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NAVY MEDICINE July-August 1991 I Surgeon General of the Navy NAVY MEDICINE Chief, BUMED VADM Donald F. Hagen, MC, USN Vol. 82, No. 4 July-August 1991 Deputy Surgeon General Deputy Chief, BUMED Chief, Medical Corps From the Surgeon General RADM Robert W. Higgins, MC, USN 1 To Be the Best Department Rounds 2 VADM Hagen Becomes Navy's 31st Surgeon General EdHor JOC W. Whittaker, USN Jan Kenneth Herman 4 Aiding the Aetas 103 J. V. Dickens, USN Assistant Editor Virginia M. Novinski 6 Navy Medical Department Participates in Victory Parade JOC W. Whittaker, USN Editorial Assistant Nancy R. Keesee Features 9 Bangladesh Relief Effort D.R. Klubes 14 Nursing Care of Iraqi Prisoners of War CDR R.L. Van Nest, NC. USN NAVY MEDICINE, Vol. 82, No. 4, (ISSN 0895-8211 USPS 318-070) Is published bimonthly by the Department of the 18 The Navy's Emergency Number Navy, Bureeu of Medicine and Surgery (BUMED 09H), Wuh1ngton, DC 20372-5120 Second-class postage paid at CAPT M.C. Huss, MC, USNR waahlngton, DC, and additonal mailing offices CDR V. Nacev, MSC, USN POSTMASTER. Send address changes to N•vy Medrcme care ol Naval Pubhcabons and Forms Center, ATTN Code 308,5801 Tabor Avenue. Philadelphia, PA 19120 Professional POUCY ~vy Medrcrne IS the official publlcabon of the 20 Treating the Psychologically Wounded Warrior Navy Medical Department R rs 1ntended for Med1cal Depart ment per10nnet and conta1ns professtonaltnformat1on rela· CDR R.N. Sampson, MSC, USN he to med1c1ne. dentiStry, and the alhed health sc•ences Opon•ona expressed are tlloaa of the authors and do not 23 Worst California Measles Epidemic in 25 Years: necesaanly represent the olf•c•al posrt1on of the Department of the Navy, the Bureau ol Medoc1ne and Surgery, or any avy Preventive Medicine Led California Efforts other governmenbll d-rtment or agency Trade names are CDR G.C. Gray, MC, USN uaed for rdentifocat1on only and do not representan endorse ment by the Department of the Navy or the Bureau of Medi LCDR L.G. Clever, MSC, USN cine and Surgery AMhough Navy Med•cme may c1te or LCDR J.P. Struewing, MC, USNR extract from d~recttves. authouty for actton should be LT J.F. Kulhenkamp, MSC, USNR obbloned from the coted reference DISTRIBUTION Novy Medrcme IS d1stnbuted to act1ve duty Medical Department personnel v1a the Standard Navy DIStri Notes and Announcements butiOn Ust The follow1ng d11tnbut1on IS authonzed one copy for each Medical, Dental, Medical Serv•ce, and Nurse Corps 17 Iraqi POW Letter officer, one copy for each 10 enlisted Med•cal Department 26 Highlights From the Naval Medical Research and members Requests to tncrease or decrease the number of Development Command allotted copies should be forwarded to Navy Medrcrne VIa the local command 27 Navy STD Treatment Guidelines ... Navy Museum Seeks Desert NAVY MEDICINE IS publiShed from appropnated funds by Shield/Storm Artifacts ... Southern Medical Association Meeting author1ty of the Bureau of Med1c1ne and Surgery on accord 28 Women in Navy Dentistry ance w1th Navy Pubhcahors and Pnnhng Regulat1ons P-35 The Secretary of the Navy has determoned that th1S publoca CAPT R.J. Flinton, DC, USN ttOn 11 necessary in the transaction of buseness requ1red by law of the Department of lhe Navy Funds for pnntlng thos publ•cabon have been approved by the Navy Publocatoons A Look Back and Pnnbng Pol1cy Commottee Art!cles,letters and address 29 avy Medicine 1922 changes may be lorwarded to the Ed1tor. Navy Med•cone, Department ol the Navy, Bureau of Med1cme and Surgery (BUMED 09H), Washmgton. DC 20372-5120 Telephone (Area Code 202) 653-1237, 653-1297; Autovon 294-1237 294-1297 COntnbut1ons from the field are welcome and w1ll be published as space perm1ts, subJect to ed1t1ng and posSI COYER: Residents of Sandwip Island, Bangladesh, carry a sack of rice ble ab<rdgmenl dropped for them by a U.S. helicopter. Following a devastating cyclone For sale by the Supermtendenl of Documents U S that may have killed over 125,000 people, the United States diverted Government Pnnl1ng Off1ce, Washmgton. DC 20402 some of its forces from the Persian Gulf to help in relief efforts. Story on page 9. Photo by Bullit Marquez, AP/Wide World Photos. NAVMED P-5088 From the Surgeon General To Be the Best 0 n 28 June 1991, I had the honor of taking the helm at home, ensuring their families were not lacking for care. of the nation's finest health care organization We have a moral obligation to maintain our