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The stalwart medics and nurses
who care for our terribly wounded there carry an especially
heavy mental burden. A medic at WRAMC told me, “Believe me,
images of the carnage stick in your head – like the
19-year-old kid with no arms whose mom was holding the phone
for him.”
Now a new wave of unexpected
horror, leishmaniasis, is arriving at WRAMC – which has the
only accredited leishmaniasis lab in the United States – and
its dedicated docs are burning the midnight oil to find a
treatment. A model predicts that 1 percent to 4 percent of our
soldiers in Iraq can expect to be hit by this potentially
deadly parasite, delivered by the bite of infected sand flies
as common in the Middle East as fleas on a wild dog.
So far, more than 500 soldiers
have been diagnosed with “The Leish.” Since there’s presently
no approved protocol for the docs in the field, most of those
infected have been evacuated from Iraq directly to Walter
Reed. And as each day passes, the medevaced casualties are
increasing, as more of our grunts come down with this painful
and sometimes deadly affliction.
The docs say it takes anywhere
from weeks to months to years for the disease to manifest, and
when it does, it's ugly – “huge, ulcerated nodules the size of
a tumor on faces and hands and other body parts which leave
long-term scars.” Stricken soldiers can have as many as 20 to
30 festering boil-like sores.
Some docs at WRAMC worry that we could be looking at a ticking
time bomb, since leishmaniasis might take as long as 20 years
to show up. Thousands of our troopers who fought in Iraq and
were heavily exposed to sand flies while pushing toward
Baghdad are now back home – and they might have what the
troops call “The Baghdad Boil” without having a clue.
Col. Dallas Hack, who heads up WRAMC’s Preventive Medicine
Division, is more upbeat. “By next season the numbers will be
way down,” he told me.
Hopefully, Col. Hack is right. The follow-on generation of
occupation soldiers to Iraq who are presently deploying have
been well-briefed on this scourge and are taking the necessary
precautions.
To date, the majority of cases have been the
non-life-threatening cutaneous surface variety. Only two cases
of its more vicious cousin – visceral leishmaniasis, which can
be terminal – have checked into WRAMC. But because both
stricken soldiers returned home from Afghanistan a year ago,
docs caution that these could be just the “tip of the
iceberg.”
The best protection in places like Iraq, Afghanistan and
throughout Southwest Asia – where the sand flies dwell by the
millions, and where we have thousands of Joes and Jills – is
what the Army calls Preventive Medicine. That means small-unit
leaders must ensure that their troops take every possible
insect-control precaution: keeping their skin covered;
spraying potentially infected areas; sleeping under mosquito
nets and using insect repellent on themselves and their
uniforms to keep the sand flies away; not sleeping in
low-lying areas where sand flies thrive; and staying away from
dogs, which are major carriers.
From a military perspective, a sand-fly bite can have the same
consequence as a bullet: leaving an empty hole in a unit team.
So far, the Army has lost almost a battalion of soldiers to
this bug.
Until the docs got a handle on it, malaria was a huge problem
in Vietnam – where it pummeled combat and logistical
supporting strength when thousands of soldiers had to be
evacuated for treatment. But unlike leishmaniasis, most cases
could be treated in theater and only the most serious had to
be sent to the States.
In time, the docs at Walter Reed will conquer leishmaniasis.
But just as with malaria, the immediate solution can be found
in the old adage, “An ounce of prevention is worth a pound of
cure.” Coupled, of course, with strong hands-on leadership
from the top to the bottom making it happen
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