Medical Logistics (Capt, Medical Service Corps, USAF)
“Costa Rica is still growing in aspects of national health care but has a reliable system in place it seems. Similar to many of the countries visited, it has great capacity for building, but is challenged to increase its infrastructure. In 2011, part of this was due to a recent economic decline in the nation and its health care sector. They have interaction both with other regional clinics managed under the same national health system construct (Caja Costarricense del Seguro Social) as well as with private practices and specialty services. The clinics are open only daytime business hours. Only the regional hospital is open 24/7 for emergent care.
“Supplies are distributed to the regional clinics primarily from San José (the capital and largest city), but also there are some smaller warehousing of clinical materials located around the region. One of these warehouses was in Puntarenas where our clinic was located. To get better information for future supply chain management support we would need to speak with the central distribution/suppliers of all nationalized clinic-run entities. What our partners did teach is that at a higher, national level the clinics are standardized with what they will carry and need to keep on-hand depending upon the clinic classification (ie, level 1, 2, or 3).
“Equipment is purchased similar to the DoD method: Requests are submitted toward the end of the year, the administration prioritizes the lists, and then buys what they feel is most beneficial to the clinic with the resources available. Our hosts stated that before the end of the year, it is very difficult to prioritize needs other than some of the items that they ‘always need’ because they are unlikely to receive items very low on their list. The hosts stated that they would be very interested in having a chance to receive any excess US military equipment from their priority lists if there was a mechanism to do so. In future EHET missions, advance coordination would need to occur to see if (locally compatible) equipment needs could be met through the Defense Reutilization and Marketing Office (DRMO). Alternatively, an embedded team focused on Biomedical Equipment repair could work alongside partners such as at this clinic to develop a sustainable preventive maintenance and equipment testing program. Advance coordination on equipment status would foster improvement for resourceful partner clinics such as Chacarita, with targeted involvement from US military biomedical equipment technicians.”
Discussion
These 4 firsthand accounts from a multidisciplinary, primary-care focused, EHET offers multiple preliminary evidence of the value of this small-scale embedded approach. The accounts are responses to an open-ended prompt for personal impressions and key thoughts as part of an EHET. Three of the advantages gleaned from these accounts are greater personal satisfaction, detailed insight into local operations and health systems, and deeper empathy and respect for common challenges despite health system differences compared with the US military health system.
These advantages are critical to afford the US military personnel the ability to more effectively execute engagement goals, such as meeting health needs in humanitarian assistance, advancing interoperable capacity for security cooperation, or achieving targeted training to enhance US medical operational skills. The greater personal satisfaction was evident in the team member responses that, despite mission stops in 7 prior countries, “This by far was the most rewarding part of the Continuing Promise 2011 mission” and “I hope this becomes a tool used to augment humanitarian missions.”
The descriptions by both the administrator and the logistician on the intimate details that the hosts shared with them is a testament to the rapid trust engendered by the embedded approach. There was a trust to share information as a result of acknowledged local strengths and legitimate interest in local challenges. Peer appreciation was evident; although they did not speak the same literal language, they spoke the same professional language, which was apparent even through the use of an interpreter.
A third advantage, evident from these written exchanges is a regular acknowledgement that health system issues, pursued processes, and desired outcomes are similar between different systems. There may be significant differences in actual resources and infrastructure, but some of the bureaucracy is similar. This last insight is essential to grasp in order to seek capacity building and interoperable solutions toward common goals; empathy is needed to encourage local ownership and sustainability while respecting local challenges and different problem-solving approaches and processes.