capability to the Navy Medical Department-from one of its meet the needs of our fighting forces while continuing to greatest leaders. V ADM James A. Zimble had a herculean care for their families. We can do that. task before him when he became Surgeon General in 1987. If we look at where we were, where we are, and where we He likened Navy medicine to a patient and diagnosed that need to be, it is amazing how close to optimum we are. patient as critical. In the years to come, he marshaled the Sometimes all it takes to solve a problem, for instance, tremendous human resources of the Navy Medical Depart increase access to a particular department and free the ment and enlisted Navy and Marine Corps leadership onto in-house staff to tackle more challenging cases, is to the trauma team that brought us back to health. arrange for a civilian provider to come in once a week on a I was privileged to be part of that team, as indeed every partnership arrangement. I urge all of you to look realisti one of us were. Admiral Zimble encouraged and solicited cally at what you need to do your job better, and then look comments from the field on how best to treat the patient. for innovative ways to meet that need. This is TQL at its Under his leadership, Navy medicine steadily gained best. And for TQL to work, you cannot micromanage, nor strength and, as so magnificently demonstrated in our can you be micromanaged. recent support of Operation Desert Storm, achieved not People at all levels need to be empowered to do their only its health but was fully fit and ready for action. jobs. I think BUMED's responsibility, and any leader's, is The initiatives, innovations, and advancements that to tell you what that job is: to set the focus, or parameters brought us where we are today must be nurtured and built of the job, tell you what resources you have, and then stand upon. Over the past 4 years, avy medicine's leadership back and let you do it. The Navy Medical Department's worked closely with Admiral Zimble in formulating the Mission and Vision statements, combined with our Guid Navy Medical Department's Guiding Principles and Mis ing Principles, provide the focus. Now I need to make it sion and Vision statements- our focus for the future. I easier for you to work at a local level, to have authority to expect to rely on our flag officers and other leaders as work with the resources available, and to do what's best. If much, if not more, as we continue the course laid in by we all strive to do what we perceive to be right, because it's Admiral Zimble. the right thing to do, we will obtain a quality of life for both One of the key elements in Navy medicine's recovery has ourselves and our customers far in excess of anything been Total Quality Leadership (TQL). We are leading identifiable through inspections or productivity quotas. most of the Navy in engendering TQ L culture throughout Navy medicine's vision has been set. My job is to help our system, partly because our scientific training is com you realize it. I would ask all of you to help me as well. plementary to the TQL statistical methodology. We all When I came on board at BUMED, I found they-we have a common vision of the future, a common sense of had set a headquarters vision "to be the best headquarters values. We're all in the same business-health care. It's a operation in the Department of Defense and to be recog TQL-based business. We just need to round out our nized as such." We are going to make BUMED what our knowledge. We need the statistical process control tech vision says it will be. We are going to be the best headquar niques, more education, and the tools to do the job. ters. Absolutely! Everyone is a customer of someone else: Yet while we go about changing our culture, we still have You are our customers. Help us serve you better; help us business to do. When the Navy and Marine Corps fighting lead Navy medicine. forces needed us, we were there for them. And we were also VA DM Donald F. Hagen, MC July-August 1991 Below: Secretary ofthe Navy H. Lawrence Garrett Ill presents VADM James Zlmble with the Distinguished Service Medal. Right: VADM Zlmble congratulates the new Surgeon Gen eral, VADM Donald Hagen, as NNMC skipper RADM David Lichtman (left) and Chief of Naval Operations ADM Frank B. Kelso II (right) look on. Department Rounds VADM Hagen VADM Donald F. Hagen, MC, a Vietnam veteran, took over the helm of the Navy Bureau of Medicine and Surgery on 28 June 