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.