LIBREVILLE, Gabon - Performing surgery is inarguably a complicated and intricate task. However, regardless of location, the basic steps are the same. Three surgical professionals who partnered with the Gabonese military surgical team learned this firsthand as part of the ten-person U.S. Army medical team that participated in the U.S. Army Africa-led Medical Readiness Training Exercise 17-4, held at Hospital D'Instruction Des Armees in Libreville, Gabon.Even the basics can pose challenges when operating with a team that speaks different languages and often uses different tools, but the U.S. Army surgical team welcomed the challenge and went into the MEDRETE hoping to learn."The language barrier has been interesting," said Maj. Christina Riojas, general surgeon, Womack Army Medical Center. "We've been able to sign with our hands, use broken English and even some Spanish in addition to the use of our interpreters to communicate while in the operating room. It adds some time during surgery but it has been working and we are able to communicate."The team spent fourteen days in Gabon working alongside their individual Gabonese counterparts and functioned solely with the equipment and resources on site, taking them outside their comfort zone of the gadgets in America."In the United States, there is a lot of stuff in the operating room that we have that you would think makes performing surgery easier but [the Gabonese military medical professionals] don't have those things here and it's not an issue," said Staff Sgt. Jennifer Singh, operating room technician, 14th Combat Support Hospital. "They are still able to perform the surgeries necessary successfully with the tools they have."The mission called for them to build sustainable relationships with the Gabonese and also to improve their individual readiness in their respective fields."My job is to quickly put the patient to sleep and make sure that they stay alive so that the surgeon, regardless of who that is, can do their job," said Maj. Fernando Lopez, certified registered nurse anesthetist, 14th CSH. "I think one of the things this mission show you is how to function with limited resources."The three person American OR team integrated completely into the Gabonese surgical staff. Working with their respective counterparts, the CRNA, OR technician and general surgeon, they observed and assisted in more than 35 surgical cases.Working in the resources-limited environment exposed the team to situations challenging them to be creative, said Singh."I've definitely learned, watching them do it, it made me put my innovative cap on. In another surgery, I didn't have something called a kittner and I came up with a way to make one on the back table so the surgeon could use it even though I didn't have it," said Singh. "So, the limited resources and equipment helps you think outside the box, especially after seeing them make the necessary tools out of what they have available."Aligned with Army Chief of Staff Gen. Mark Milley's vision, this mission provides a small medical team a chance to train. To train together as a team, alongside our partners and individually on their skill set to be operationally ready for what the future might hold.Riojas said, "The opportunity to function within that environment, it's been really valuable. This could possibly simulate a future military real world scenario and being able to be here in a controlled environment is really good training and experience."