By Lt. Col. Anthony Deiss , South Dakota National GuardApril 25, 2019
ALBINA, Suriname - Soldiers from the South Dakota Army National Guard traveled to the South American county of Suriname to provide medical and dental services to the local population of Albina, April 10-12.
The mission was part of a medical/dental readiness education and training exercise to assist with ongoing efforts of improving systemic and oral health in the region.
Nine Soldiers from the SDARNG's Medical Command and 730th Area Support Medical Company worked alongside Suriname Defense Force medics, a local doctor and pharmacy personnel to provide services to residents in the rural community.
The mission was conducted as part of the Suriname and South Dakota State Partnership Program, which seeks to strengthen ties through engagement activities and share experiences and best practices through a variety of military training exchanges.
"A significant need for rural dental care, as well as medical care, was identified as part of an ongoing exchange with South Dakota's partner country," said Maj. Ronovan Ottenbacher, a field surgeon in the 730th ASMC and provider in Medical Command. "This was a first-ever 'ground-up' mission for the SDARNG medical-dental community in Suriname."
The SDARNG team was comprised of two medical providers, two medics, three dentists and two dental technicians, some of which have been to Suriname before.
"This is now my third trip to the area and working with the SDF has always been very rewarding," said Col. Murray Thompson, a dentist and officer in charge of SDARNG team. "We were able to see different methods of medical care unique to that area. We do not get a lot of exposure to jungle medicine in South Dakota, so I know the medical team learned and saw unique and challenging situations."
Once the team arrived at Suriname's capital city of Paramaribo, they had only one day to plan and prepare equipment and supplies for the daily trips to Albina, about 90 miles away.
"This mission was put together in a hurry," said Thompson. "In fact, we were not exactly sure of which equipment we had available as it had to be shipped down early without us being able to look at it due to a blizzard and moving drill that weekend.
"We had to find and borrow local dental instruments, supplies and disposable gloves," continued Thompson. "Basically, everything we were doing had never been done before in that area. We did not even know exactly what the facility looked like until one hour before we began seeing patients.
"This was an excellent exercise in mission planning on the fly and execution of that mission with minimal supplies," he added.
According to Ottenbacher, each day they linked up with the Surinamese team at the local military base then traveled together to a newly constructed medical facility in Albina, a town of approximately 5,000 people.
"The local military would assist in organizing the patients and sorting those who needed dental vs. medical care," said Ottenbacher. "There were lines waiting for the team every morning. The organization was a critically necessary step."
Over the three days, the team saw nearly 300 patients for a variety of medical needs -- from minor body aches and pains to more severe cases.
"One of the last and strangest patients I have seen was a middle-aged gentleman who came with an extremely swollen leg, walking in on sandals expanded and held together with rope," said Ottenbacher. "The patient had severe lymphedema (swelling), which may have been secondary to elephantiasis, a condition which can be caused by parasites living in the lymphatic system.
"The patient had a large ulcer on his leg related to the swelling and was infested with [parasites]," continued Ottenbacher. "These were removed and then the wound bandaged by the team's medic. The patient had future surgical care arranged via the Surinamese team."
In contrast to these unusual cases, Ottenbacher said the vast majority of patients came for simple complaints such as head to toe body pain for many years. Others simply wanted to be seen and get vitamins. Many parents also requested anti-parasite/de-worming medication for their children.
Common viral illnesses and skin conditions were also some of the most frequent concerns.
"Other patients had relatively atypical and long-standing symptoms and wanted a review by an American doctor," said Ottenbacher. "The translators played a critical role in helping the Dutch and local-dialect speaking Surinamese."
However, the main emphasis on medical care was for oral health. The dental team performed nearly 400 adult and pediatric tooth extractions.
"The dental team undoubtedly saw a tremendous dental need," said Thompson. "Like the rural population of South Dakota, Suriname also struggles with accessing a dental provider, ability to pay for treatment and challenges in traveling long distances for dental care.
"As the community had almost no access to dental care, the dentists had an immediate impact on the patients' pain and issues," Thompson added. "Although restorative dental care is something important to dentists, we recognized the utility of extractions in a mission like this. The time required for extractions is significantly less than other dental work and the reduction in pain can be tremendous."
In addition to medical and dental care, the mission created a collaborative multi-national team.
A key member of the South Dakota-Suriname team was Dr. Paul Aikman, medical director of the Paramaribo Military Hospital. For this mission, he was the lead Surinamese doctor on site, as required by their Ministry of Health. Aikman advised the team on treatment options and effects common drugs and medications can have on the local populous.
"Due to certain infections and GI (gastrointestinal) parasites, Dr. Aikman noted that Surinamese providers will not use over the counter medication from the United States at the full dose," said Ottenbacher. "As he put it, the aspirin can potentially make the patients die! This was one of several examples where common medical treatments had to be tailored to the local needs."
"I think [the mission] went very well -- the medical and dental care was very helpful," said Aikman. "There was a need for the care because in the case of dentistry there isn't much availability because of the local conditions with no dentist on location.
"We saw some interesting patients, like one we suspected of lung cancer," added Aikman. "What was notable was that we as medical personnel think alike, and we approach patients more or less the same way."
Even with the mission's successes, the teams had their challenges. While the dental team was able to take some unit equipment and use some local dental school equipment, this needed to be set up and tested.
On-site sterilization was another obstacle that needed to be accounted for, said Ottenbacher. Although known issues such as electrical outlet types and voltage were taken into consideration, other difficulties arose.
"During set up, there did not seem to be enough electrical power to run the sterilization equipment sufficiently to achieve appropriate temperatures," Ottenbacher said. "Thankfully, when the equipment was used at the newer facility in Albina with better electrical wiring, everything went well."
Overall, the mission was an experience that all members of the team, and likely the hundreds of people who were helped, will not soon forget, said Ottenbacher and Thompson.
"As a physician and as a Soldier my goal is to help others, and with this population, many times that could be accomplished with the simplest of things," said Ottenbacher. "Handing out bags of vitamins, giving patients the opportunity to discuss their problems, handing out stickers and small toys such as sunglasses for girls and cars for boys -- all these impacted their lives. Seeing a young child leave the clinic smiling from ear to ear holding a new toy car is an amazingly rewarding experience!"
"No matter where you go in the world, even in the U.S., people need medical and dental care," said Thompson. "Providing care to local citizens is very rewarding."
"The providers, dentists, technicians and medics that were brought on this mission are some of South Dakota's finest civilian providers outside of the National Guard," Thompson added. "Being able to put on the U.S. Army uniform and provide top-notched professional care to those in need shows the world that the U.S. and the SDARNG care for humanity and desires a world where pain decreases and dignity and comfort increases."