Figure 1: LT Mark Gray hands a young boy his new pair of prescription glasses just produced by USPHS officers and RAM vision technicians in the mobile vision lab parked behind the school.
Rosebud, South Dakota: This past July, 86 officers in the U.S. Public Health Service Commissioned Corps (USPHS) were deployed during ‘Operation Fortitude’ to the Rosebud Sioux Reservation in Mission (Todd County), South Dakota. Over the course of the ten day deployment, officers provided essential public health services to the Rosebud Sioux Tribe, a community that was selected by the Indian Health Service (IHS) as having great public health and medical infrastructure needs. The Community Health and Service Mission (CHASM) aimed to help the surrounding community, serve the local Rosebud Sioux Reservation (Sicangu-Lakota Oyate), form local partnerships, improve the readiness of USPHS officers for disaster response operations. Officers, including dentists, physicians, mental health professionals, engineers, and others, formed four different teams and functioned under a unified command based on their public health or medical specialty: Rapid Deployment Force-5 (RDF-5), Applied Public Health Team-5 (APHT-5), Mental Health Team-5 (MHT-5) and Services Access Team-5 (SAT-5). These four teams provided medical and public health services to the community, as well as trainings to ensure the mission objectives endured beyond the two week deployment.
On paper, the RDF-5 team’s mission objectives included: planning and operating a medical clinic based out of a local middle school augmenting Remote Area Medical (RAM) and administer free vision, dental and medical services; supporting Rosebud Head Start, a well-child program; providing vision, dental and medical services to vulnerable populations within adult and juvenile tribal detention centers; collaborating with the community public health nurses to increase pediatric immunization participation, engaging in public relations and public information distribution and carrying out team building and resiliency training and exercises to improve emergency response capabilities . APHT-5 provided preventive medicine services, health education, engineering expertise, environmental health services, epidemiological/surveillance services, and veterinary services. MHT-5 and SAT-5 combined assets to augment their response capacity and support their mission objectives and conducted community outreach with children and families while providing behavioral health resilience and psychological first aid training, clinical behavioral health interventions, and case management services at the IHS hospital and RAM Clinic. In addition, SAT-5 Officers participated in a Health and Human Services emergency response training on the Joint Patient Assessment & Tracking System (JPATs) utilized to track patients evacuated from their communities during disasters, while MHT-5 Officers participated in a training on the Mercy Model, aimed at trying to identify sustainable solutions in communities that are extremely lean on funding and resources.
Figure 2: USPHS Dentist and RAM dental volunteers conducted dental cleanings, restorations, extractions and provided oral health education to local community members over the course of the 2 and a half day clinic.
In practice, CDR Michael King, a social worker with the Centers for Disease Control (CDC) in Atlanta, GA said that what set this mission apart was its flexibility and focus on helping the community. “We started with the community needs. Our goal was not to come in and be a leader, but to be a faithful partner. We came in with resources that were there for a short period of time, so we focused on things that could create a lasting change. We started where the folks want us to start.”
For example, LCDR Mark Hench of the APHT-5 team, and a Senior Environmental Engineer in the Indian Health Service (IHS) Sanitation Facilities Construction Division, participated in a GPS initiative to identify and chart the locations of homes in six local communities that currently lack drinking water and wastewater systems. “When projects are up for potential funding on an Indian Reservation, proof of how many homes will be affected as well as the current situation of those homes is needed as evidence to support the request,” he explained. LCDR Hench and his team documented GPS locations for homes that would be impacted by government funding, providing the evidence that the communities need in order to receive funding for water and sanitation projects. On the Rosebud Sioux Reservation and reservations across the US there are still many homes without safe drinking water and indoor plumbing. “This effort will play a big role in making it possible to achieve funding and solving these communities water and sanitation issues in the future.”
Figure 3: Two USPHS clinicians conduct diabetes glucose level screenings at the clinic. Diabetes and high blood sugar are common on reservations; blood sugar tests were vital to ensure patient safety during dental procedures.
LCDR Mitchel Holliday, a Nutrition Specialist with the Federal Bureau of Prisons stated that “without question, the CHASM initiative was able to make a difference. As the RDF-5 Public Information Officer (PIO), I had the privilege of interviewing community members that had utilized the RAM Clinic services. The testimonials they gave related to the healthcare challenges they face was unbelievable. The sincere appreciation they had for the services they were provided was unquestionable.”
Overall, the officers returned to their respective posts knowing they were able to have a direct impact on the lives of those in need, and improve their teams’ readiness for emergency response operations. According to LCDR Mark Hench, “Our offices are all scattered throughout the Nation, but when we all get together, it’s like we’ve known each other forever.” CAPT Ellison, RDF-5 team lead, and a Regional Pharmacy Consultant with the Health Resources and Services Administration (HRSA) has already seen this mission pay off. “The CHASM training mission at Rosebud allowed 28 members of our 140 member team to meet and see each other for the first time in months. That exposure helped us to hit the ground running when we were called out for hurricane Isaac.” The Rosebud deployment helped CAPT Ellison to assess the different strengths and weaknesses of his team by seeing what they could do in South Dakota. When they were called to Louisiana to respond to Isaac, CAPT Ellison had to divide his team in two, sending some to Baton Rouge and the rest to New Orleans. The exercise in South Dakota allowed him to strategically decide who belonged where, and he was able to quickly allocate his people effectively. “I was really impressed with my team’s ability to seamlessly integrate with the DMAT (National Disaster Medical System, Disaster Medical Assistance Teams) teams in both New Orleans and Baton Rouge. The officers that had deployed to the exercise in Rosebud, South Dakota in July exhibited great leadership skills and mentored junior officers with less deployment experience. As the new commander of the team, Rosebud was my first chance to see my team in action and I am grateful for that opportunity before we had to deploy in support of the Hurricane Isaac response in Louisiana.”