Features

2

6

Commentary. DoD orders servicemembers 

at greatest risk to be issued the smallpox 

vaccine.

Tracking Civilians. U.S. Army develops new 

system to track civilian employees deployed overseas.

History Project. The Veterans History Project is a grassroots effort to collect stories 

from veterans living in the U.S.

No Longer Weekend Warriors. Nearly 300 

Reserve Marines return from participating in

Unitas 43-02.

A Home Away from Home. Families and 

patients experience comfortable home-like 

surroundings at Fisher House while waiting 

for medical treatment.

2003

7

winter

Under Construction. New medical shelters 

designed to be smaller, lighter and more 

easily transported.

The Best Revenge. Researchers at the Walter Reed Army Institute of Research are in 

hot pursuit of vaccines to halt deployment 

diarrhea.

Breakfast. Nutritionists advocate adults and 

children eat a healthy breakfast to 

start the day.

13

15

10

17

In Every Issue

News from Around the World 3 

USS Harry S. Truman Deploys

 Military Rebalances Reserve Component, Active Duty. 

Medical Convoy Offers Health Care to Afghans

Ask Our Doctors 5

How To Prevent Strep

Vaccines, Drugs & Herbs 5

Smallpox Vaccine: How It Relates To You

Gulf War Update 9

Final Gulf War Air Quality Report Released 

DoD Studies Laboratory Assessments of Urine

Health Beat 17

Diabetes Awareness: Have A Complete Check-up

Resource Guide 20

OPERATION ENDURING FREEDOM — Staff Sgt. Rick Casto guides a 

B-52 Stratofortress from Minot Air Force Base, N.D., into the wash rack 

at a forward-deployed location supporting Operation Enduring Freedom. 

Photo by Senior Airman Amanda Cervetti

On the Cover

Pvt. 1st Class Jessie Elder takes a knee 

and scans his sector a patrol mission along the 

Former Yugoslav Republic of Macedonia border on Dec. 11, 2002. Soldiers of 1st Platoon, 

C Company, 2nd Battalion, 2nd Infantry Brigade conducted this mission to help deter any 

smuggling and illegal activity on and around 

the Former Yugoslav Republic of Macedonia 

border. The soldiersof 1st Platoon, C Company, 

2nd Battalion, 2nd Infantry Brigade are in Kosovo 

supporting Operation Joint Guardian II. 

U.S. Army photo by Sgt. April Johnson
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

L

fromhealthaffairs

William Winkenwerder Jr., M.D., M.B.A, is the assistant 

secretary of defense for health affairs. He serves as the principal 

staff assistant and advisor to the secretary of defense for all the 

Department of Defense health policies, programs and activities, 

and subject to the direction of the secretary of defense, exercises 

oversight of all Department of Defense health resources.

ast month, President Bush announced the national smallpox 

vaccination program. The decision to immunize those who 

will serve as members of emergency response teams, clinical 

staff and our deployed forces at greater risk of exposure is 

part of that national strategy. The decision was based on a 

careful risk and benefit analysis. 

Smallpox is a deadly and contagious disease, and the 

vaccine is the only way to prevent it. 

The health and safety of our troops are our top concerns. 

Servicemembers are among the first to receive the 

vaccinations because of their occupational responsibilities 

on smallpox response teams, in hospitals and clinics, and 

because they could be on the frontlines of a biological 

attack. This protection ensures that military missions can 

continue even if a smallpox outbreak occurs. Since our 

servicemembers are deployed worldwide, it may not be 

feasible to vaccinate soon after exposure if they are deployed 

to remote locations or engaged in military operations. And 

we know that some military personnel will be unable to 

postpone vital missions if smallpox is used as a weapon. We 

must ensure our forces are protected.

We know the vaccine requires careful use. Many millions 

of people have been vaccinated successfully against 

smallpox since the introduction of the vaccine in the late 

1700s. The smallpox vaccine was routinely administered 

worldwide until the World Health Organization declared 

the disease eradicated in 1980. DoD continued to vaccinate 

our servicemembers until 1990. We have experience in 

managing the risks that come with smallpox vaccination. 

Comprehensive pre-vaccination screening and active postvaccination surveillance are the two critical components of a 

successful vaccination program. 

Pre-vaccination. We are actively evaluating and 

exempting people with certain risk factors for vaccination. 

Potential vaccinees must complete a medical form asking 

about any conditions that may exclude them from receiving 

the vaccine. These conditions include eczema or a history 

of eczema, atopic dermatitis, a suppressed immune system 

or taking medication or radiation therapy that suppresses 

the immune system, pregnancy, an allergy to the vaccine 

or any of its components, or having a household member 

who has any of these conditions. Physicians and health 

care providers will decide who should be exempted. These 

exempted personnel will still be deployable and their 

vaccination status will be reevaluated if an actual smallpox 

attack occurs. 

Post-vaccination. Apart from the pre-screening process 

there will be a follow-up examination to verify that the 

vaccine “took.” DoD has developed a vigorous monitoring 

program so that in the rare instance of an adverse reaction, the 

vaccine recipient will be cared for quickly and 

thoroughly. There may be additional concern in the 

National Guard and Reserve community about coverage for 

smallpox-related treatments. Any smallpox vaccine reaction 

is considered a line of duty condition. National Guard and 

Reserve personnel and their families can seek care at a military 

treatment facility for any smallpox vaccine-related events. If a 

military treatment facility is not available, Reserve Component 

members or their families can be reimbursed for civilian care 

obtained due to a medical problem resulting from the smallpox 

vaccination. 

The Department of Defense is conducting a comprehensive 

education program for servicemembers and their families. 

Along with information available from your chain or command 

and health care professionals, each vaccine recipient will 

receive information to take home. This information explains 

what a normal reaction looks like 

and how to care for the vaccination site. There is also an 

optional 30-day diary card for individuals to track their 

health status and include in their medical records. 

Servicemembers are encouraged to ask any questions if 

they have concerns. 

Even if you have been vaccinated against smallpox in the 

past, revaccination is necessary to ensure solid protection. 

If you are one of the people designated to receive the vaccine 

and still have a question, there are several places 

you can go for more information. The U.S. Department of 

Health and Human Services, the Centers for Disease 

Control and Prevention, and the Food and Drug 

Administration have information available on the Internet. 

DoD has created a Web site specifically for the military 

smallpox vaccination program. It can be found at http://www.

vaccines.army.mil/smallpox.asp. 

Smallpox vaccination is a prudent course for preparedness 

and may serve to deter our enemies. We have the medical 

expertise and training to ensure that our servicemembers 

are safely protected from this biological warfare threat. ■

Smallpox Vaccine:

Part Of A National Strategy

By William Winkenwerder Jr., M.D., M.B.A. 
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

A

Harry S. Truman Deploys in Support of 

Operation Enduring Freedom

BOARD THE HARRY S. TRUMAN 

— The aircraft carrier USS Harry S. 

Truman (CVN 75) left its homeport 

of Norfolk, Va., Dec. 5, 2002, for a 

“little slice of home” underway, sailors 

have different ways of coping with 

being away from their loved ones for 

six months. 

“Even though this is my second 

deployment, it’s going to be difficult 

to be away from my loved ones 

again,” said Aviation Electronics 

Technician 2nd Class (AW) Andrew 

J. Hill, a member of the ship’s aircraft 

intermediate maintenance division. 

“So I plan on constantly keeping in 

touch with my girlfriend and family 

throughout the next couple of months.” 

The emotional stress felt by both 

the sailor and their families can be 

lessened through regular contact via 

mail, e-mail and telephone calls. Sailors 

who left children behind will be able 

to remain close thanks to the “United 

Through Reading” program.

The program will give deployed 

sailors and Marines the unique 

chance to read stories aloud on video. 

The video is then send home so their 

children can listen to their favorite 

stories as told by their parent. 

“I think this is a fantastic opportunity 

to help deployed 

families keep in touch,” said Chief 

Disbursing Clerk (SW) Nancy 

McNeil, who oversees the program. 

“It’s a comforting feeling knowing that 

my family will miss me when they see 

the video. It helps me focus on what’s 

out here by giving me 

peace 

of mind.”

Harry S. Truman is scheduled to 

relieve USS George Washington 

(CVN 73), whose return date has 

not been determined. ■

regularly scheduled sixmonth deployment, the 

ship’s second since its 

commissioning in 1998. 

The ship and 

embarked Carrier Air 

Wing Three are 

deploying in support 

of Operation Enduring 

Freedom.

According to 

executive officer Capt. 

Ted Carter, there is no 

need for anything extra 

to inspire the crew. 

“Everybody here 

is self-motivated,” 

Carter said. “No job 

is less important than 

any other. I’ve never 

felt the need to give 

the crew any ‘artificial 

motivation.’”

Preparing for a 

six-month stint away 

from their homes and 

families, Harry S. 

Truman sailors made 

sure to have their lastminute necessities and 

comforts packed and 

ready to go. 

“I brought all my 

favorite CDs and 

pictures of my family 

on board,” said Interior 

Communications 

Electrician 2nd Class 

(SW/AW) Noah A. Cook 

of Harry S. Truman’s 

combat systems division. “These 

little things help me escape the daily 

routine when we are out to sea.”

