Archives for October 20, 2003

Liberian Marine Malaria Results

In an article that has the facts right, but the headline exactly wrong: Malaria Outbreak Blamed On Troops.

Looks like my original rant was correct, this was a leadership failure, notwithstanding the blame-the-victim headline.

October 20, 2003

WASHINGTON – The large outbreak of malaria among Marines who spent time ashore in the West African nation of Liberia in the summer was apparently caused by a nearly wholesale failure of the troops to follow protective measures, and in particular not taking a once a week malaria preventing drug.
Blood samples taken from the 26th Marine Expeditionary Unit right after malaria was diagnosed in several troops in early September showed that only 5 percent had been regularly taking the recommended drug, mefloquine. Only 12 percent wore uniforms properly treated with the insecticide permethrin. Only 27 percent reported using the time-released insect repellant issued to them. And none slept under insecticide-treated mosquito nets.

The findings were presented last week in closed briefings to the House and Senate Armed Services committees. (emphasis mine)

I said it then, and Ill say it now, this was a leadership failure. If the command gets it, the troops get it. But, when force protection, in this case malaria, isn’t pushed, hard, from the top down, it will not get done.

In a classic statement that blames the individual but not the system:

“It is difficult to get these young Marines, who are willing to charge a machine gun nest, to be worried about a mosquito,” said … a Navy physician involved in the investigation. “It is much more difficult than we believe it should be.”
Later, the investigators specifically said they don’t think observed / forced compliance is the answer ‘more education’ is.

As several commenters to the recent posts have pointed out, it’s not all that hard to get compliance on this issue: observe your people taking their meds. No excuses, no wimpouts, just take it. Education is great; 100% compliance with the goal of having a force that’s combat capable is better.

Read the source article for the astonishing stats (a 44% attack rate for a 2 week deployment ashore), then be very glad that all have recovered.

Malaria isn’t a mystery illness, and it’s mostly preventable, if you just try. They (the commanders) knew going in that Liberia is 1,000 times more malarious than the Persian Gulf or Afghanistan, and they did essentially nothing to prevent this parasitic ambush. This force was basically combat ineffective by the time they were withdrawn to the ships, it’s a good thing we didn’t need to fight there.

Now, back to my original answer: a career or two need to come to a screeching halt over this, the ultimate career officer motivator.

Many thanks to Tony for the link!

General reading:
Malaria, from the CDC
Virtual Naval Hospital, NavMed Malaria Prevention

GE MedPro Drops Texas EP’s

At the end of the following article – Doctors hope law boosts patient care is a paragraph which is, now, ironic.

One carrier, Texas Medical Liability Trust, announced before the Sept. 13 vote it would cut rates by 12 percent on Jan. 1. Two others, GE Medical Protective of Fort Wayne, Ind., and The Doctors Co. of Napa, Calif., are considering similar cuts.

Our ED group started getting registered letters Saturday notifying them that MedPro will not be renewing any of their policies, “to decrease the number of Emergency physicians” they cover. There’s a cut!

90% of the docs in our group are covered by MedPro, and now my colleagues are going to have to apply for new coverage, in a uncertain market, many now having outstanding suits from the flurry of filings just before the new tort laws went into effect. (I’m with another company, and praying I’m with them in the future).

So much for tort reform fixing our medmal problems. Next: Insurance Reform.

West Nile Graphics update

In my prior post several states’ West Nile data wasn’t represented, as they weren’t sharing data with the CDC. I still don’t know why they weren’t sending in data, but they weren’t. If you know why, write or comment.

Now they are, as evidenced by the new CDC map; But, once again, the USGS has more detailed information (that’s how we know the one California case was in Riverside County).

A big thanks to Beth for the information! (And thanks for reading).