1. Role of the Military during disease outbreaks
Col MAMA Ambroise, MD
Director of Military Health
LCol MPOUDI NGOLE, MD MPH
Head Pandemics Unit/HIV Focal Point
Department of Military Health, CAMEROON
APORA, 20/04/15 in Accra, GHANA.

2. Humanitarian action is not specifically part of the mission assigned to the Cameroonian Defense and Security Forces. Involvement is not formal.
In practice, military health and non health personnel commonly take active part in outbreak management in support to the MOH, especially in non urban areas.
Major partner to the MoH in disaster management and strategic planning in pandemics (i.e HIV, Ebola).
Main contributions are found in provision of care and logistics.

3. Strategic planning
HIV and Ebola responses With coordination of the MoH. Other stakeholders include Interior, Communications, Environment, fishing and animal industries, NGOs and international partners Led early response to HIV Contribute to the IMS (in development). EOC located in mil buildings.

4. Detection of outbreaks
Surveillance focal points in mil. health facilities located in endemic areas. Report surv. data to Mil health and regional health authorities. Routinely done for HIV, less effective for other diseases.
In remote areas and borders: Gendarmerie (Military police) staff are often the only authorities available. Routinely provide regular reports to their hierarchy. Readily available means of communication and liaison vehicles.
Frequently the first to notice and/or report unusual changes in their environment including upsurges in fatalities/sick where they are posted. Commonly informed by communities.
They alert health authorities when unusual outcomes are observed

5. Early response:
The gendarmerie (mil. police) is trained to quarantine areas where potentially transmissible infections are suspected by restricting movements of populations.
They lack training for infection control and sometimes get contaminated.
They assist local health authorities in the early response as requested by the Ministry of Interior, usually triggered by the Ministry of Public Health

6. Management of outbreaks:
Mil. health network: 126 health facilities nationwide, 75 leaded by a military physician.
Hospitals and health centers are open to civilians; commonly involved in management of disasters and outbreaks when located in affected area.
Provide care +/- Lab Diagnostic
to walk-in patients or when requested by MoH.
Regularly provides logistics support (informal arrangement MOD-MOH)

7. Logistics
Most of the mil-civ collaboration is achieved through logistics support, especially outside major urban areas.
Making use of the high mobility, fast communications chains and nationwide deployment of the military, the MoH via Interior have requested support from the MoD for issues related to transportation of patients, security (borders, quarantined areas), buildings/sites and communication.
Examples: cholera with communication and provision of potable water in Far North region or Ebola with IMS structure and isolation units offered by the MOD.

8. Care provision Prevention
Mil health staff provides medical care when mil. heath facility is located in the area affected by the outbreak.
Frequently receives equipment/intrants support from the MOH in these cases.
Mainly applies to mil health personnel, except for
Screening for diseases at entry points.
No post crisis nor recovery measures

9. In a nutshell:
Contribution of Defense and Security Forces in Cameroon : not clearly defined.
Involved as requested by the MoH through leadership of MoI or unpredictably as caught in frontline.
Health services, Engineering, communications
Organisation, training, celerity and equipment in the military provide a strong potential to more efficiently contribute to outbreak management, should mission and expectations be clearly spelled out and supported.

11. Gaps…

12. Healthcare system strengthening
Reliable stockpile of PPE/reliable channels to secure PPE.
Access to appropriate shipping containers/safe specimen handling . IATA trained personnel
Lab available but not equipped for diagnostic and shipment.
Isolation units not available
SOPs
Military-friendly visuals/brochures

13. HR capacity building (1/2)
Additional personnel training needed for :
Surveillance ; adequate reporting of data
detection of outbreak and management/action during outbreaks
Epidemic management and rapid response teams
Importance and use of EPI
Shipping of infectious substances. IATA trained personnel.

14. HR capacity building (2/2)
Training needed in:
Handling of blood, infectious specimen.
Resources and knowledge to establish isolation units
Staff training for infection control, esp handwashing.
Appropriate measures in place to isolate and transport suspect travel-related cases to the ETU
Risk Communications

15. THANK YOU!!!