Apart from the books, photo 

albums, blankets, CDs and other 

material possessions that will bring a 
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

news from around the world

WASHINGTON — Certain 

military job specialties, including 

military police and civil affairs, are 

being overburdened in the Reserve 

Components and may need stronger 

representation in the active duty 

force, the Defense Department’s 

senior adviser on Reserve affairs 

said today.

Thomas F. Hall, assistant secretary 

of defense for reserve affairs, told 

a group of reporters on Nov. 19, 

2002, that repeated call-ups of 

certain specialties might eventually 

hurt recruiting and retention in the 

Reserve forces.

Hall related his experiences last 

week in a St. Louis, Mo., meeting 

with state representatives for the 

Employer Support of the Guard 

and Reserve program. He said 

employers generally support 

Reserve duty by their workers, but 

at times it can become a burden, 

particularly for small businesses and 

private practices.

“When their reservist is mobilized 

for the first time, it’s probably 

OK,” Hall said the state employer 

representatives told him. “When 

they’re mobilized for the second 

time, it might be OK. But when 

they’re mobilized the third time in 

three years running, this causes a 

particular problem for the Reservist, 

their family and the employers.”

Still, he cautioned, 

servicemembers shouldn’t look 

for a mass exodus of specialties 

being moved from the Reserve 

Components to the active force. He 

called it more of a “rebalancing.”

Hall was sworn in Oct. 9, 2002, 

but he was already familiar with 

issues facing Reserve forces. He 

previously commanded the Naval 

Reserve for four years after a 34-year 

active duty career as a naval aviator.

He said the greatest challenge 

facing him in his job isn’t necessarily 

about the numbers. Ensuring 

Reserve forces are effective when 

called is much more important than 

how many there are, he remarked.

“The guiding principle for all of 

us should be that we have the right 

Reservist with the right equipment 

[and] the right training at the right 

place at the right time to help make 

a difference in any conflict,” he said.

Hall spoke of the heavy burden 

placed on the Reserve Components 

by the war on terrorism. Thousands 

were called to duty on or 

immediately after Sept. 11, 2001, 

when terrorists struck in New York 

and at the Pentagon.

Today, roughly 51,000 Guard 

and Reserve members are on active 

duty across the United States and 

around the world. At the peak 

of the call-up, nearly 100,000 

Reserve Component members were 

activated. In all, roughly 130,000 

Reserve troops have served in 

support of operations Enduring 

Freedom and Noble Eagle. ■ 

Medical Convoy Offers 

Health Care to Afghans 

BAGRAM, Afghanistan — An 

Army convoy with supplies and Army 

personnel set out to make a positive 

difference in the lives of residents of 

an Afghan community Oct. 14, 2002, 

by conducting a medical capability 

mission. 

Setup in the town of Koshi-Sofi, 

south of Bagram, including organizing 

paperwork, pills and ointments and 

lining up patients,took only moments. 

Through a Pashtu interpreter, 

patients first filled out a form 

listing their ailments, ranging from 

toothaches to dysentery. Children, 

many of whom suffered from 

internal parasites, were treated 

with a de-wormer. 

“We’re enabling the local people 

to live a healthier life,” said Army 

Capt. Regina Long, 339th Combat 

Support Hospital, a nurse practitioner 

from Cincinnati, Ohio. Long gave 

overall health examinations, treating 

everything from ear infections to 

dysentery. 

The team instructed the patients 

on how to live healthier lives and 

handed out toothbrushes and 

toothpaste. 

“We briefed them on mine 

awareness and basic sanitation 

and how to prevent illness,” said 

Sgt. 1st Class Samuel Osborne, 

227th Preventive Medicine, the noncommissioned officer- in-charge, from 

Fort Lewis, Wash. 

Oral surgeon Col. (Dr.) Donald 

Hart, 339th Combat Support Hospital, 

also explained the importance of oral 

hygiene to 

the patients.

He extracted teeth to prevent future 

complications with deep cavities. He 

also used the 

interpreter to reassure patients who 

refused the extraction out of fear. 

“For many of the patients coming 

in today, this is the first time they are 

seeing a dentist or medical care,” Hart 

said. 

Soldiers were also on hand to help 

the local livestock. ■ 

“Until recently, we’ve been planning ostensibly for chemical 

events and most of the services tended to lump ‘biological’ in 

the same word as ‘chemical’. And only now are we beginning 

to have our civilian and military leaders understand that those 

are actually different.” 

— Lt. Gen. (Dr.) George Peach Taylor Jr.

U.S. Air Force Surgeon General

Military Looks at 

‘Rebalancing’ Reserve 

Component, Active 

Force

notable quote
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

Q

Q

A

A

ask doc

vaccines drugs & herbs

Many people have expressed 

similar concerns. First, 

because of the significance of 

the threat, the inherent risks 

I am on active duty, over 40, and 

pretty sure I have received the 

smallpox vaccine twice in my 

life. I am considered one of the 

first responders at my installation. I am 

told we will be soon receiving smallpox 

immunizations. Is this really necessary 

since I have already been immunized? 

Will additional immunizations with the 

smallpox vaccine increase my chances of 

having one of the more severe reactions 

that the media continues to harp on? I 

am not afraid to receive the shot again, 

but I do have a ton of questions. The little 

information that I have heard 

about this has all been negative.

associated with the vaccine, and the 

importance the 

Department of 

Defense places 

on protecting 

the health of 

our forces, there 

is a wealth of 

information 

available to 

you. Because 

you are a 

servicemember, 

I recommend 

you 

use the DoD 

Web sites that provide medical 

information and policy guidance that 

directly affects you. There are two 

good choices to 

choose from. First is the DoD’s 

Military Vaccines Office at 

http://www.vaccines.army.mil. It has 

a lot of information for the 

general public and for health 

care providers. 

Second is the Office of 

the Assistant Secretary of 

Defense for Health Affairs 

Web site at http://www.ha.osd.

mil. This Web site contains 

administrative and clinical 

policies that provide guidance 

on the Defense Department’s 

smallpox immunization 

program. 

I highly recommend you 

familiarize yourself with 

the specifics of these policies. They 

contain guidance on medical screening 

necessary before immunizations, 

pregnancy screening, vaccination and 

revaccination, timing and spacing of 

vaccinations, medical exemptions, and 

— Continued on Page 16

Most sore throats are caused 

by viruses, but strep A bacteria 

(Group A streptococcus) 

I’ve heard recent news reports 

about Marines having strep A. Is 

this something I should be worried 

shock syndrome, 

necrotizing 

fasciitis, blood 

stream infections, 

and pneumonia. 

Group A 

strep bacteria 

can spread from 

person to person 

by direct contact 

with saliva or 

nasal discharge. 

Most people do 

not get group A 

strep infections 

from casual 

contact with others, but a crowded 

environment like a dormitory, school, 

or an institutional setting can make 

it easier for the bacteria to spread. 

There have been numerous instances 

of Group A strep epidemics in 

military recruit populations. Many 

of these outbreaks have been unusual 

because of a high frequency of cases 

of streptococcal pneumonia. Recruit 

populations in the U.S. military are 

routinely monitored for cases of 

Group A strep disease. When rates 

of infection rise, military medical 

about? I thought that strep 

was similar to getting a really bad 

sore throat. 

are also a common cause of sore 

throat. Your doctor may call it acute 

streptococcal pharyngitis. People 

with strep throat infections have a red 

and painful sore throat with white 

patches on their tonsils. A person may 

also have swollen lymph nodes in the 

neck, run a fever and have a headache. 

Strep A also cause a common skin 

infection called impetigo in children. 

Experts estimate that more than 10 

million throat and skin infections like 

these occur every year in the United 

States.

Group A streptococci are also 

responsible for a variety of less 

common, but potentially serious 

health problems. These include lifethreatening conditions such as toxic 

authorities administer 

preventive antibiotics to 

all recruits to eliminate the 

bacteria from the population. 

After 24 hours of antibiotic 

treatment, a person will no 

longer spread the bacteria 

to others. There have also 

been reports of contaminated 

food, especially milk and 

milk products, as a source of 

infection. 

People with strep throat 

usually recover from the 

symptoms of infection on 

their own. The principal 

reason for treating strep throat with 

antibiotics is to prevent later occurrence 

of acute rheumatic fever or acute 

glomerulonephritis. These serious 

complications, which most affect the 

heart and the kidney, respectively, 

appear to result from the immune 

system being turned against our own 

bodies.

If you develop a severe sore throat, 

your doctor or other health care worker 

can take a sample from your throat. 

This will be used for a culture or a 

— Continued on Page 16
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

T

hen American forces deploy overseas, 

they are increasingly accompanied 

by civilians. Defense civilians and 

contractors are needed to provide 

technical support, often in highly 

specialized fields. They handle 

communications, logistics, and morale, 

welfare and recreation functions. They 

also perform maintenance, analysis, and 

information and technology functions. 

As vital as these civilians are, it has 

been difficult to track their locations in 

a combat zone. The Army has recently 

introduced a solution to that problem 

with their Civilian Tracking System, or 

CIVTRACKS. 

Maintaining accountability of 

deployed civilians has been a major 

issue for the services for more than a 

decade, according to James Feagins, 

chief of the Army’s civilian mobilization 

branch.

