This is small sample of a few team members who responded to a simple, open-ended prompt to record their impression of the EHET concept and experiences. Documenting this information should highlight the importance of seeking similar qualitative mission data for future health engagements. Standardized questionnaires have been used to evaluate health activities and have provided valuable analysis and recommendations that have advanced US Department of Defense (DoD) global health engagement.3 Captured narrative observation from the EHET pilot study is a complementary qualitative method that supports the concept of small, well prepared, culturally competent, EHETs tailored to work within a partner system rather than outside of it will achieve greater mutual benefit, including the application of better, more equitable health and health system principles.4 In this embedded manner, health care professionals may readily contribute to host nation health sector plans and goals while achieving military objectives, political goals, and mutual strategic interests through both military-military and military-civilian applications.
Observations and Reflections
Family Physician (Maj, Second Physician, USAF)
“Overall, the experience I had with the embedded team was truly rewarding. I hope this becomes a tool used to augment humanitarian missions. There is no way to truly understand a systems strengths and weakness except by being embedded in the clinic or hospital. For 3 days I worked alongside a bilingual physician at a local family practice clinic. The clinic did full spectrum family practice, including prenatal care. The doctor saw between 25 and 35 patients each day plus covered urgent care during lunch. Paper charting was used although the clinic is looking into electronic records. The clinic was very efficient. All team members were very aware of their roles and did their jobs with a smile and worked well together.
“Most patient encounters took between 10 and 15 minutes although the patient might stay around for IV therapy, intramuscular pain medications, or other treatments that were carried out by the nursing staff. There was a small procedure room and procedures would be performed on the same day they were identified. The nursing staff would set up everything, and in between patients the provider would complete the procedure. On the first day I mostly shadowed, but in the afternoon, I was asked to consult on some of the more complicated patients with diabetes mellitus or hypertension. On the second day I shadowed a health care provider who did not speak English and through an interpreter he asked for my input. In the afternoon the nursing staff asked me to discuss the treatment of abscesses. I discussed techniques of incision and drainage and importance of packing and proper wound care, worked with one of their wound care nurses on packing of several wounds, and consulted on a patient with a venous stasis ulcer.
“We identified an educational opportunity for the nursing staff. On the third day I brought a US certified wound care specialist and I gave a Microsoft PowerPoint presentation on venous stasis ulcers and proper wound care. The nursing staff and clinic were very receptive and asked if we would develop a patient-based educational presentation. The wound care specialist spent the afternoon giving hands-on demonstrations in the wound care clinic, and I taught technique for excisional biopsy of skin tags and moles to physicians. One of the host physicians arranged for more consultations on more of the clinic’s complicated patients, which included a staff member and a relative.”
