The Lived Experience of Chief Nurses in Military Operations Other Than War -- M. Turner

Fundamental Structure of the Experience
- Working
-- Population diversity and patient conditions

The chief nurses had to address health care needs at multiple levels. In the deployments where there were very large numbers of people, the health care needs were population based. This included availability of water for washing and drinking, availability of food that was nutritionally adequate and palatable/culturally acceptable, toilet facilities which were clean and properly used, access to first aid and transportation to higher levels of care. Many individuals within the populations had special needs or required additional care in some way. There were people of all ages in the camps, families and individuals without families, some of whom were children. There were prisoners, and groups who saw each other as the enemy and thus had to be kept separated in the clinics, on air-evac flights and in the ATH. The medical conditions of the patients were, for the most part, familiar to the staff. What was unfamiliar was the concentration of patients with a single diagnosis which resulted in the equivalent of large wards. Psychiatric diagnoses, AIDS, TB and dehydration were examples of these patient populations. OB was also represented in several of the deployments creating a need for services which were not ordinarily part of an ATH.


We had an... epidemic of sand fly fever. All these soldiers would be on maneuvers and the sandy... Sandy and dusty and whatever else. And they would come in with these high fevers, like 103_, and you were wondering... Well we thought the patient maybe had a cold or something. . But we saw, I think... We saw almost a thousand of those guys. What it necessitated was us putting up another tent and actually having like a hospital where those people went in and they had to stay. They stayed there for like three days and if... After three days, the people were pretty much good if they got Cipro and all of that stuff that we gave them. But they were in the tent and we had the Marine Corps and the Army that actually came in and augmented our group to provide care for the people. They also... The doctors pulled call, the marines and army. They would pull call with the docs and the corps men who were all LVN's and there... Those people that were deployed with the marine corps and the army were the best prepared technicians that I have ever seen. Most of them were LVN's in the first place but they were really good.


It expanded... I mean, there were over a thousand of them in the detention center. Horrible conditions. And who do you suppose had to do the aid station for the detention center? The ATH. So that was another tasking we had is to have around the clock detention center medical aid station... also severe psychiatric patients. Strait jackets, sedated, shackled. Really a traumatic time for our staff, we had to go help with them.


We had to man a 60 bed ATH. Uh... Of course, they would be the United Nations troops so we would be taking care of people from various nations, many different nations, and 38 different languages spoken. We took care of any U.N. troops. If they had a U.N. I.D. card, they were eligible for care. If they didn't have a U.N. I.D. card they were not entitled but we didn't turn anybody who was emergent away.


The war kicked off apparently very, very violently and we ended up with... If I remember the number correctly, 6 prisoners of war, wounded. And they went to our mobile air medical staging facility that was in that area. . We had been running air-evac missions all along but they were all disease, non-battle injury, soldier jumped out of the back of the truck, sprained his ankle, got to air-evac him back to the states, that's what we had been running. This was the first air-evac mission that we were going to have with enemies... The enemy.
We met some of the members of a terrorist group who were friendly to the Americans so they brought their people in in helicopters to be treated and there was another group and I can't remember what the other terrorist group that they were fighting and we were working with both of them. So they came in at the same time and we had to actually get one group out and put them on the other side of the hospital to make sure that the other group never even came any place close to each other so they wouldn't find out that we were treating both of them. And that was very interesting. That's the first time I've ever seen any political thing like that in my life.


A lot of the people that were the refugees or the migrants were professionals. And they had been persecuted in Cuba so they wanted out. And then we had people who were hardened criminals, who were murderers, who were in a camp that was triple barbed wired and marine guards and loaded weapons and that kind of thing, who were absolutely criminals. And those people that they knew, they put them in Camp X-ray. That was X, Camp X. I went out there to Camp X-Ray several times to deliver some medical care and they always had guns on the patients while we were out there with them. And they told us, you know "Don't have anything that they could take away from you. Any kind of thing that they could use for a weapon or something."


There were even some old folks there, in their 70's, that had gotten across the bay. And there were a bunch of kids that didn't have parents that had gotten across the bay. And that was... So that was the camp in itself. And that was kind of interesting 'cuz it was kids taking care of kids.