“Desert Storm was the first time we 

had a significant number of civilians on 

the battlefield,” he says. “Before that, it 

wasn’t as big an issue.”

About 2,500 civilians are 

deployed overseas with the military, 

performing support duties that enable 

servicemembers to do their jobs. Those 

civilians may work for the Department 

of Defense, any of the military services 

or defense contractors. A few hundred 

of those civilians are Army employees, 

and the Army has been working to 

maintain better location data on those 

workers.

At first, Army officials tried to get 

their civilians incorporated into military 

personnel accountability systems, but 

it simply wasn’t practical. In time, the 

Army developed a secure, web-based 

system that allows deployed civilians 

who have access to the Internet to 

provide the tracking data for their 

permanent records. That system went 

online in May 2002. Each civilian 

employee is responsible for reporting 

his or her own location, and past 

confusion about who was where during 

wartime is an incentive for them to keep 

the record of their location up to date.

Army Develops New System to Track Deployed 

“If there’s a similar situation to Desert 

Storm, where there may be harmful 

exposures, CIVTRACKS would provide 

data to help us identify who might have 

been exposed to what,” Feagins says.

This is just one example of 

CIVTRACK’s usefulness. Many 

kinds of wartime incidents, including 

enemy attack, could make personnel 

accountability vitally important. And 

beyond the need to protect civilian 

workers, the Department of Defense has 

a responsibility to be able to account for 

its civilians on foreign shores. Congress 

periodically calls for reports of how 

many civilians have been deployed, 

where they were sent, and what 

necessary skills they possess. 

Currently it is mandatory for Army 

civilians to keep their location data 

current on the system, and optional for 

Army contractors. Each employee is 

responsible for entering his or her own 

data. Each is issued a deployment card 

that contains instructions, their user 

identification code and a password to 

access the system. Army web designers 

have made the process as simple as 

possible.

“We take the minimum amount of 

data possible from the civilians,” Feagins 

says. “We figured the less complicated 

we make, it the more likely people are to 

use it.”

Once a deployed civilian logs in, he 

need only enter his name and social 

security number, the time and dates of 

deployment, and changes to his location. 

If it is impossible or impractical for the 

civilian to get online, their supervisor can 

make the entries. The data is stored at 

the headquarters of the Army’s Civilian 

Personnel System. Army officials 

can then use that database to gather 

whatever statistical information they 

need to generate reports for the major 

commands. Naturally, the information is 

kept confidential, to be released only by 

the commander. 

Although it is currently an Army tool, 

CIVTRACKS is structured in such a way 

that it could accommodate all of DoD. 

Civilians working for any of the services 

can use it now on a voluntary basis, and 

Army can generate limited reports to 

their components on request. Feagins 

says his team is already in the process 

of upgrading the system, and that it is 

possible that some time in the future, the 

location of all civilians deployed with 

the American military will be monitored 

by CIVTRACKS. ■

— Continued on Page 14

by austin camacho

Veterans History 

Project Keeps War 

Memories Alive

by Sgt. 1st Class Doug Sample, USA

American Forces Press Service

here are more than 19 million 

veterans living in the U.S. today. 

With each is a personal story of 

battles fought, victories and defeats. 

Each story, though sometimes 

heartbreaking, is full of love, 

dedication and patriotism. 

That’s how Peter Bartis describes 

his work with the Veterans History 

Project. The grassroots effort that 

began two years ago — and has now 

caught fire — is hoping to keep those 

memories alive. 

Bartis, a senior program officer for 

the project, said that each day some 

1,500 U.S. veterans die — and with 

them a treasured part of the nation’s 

past. 

“These are some of the most 

amazing stories; when you put them 

all together you get a story of the 

nation,” he said. 

Over the past year alone, the 

project’s staff of 16 has already 

collected more than 14,000 items, 

such as letters and other memoirs, 

and video and audiotape interviews. 

“We’re all just blown away 

by these stories,” he said. “The 

information has been very rich, 

it’s been emotional, and it’s very 

heartening to listen to the stories, to 

learn how and why they [veterans] 

joined, their war-time experience.” 

With the idea that future 

generations could learn from the 

histories of the nation’s veterans, 

the American Folklife Center at the 

Library of Congress,began the effort 

to collect video and audio recordings 

of personal histories and testimonials 
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

T

Reserves Complete A 

Historic Deployment

Force, based at Camp Lejeune.

According to Hattey, who left 

behind his position as a police officer 

in San Jose, Calif., to command the 

unit, the use of Reserves in this 

capacity has bolstered the Corps’ 

capabilities for future missions.

“We have developed a unique 

manner by which the Marine Reserve 

can contribute to the ongoing missions 

of the active duty component, and 

we have done it well,” Hattey said. 

“Our Marines will return to their units 

with years’ worth of experience — as 

well as sea stories — that will assist in 

retention and ‘volunteerism’ for future 

operational relief exercises.”

The active duty Marines of II MEF 

agree. 

“They stepped up to the plate 

and hit a home run for us,” said U.S. 

Marine Corps Col. David Mauldin, 

chief of staff of II MEF. “With little 

time to prepare, they stood up 

and took a real world mission off 

our hands — providing valuable 

operational relief for our active duty 

Marines.”

The four-month long deployment 

began July 23, 2002, when Marine 

Forces Unitas loaded buses bound 

for Morehead City, N.C., to embark 

aboard the USS Portland (LSD-37), 

a dock landing ship based at Naval 

Amphibious Base Little Creek, Va.

Once onboard, the Marines 

conducted pre-deployment training in 

Onslow Bay, N.C., prior to steaming 

to Little Creek to load supplies for the 

cruise. They de-parted Little Creek on 

Aug. 5, 2002, willing, ready and able 

to forge new ground.

“Every new country brought us 

a new opportunity,” said Reserve 

Sgt. Russ Gordon, a reconnaissance 

team leader, who left behind a job as 

the manager of a fishery in Yakutat, 

Alaska, for the exercise. “Being 

Reserves, we usually train at the same 

places, doing the same old things. 

Down there, every beach meant a 

— Continued on Page 8

Marines from Golf Company, Battalion Landing Team, 2nd Battalion, 2nd Marines, 24th Marine 

Expeditionary Unit (Special Operations Capable) begin a patrol after coming ashore and securing 

a landing site for “Exercise Edged Mallet 2003” in Manda Bay, Kenya.

by staff sgt. sam kille

marine forces unitas public affairs

here were those who doubted whether 

or not it could be done. After all, 

Reserves are merely weekend warriors. 

Right? 

Wrong. With stops in 11 Latin 

American countries and six intense, 

bilateral exercises under their belts, the 

nearly 300 Reserve Marines who took 

part in the amphibious phase of Unitas 

43-02 shattered myths and proved their 

value as an integral part of the Marine 

Corps’ total force principle before 

returning to Camp LeJeune, N.C., in 

early December. 

“Unitas was a highly successful 

deployment in which our Marines and 

sailors performed magnificently,” said 

Reserve Lt. Col. Anthony Hattey, the 

commanding officer of Marine Forces 

Unitas. “These Marines are coming 

back from this deployment with some 

special skills that drilling Reserves 

don’t normally acquire.” 

Unitas — Latin for unity — is 

an annual, multinational series of 

training exercises with the maritime 

forces of several Latin American 

countries. Since 1981, U.S. Marines 

have participated in Unitas, helping to 

improve international relations in the 

Southern Hemisphere while promoting 

democracy and hemispheric defense. 

This year marked the first use of 

Reserves, 

who are providing operational 

tempo relief to II Marine Expeditionary 
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

different reef, a different obstacle. 

Plus, there is only so much training 

you can do during a weekend drill. 

There, we were able to work every 

asset and learned something new 

every day — whether we realized it or 

not.”

Through the course of their travels, 

Marine Forces Unitas trained in every 

environment imaginable — from 

white, sandy beaches in the Caribbean 

to steamy jungles in the Amazonian 

Basin from barren deserts along the 

Pacific Coast to the snow-capped 

mountains of the Andes. Their 

experiences were highly educational.

“The deployment provided us 

excellent training and a wealth of 

knowledge,” said Reserve Lance Cpl. 

Scott Kasules, a machine gunner and 

a special education teacher assistant 

from Elgin, Ill. “The more we did, 

the better we got. The training was 

the closest one could get to combat 

without actually being in combat 

— in today’s world — that is more 

important than ever.”

A highlight for many of the Marines 

was the exchange of ideas and 

tactics with the host country military 

forces, which included the marines 

of Colombia, Ecuador, Peru, Chile, 

Argentina and Brazil.

“Exercises like this [with foreign 

countries] not only give us a better 

understanding of how others operate 

in combat, but helps to destroy 

stereotypes that both nations have,” 

said Reserve Lance Cpl. Jason Juarez, 

an infantryman and a sophomore 

at the University of Texas in San 

Antonio. “Through this, we can relate 

to each other much better.”

Many of the host countries marines 

agreed. One such marine was Cadet 

Jorge Raos, from Medellin, Colombia. 

During the Colombian Bilateral, Raos 

and fellow future marine officers 

from the Colombian Naval Academy, 

received training on the employment 

of the M-240G machinegun. Raos was 

genuinely enthused about the training 

he received.

