodney Noah, MSC.

• Date Taken: 05.19.2022
• Date Posted: 05.26.2022 10:53
• Story ID: 421594
• Location: BETHESDA, MARYLAND, US