Photo By Kevin Hynes | Medics from the Rwanda Defense Force's Medical Corps treat a patient -- in this case a...... read more read more
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GAKO, Rwanda – Imagine trying to construct a jigsaw puzzle without any pictures or drawings from which to start. Now imagine trying to construct it with a team of puzzle-builders from a different country who speak a different language and have significantly different approaches to accomplishing the task.
Sound tough?
While the scale of the problem may have differed significantly, that was essentially the task that confronted a team of four Nebraska National Guard medical professionals and their counterparts from the Rwanda Defence Force, March 2-21, 2022, when the two teams met at a Rwandan military base to conduct their first-ever engagement through the National Guard’s State Partnership Program.
According to Lt. Col. Dennis Rieke, a Nebraska Army National Guard physician’s assistant who served as the senior American officer-in-charge of the Rwandan ‘spoke site’ located on a dusty hilltop in southern Rwanda, the mission for the Nebraska team’s first SPP engagement in was fairly straightforward.
“We’re here to serve as representatives of U.S. Africa Command and serve as evaluators of Rwanda’s ability to establish a hospital site and operate as a (United Nations) Level 2 hospital,” said Rieke, who also serves as a physcian’s assistant at the Omaha-based University of Nebraska Medical Center in civilian life.
“It’s actually a really interesting mission,” Rieke said. “The United Nations has donated two Level 2 hospitals to Rwanda to help them prepare to participate in the African Peacekeeping Response Program, to conduct peacekeeping missions or to do natural disaster relief responses.”
However, although the mission seemed simple in concept, it was actually extremely complex, thus providing a critical first test of the Nebraska National Guard and Rwanda Defence Force medical teams’ ability to work together.
Part of that complexity, said Rieke, was the fact that few among the combined team had ever actually set up the field hospital or seen it in action.
“The Rwandans had been using the (Level 2 hospital) as a COVID-19 overflow facility at one of their large hospitals,” Rieke said. “Before we got into country, they had disassembled it and packed it up and were getting ready to transport it out to the (field exercise) site. We weren’t there when it was disassembled, so we had a real lack of knowledge about how it was supposed to look once it was set up.”
Further complicating the problem, Rieke said, were the facts that few of the Rwandan medical doctors or enlisted medics had set up or operated in the hospital complex, either.
“For most of the Rwandan team, this was a new experience, too,” Rieke said. “They had a core group of noncommissioned officers and young officers who had operated the hospital once or twice before, but for the majority of us, this was a learning experience.”
Still, Rieke said, what might have been a significant problem that could’ve put the burgeoning SPP relationships in jeopardy, however, actually proved to be great opportunity for the Rwandans and Nebraskans to learn and work together.
“The Soldiers and Airmen on both sides have good medical knowledge,” Rieke said. “So,” we were able to work together to address the problems and overcome them together… It really built a good team where it wasn’t like a leader-follower relationship, but rather it was two teams working together to solve common problems.”
The U.N. Level 2 hospital is a series of tent-like structure that, when set up and connected together, can be configured in many different ways based upon the types of functions that the hospital staff are called upon to provide. In the case of the Rwandan hospital, Rieke said the staff are trained and equipped to provide both outpatient care – essentially care for patients with non-threatening issues like bruises or colds – as well as inpatient care for patients with more significant problems requiring stays within the hospital itself. The inpatient care includes an emergency room/triage area, operating rooms, intensive care units, normal inpatient wards and a hospital pharmacy.
The Rwandan hospital staff also offer dental and physical therapy care for their patients.
With so many services available, Rieke said one of the primary tasks for the team was to develop an operational plan that allowed for the best flow of patients within the hospital.
“There are all these different things that happen out of this hospital, so you want to assemble the tents and organize it in a way that patient flow makes sense,” Rieke said. “You want to make sure that you’re able to provide the highest level of care for every patient that come into and out of that facility.”