“This was very good training for 

the Colombian Marines — we really 

needed to learn these techniques,” 

Raos said. “I hope we get to 

participate in Unitas every year with 

the U.S. Marines. They are the best in 

the world.”

Training aside, the deployment 

also exposed the Marines and sailors 

to a world few Americans get to see. 

In the Dominican Republic, they 

stood on the site where Christopher 

Columbus first set foot in the New 

World. In Colombia, many helped 

renovate a school in an impoverished 

village. In Ecuador, they bought 

Incan-influenced souvenirs. In Peru, 

they broke bread with locals, and were 

entertained by traditional dancers. In 

Chile, a number took advantage of 

various tours. The U.S. Marines even 

had the opportunity to mix culture 

and tradition when they celebrated 

the U.S. Marine Corps’ 227th birthday 

in Rio de Janeiro, Brazil.

“This deployment has been a real 

eye-opener,” said Reserve Lance Cpl. 

Rory Thornton, a machine gunner 

from Nahant, Mass. “I was able to 

see some of the most beautiful places 

in the world. I thought it might be 

a little strange being an American 

there, but the people are very genuine 

— absolutely friendly.”

The Marines and sailors also gained 

a greater appreciation for life in the 

United States.

“When you see how little these 

people have, you realize how 

lucky we are to live in a wealthy 

nation,” said Reserve Maj. Rod 

Long, commanding officer of the 

unit’s ground combat element and a 

corporate recruiter in Houston, Texas. 

“Even an MRE [Meals-Ready-toEat] looks different after seeing how 

little they have — it’s a lot harder to 

complain about the little things now.”

With the deployment now behind 

them, the Reserve Marines will 

return home to the daily grind of 

their civilian lives, just in time for the 

holidays. Although they will resume 

the lives they put on hold to deploy 

with Marine Forces Unitas, they will 

be even more prepared to answer the 

call, the next time they are needed. 

Weekend warriors they are not. ■

Historic 

— Continued from Page 7

Marines from Golf Company, Battalion Landing Team, 

2nd Battalion, 2nd Marines, 24th Marine Expeditionary 

Unit (Special Operations Capable) leave USS Austin 

(LPD-4) in combat rubber reconnaissance crafts before 

securing the beach landing site for “Exercise Edged 

Mallet 2003” in Manda Bay, Kenya.
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

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gulf warupdate

he Department of Defense released its 

final environmental exposure report 

that addresses the effects of exposure 

to poor air quality during the Gulf 

War and the effect it may have had 

on the health of Gulf War veterans 

on October 31, 2001. Investigators 

from the Deployment Health Support 

Directorate — supporting the Special 

Assistant 

for Gulf War Illnesses, Medical 

Readiness and Military Deployments 

— still assessed the risk of adverse 

long-term health problems from 

exposure to be minimal.

An interim environmental exposure 

report on particulate matter was 

released July 27, 2000, to the general 

public. Since that time, investigators 

have uncovered no new information 

that would change their original 

conclusions. The final report can 

be read on GulfLINK at http://www.

gulflink.osd.mil/particulate_final/.

The region’s air quality was a 

primary concern due to the high 

levels of dust and sand particles 

present in this region of the world. 

In addition to blowing sand from 

the desert environment, soot and the 

by-products of combusted crude oil 

contributed to the poor air quality. 

These particles are collectively 

referred to as particulate matter. 

Particulate matter is a generic 

term applied to a broad class of 

chemically, physically and biologically 

diverse substances spanning a range 

of particle sizes. The chemical 

composition of the samples indicate 

that roughly 75 percent of the airborne 

particulate matter consisted of 

clays, primarily calcium and silica 

originating from the sand indigenous 

to the region. Another 10 to 23 

percent was soot that originated from 

a variety of sources, including oil well 

fires and other industrial sources, 

and less than 10 percent came from 

DoD Releases Final 

Gulf War Air Quality Report

miscellaneous sources. 

The environmental exposure 

report is intended to present what 

is currently known regarding 

U.S. servicemember exposures to 

particulate matter while serving 

in the Gulf War, and to summarize 

the results of the medical literature 

review and a qualitative health risk 

assessment. This report examines 

respirable and soot concentrations 

— the principal components of 

concern in particulate matter — from 

monitoring data and provides an 

estimate of troop exposure. The 

overall objective of the report is to 

determine the likelihood of the onset 

of chronic or long-term effects rising 

from particulate matter exposure.

Particulate matter levels were often 

twice the recommended levels for 

safeguarding health. While pre-war 

monitoring data indicated that these 

levels are among the highest in the 

world, they are considered “normal” 

for the Kuwaiti region and result 

primarily from natural and man-made 

sources. 

From May to December 1991, 

numerous efforts were undertaken to 

assess the air quality in Kuwait and 

Saudi Arabia. Air quality sampling 

and monitoring data were collected 

by several agencies and various 

countries. Collectively, the data 

indicated that, with the exception of 

particulate matter, pollutant levels 

were surprisingly low.

“Data of this nature is critical in 

developing a causal relationship and 

in determining whether there was a 

potential for long-term health effects 

in Gulf War veterans,” said William 

Shaughnessy, the lead investigator on 

the report.

The report also found that there 

was a significant mass of particles 

in the respirable size range, that is, 

those less than 10 microns in diameter. 

A

DoD Evaluates Labs Analyzing Vets’ Urine

 laboratory assessment information paper that cites the results of a study 

to evaluate the performance of laboratories that were analyzing veterans’ 

urine for uranium was released by the Department of Defense on October 

31, 2002. Specifically, the study evaluated laboratory capabilities for 

analyzing uranium in urine at concentrations observed in Gulf War 

veterans by assessing the accuracy and reproducibility of measurements of 

total uranium and isotopic uranium. It also evaluated the performance of 

six laboratories that tested urine from veterans or Department of Defense 

personnel, using American National Standards Institute/Health Physics 

Society standard criteria and statistical methods. 

Members of the Deployment Health Support Directorate evaluated the 

study’s implications for using urine analyses for estimating the potential 

health effects of depleted uranium exposures and for differentiating 

depleted uranium from natural uranium in the urine. The assessment 

concluded that participating laboratories could accurately quantify total 

uranium at concentrations considered harmful to health or above exposure 

guidelines (1.0 microgram of uranium per liter or more).

The paper in its entirety can be read on GulfLINK at

http://www.deploymentlink.osd.mil/du_library/lab_assessment/index.htm. ■

— Continued on Page 14
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

B

story and photos by joan kennedy

eing hospitalized in a military hospital far from home used to mean a 

separation of hundreds or thousands of miles from family — unless the 

family could afford the financial burden of a prolonged hotel stay in an 

unfamiliar city. The cost of getting to the hospital’s location, renting 

accommodations, and living for weeks on restaurant and cafeteria food 

could wipe out a family’s savings and even drive it into debt. Camping 

out on hospital furniture and living on vending machine fare was once 

the only alternative for families who were far from home and could not 

afford hotel rooms. But since 1990 the Fisher Houses have been changing 

that. 

“Not every military or VA hospital offers the full range of medical 

specialties. Sometimes, a more distant hospital will have specialized 

expertise or a particular piece of equipment needed for the patient’s 

treatment,” says Jim Weiskopf, public affairs director of the Fisher House 

Foundation.

Soon after learning she needed surgery and other treatment to remove 

inner ear tumors and rebuild her cochlea, Tammy Kirk learned she 

would be traveling for the treatment to Walter Reed Army Medical 

Center in Washington, D.C. Since Tammy lives in Vilseck, Germany 

— where her husband, Sgt. David Kirk, is currently stationed — she 

was anxious at the prospect of traveling alone for a prolonged stay in an 

unfamiliar city. Tammy soon learned that she and David would be able 

to stay together, in a homelike environment close to the hospital, for as 

long as she needed to be close to Walter Reed. 

“When they told me Fisher House would cost us only $10 a day,” says 

Tammy, “we were really glad to have a place but I didn’t think it was 

going to be very nice.” 

Families, Patients Waiting for Medical 

Treatment Find Comfort at Fisher Houses

Fisher House at the Forest Glen Army Annex in Silver Spring, Md., serves as a temporary home to family members and outpatients undergoing treatment at 

Walter Reed Army Hospital.

Tammy Kirk and Sgt. David Kirk flew in from Vilseck, Germany; 

they are both staying at the Forest Glen Fisher House while Tammy 

undergoes medical treatment at Walter Reed.
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

She smiles and gestures, her arms 

taking in a warm, sunny dining 

room decorated in colonial style with 

centerpieces on each small table. 

“Then we got here, and it looked like 

... this.”

Tammy and her husband have been at 

Forest Glen Fisher House — located near 

the Walter Reed Army Medical Center 

— for a month, awaiting and receiving 

medical treatment. 

“This really does feel like a home 

away from home, and it takes the stress 

off being at a hospital.” Referring to the 

other residents of the Fisher House, she 

continues, “We’ve got a family here, and 

when we support each other it makes us 

all stronger. Taking the financial burden 

away lets us focus on just getting better.” 

