17 November 2014

Analysis: Photos Offer Clues to Guard's Ebola Mission

Footprint outlines mark the floor in the doffing station Nov. 4, 2014, where medical 
workers at the Monrovia Medical Unit will decontaminate and take off their personal 
protective equipment after working in the high-risk zone where suspected and infected 
Ebola patients are cared for. PHOTO: Sgt. 1st Class Nathan Hoskins, Joint Forces 
Command–United Assistance Public Affairs/RELEASED
News releases and photography by 101st Airborne Division (Air Assault) public affairs soldiers describe and depict potential working environments for the 80 citizen-soldiers of the Iowa National Guard's 294th Area Support Medical Company (294th A.S.M.C.), Washington, Iowa, which was notified earlier this week of a possible spring 2015 deployment to Liberia.

More generally, the reports also help put into context the mobilization of 2,100 citizen-soldiers nationwide for Operation United Assistance, a mission supporting the containment of Ebola virus in West Africa. That mobilization includes the headquarters for the Minnesota National Guard's 34th Infantry "Red Bull" Division, based in Rosemount, Minn., which will replace the 101st Abn. Div. in country.

Footprint outlines designate where medical
personnel will stand when doffing protective
equipment after caring for patients suspected
of Ebola infection. PHOTO: Sgt. 1st Class
Nathan Hoskins, Joint Forces Command—United
Assistance Public Affairs/RELEASED
The deployments are anticipated to last approximately 6 months, and will include 21-days of medical observation upon return from active-duty.

Normally, for purposes of operational security, deployed Army photographers are trained to crop in tight and focus on people, which limits visual details about the surrounding environment or area of operations. The focus of recent Army images and messages, however, has been on increasing the global public's confidence in the medical facilities, personnel, and resources being put on the ground.

In their respective news releases, for example, Iowa and Minnesota National Guard spokespersons took pains to emphasize that National Guard personnel would not be treating residents of West African nations. Specifically, the Iowa medical unit would provide administration and care to U.S. and coalition medical workers who themselves may have contracted Ebola, in a setting such as the one-of-a-kind 25-bed "Monrovia Medical Unit" (M.M.U.) described in the Army news release printed in its entirety below.

The 12-tent facility features an open-air reception area, a low-risk zone for medical support and healthcare workers, and specified areas for treating "suspected" and "confirmed" Ebola cases.

As noted in the boilerplate captions for the photo series:
The 25-bed MMU is a unique [Ebola Treatment Unit (E.T.U.)] built specifically to care for medical workers who have become infected with Ebola while treating patients. United Assistance is a Department of Defense operation to provide logistics, training and engineering support to U.S. Agency for International Development-led efforts to contain the Ebola virus outbreak in West African nations.
U.S. Ambassador to Liberia Deborah Malac, leftand Liberian President Ellen 
Johnston Sirleaf, right, during recent visit for the ceremonial opening for the 
Monrovia Medical Unit (M.M.U.) PHOTO: Sgt. 1st Class Nathan Hoskins, 
Joint Forces Command–United Assistance Public Affairs/RELEASED
Recent Army news coverage has also featured photography of the Liberian President Ellen Johnson Sirleaf and U.S. Ambassador to Liberia Deborah Malac, who toured the Monrovia Medical Unit prior to its being placed into service.

The country of Liberia has its roots in American history. Starting in 1820, the country was colonized by freed slaves. The Republic of Liberia was established in 1847. Its capital Monrovia, takes its name from the James Monroe, the fifth U.S. president. The country's red-and-white-striped flag is also a persistent symbol of the historical connections between the United States and Liberia.


Panoramic photo of the recently opened Monrovia Medical Unit, located 30 miles outside the Liberian capital. PHOTO: Sgt. 1st Class Nathan Hoskins, Joint Forces Command–United Assistance Public Affairs/RELEASED
By Sgt. 1st Class Nathan Hoskins
Headquarters, 101st Airborne Division (Air Assault)

Released Nov. 5, 2014

MONROVIA, Liberia—The Monrovia Medical Unit (M.M.U.), an Ebola treatment unit constructed specifically for the treatment of medical workers who were infected while caring for Ebola patients, is scheduled to open Nov. 8, located about 30 miles outside Monrovia, Liberia.

"The Monrovia Medical Unit, otherwise known as an MMU, is different than an Ebola treatment unit—E.T.U.—because our main purpose is to give hope to doctors and nurses as we will be treating any suspected or infected cases that happen around West Africa," said U.S. Public Health Service Lt. Shane Deckert, the MMU facility engineer.

No other facility like this exists, said Lt. Col. Lee Hicks, the Joint Forces Command–United Assistance command engineer.

"If an aide worker gets sick, they bring them to the MMU to get taken care of by the U.S. Public Health Service," said Hicks. "It’s an incentive for health care workers to go work in an ETU, knowing that if they get sick, they’ll be taken care of."

The 25-bed facility was constructed from the ground up by a team of Navy Seabees, soldiers and airmen from Joint Forces Command—United Assistance and will be operated by personnel from the U.S. Public Health Service, said hicks.

Before arriving to Liberia to help construct and run the MMU, medical personnel from the [U.S. Public Health Service (U.S.P.H.S.)], contacted other treatment facilities to compile and absorb as much information on best practices for ETUs, said Cmdr. Tom Janisko, a physician’s assistant with USPHS who will be working in preventative medicine there.

Once on the ground in Liberia, the USPHS team trained extensively before doing rounds at an active ETU, he said.

The MMU compound is separated into two—one side is the low-risk zone for medical workers and support staff; the other side is the high-risk zone for suspected and infected patients, he said.

The structure is comprised of 12 tents, four that make up an administrative area for staff members and eight that make up three wards for patients and other necessary services, said Deckert.

The administrative tents are where all the behind-the-scenes work happens—the ordering of personal protective gear, scheduling, processing of paperwork, eating meals.

The high-risk zone is where the patients reside and receive treatment. Because of the contagious nature of the disease, the two halves do not connect in any way.

"The most acute ward would be for the patients who have Ebola," said Janisko. This is the confirmed ward.

The other two wards are the suspected and a flex ward that will be used as needed, said Janisko. Patients who are suspected to have Ebola will be cared for in the suspected ward while they wait for their blood tests to come back from the on-site laboratory.

"There’s nothing else like the MMU in Liberia," said Hicks. "It has everything to take care of folks who may have Ebola or do have Ebola and help them recover from that deadly virus. It’s the first time it’s ever been built like this and used in this type of fashion."

Along with the laboratory, there is a pharmacy, behavioral health section, and a patient reception area on the grounds as well, said Janisko. Restrooms and showers are located behind the wards.

The reception area is unlike most in that it is outdoors. The patients speak to their friends and family members through a windowless structure that is six feet away from a similar structure on the other side of the compound’s fence.

Studies have shown that when Ebola is emitted from a patient due to a sneeze or spittle from a cough, it dies before traveling approximately a meter, said Janisko.

The entire fenced-in compound is nearly self-contained, needing only resupply of water, fuel and food, said Deckert. Fuel supplies two large generators that power the electricity and one small generator that powers the perimeter lighting. The water is for cleaning and decontaminating personnel and equipment.

Every detail was thought out, said Deckert. The complex is built on a slope so that any infectious materials or fluids would drain away from the safe zone in case of heavy rainfall.

There’s also an incinerator on site to dispose of used personal protective equipment so that no trace of the virus leaves the compound, said Deckert.

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