1991, replacing VADM James A. Becomes Navy's Zimble, MC, as Surgeon General of the Navy. The event took place in a tradi tional change of command ceremony, which featured H. Lawrence Garrett 31st lll, Secretary of the Navy, as keynote speaker. More than I ,000 attended the occasion, in the shadow of the 18-0oor Tower at National Naval Medical Center, Bethesda, MD. Surgeon General "The admiral takes over as the Sur geon General at an especially challeng ing time for the Navy and its Medical Department," the Secretary said. "It is a time when our resources are shrink- 2 NAVY MEDICINE 'T - '11 - I --1 I - -- 1 ~ ' _ I I ~ Photos by HM2 Dan Kelly, NSHS I t) I VADM Zimble gives farewell address. Navy medicine has come in the 4 years what did not. Our primary purpose is, that Jim Zimble has been at the helm. and always has been. to support the Retention is up. Recruiting is up. sailors and marines in combat, and to Patient visits are up. Quality is up. ensure they are fit to fight." "The catalyst for that change, the His predecessor, Hagen added, was motivating leadership, has come right a legend in Navy medicine. "How do from the top, from the office of the you follow a legend?" he asked. "It Surgeon General." won't be easy, but Admiral Zimble has Zimble, who retired after more than laid the foundation. The Medical three decades in the Navy, took over Department leadership is on board. his new position later in July as presi The stage has been set. Now we must dent of the Uniformed Services Uni all work to followthrough. Our people versity of the Health Sciences. the can make it happen and I will be proud nation's only medical school for train to lead them." ing much more quickly than our com ing doctors for career medical service The ceremonies were highlighted by mitments, a time when visionary in the armed forces. appearances by the Navy Band and the leadership and innovative thinking The keynote speaker also praised Ceremonial Guard, the retiring of will be more vital than ever.., the performance of Navy medical peo Admiral Zimble's flag, and the presen Garrett said that Hagen was an ple in Operation Desert Storm. "To tation of the national ensign that had excellent choice as theN avy's 31st Sur the entire nation's enormous relief, the flown over the U.S. Navy Memorial geon General. "Admiral Zimble's naval medical talent standing by in the on 3 March, the !20th birthday of the shoes will be very capably filled by a Gulf region did not have to show all of Navy Medical Corps. The flag was man who is an extraordinary officer, its stuff. but it was there. ready to pro passed from hand to hand down a row leader, and physician." Garrett con vide the most sophisticated mcd ical of sailors and chief petty officers to tinued. "I have the greatest confidence care ever available to American troops Zimble. in you. admiraL and I welcome you in a combat theater," Garrett said. The Bureau of Medicine and aboard with best wishes for continued Hagen, in accepting his orders, said Surgery. now in its 149th year, sup success and my promise of continuing that as Surgeon General he would not ports the work of more than 73,000 support for Navy medicine." be complacent about medical suc active duty sailors, reservists, and Garrett also lauded Zimbleas a man cesses in Desert Storm. civilian medical perscnnel. o who made things happen. "I am 'The job is not over," the new Sur - Story by JOC Walton Whittaker. BUM ED extremely distressed to sec him go," geon General said. "We need to get Public Affairs. Photos by H M2 Dan Kelly, the Secretary said. "Admiral Zimblc is involved with all of our people who NSIIS. l.lethe;,da, MD. a dynamo. a fireball. Look at how far deployed, to find out what worked and July-August 1991 3 Aiding A volcano drove them from and throats. They also doled out their homes. Dump trucks bottles of cough medicine, Tylenol, from the Highway Depart and other nonprescription drugs. ment ferried them to safety in the small The right-hand side of the courtyard village of Poonbato, where they were was dotted with dental chairs and also provided with shelter and food. And sported a table covered with a variety the 7th Fleet support units from the Subic of instruments ready for action. The Bay area provided free medical and dentists' plan for the day was simple: dental care. administer anesthetics and pull any Until recently, these Aeta tribesmen troublesome teeth. According to had been living in the shadow of DTCM Henry