Hospitality houses, built at no charge 

to the government by the Fisher House 

Foundation, have been cropping up on 

the campuses of major military centers 

and Veterans Affairs hospitals for the 

past 12 years. Increasingly, military 

patients’ families now have the option of 

staying in a comfortable, attractive and 

supportive setting. The Fisher House 

Foundation pays for the construction of 

the fully furnished houses. They are built 

on government property and donated to 

the military services or VA, which then 

assumes responsibility for their operation 

and maintenance.

Vivian Wilson, who has served as the 

manager of the Forest Glen Fisher House 

since its 1991 opening, recalls the first six 

months after it opened its doors. In a 

word, it was “chaotic,” she says. 

“Probably the hardest part of 

coordinating with the hospital 

was getting straight exactly what 

kind of patients we were set up to 

accommodate,” says Wilson. 

Fisher Houses, she stresses, are 

set up for families of patients and 

for ambulatory outpatients who do 

not need nursing care in the house 

itself beyond what their families 

can provide. One significant patient 

population served during that first 

year, she recalls, consisted of returning 

Gulf War veterans being worked up 

for medically unexplained symptoms. 

“I remember them sitting here 

describing how they didn’t know 

why they were dizzy and tired, some 

of them describing altered senses 

of smell and taste, and all saying how 

hard it was to get anyone to take their 

concerns seriously,” says Wilson.

Another couple staying at the Walter 

Reed Forest Glen Fisher House are Ed 

and Dyna Meyer, here from Alaska for 

evaluation and treatment for a tumor 

on Ed’s spine. Alaska can seem like an 

unlikely choice for a retiree’s home until 

you hear Ed talking about their life near 

the Kenai River. There, King Salmon give 

way to Reds in mid-July, which in turn 

yield to the Silvers at the end of July. Ed 

and Dyna’s home has its own salmon 

smoker and filleting table in the backyard. It makes you want to pack up and 

book a room by the Kenai River, at least 

for couple of weeks in July. 

Thirty-one Fisher Houses now 

operate at 17 military installations and 

at five Department of Veterans Affairs 

medical centers across the United States 

and in Germany. Each year, they offer 

more than 184,000 days of lodging to 

more than 7,000 families in a nurturing 

environment designed to allow military 

and veterans’ families to face a medical 

crisis together. The typical Fisher 

House has eight suites, two of which are 

designed for handicapped access. The 

houses, each furnished in the tone and 

style of the local area architecture, can 

accommodate up to 16 family members. 

The basic design features a shared kitchen, 

laundry facilities, spacious dining room 

and an inviting living room, complete 

with fireplace, library and children’s 

toys. Most of these houses are built on 

military installations with easy access to 

everything guests might need: church, 

commissary, exchange and recreational 

facilities. Usually the hospital is just a few 

hundred yards away. If a Fisher House is 

located beyond walking distance, shuttle 

transportation is available.

To stay at the Fisher House, family 

members must be a patient, or the spouse, 

child or parent of a patient, and space is 

prioritized on the basis of financial need 

and other factors. No reservations can 

“This really does feel like a home away 

from home, and it takes the stress off 

being at a hospital.” 

— Continued on Page 12
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

be made. Available rooms 

are provided to qualified 

families as they arrive. If 

several eligible families 

arrive at once, priority 

is often given to families 

of active duty military 

members and families 

visiting patients with a 

severe medical condition. 

The medical center 

commander makes any final 

decisions.

A native of 

Brooklyn, N.Y., 

Zachary Fisher 

began working 

in construction 

at the age of 16. 

Shortly thereafter, 

he and his 

brothers Martin 

and Larry joined 

forces to form 

Fisher Brothers, 

which has 

grown into one 

of the real estate industry’s 

premier developers. Fisher 

was ineligible for military 

service during World War 

II due to injuries sustained 

in a construction accident. 

Determined to do his 

part, Fisher aided the U.S. 

Coastal Service in building 

coastal fortifications. His 

wife Elizabeth entertained 

military troops in Europe 

during the war as a member 

of the USO tour. In the 

1970s, while remaining 

active in the family business, 

Zachary Fisher took a 

leadership role in a number 

of major projects. In 1978 

he founded the Intrepid 

Museum Foundation 

to save the historic and 

battle-scarred carrier 

Intrepid from the scrap 

yard. Through his efforts, 

the vessel became the 

centerpiece of the Intrepid 

Sea-Air-Space Museum, 

which opened in New York 

City in 1982.

That year, Mr. Fisher also 

established the Zachary and 

Elizabeth 

M. Fisher 

Armed 

Services 

Foundation. 

Through the 

foundation, 

he made 

significant 

contributions to the 

families of the victims of 

the bombing of the Marine 

barracks in Beirut in 1983. 

Since then, the Foundation 

has contributed $25,000 

each to numerous military 

families who have lost 

loves ones under tragic 

circumstances.

In 1990, Pauline Trost, 

wife of former Chief of 

Naval Operations Admiral 

Carlisle A. H. Trost, 

approached the Fishers 

with the idea of building 

Fisher House

— Continued from Page 11

“comfort homes” on the 

grounds of some military 

medical facilities. The 

Fishers, who had witnessed 

first-hand the value of 

having families close by to 

help in the healing process, 

began the Fisher House 

program, contributing 

more than $20 million to 

the construction of homes 

for families of hospitalized 

military personnel. Since the 

program’s inception, more 

than 50,000 families have 

stayed in Fisher Houses.

The newest Fisher House 

is a 7,900 square foot twostory, the second built at the 

Landstuhl Regional Medical 

Center, the U.S. military’s 

only major medical center 

outside the United States. 

The first Fisher house built at 

Landstuhl was dedicated in 

June 2001. When the Fisher 

family learned that U.S. 

military personnel injured or 

wounded in Afghanistan are 

normally sent to Landstuhl 

for their medical treatment, 

Arnold Fisher presented a 

proposal to the Foundation’s 

Board 

of Trustees to immediately 

begin building a second 

home there. This newest 

building, which opened in 

December of 2002, is larger 

than the typical Fisher 

House. It has 11 bedrooms 

and a manager’s office, plus 

a family room. 

Secretary of Veterans 

Affairs Anthony J. Principi 

recently recommended 

five more sites for Fisher 

Houses on the grounds of 

VA hospitals. Construction 

could begin as early as 2004 

on the new sites. 

“Fisher Houses provided a 

‘home away from home’ for 

veterans and their families 

in their time of need,” said 

Principi. 

The recommended sites 

are the Houston VA Medical 

Center in Texas and the 

VA North Texas Health 

Care System; the New York 

Harbor VA Health Care 

System, Brooklyn campus; 

the VA Palo Alto Health Care 

System in California; and the 

VA Puget Sound Health Care 

System in Seattle, Wash.

For information on 

Fisher Houses, go to 

http://www.fisherhouse.org

on the Internet, or call 

toll-free (888) 294-8560. ■

Fisher House Facts

❖ Families served: More than 50,000 million

❖ Number of lodging days offered: 1.25 million

❖ Average length of stay in 2001: 13.7 days

❖ Average cost per day: less than $10

❖ Six locations offer free lodging

❖ Saved families more than $40 million 

in lodging costs, plus savings on subsistence 

and transportation costs

❖ There are 31 Fisher Houses located 

on 17 military installations.

❖ There are 5 Fisher Houses located on 

VA medical centers across the U.S. and Germany

To find a location nearest your medical facilitiy, go to 

http://www.fisherhouse.org/Locations/locations.htm or call 

toll-free (888)294 - 8560. ■

Each Fisher House is professionally decorated. Many of the Fisher House 

living rooms are complete with books, a video library and toys.
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

T

by karen fleming-michael

u.s. army medical research and 

materiel command, fort detrick, md.

he Army’s future medical shelters 

must meet specific parameters before 

a C-130 loadmaster will strap them 

down and send them to a deployment. 

They must require fewer flights and 

promise lighter loads for the airlifter.

For the past year, program 

managers at the Army Medical 

Materiel Development Activity have 

been working with the Army Medical 

Department Center and School to 

move the service away from its 

current deployable medical systems 

shelters to ones that are easier to 

deploy.

The new shelters are envisioned as 

a leap forward in shelter technology 

for fielding a next-generation forward 

surgical team shelter or a combat 

support hospital 

with operating room 

capability, said 

Steven Reichard, 

USAMMDA project 

manager for the 

future medical 

shelter system. 

“We’re trying to 

get a smaller, lighter, 

more transportable 

package so it’s easier to deploy,” 

which is a major objective of the Army 

transformation, Reichard said.

“It comes down to the ‘ilities’ of 

mobility and transportability,” said 

Mark Arnold, a USAMMDA engineer 

working on the future medical shelter 

system. “It takes too many airplanes 

to get a hospital into the field. And 

once they’re in the field, it takes too 

long to get them set up and take them 

down.”

 Deployable medical systems 

shelters, fielded since 1987, can 

house combat support hospitals, field 

hospitals and general hospitals. Each 

shelter has different configurations of 

standard modules, such as operating 

rooms, laboratories, X-ray units and 

New Medical Shelters Promise Lighter 

wards.

Getting a deployable medical 

systems shelter ready is 

time-consuming, Arnold said, 

because they’re heavy and 

bulky. It takes seven soldiers 

one hour to put up a shelter, 

and an entire hospital can take a 

week to set up.

What developers of the 

combat support hospital shelter 

hope to produce is a surgical 

shelter with a complete operating 

room outfitted with two surgical 

tables, medical equipment and a 

patient holding area — all in one 

container.