To accomplish this, the Rwandans and Nebraskans conduct sit-down conversations throughout each day to better understand the problems they were facing and to develop solutions to those areas. At the end of the day, a longer after-action review would touch upon what the team accomplished and what it wanted to do the next day
Maj. Angela Ling is a Nebraska Air National Guard nurse practitioner with the Guard’s Lincoln-based Chemical, Biological, Radiological, Nuclear and high-yield Explosive (CBRNE) Enhanced Response Force Package – or CERFP. She said the team tested the setup by conducting a series of patient scenarios and then running through the after action review process to discuss possible solutions to the problems they uncovered.
Ling said she was amazed by the Rwanda medical team’s flexibility and willingness to make changes. “I was impressed by just how adaptable they are,” said Ling, who works as an incident commander with the Nebraska Department of Health and Human Services in civilian life. “Sometimes in the U.S. we just get so stuck in that this is the way we do it, this is how we set it up, don’t deviate.”
“And they’re like, ‘Okay, we’re going to do it this way and when you come back the next morning, things have been changed and it’s even better than the day before,” Ling said.
Rieke agreed, saying that the Rwandan medical team seemed extremely interested in the Nebraskans’ points of view.
“The Rwandans were super receptive to what we were there to do,” he said. “They were very pleased with the sort of knowledge transfers that were taking place as well as the training and the working together.”
“They were also really ecstatic to get the opportunity to work with a team that was just excited to be there themselves,” Rieke added.
Master Sgt. Jacyln Carlisle, a medic with the Nebraska Air Guard’s 155th Medical Group, said this level of interest on both sides of the team made the learning environment all that more effective.
“Building up rapport and relationships was our big goal coming over here and I think we accomplished that,” she said. “When we first came out (to the field exercise site), there was nothing here. As they brought out stuff little by little, it was like every day they were making incredible improvements on (the hospital).”
“We would debrief at the end of the day and when we came out the next morning, the things that we discussed either had been adjusted or added,” Carlisle added. “The tents just kept getting better and better.”
Another positive aspect of the mission, said Ling, was the interaction that occurred throughout the day when the teams were able to take a break from their work. She said the conversations included both the exchanging of ideas as well as learning more about each other’s medical backgrounds and life at home. Ling said having the opportunity to speak with the female enlisted medics from Rwanda was especially important for her.
“For me it was extremely meaningful that we had an opportunity to interact with the women here. That was huge,” Ling said. “(The Rwanda Defence Force) is looking to grow their female force right now, so I think what was really helpful for them was to have three female Air Guardsmen on this trip and to see the work that we do as part of our normal military responsibilities.”
“The interaction we were able to have with them was wonderful,” Ling added.
The Nebraska Guardsmen each said that the ability to travel to Rwanda and participate in an extremely important mission on behalf of Nebraska and the United States was an “awesome” experience.
“Just by being here I feel like I am expanding my horizons,” Ling said. “Being able to experience Rwanda, getting introduced to their culture and working side-by-side with their military has definitely been something that I will never forget.”
“It’s been incredible to meet these people and learn more about them,” Carlisle added. “We’ve gotten just so much out of this.”
That was exactly the goal, said Rieke. Along with providing an important assessment of the Rwanda Defence Force’s medical corps ability to set up and operate the field hospital, the Rwanda mission allowed the Nebraskans and Rwandans the chance learn new skills while also developing their initial relationships, which should pay significant dividends in the future.
“This was a mission planned and conducted by Nebraskans,” Rieke said. “The experience of taking these young Soldiers and Airmen to do their job in an austere environment where there’s not a large support system and they have to just figure things out without a lot of higher headquarters guidance… that really builds competence and problem-solving skills from the lowest ranking Soldier and Airman to the highest-ranking person.”
“You could really see the young Soldiers and Airmen step us and say, ‘I know what I’m doing,’” he said. “I really believe that experiences like this where are Nebraska National Guardsmen are able to build up their military skills and receive important cultural training like shopping in an African market or meeting and working with people who are maybe look at life a little differently than you, these are all important skills that we need in our organization going forward.”
“I think this was a great first step.”
(U.S. Air National Guard story by Lt. Col. Kevin Hynes)
| Date Taken: | 04.01.2022 |
| Date Posted: | 07.07.2022 12:25 |
| Story ID: | 424511 |
| Location: | RW |
| Web Views: | 123 |
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