Military Pediatric Residency Program Director Wright-Patterson Medical Center Beavercreek, Ohio, United States
Background: Stability operations, including humanitarian assistance and disaster relief (HADR) missions, are a key function of U.S. military medicine, and the Military Medical Humanitarian Assistance Course (MMHAC) is a two-day course widely used to prepare military medical personnel for such missions. It focuses on caring for those most vulnerable in the wake of disasters, particularly children. The large-scale humanitarian deployment of military medical providers in support of Operation Allies Welcome/Operation Allies Refuge (OAW/OAR) presents an opportunity to evaluate the preparedness of these providers to care for the needs of the Afghan travelers. Objective: To explore the experiences of military medical providers deployed in support of OAW/OAR in order to inform improvements in the MMHAC. Design/Methods: We conducted a qualitative study of military medical providers, with a focus on pediatricians, who deployed in support of OAW/OAR using a series of three virtual focus groups of 14 providers. Focus group questions were structured around the main topics covered in the MMHAC (patient care, ethical considerations, logistical concerns, and preventive and public health) and explicitly asked about adaptive leadership challenges faced and strategies used to overcome them. We analyzed transcripts using inductive thematic analysis within a constructivist paradigm, with adaptive leadership as a sensitizing concept. Results: We constructed four themes from participant responses, each addressing challenges that medical providers faced during their mission: (1) Medical providers navigated tension between medical and public health priorities and military mission priorities; (2) Chronic and complex care needs posed unique challenges for medical personnel, particularly in children; (3) Challenges in patient care were compounded by logistical and systems-based barriers; and (4) Cultural barriers led to ethical dilemmas that physicians felt inadequately prepared to handle, most notably with respect to gender-related concerns. Within each theme, participants described which aspects of MMHAC training were most helpful and which areas were inadequate.
Conclusion(s): Physicians found the OAR/OAW mission meaningful but also identified challenges related to medical care provision, public health, logistics, and ethical dilemmas that hindered their ability to carry out their medical mission, particularly with respect to care of children. Lessons learned from OAW/OAR highlight several areas in which the MMHAC training could be augmented and improved to further mitigate these challenges.