The new configuration for the 

shelter will prevent logistical 

mishaps.

“Right now, all the equipment 

and supplies are in aluminum 

boxes and are in their own shipping 

containers,” Arnold said. “The 

new system eliminates the scenario of 

your shelter arriving, but waiting for 

a box of supplies that didn’t arrive at 

the same time.”

A second shelter, intended for 

use far forward in combat zones, 

will also be studied starting in 

2003. Mobile Medical International 

Corporation will develop a “surgical 

suite in a box.” Though it won’t be 

as sophisticatedly equipped as the 

combat support hospital shelter, 

it will be ready to see patients in 

minutes and have 

the added features of 

environ-mental control 

and power generation 

systems.

Right now, 

developers for the 

combat support hospital 

shelter are working 

with Tennessee’s Oak 

Ridge National Labs 

on creating a new International 

Organization for Standardization 

container, an 8- by 8- by 20-foot box, 

for the shelter. The container will be 

lighter and more movable.

Key to moving the shelters’ containers is the new load-handling 

system version of the medium tactical 

vehicle, which resembles a flat-bed 

tow truck, complete with a crane and 

a platform that serves as a ramp for 

off- and on-loading containers. Once 

the load-handling vehicle rolls off 

the plane with a surgical shelter on 

its back, the shelter can be ready for 

patients in as little as three minutes, 

much like a Stryker brigade rolls off 

the plane fighting, Arnold said.

When the prototype container, 

sporting ballistic and chemicalbiological protection, is complete 

in about a year, Oak Ridge will also 

tackle the tents that will travel in the 

containers. Working with shelter 

experts at the U.S. Army Soldier 

Systems Center in Natick. Mass., as 

well as the Army Medical Department 

Center and School, developers aim 

to have a lighter, more deployable 

shelter for users to examine as early as 

next year.

“We fight for space on 

C-130s with beans and 

bullets,” Arnold said. 

“If we can reduce the 

number of flights it 

takes to ship a field 

medical 

hospital, taking 20 to 30 

percent of the flights out 

of the requirement, it 

doesn’t seem unreasonable to ask 

for space.” ■

research
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

Particles of this size have the potential to 

reach deep into the lungs. When found 

at high concentrations in the general 

environment, these particles have 

been associated with changes in lung 

function, damage to lung tissue, and the 

impaired ability to eject foreign matter 

via exhalation.

“It is extremely important to keep in 

mind that the critical dose one receives 

— that is, the amount of a contaminant 

necessary to induce some adverse 

health effect — is as much a function 

of the length of time an individual was 

exposed as is the actual concentration to 

which the person was exposed,” said Dr. 

Michael E. Kilpatrick, deputy director 

of the Deployment Health Support 

Directorate. 

“In this case, Gulf War veterans were 

exposed to relatively high levels of 

particulate matter, that is, they frequently 

exceeded U.S. ambient air quality 

standards while serving in the Gulf area. 

However, the amount of time they were 

exposed to these levels was short when 

compared to occupational exposures 

which occur over a working lifetime,” 

added Kilpatrick. 

According to the report, high 

particulate matter levels, from a health 

effects perspective, have been linked 

with allergic responses in the civilian 

populations of Kuwait and Saudi Arabia. 

Roughly 18 percent of the civilian 

population of Kuwait suffer from some 

form of respiratory complaints, usually 

asthma, compared to about six percent in 

the United States.

For Gulf War veterans, the inhalation 

of ambient levels of particulate matter 

observed in the Kuwait theater of 

operations could have resulted in several 

acute symptoms and could have 

aggravated asthmatic conditions in 

some personnel. 

“Typical short-term reversible 

symptoms were cold or flu-like and 

included cough, runny nose, eye 

and throat irritation, and shortness 

of breath. Skin exposures to sand 

and soot may have produced shortterm reversible symptoms as well. 

Anecdotal information suggests that 

some servicemembers experienced 

rashes, scaling, and skin irritation,” said 

Shaughnessy.

Based on analyses, investigators 

determined the risk of adverse 

long-term health effects from the 

exposure to be minimal. 

While the soot from the oil fires 

was a large contributor to the 

particulate matter levels, post-war 

analysis collected by the U.S. Army 

Environmental Hygiene Agency 

determined that more than 75 percent 

of the particulate matter measured 

originated from the sand that was 

common to the area. Because many 

U.S. troops spent much of their time 

in the desert, health specialists were 

concerned about the possible adverse 

health effects on U.S. troops associated 

with exposure to high levels of blowing 

and suspended sand. For some 

personnel with respiratory problems, 

the fine blowing sand did aggravate 

their symptoms. 

However, not all of the respiratory 

complaints experienced by Gulf War 

veterans result from exposure to high 

particulate matter levels. Investigators 

found that epidemiological surveys 

determined that respiratory symptoms 

were more common among the 

troops who worked and slept in airconditioned buildings than among 

those who lived in tents or open 

warehouses.

Investigators conducted exposure 

assessments to examine the possible 

adverse health effects from exposure 

to particulate matter by Gulf War 

veterans. When making assessments 

of potential long-term or chronic effects 

from the inhalation of particulate 

matter, both cumulative and total 

doses must be taken into consideration. 

The methodology used to make the 

assessments estimates the cumulative 

exposure to which an individual is 

exposed and the total dosage, that 

is, the amount actually absorbed by 

the human body, that the individual 

accumulates over the period of 

exposure. Investigators concluded that 

the cumulative exposure and the total 

body burden dosages were below the 

general guidelines established by the 

EPA for the protection of human health 

and, therefore, chronic health effects 

would not be expected.

Although the results of the literature 

search and health risk analyses 

conducted during the course of this 

investigation suggest that long-term 

adverse health effects are not likely, 

investigators have recommended 

more research into understanding the 

potential long-term health problems 

in soldiers exposed to respirable 

desert dust and other pollutants. 

Additionally, researchers would 

like more information about the 

physical, chemical and/or biological 

properties of particles that might cause 

adverse health effects and how these 

particulates might interact with other 

contaminants to present a more potent 

health threat. ■ 

Particulate Matter

— Continued from Page 9

Historical centers, as well as DoD’s 

official committee commemorating the 

50th Korean War anniversary. Major 

national veterans associations are well 

represented also. 

“This is not our project or the 

library’s project. This is the nation’s 

project,” Bartis said. “We want 

people of all walks of life to feel 

ownership of this project.” 

To learn more about the 

Veterans History Project, visit 

http://www.loc.gov/folklife/vets. ■

Veterans

— Continued from Page 6

of American war veterans — men, 

women, civilians who served in 

World Wars I and II, and the Korean, 

Vietnam and Persian Gulf wars. The 

center needs contributions of civilian 

volunteers, support staff, and war 

industry workers also. 

Bartis said the amount of regular 

mail and the number of e-mails and 

phone calls vary from day to day, “but 

the response to this project has been 

enormous.” 

“We get to know a lot of these people 

personally. That’s the fun part,” he 

said. 

Aside from the thousands of items 

received from every day Americans 

each year, Bartis said the project has 

gained tremendous support from the 

corporate community as well. 

The Veterans History Project’s official 

Web site lists more than 50 national 

partners and support organizations 

from every state. The military services 

contribute through offices such as the 

Army’s U.S. Center of Military History 

and the Naval and Marine Corps 
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

T

Combat 

Off-load

KRTSANISI, Georgia — Members of the 

Georgian Commando Battalion perform a 

combat off-load at a training range in Krtsanisi, 

Georgia. The U.S. Army’s 10th Special Forces 

Group (Airborne) is in Georgia conducting the 

Georgia Train and Equip Program, which will 

enhance the Georgian soldier’s abilities in 

various battlefield techniques. 

Photo by Staff Sgt. Justin D. Pyle

he runs. The trots. The quick step. 

Montezuma’s revenge.

Although not the most pleasant 

topic, diarrhea can debilitate, even 

kill, deployed soldiers.

Less-than-sanitary living conditions 

and foreign diets, teamed with few 

opportunities to wash after using 

the bathroom, let diarrhea-causing 

bacteria with names like Shigella 

flexneri, Shigella sonnei, Shigella 

dysenteriae and Escherichia coli

flourish in the field, quickly disabling 

thousands and upending readiness.

In fact, according to the 1998 Army 

Science and Technology Master Plan, 

during Operations Desert Shield and 

Storm 57 percent of troops had at least 

one bout with diarrhea; 20 percent 

reported they were temporarily 

incapacitated by it.

To combat the foe, researchers in 

the Walter Reed Army Institute of 

Research’s Department of Enteric 

Infections are developing new 

vaccines to help deployed war-fighters 

combat the ubiquitous bacteria.

So far, the institute has four 

vaccines in the works. 

“Ideally, the goal would be to have 

one vaccine that will protect against 

multiple pathogens that can easily be 

given to deploying 

soldiers,” said Maj. 

David Katz, a senior 

clinical investigator 

at WRAIR. “So 

soldiers can take it 

before they deploy to 

an area, and they’ll 

be protected.”

A vaccine to combat Shigella flexneri, 

called SC602, was developed along 

with The Institute Pasteur. Since 1992 

it has undergone clinical trials in the 

United States and Bangladesh. 