Cuilty, aid projects Mount Pinatubo, where they eked out such as this are low-investment, high a simple existence from upland farm return propositions. Aetas ing. The volcano is sacred to the Aetas "It doesn't cost a lot," Cuilty said. and when it began to show signs of life, "Most of the material comes from many of the older ones wanted to Project Handclasp. The manpower remain in their own village. But doesn't cost anything because it's done according to Chito Balatay, an Aeta all on our own time. I look forward to tribesman, the need to evacuate their these. It makes me feel good and I get a homes soon became apparent to all. chance to see the provinces." "We didn't have medicines and we According to Chito Balatay, the had a lot of medical problems," Aetas will stay where they are for now. Balatay said. "We picked Poonbato But the future of the tribe is still un because it was close to our village. My certain. "So far, there is no definite people are grateful. They feel the con plan," he said. "The villagers will have cern of these American brothers." to decide for themselves. We will have A large courtyard in Poonbato was to wait and see what happens." o transformed into a makeshift hospital and dental clinic. On the left were the - -Story and photos by J03 J. Vincent doctors and hospital corpsmen ex Dickens, Seventh Fleet Public Affairs, Subic amining dozens of eyes, ears, noses, Bay, R.P. On 12 June 1991, after a bout off itful small eruptions, Mount Pinatubo racked the Philippines with a series ofm ajor eruptions that continued for days. The eruptions spewed ash and rocks over a wide area and caused many earthquakes, forcing the evacuation of over 200,000 Filipinos. Furthermore, the United States eventually evacu ated all personnel from Clark Air Force Base and many nonessen tials from Subic Naval Base. The fact that Clark being 10 miles from the volcano was devastated does not bode well for the A eta tribes men. Some Aetas were confirmed as dead among the over 330 people killed by the volcano. Due to uncertainty about their long-term safety, the Filipino President, Corazon Aquino, recently decided to resettle 20,000 Aetas approximately 30 miles to the northwest of the volcano. However, the Aetas are spiritually tied to the volcano and it is still uncertain whether they will agree to the move. 4 NAVY MEDICINE Clockwise from top left: HM2 Roberto Magcalas reads the recommended dosage on a bottle of cough medicine for an Aeta evacuee and her son; LT William Lyons administers an anesthetic to a Filipino man as his son looks on; HMCS Kathleen Noll and HM3 David Shelton break open a container of medical supplies for the Aeta tribe evacuated from the Mount Pinatubo volcano; and LT Wayne Boulton checks a young Aeta's heartbeat as the boy attempts to stay calm. July-August 1991 5 Navy Medical Department Participates in Victory Parade I t took 5 weeks, 500 men and Constitution Avenue on 8 June 1991. the celebration was to begin officially women, and a Navy officer who It was the largest military parade in the on Saturday morning, people flocked became an on-the-spot plumber, nation's capital since World War II, to the Mall and went through Navy but when it was over Navy medicine and Navy medicine was smack in the exhibits on Friday night, with more had put on one of its finest shows ever. middle. than 45,000 going through Navy medi "Magnificent," said RADM Robert "I have never experienced anything cine's tents, even though all of the dis W. Higgins, Deputy Surgeon General like it in my life," said CAPT Claire plays were not yet installed. of the Navy. "It told a real story, a Purdy of the Nurse Corps. "People That was just the tip of the iceberg. human story, of Navy medicine in sup were shaking hands and wanted your During the next 2 days, over 100,000 port of Desert Storm forces." autographs on anything- shirts, pos poured through the five Navy and More than 200 Navy medical peo ters, caps, pieces of paper, books. It is Marine Corps medical tents, conspicu ple, all volunteers-their white suits a fantastic personal thing when people ously located by the Mall's carousel, bright in the June sun- put their best come up to you and say, 'Gee thanks, directly across from the Smithsonian foot forward at 116 steps per minute, we're glad you're home!"' Castle and near the Metrorail joining 8,000 other soldiers, sailors, Purdy and the rest of the medical entrance. marines, and coastguardsmen in the team who marched and