Page 17 - QARANC Vol 14 No 10 2015

The Military Nurse Practitioner
I find it hard to put into words just how lucky I feel to have been part of 5 Medical Regiments recent Exercise on ASKARI SERPENT. We write a list of ‘to dos’ through life, some of these include activities such as a bungee jump or perhaps even coming face to face with a lioness and her pack of cubs however, there are always a few work related ‘to dos’ and one of mine was completing this exercise. I qualified as a Military Nurse Practitioner (MNP) at the end of 2011 including qualifying as a prescriber in April 2012 and joined the Regiment as a MNP in summer 2012.
Of course an exercise as such requires much preparation and in support of the Squadron I provided clinical training from a PHC perspective. In addition, my role prior to Ex ASKARI SERPENT in conjunction with the SMO was to put together the Role 1 validation exercise thereby providing assurance for the chain of command that the clinical team were prepared to deploy.
I recall sitting on the coach from Nairobi Airport on our journey to Laikipia Airbase from which we would forward mount thinking about the colours of Kenya that surrounded me. The air was clear and land was either a deep coral or lush green. Not a road was travelled throughout the exercise where there wasn’t a small or large gathering of animals, goats, cows and donkeys.
Whilst the exercise was scheduled to run for approx. 16 days 2 Tp (MRS 2) had a number of responsibilities. I was fortunate enough to work clinically alongside Captain Paul Davies with whom I had deployed with on HERRICK 18 and I had Captain Mike Rawden as Troop Commander. In addition we had Sgt Coldrick as Tp Sgt. Together we ensured kit and equipment was prepared and ready to move, smooth integration of our Kenyan Defence Force Medical personnel and that we prepared for and carried out a demonstration for KDF Commanders and visiting AMD VIP’s. This demonstration provided all involved and observing with confirmation that whilst British and Kenyan training and experience may prove different, we can unite together and work as a clinical team.
During the exercise Tp 2 visited 5 separate locations to provide PHC outreach clinics to the local population. This involved on some occasion lengthy travel in Troop Carrying Vehicles (anyone experiencing this will tell you it is just a very prolonged Alton Towers ‘Runaway Mine Train’ ride although perhaps not so fast!) with kit and equipment carried in Service Vehicles. The journeys brought much visual fascination though small tribal villages and busier larger towns. We were surprised at how much wildlife we saw, just on the road – warthogs, elephants, impala and giraffe.
My clinical responsibilities were similar to that of the GDMO and we worked hand in hand. Any referrals made by the CMT team came through to either Capt Davies or myself. We were fortunate to have a KDF pharmacy technician integrated into our team. He added so much value and eased the burden of busy clinics on a daily basis. The clinical presentations were varied and ranged from acute conditions such as pneumonias, wound infections and eye problems to chronicity and terminal disease. There are a few experiences clinically that are embedded with me and two patients have clearly left a longstanding imprint in my memory. Jane* was brought into the treatment facility by a local who had been employing her on his farm. She was around 10 years old and an orphan. Quite clearly just upon looking at her she was covered in insect bites some very badly infected. In addition to this and upon assessment she had a chest infection and most likely worm infestation. As a treatment facility we were
able to provide her with the treatment and management required for these conditions. A second patient who made such an impact on me was Martha*, a 38 year old female who had abdominal pain. This had been ongoing for the past 4 months and had become worse. She had attending a local cervical screening clinic some weeks before and they had screened her recommending referral to the gynaecologist in the large hospital for further investigation. Martha did not have the funding to pay for this referral and the state do not have a national health service, which will pay for assessment and possible treatment like this. Through the Red Cross we were able to refer Martha urgently ensuring that her funds would be paid through a local charitable organisation, proving the value of our services as a conduit for onward care. The MTF team pulled together and despite the remote environment, sometimes lack of resources and ability to refer we delivered an exceptionally high standard of care.
I believe the team came away from the experience with a hugely positive frame of mind with many lessons learnt and new skills developed. This has been one of the highlights of my career both as a Nurse and in the Army.
*Not real name
Maj K J McFadden-Newman QARANC
The Primary Healthcare Nursing
Officer
Due to the OET requirement I had been trawled at short notice from my DPHC role as SNO at RMA Sandhurst to join 5 Med Regt on Ex ASKARI SERPENT. Before arrival in Kenya I was informed that I would be deployed alongside a GDMO (Capt Parsons), Cpl RGN (Cpl Dark) and the CMTs of 1 Tp, delivering PHC to the local population in the Nanyuki slums. I was also provided with a copy of the Kenyan Health Protocols and this provided an invaluable opportunity to familiarise myself with the differences in Kenyan practice and also revise the relevant tropical medicine aspects.
On arrival in Kenya I was able to bond with 1 Tp over 3 days of AT (including some exhilarating white water rafting). On return to Lab East, the Tp spent a number of days preparing the MTF for deployment, including the organisation of medicines and paperwork. The med modules aren’t scaled for the type and numbers of health care we were about to deliver and therefore a good amount of ingenuity and enterprise was used to organise the MTF, including the use of empty ration packs as medicine storage drawers!
Immediately prior to the deployment we conducted a validation Ex, utilising a broad variety of scenarios from routine PHC conditions to snake bites or schistosomiasis. I was impressed and reassured by the level of knowledge demonstrated by the CMTs and it was clear that they had received excellent and relevant training prior to the deployment. At this point we were also introduced to our KDC counterparts and had an opportunity to familiarise them with our processes and also explore their parameters of expertise and clinical practice.
Over 8 days we deployed to 2 different locations in Nanyuki and delivered healthcare to hundreds of patients. It rapidly became clear that we were unable to meet demand and were required to issue a quota of tickets at the start of each day in order to avoid disappointment at the end of a long wait. Local Red Cross volunteers provided translation services and were invaluable in facilitating the delivery of care. The presentation of conditions was extremely varied and ranged from acute burns and RTA injuries to end stage cancer.
THE GAZETTE QARANC 15