“The wonderful thing about the 

shigella vaccines is ... the bacteria [used 

in them] are alive but weakened to 

diminish the amount of symptoms,” 

Katz said. “The body thinks it’s 

infected and gives an immune 

response, but you don’t get infected 

like a natural infection because the 

bacteria don’t spread from cell to cell.”

Receiving the oral vaccine before 

deploying is key, Katz said. 

“Most of the soldiers will get hit 

right when they arrive in a new area, 

either because they’re eating on the 

economy or they’re in a new area and 

their system has not been primed.”

Another reason to give the vaccine 

ahead of time is because of potential 

side effects, said Dr. Thomas Hale, 

chief of the department of enteric 

infections at Walter Reed Army 

Institute of Research. 

“The vaccine 

can cause some 

short-term fevers 

and mild diarrhea 

in 20 percent of the 

people who receive 

it, so soldiers need 

to take it well before 

they get on a plane,” 

said Hale.

A vaccine for Shigella sonnei, which 

often attacks travelers and stateside 

daycare centers, is a possible standalone product, Hale said. 

“This one vaccine could make a 

significant difference in the health of 

soldiers deployed to the Middle East 

[where 90 percent of outbreaks occur] 

and the developing world,” continued 

Hale.

Drs. Malabi Venkatesan and 

The Best Revenge

Researcher In Hot Pursuit Of Vaccines 

To Halt Deployment Diarrheal Disease

— Continued on Page 19

by karen fleming-michael

u.s. army medical research and 

materiel command, fort detrick, md.
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

adverse event management, as well 

as many other issues. Additionally, 

each branch of service will have 

implementation plans specific for you 

and your particular situation. 

We know that mnay of you don’t 

have access to the Internet. If this 

is the case, contact the medical unit 

or facility you would normally use, 

to obtain information. Detailed 

training will be provided to all 

medical providers involved in the 

administration of the smallpox 

program, and should be able 

to answer specific questions or 

concerns. 

Regarding the fact you have been 

previously immunized, the Centers 

for Disease Control and Prevention 

indicates vaccination provides a high 

level of immunity for about three to 

five years and decreases thereafter. 

If you are immunized again, your 

immunity will last even longer. For 

more information, visit the CDC’s Web 

site on smallpox and bioterrorism at 

http://www.bt.cdc.gov. 

Finally, there is some data to 

suggest that having been previously 

immunized against smallpox further 

decreases the chances of severe 

adverse reactions. Don’t let me 

mislead you. This vaccine does 

have side effects and risks associated 

with it. Gather as much information 

possible and talk to your health care 

provider to better understand the 

risks and benefits of this vaccine. 

Thank you for your support and 

dedication. ■

Cmdr. Gene DeLara, Medical Service 

Corps, U.S. Navy, serves as the medical 

planner in the Directorate for 

Deployment Health Support. He has 

a Doctorate of Pharmacy degree and a 

Masters of Business Administration 

degree. DeLara is both a pharmacist 

and medical planner holding the 1805 

Plans, Operations, and Medical Intelligence specialty code. 

Smallpox

— Continued from Page 5

rapid strep test, which only takes 10 to 

20 minutes. If the result of the rapid 

test is negative, your doctor may do 

a follow-up culture to confirm the 

results, which takes 24 to 48 hours. 

If the culture test is also negative, 

your doctor may suspect you do not 

have strep, but rather another type of 

infection. The results of these throat 

cultures will affect what your doctor 

Ask the Doc

— Continued from Page 5

decides to be the best treatment. 

Most sore throats are caused by viral 

infections, however, and antibiotics 

are useless against them. 

Penicillin is considered the 

medicine of choice for treating strep 

throat because it has been proven to 

be effective, safe and inexpensive. If 

you are allergic to penicillin, there 

are other antibiotics your doctor 

can give you to clear up the illness. 

During treatment, you may start to 

feel better within four days. This 

can happen even without treatment. 

Still, it is very important to finish all 

the medicine in order to prevent the 

complications described above. ■

Col.(Dr.) John W. Gardner, MC, FS., 

U.S. Army, serves as the program director of medical readiness in the Deployment Health Support Directorate. He 

received his medical degree in 1976 from 

the University of Utah and 

a doctorate in public health from Harvard 

University in 1981.

Through a haze of smoke and mortar fire, members of 2nd Company, Georgian Commando 

Battalion, move and attack the objective during a company level deliberate daylight attack 

at a training range in Vasiani, Georgia. 10th Special Forces Group (Airborne) is in Georgia 

conducting the Georgia Train and Equip Program, which will enhance Georgian soldiers 

abilities in various battlefield techniques. 

U.S. Air Force photo by Staff Sgt. Justin D. Pyle

Smokin’
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

T

A

healthbeat

ccording to the American Diabetes 

Association, 17 million Americans have 

diabetes, and about a third of them 

don’t know it. 

With its complications — blindness, 

kidney disease, amputations, heart 

attack and stroke — diabetes is the fifth 

leading cause of death by disease in 

the United States. The National Naval 

Medical Center’s Diabetes Educator, 

Sue Marullo, said that since diabetes 

is the leading cause of blindness, it 

is important for everyone with this 

condition to get their eyes checked 

yearly.

“Diabetes is a metabolic disease in 

which the body does not produce or 

properly use insulin to regulate the 

level of glucose [sugar] in the blood,” 

Marullo said.

According to the ADA, there are 

two types of diabetes, Type 1 and Type 

2. Type 1, formerly called insulindependent or juvenile diabetes, often 

runs in families. Although it can occur 

at any age, it usually develops before 

the age of 30. 

About 12,000 children in the United 

States get diabetes every year. People 

with Type 1 diabetes usually don’t 

by brian badura

bureau of medicine and surgery

he old adage that says “breakfast is 

the most important meal of the day” 

isn’t just some old wives’ tale.

Research over the years has shown 

the benefits of breakfast touch 

everyone, young and old.

“Studies have shown how eating 

breakfast benefits memory and overall 

health,” said Lori Tubbs, a registered 

dietician and the nutrition program 

produce insulin because pancreatic 

beta cells have been destroyed. 

Treatment of Type 1 diabetes requires 

a strict daily regimen that includes 

a carefully monitored diet, insulin 

injections and monitoring of blood 

glucose. 

Type 2 diabetes, formerly called 

non-insulin-dependent or adult-onset 

diabetes, typically develops after 

the age of 45, but can appear earlier. 

People with Type 2 diabetes produce 

some insulin, but the body cannot use 

Diabetes Awareness: 

Get a Head-To-Toe Checkup

by journalist 3rd class rebecca horton

national naval medical center 

public affairs

U.S. Air Force photo by Staff Sgt Tony R. Tolley 

U.S. Air Force Capt. Michelle Koe, an optometrist from the 48th Aerospace Medicine Squadron, 48th Fighter 

Wing, RAF Lakenheath, United Kingdom, does a slit-lamp evaluation on Airman 1st Class Charles Everett from 

the 48th Equipment Maintenance Squadron’s sheet metal shop. A slit-lamp evaluation is conducted to check 

for glaucoma, diabetes or high blood pressure. 

manager at the Navy Environmental 

Health Center in Portsmouth, Va.

Tubbs said skipping breakfast 

robs your body of the fuel it needs 

to perform essential functions. It 

helps boost your body’s energy level 

throughout the day, improving brain 

function, regulating your eating 

patterns and stimulating metabolism.

Think about it another way. Let’s 

say you eat dinner at 7 p.m., skip 

breakfast the next day, and eat your 

next meal at noon. That’s 15 hours 

of depriving your body of important 

energy it needs to operate.

“Breakfast helps get your body’s 

metabolism going and helps meet 

the recommended dietary intake of 

carbohydrates, fiber and protein,” said 

Tubbs.

Your car needs fuel to run properly 

and so does your body. When you 

skip meals, your body must work 

extra hard to break down stored 

energy in order to keep going, which 

Breakfast: It’s Essential for Adults and 

— Continued on Page 18

— Continued on Page 19
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

it effectively. Treatment includes weight 

loss (many Type 2’s are over- weight), 

proper diet, monitoring of blood glucose 

and exercise. Most cases are treated with 

oral medication or insulin injections.

“A simple blood test known as the 

Hemoglobin A1C [glycohemoglobin] 

is the best method to date for patients 

with diabetes in determining how well 

blood sugar is controlled over a threemonth period,” Marullo explained. “It 

measures the percent of sugars attached 

to red blood cells, with a six percent 

result being normal for people without 

diabetes. It’s very important for patients 

to know their A1C level and goals, so 

they are able to be proactive in helping 

to prevent diabetes complications.” 

Tight control, according to the ADA, 

means keeping blood glucose levels as 

close to normal as possible — typically 

with levels falling between 80 and 120 

mg/dl before meals and less than 160 

mg/dl after meals. 

“In real life, setting individual goals 

with your health care provider is 

critical,” Marullo said. “Every little 

bit you lower your blood glucose level 

helps prevent complications.

“There are more than 2,000 diabetics 

who are treated at NNMC or one of its 

tenant commands. More than 600 of 

those patients have what is considered 

uncontrolled diabetes, meaning they are 

at higher risk for complications,” Marullo 

said.

