Everyday operations in the combat zone are ever changing and usually involve intelligence of an enemy force, their activities, capabilities, threat level, and locations on the battlefield.

However, another enemy exists that does not wear a uniform or swear loyalty to any specific nation that must also be defended against. That enemy is illness and disease present in the area that Soldiers live, work, and fight. More commonly referred to as disease non-battle related injury (DNBI), which affects more than 30,000 troops in OIR. According to a 2018 study conducted by the Journal of the American Medical Association, one third of all injuries sustained in Iraq and Afghanistan were related to DNBIs.

Combined Task Force Med 374 is ready to counter this elusive foe, and not in the way you might think. This very compact team is made up of one community health nurse, a community health nurse/environmental science officer and a preventive medicine NCO, as well a fully licensed veterinarian.

“Our job is really about keeping the forces healthy,” said Sgt. Brad Talk, 68S. “There is a lot of behind-the-scenes things that we do to make sure that can happen, and a lot of it is more common sense than anything. We have a facility assessment report that we try to complete quarterly that covers many areas. One of the big areas we look at where food is sourced from, how it is washed and cleaned, how long food is kept.”

In addition to food inspections, the team is also charged with conducting various sampling across the multiple locations throughout Operation Inherent Resolve to include over 20 facilities in the area of operations, encompassing over 15,000 working area troops, Coalition Forces and contractors. Common tests conducted include sampling of the air, food, water, soil and even noise. Additionally, the team reviews waste management procedures and conducts on-site inspections.

“Facility camp assessments are more than just looking at food” said Maj. Kimberly Moore, assigned Preventative Medicine RN (68B) and Environmental Science Officer (72D). “We really try to look at the overall workplace safety of service members such as air quality, water quality , rodent control, vector control, the handling of hazardous materials, sanitization methods. We also look at common areas such as the MWR and the PX (Post Exchange), work out areas, the presence of the mold in working or sleeping areas Basically, we look at the location as whole and think about what a service member may interact with and how their safety is affected,” she said.

“There is a lot of testing involved,” said Talk. “And even though this is an enlisted position, some college credits with a concentration in science is preferred. We collect a lot of data and have to send it higher up. I like doing the job, and I know it is making a difference. We have the authority to shut down facilities if we have to, but that is never our aim. We make observations, ask a lot of questions, and prefer to make on the spot corrections about deficiencies. This job is really about keeping people healthy and keeping them out of the hospital.”

Discussing to the downfalls he usually finds during an inspection, Talk said it has a lot to do with resources each of the sites has access to.

“Some of these sites are pretty remote and are just making do with what they have. They might think that if no one is watching then no one cares, but we do care. It makes a difference when you have a good working relationship with people. When you have that already setup, they are much more cooperative in making the necessary changes to comply with Army standards.” said Talk.

Other areas PM frequently sees problems in is sanitation procedures in food serving areas, shelf life of produce, and water quality. These common places have the potential to harbor and spread harmful bacteria and virus which can lead to gastrointestinal tract problems in service members. To combat these common problem areas, the team does routine observations, testing and education. Interestingly enough, all recorded samples collected are recorded and archived in an electronic database called the Defense Occupational and Environmental Health Readiness System. This extensive database is used to store data and to provide individual exposure records and occupation environmental hazards exposure histories for all DOD (Department of Defense) personnel, both military and civilian, according to Army Force Protection literature, ATP 4-02.8.

This database is instrumental in matching Soldiers to certain service connection claims related to their military service. This same database, and sampling techniques are being utilized in relation to burn pits, as discussed in recent news, which has been associated with other previous operation campaigns.

“I think it’s kind of cool that I get to be a part of the documentation process. The samples I take will be kept for years after I am out the service and could potentially be used to help other service members receive care long after they retire,” said Talk.

Working very closely with the veterinarian team, the PM monitors the animal populations that affect troop health specifically cats and dogs. While these animals at home are treated as friendly domestic pets, they have significant connection to the spread of disease in the middle east. The main concerning disease is rabies, a viral infection that affects the nervous system. The disease is spread through the saliva or when the animals bites another animal or a person. Rabies is a treatable condition that needs to be treated in the timely manner to prevent permeant neurological damage. However, the availability of this life saving three-dose treatment is not always available in remote locations where Soldiers have higher chances of interacting with animals infected with rabies.

“Rabies are extremely dangerous,” said Moore. “Back in the states there is a 7 percent chance of an animal having rabies, but in the current area of operation the incidence rate is closer to 25 percent. That is why Soldier education is important and reminding them not to touch the animals. We are constantly reminding Soldiers to leave the critters alone and they will leave you alone.”

To help further the mission of rabies control prevention the PM team, veterinarian, and vet tech are also partnering with the host nation in an initiative known as the trap, neuter, vaccinate program. The driving push of the program is help lower the overall rabies prevalence rate in the animals and reducing the chance of SMs and the surrounding populations from contracting the disease. A bonus for re-releasing cats is they are territorial and will naturally track and hunt rats who can also carry the disease. The vaccinated cats purpose is to reduce the overall number and rates of rabies in the area thereby protecting other Military Working Dogs and SMs.

Cooperation and education are also taking place among the coalition nations, with an emphasis on maintaining the vaccination status of assigned Military Working Dogs, as some of the other countries do not maintain vaccinations at the same level the U.S. military does.

Reflecting on her experience in PM Moore said, “There is never a dull moment. It’s a lot of detective work and problems solving with the goal of keeping Soldiers healthy while also completing the objectives of the mission. We [PM] have the responsibility to improve whatever conditions we can. We can’t fix everything, but we serve as the eyes and ears for the command to keep the fighting force as healthy as we can while increasing morale.”