We had a jail there. I had a nurse that I put over there and he used to do medications at the jail... Or institution. Which was really run by the Army and it was a very tight... We had some folks come in who had tried to commit suicide, slashing their wrists or trying to hang themselves or stabbing themselves with plastic spoons and things they had and um... What else? It was just a really unique environment. People learned...


And the problem was the population that came to us #1 when you think about OB they were non... None of them were supposed to be pregnant.... None of them were pregnant supposedly. Well about a 8 month pregnant woman showed up very quickly. But we had to get an exam table and an ultrasound to deal with the pregnant population that we had. The political concern about that was that the president of the country said we would not have any migrants having babies. . They fought about where these ladies were going to deliver. And I just laughed because the ladies were going to deliver. You know, they were going to deliver so, I mean, what's the big deal, it's not a political decision, the delivery is going to happen. But none of them did deliver they were shipped back in fact to Texas and that's where they delivered. But, I mean, the OB concerns. ... the health risks about not getting the prenatal care that you needed. But we had the pregnant women and then we had the... I think 75-80 was the top age in our population. And the internal medicine kind of concerns that that age group brings you. The cardiacs that we had, Diabetics. Patients with seizures. Um... We were not set up originally to take care of those people so we ended up actually setting up on one of the wards sort of SCU if not an ICU, an SCU, to take care of those patients


But they decided to keep our patients to the very last and the psychiatric patients were the very last of the very last. We ended up developing a 30 bed psychiatric annex right next to our facility and it had in it the most severely psychologically, psychiatrically involved patients I have ever seen in my life. The psychiatrist who was with us, had never seen such severely affected patients. The doses of medications that he used in Prozac... I mean, it was like water. The doses he used to just keep them calm would make us unconscious. But supposedly in their country people can get Valium over-the-counter. You know, their tolerance much have been built up. But he really... He learned a lot from his time there. But we had acting out. We had... We had more leather restraints on a routine basis. addition to chemical restraints. What a population of patients.


I learned a valuable lesson. If you were to do psych patients, you'd almost have to have a facility where you could lock them in or somehow secure them. And I don't think you can do it in a tent. I mean, in a tent, how do you secure the man? So you... We would have had to use a hardened structure to really be able to provide that type of security. Or if you ev... Like restraints, which is a big deal state side. How would you restrain? What would you restrain them to? I mean, those cots you can almost pick them up and walk off with them. It... It would be a challenge. It would be a challenge.


And the issues she had were just unbelievable with education and working with patients with active TB, patients... We had a whole camp just of TB patients. And a whole camp of HIV. And then when we had the chickenpox outbreak, we had a whole camp of chickenpox.


So there was a tremendous amount of fake illnesses and self-mutilations that went on constantly. I have slides of people who had swallowed batteries, swallowed glass, and intentionally injected their legs with diesel fuel to get scars and cellulitis. We had people with fake chest pain constantly coming into the clinic and also with fake seizures. There was a lady who had an Alka-Seltzer tablet foaming in her mouth.


All the OB was done on our side and that was one of the most pleasurable things, to see those babies born. And we had so many babies.


And then we had the ones that were really sick. ... the little kids who had really bad things wrong with them. We had an arrest of a little girl. She might have been 2 or 3 years old. An active TB patient, she had a respiratory arrest and almost died.


Most of our patients were just typical air evac type movement patients, ambulatory, and, you know, broken legs, bones, and stuff like that. After you come from a medical center, this stuff was easy stuff. And you had the most expert people there to take care of them and they didn't have anything to take care of. I mean, they were wishing things were wrong with the patients so they could take care of them. So, you know,to treat 70 patients over that period of time was really nothing when you think of how many we had at the medical center.


We had, ah... A number of people with migraines. I had some of my own staff with migraines. So I get real sensitive when we talk about deploying people and doing profiles. I go, "People with chronic migraines, why are we deploying them in an environment like that?" got them in a warehouse, you're supposed to keep it quiet and you're medicating and trying to break the cycle and we're in a warehouse where half of the warehouse you've got forklifts going and all this and it's... You know, that makes it hard when you're trying to treat those types of conditions.