Pediatric diseases and operational deployments

Many nations now export military health as a proactive arm of the nation's contribution to the maintenance of international peace in troubled regions of the world; and all nations are called upon from time to time in emergenc y and disaster situations to help out in their regions of interest. Childre n and young teenagers constitute some 50% of war-stricken populations. This paper explores this increasingly important role of military medicine from the point of view of a practicing pediatrician and career doctor-soldier. M any international operational deployments undertaken in the last 5 years ha ve required the insertion of pediatric clinical and preventive health resou rces. Deployments to Rwanda, the countries of the former Yugoslavia, Somali a, Bougainville (in Papua New Guinea), Irian Jaya (in Indonesia), and the A itape tsunami disaster response (the Sepik region of Papua New Guinea) have all necessitated major pediatric interventions. In some operational deploy ments, in excess of one-third of patient and clinical contacts have involve d the care of children, including clinical treatments ranging from life-sav ing resuscitation to the care of children with both tropical and subtropica l illnesses. They have also involved mass immunization campaigns (e.g., in Rwanda) to prevent measles and meningococcal septicemia. In developing coun tries, at any time approximately 1 in 4 teenage and adult women is pregnant ; and of these, 1 in 15 is suffering a miscarriage during any 2-week period . The implications of this audit are that service members must be multiskil led not only in the traditional aspects of military medicine and nursing bu t also in (a) the developmental aspects of childhood; (b) the prevention of infectious childhood diseases by immunization and other means; (c) the rec ognition and management of diseases of childhood; and (d) the management of the normal neonate and infant, especially those orphaned in refugee, disas ter, and other emergency situations. Doctor-soldiers hold special credentia ls to be advocates for the protection of children caught up in armed confli ct and its aftermath. In this context, advocacy to ban antipersonnel land m ines is topical, because unfortunately the more than 2,000 deaths and injur ies each month involve children and their families, often injured long afte r the cessation of hostilities. Pediatric issues are now the business of al l who serve in the health disciplines in the broader profession of arms.