Liberia Marine Malaria: Inexcusable

CNN.com – Sources: Marines who were in Liberia contract malaria

Twelve U.S. Marines who were in Liberia last month in support of a West African peacekeeping mission have contracted malaria and 21 others have symptoms of the disease, defense officials said Monday.

Two of the Marines were flown from the USS Iwo Jima warship off the coast of Liberia to a U.S. medical center in Germany on Saturday and 31 others were flown from the ship Sunday to the Bethesda Naval Medical Center in Maryland, the officials said, speaking on condition of anonymity.

The Marines, members of the 26th Marine Expeditionary Unit based at Camp Lejeune, North Carolina, were in Liberia in mid-August as part of a U.S. quick-reaction force of about 150 U.S. troops. They operated from an airport outside Monrovia, the capital.

This is Inexcusable. The Navy medical department has known about malaria for decades, and has specific, well publicized guidelines to prevent it in their deployed Marines and Sailors.
From the US Navy GMO Manual:

(9) Malaria Prevention
(a) Essential concepts
1. Assessment of risk and selection of appropriate chemoprophylaxis.
2. Use of personal protective measures.
3. Command enforcement of chemoprophylaxis and personal protective measures.
4. Early identification and investigation of possible cases.
5. Mosquito vector control measures, if appropriate.
(b) Personal protective measures
1. Avoid night-time exposures when possible.
2. Wear long sleeve shirts and long pants with sleeves rolled down.
3. Use insect repellent (long acting DEET preparations) and treat uniforms with permethrin.
4. Use mosquito bed netting.
5. Spray mosquito bed netting with permethrin spray.
(c) Chemoprophylaxis

There is a (stupid, Western) contempt of mosquito-borne illnesses, and it meets its zenith in Marines, especially Marine officers. I genuinely admire Marines, but their inability to accept the germ theory of disease (or the protozoal theory of malaria) boggles my mind. When this many troops come down with a preventable and debilitating disease it means that they didn’t take their medications.

Why? Bad Leadership.

There. I said it. This is a Leadership Failure of the First Order. Thirty three hard-charging US Marines weren’t told (forced, impelled, browbeaten, take your pick) to take their medications and malaria prophylaxis wasn’t taken seriously (see above, 9.a.3). I guarantee senior people rolled their eyes when the corpsmen and Preventive Medicine Techs (PMT’s) talked about the daily drugs, and the juniors got the message: this is for wimps, real Marines don’t take pills for no-seeum bugs.

The Sea Services re-learn about Malaria frequently. After Somalia there was a stink about the number of preventable malaria casualties that occurred, and while I was in there was Religion about malaria (rumor was it cost some careers, which is the career officer motivator-par-excellence). I took a MEU to Singapore and Thialand and sent a detachment to the Phillipines, and we had zero cases of malaria, because prophylaxis was important, and because we had command support from the top down.

I sincerely hope for two things: all these Marines and Sailors recover fully, and that this costs some senior Marine careers, to encourage the others.


Comments

  1. Damn straight. I just hope that all of the troops recover… if there are any deaths as a result of this failure – well, a “career ending” won’t even be enough.

    Dammit.

    More later.

  2. I agree 100%.

    You nailed it exactly.

  3. John Schedler says:

    Well, truly, & righteously said. Just where the heck were the NCO’s? Making sure the troops tale their Rx is their job. If the Plt Cdr or the Skipper is cavalier about this, the Plt Sgt or Co GySgt should be bending their ears.

  4. An excellent point, and one which I didn’t address: who’s responsible? Of course, the Senior Officer is ultimately responsible, but as you point out the senior enlisted leaders (who really run the services) must have been out to lunch as well. Something bad happened here, and I wonder what lead to such an abject failure on many levels.

  5. As a retired Senior NCO who did several tours in Somalia and other, lesser known places in Africa, I agree that the blame here, if warranted, belongs to the NCOs.

    I can remember browbeating, cajoling and threatening the troops to take the pills and use the mossie nets.

    Threats were generally the most effective. In a deployment such as this, Sgt. Majors/Chief Master Sgts/Master Gunnery Sgts (sorry I didn?t identify Naval senior NCOs; can’t remember seeing any of them on the beach!)

    The problem is almost always where the troops billet. Usually un-air-conditioned, little moving air and hot, gawd, does it get hot in Africa.

    Mosquitoes cannot land if there is a breeze 3 mph or greater; which is why we lie, cheat and steal to get some fans for the billeting areas.

    All said, it?s always been an article of faith that G.I.s will find a way around the rules they don?t like.

  6. Roger Bigod says:

    There was a problem with malaria prophylaxis in Nam. The pill was called the “CP pill”, for chloraquin and primaquin. The doses were on the high side, because the pill was to be taken once a week. The urban legend among the troops was that it caused diarrhea and disturbed sleep with vivid dreams and nightmares. There was no way to check out tha accuracy of this, but it led to a lot of noncompliance.

    Another great urban legend, possibly true is that a junior officer was doing through the chow line on a Monday, CP day, and noticed and noticed a bowl of orange tabs. He asked and was told that he should have taken them every week and that the CO was very serious about enforcement. Being a gung ho type, and having been in country about 3 months, he downed 12. This produced acute renal failure and he spent some time in the dialysis unit in Saigon. This isn’t a great margin between a therapeutic dose and a life-threatening one.

    On balance, the program was good prophylaxis, but I suspect compliance would have been better with a lower dose.

    Most of the malaria in Nam was P. vivax, which effectively is never lethal because it doesn’t cause cerebral malaria. IIRC, in West Africa the common organism is falciparum, which is nasty (cerebral malaria, “blackwater fever” = massive hemolysis with altered hemoglobin in urine). That makes the case for command discipline much stronger.

  7. Everyone sure does have their thoughts about whether or not the Marines were compliant about taking their regime to prevent Malaria, about who’s heads should roll over they-did-they-didn’t scenario. Let me help you think about the other side of the coin. My brother is one the 31 removed from the 26th MEU and flown to Bethesda. Imagine the horror of being told that he was being airlifted for a “mystery illness” while the rumors all pointed to Malaria. There are about a million and one strains of Malaria these days. Has is it ever crossed anyone’s mind that possibly, just possibly that the strains out there are not probably IN the anti malaria regime AND that this disease is HIGHLY is beginning to be resistant to medications traditionally given for this illness? Some of these guys are fighting for their lives as we speak…I think it’s more appropriate for us to be passing thoughts and prayers to THEM. There will be plenty of time later to point fingers.

  8. Roger Bigod says:

    Resistant strains occurred in Nam. theyy were unusual but IIRC all in P. falciparum, the most dangerous species and unfortunately a common one in West Africa. I hope things go well with your brother.

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