manned dis Long lines formed at 7:30 Saturday mammoth Victory Day Parade along plays had their hands full. Although morning at a mock operating room, 6 NAVY MEDICINE RADM Robert Hig gins, Deputy Surgeon General of the Navy (left) and VADM Donald Hagen, Sur geon General, exam Ine Navy medicine display on Washing ton's Mall. where visitors looked at dozens of medical instruments laid out and a lone operating table. HM I Robert Perry was peppered with questions. "How hot was the tent?" one boy asked. "The table seems small," said another. "What if you're 6 feet tall?" "In 5 months in Saudi Arabia," Perry replied, "it sometimes got hot and, yes, the table would accommo date tall people, too. "There have been long lines outside ever since we opened," Perry said. "I've had my picture taken lots and lots of times. It has been amazing, just amaz ing." Nine-year-old Jacob Kramer of Silver Spring, MD, gave Perry a cap and asked him for his autograph. "My dad was in the Navy," the boy said. , "He told me I should get your auto ' graph." In a camouOaged tent set up just as it was in Saudi Arabia, IsidoreZaider man of Potomac, MD, stopped in ·I front of a dental chair and equipment and spoke to DT3 Melissa Canady of the 2nd Dental Division from Cherry Point, NC. July-August 1991 Photographing it all were sailors from the Medical Photography Branch of the Naval School of Health Sciences, Bethesda, MD. "My own family came in from Ohio just to see the medical displays," said HM2 Donald Singleton, one of the photog raphers. "They were overwhelmed at · what Navy medicine did in the Gulf." CAPT Harold T. Pheeny, MSC, team leader for the Action Committee set up by the Bureau of Medicine and Surgery to handle 'avy medicine's participation in the event, said there - were few glitches in the effort, which began just 5 weeks before the celebra tion. "It looked smooth and impressive but the logistics kept us working even Left: A Navy officer answers questions on the hospital ships' exhibit. Below: ings and weekends," Pheeny said. "At VIsitors gaze at the medical Instruments 7 a.m. on the day of the parade we In one of Navy medicine's displays. discovered one of the 20-foot poles to hold the Navy Medical Forces banner to be carried in front of our marchers was missing. LTJG Mark Ulrich found a plumbing shop, acquired some pipe and had it cut and decorated in time for the parade. I doubt anyone knew the difference." When it was over,just 100 days after the end of the war with Iraq, Victory Day had shown off its wares to 800,000 visitors and millions more on televi sion. Patriotism ran amuck, 10,000 "I didn't realize there were dentists American flags were handed out along over there," he said, "but when you the 2Y1-mile parade route, 83 war think about it, that would be a neces planes flew overhead, and the military sity. This is fantastic. It brings the war men and women who participated closer to home at a level we can relate devoured 40,000 pieces of chicken, to. I watched the war on television 25,000 hot dogs, and 50,000 ice cream nearly 24 hours a day. This makes me bars. feel almost like I was there." .. - I For ~avy medicine, it was a great Also popular were displays of scor show and. officials said, well deserved. pions. snakes, and insects collected by In the war, more than 12,000 active some of the medical staff, an exhibit Navy nurses, 8 Medical Service Corps duty and reserve men and women in from the Navy Blood Research Lab personnel, and 75 hospital corpsmen the medical community served in the showing frozen blood, a show on treated visitors who fell ill to the June operational theater. The fleet hospitals desert survival techniques, photo heat. Some worked 14 hour days. alone treated more than 32,000 pa graphs and slide shows of Navy medi Altogether more than 100 celebrants tients, some of them for heat stress. cine in action in the Gulf, an exhibit on were treated for cuts, headaches. heat, Some of the civilian supporters at the the fleet hospitals and hospital ships, dehydration, and other complaints. parade got similar treatment from the and a Humvee ambulance. Another 25 were transferred to 1\avy medical personnel who were But much of what the :"Javy's medi Washington area medical facilities for once again standing by to assist. o cal people did was not in the public more serious problems such as asthma Story by JOC Walton Whittaker. BU MED arena. Each day 24 Navy doctors, 22 and vertigo. Public Affa.rs. 8 NAVY MEDICINE