“I believe that education is really the 

most important thing for diabetics to 

focus on. The more they know, the 

better they can take care of themselves. 

Knowledge is key to managing diabetes,” 

Marullo said.

Marullo teaches diabetes patient 

education classes twice a month. In 

addition to discussing diabetes and the 

disease process itself, the class focuses on 

nutrition management; physical activity; 

understanding medications; monitoring 

blood glucose levels; preventing, 

detecting and treating acute and chronic 

complications through risk reduction; 

goal-setting; problem-solving; and 

psychosocial adjustment. 

“Program participants say initial 

classroom education efforts help them 

better understand the disease, diagnosis, 

treatment options, combination therapies, 

medications and insulin needs, selfmonitoring and the need for tracking 

overall care of their health,” she said.

“The importance of annual eye and 

foot exams, as well as preventive testing 

Medical personnel perform corrective hernia surgery aboard the aircraft carrier 

USS Carl Vinson (CVN 70). Taking care of sailors at sea is one of the primary 

duties for Navy doctors and hospital corpsmen who provide an extensive 

medical services capability to any deployed battle group. 

U.S. Navy Photo by Photographer’s Mate 3rd Class Jeff Stanislawski

Surgery At Sea

for kidney function, cholesterol levels 

and other health factors also is covered,” 

she added.

Marullosaid that class attendance 

has been great, with an average of 15 

students in each class.

“The classes are not only for patients,” 

she said. “I encourage corpsmen, nurses, 

spouses and other family members to 

attend.”

Marullo is working toward getting 

program certification from the ADA. 

Class lengths will extend to three fourhour sessions, and topics will be more 

in-depth and more intense.

“Patients will also be able to establish 

personal goals during the course,” she 

said. “We will be able to follow up with 

each patient to see if the class has helped 

them manage their diabetes.”

Since ADA recognition also requires 

tracking specific outcomes, she said that 

the program will be tracking pre-class 

A1C and a three-month post-class A1C.

Feeling better and preventing future 

complications are two very good reasons 

to learn as much as possible about this 

disease. ■

Diabetes

— Continued from Page 17
http://deploymentlink.osd.mil • winter 2003 Deployment Quarterly

leads to deprivation of function in 

other areas, such as the ability to 

concentrate.

Some people believe skipping 

breakfast will help them lose weight. 

But according to studies, skipping 

breakfast often leads to overeating 

later in the day, which can actually 

result in a greater intake of calories.

Children also benefit greatly from 

eating breakfast. A 1998 joint study 

by Harvard Medical School and 

Massachusetts General Hospital found 

that school age children who eat 

breakfast have improved math grades, 

reduced hyperactivity and decreased 

absence when compared 

to children who did not eat breakfast.

If mornings are too busy for a 

hot cooked 

breakfast, Tubbs 

recom-mends 

grabbing a piece of 

fruit or a container 

of yogurt to eat on 

the run.

“There are many 

products on the 

market today 

in convenient 

packaging designed 

to fit our busy 

lifestyles,” she 

dded.

Try eating 

breakfast for a 

week. Chances are 

you’ll experience 

an improvement 

in the way you 

feel throughout 

the day. ■

Breakfast

— Continued from Page 17

U.S. Army Reserve Col. (Dr.) Jack Rule assigned to the 

44th Task Force, Combat Support Hospital, Bagram Air Base, 

Afghanistan, sutures the thumb of a local Afghan worker. The 

hospital here provides care for all coalition forces involved in 

Operation Enduring Freedom, detainees and many of the 

local residents around the air base area from minor injuries 

to extreme trauma cases. 

U.S. Air Force photo by Tech. Sgt. Stephen Faulisi

Antoinette Hartman from Walter Reed 

Army Institute of Research developed 

the oral vaccine, called WRSS1, 

that is currently in clinical trials in 

conjunction with the University of 

Maryland Medical School and the 

National Institute of Allergy and 

Infectious Diseases.

The Department of Enteric 

Infections at Walter Reed Army 

Institute of Research has teamed up 

with the Israel Defense Force for a 

vaccine trial evaluating WRSS1 this 

winter. 

“Israel has cities that are very 

westernized, but almost everyone has 

a compulsory military obligation, so 

they go from cities to field posts and 

the incidence of diarrheal disease is 

significant,” Katz said.

To combat the deadly form of 

diarrhea, dysentery — also called 

bloody diarrhea — WRAIR researchers 

are working with the Bloomberg School 

of Public Health at Johns Hopkins 

University to test the oral Walter Reed 

Shigella-Dysentery-1 vaccine, WRSD1.

The other diarrhea-causing bacteria 

WRAIR and the Navy Medical 

Research Unit researchers are trying 

to disable is E. coli. Whereas shigella 

bacteria invades a cell’s wall and moves 

from cell to cell to spread the disease, 

E. coli prefers to stick to the intestine’s 

lining, homestead and crank out toxins 

that cause diarrhea. To outsmart the 

unwanted tenant, researchers are trying 

to make antibodies that will prevent 

squatters from colonizing because they 

can’t stick to the intestine. The vaccine’s 

been tested in a time-release capsule 

form as well as a transdermal patch.

“It should be easy for the soldier to 

use: Just pop the patch on and that’s it,” 

Katz said.

Though having one vaccine to combat 

all major forms of infectious diarrhea is 

a ways off, the quest to prevent soldiers 

from needing to run, trot and quick step 

will be Walter Reed Army Institute of 

Research researchers’ best revenge on 

Montezuma. ■

Vaccine

— Continued from Page 15

Medical Care
Deployment Quarterly winter 2003 • http://deploymentlink.osd.mil

other resources

Air Force Association

1501 Lee Highway

Arlington, VA 22209-1198

Phone: (800) 727 - 3337

http://www.afa.org

American Legion

1608 K St., NW

Washington, DC 20006

Phone: (202) 861 - 2700

http://www.legion.org

American Red Cross

17th & D Streets, NW

Washington, DC 20006

Phone: (202) 639 - 3520

http://www.redcross.org

AMVETS

4647 Forbes Blvd.

Lanham, MD 20706

Phone: (877) 726 - 8387

http://www.amvets.org

Association of the U.S. Army

2425 Wilson Blvd.

Arlington, VA 22201

Phone: (800) 336 - 4570

http://www.ausa.org

Department of Veterans Affairs

810 Vermont Ave, NW

Washington, DC 20400

Phone: (202) 273 - 4300

http://www.va.gov

Disabled American Veterans

807 Maine St., SW

Washington, DC 20024

Phone: (202) 554 - 3501

http://www.dav.org 

Enlisted Association of 

the National Guard

1219 Prince St.

Alexandria, VA 22314

Phone: (800) 234 - 3264

http://www.eangus.org

Fleet Reserve Association

125 N. West St.

Alexandria, VA 22314-2754

Phone: (703) 683 - 1400

http://www.fra.org

Marine Corps Association

715 Broadway Street

Quantico, VA 22134

Phone: (866) 622 - 1775

http://www.mca-marines.org

Marine Corps League

8626 Lee Highway, #201

Merrifield, VA 22031

Phone: (800) 625 - 1775

http://www.mcleague.org

National Association for 

Uniformed Services

5535 Hempstead Way

Springfield, VA 22151

Phone: (800) 842 - 3451

http://www.naus.org

National Committee for Employer 

Support of the Guard and Reserve

1555 Wilson Boulevard, Suite 200

Arlington, VA 22209-2405

Phone: (800) 336 - 4590

http://www.esgr.org

National Guard Association

of the United States

1 Massachusetts Ave., NW

Washington, DC 20001

Phone: (202) 789 - 0031

http://www.ngaus.org

Naval Reserve Association

1619 King St.

Alexandria, VA 22314-2793

Phone: (703) 548 - 5800

http://www.navy-reserve.org

Navy League

2300 Wilson Blvd.

Arlington, VA 22201

Phone: (800) 356 - 5760

http://www.navyleague.org

Non Commissioned 

Officers Association

225 N. Washington St.

Alexandria, VA 22314

Phone: (703) 549 - 0311

http://www.ncoausa.org

Reserve Officers Association

1 Constitution Ave., NE

Washington, DC 20002

Phone: (800) 809 - 9448

http://www.roa.org

Retired Officers Association

201 N. Washington St.

Alexandria, VA 22314

Phone: (800) 245 - 8762

http://www.troa.org

Veterans of Foreign Wars

200 Maryland Ave., NE

Washington, DC 20002

Phone: (202) 543 - 2239

http://www.vfw.org

Vietnam Veterans of America

8605 Cameron Street, Suite 400

Silver Spring, MD 20910-3710

Phone: (301) 585 - 4000

http://www.vva.org

By Phone

Direct Hotline for Servicemembers, 

Veterans and Families 

(800) 497 - 6261

Department of Veterans Affairs

(800) 827 - 1000

VA Gulf War Registry 

(800) 749 - 8387

VA Benefits and Services 

 (877) 222 - VETS

On the Web

Department of Defense

http://www.defenselink.mil

Department of Veterans Affairs

http://www.va.gov/

DeploymentLINK

http://deploymentlink.osd.mil

GulfLINK

http://www.gulflink.osd.mil

TRICARE

http://www.tricare.osd.mil/

re- guide