How does a mechanical engineer, a former Marine and a Brazilian immigrant find themselves together in an operating room in N’Djamena, Chad, conducting a U.S. Army Medical Readiness Exercise (MEDREX)?

For U.S. Army Lt. Col. Charles Foley, Maj. David Macdonald and Sgt. Laysa Nogueira, the U.S. Army Reserve is the answer. Assigned to the 402nd Forward Resuscitative Surgical Detachment (FRSD), they are currently conducting their two weeks of annual training at a U.S. Army Southern European Task Force, Africa (SETAF-AF) organized MEDREX in N’Djamena, Chad.

Often many go through life wondering what they can be, or what they should be as if there is a singular definitive answer to this profound question. Here in N’Djamena, the medical readiness exercise is one of several partner-led, U.S. enabled commitments to medical readiness across the African continent. During this MEDREX these individuals being all they can be while working with Chadian military surgical partners split between two operating rooms at the Garnison Hospital.

Joining the Army and being a surgeon were independent childhood dreams of Lt. Col. Charles Foley. In middle school, he dismissed joining the armed services due to poor eyesight. Although wanting to be a fighter pilot and not being able to, he also dismissed the Army for fear of becoming a liability if he lost his glasses.

By high school he thought “college plus another four years of medical school plus residency just did not seem like something I wanted to do,” so he dismissed becoming a surgeon too. He eventually started his professional career as a mechanical engineer working for Otis Elevator company.

Foley eventually made the transition to surgeon, after being inspired by a civil aviation friend who was also a plastic surgeon.

“After going to the library looking up reconstructive surgery you see reconstructive plastic surgery came out of World War I. It was absolutely riveting to see what people had done with war injuries and how they did reconstruction on World War I soldiers then transition to World War II reconstruction and Vietnam. I found that unbelievably captivating. It is human engineering for me,” Foley said.

Although still interested in joining the military, Foley’s initial attempts to join were unsuccessful; neither the Army or Navy were looking for plastic surgeons. It would be over ten years before he got the opportunity to join the Army Reserve.

He directly attributes his ability to live out his dream to his wife, Maj.(R) Sheila Foley, and their support system. “She was the one who encouraged me to consider joining the Army when I told her I’d always wanted to join,” he said.

His wife arranged an appointment with a recruiter. Still, he had a two-year administrative wait prior to being sworn into service.

“I found out about [forward] surgical teams when I was doing some research. I'm like FST, oh yeah that’s totally my thing, 100%. Well, it also goes back to me being an adrenaline junkie. You know, riding motorcycles, flying airplanes, etc. The FST is like special forces for doctors,’ he said.

Instead of joining a forward surgical team, he was assigned to a field hospital. It was during this time the world experienced the COVID pandemic, and Foley found himself in New York treating patients. It was during his service in New York that eventually led to him joining a forward surgical team.

“The reason I got the position in the FST was because one of the commanders in NYC gained confidence in my abilities. I was sitting around at a coffee table one day about waiting to join a FST, which is why I really joined the Army...”.

Months later, that same Commander called Foley with an offer for a position with the 402nd FRSD, but he had to submit his paperwork that night. “You bet I got my paperwork in that night,” Foley said.

Lt. Col. Foley, now a U.S. Army general trauma surgeon (61J) said, “I sat here [in Chad] the day before and looked out over the river and saw the people out farming and fishing and thought, what an honor and privilege for me to be over here. How many people can say they went to Chad, or Africa, with the Army and operated to support the people there. Does it get better than that? For me no, it’s awesome”.

Foley isn’t the only one in the operating room at the Garnison Hospital who wanted to join a forward surgical team.

When Maj. David MacDonald, a nurse anesthetist (66F), was asked why an FRSD over a field hospital unit he said, “In a field hospital there is structure like a real OR, intensive care unit, radiology, and pharmacy it’s like a giant hospital in an FRSD it generally you and your 20 or maybe 10 people depending where you’re at that’s your medical assets, so you do have to do a lot more cross training in the FRSD. You have to know what everybody does in the FRSD. The expectations are a little different, you don’t have all the same supplies or equipment. It’s a lot more fun in an FRSD”.

Prior to the Army and healthcare, Macdonald was a Marine infantry assaultman from a long lineage of U.S. service members. “I really liked the movie Full Metal Jacket, so my uncle, who was a marine, convinced me to join the Marines”.

Upon completion of his enlisted service, Macdonald started college but was unsure of what to major in. A Marine friend convinced him to take a nursing class with him, and he found his calling. However, it was during his clinical rounds that he found his specific calling.

“I shadowed the Certified Registered Nurse Anesthetist (CRNA) in the hospital, and I just love what they did. A lot of independent decisions and a lot of different medication stuff. It was a lot more technical,” Macdonald stated.

Upon completing his program of study Macdonald’s initial service preference was the U.S. Navy Reserve. The Marines don’t have healthcare positions but joining the Navy would allow him to give back to the Marines by taking care of Marines.

Unfortunately, the Navy Reserve did not have any CRNA slots available; however, the Army did.
“It was a good decision and I’m glad I went Army,” Macdonald said.

Nogueira, born in Brazil, immigrated to the U.S. with her family as a child. By the time she graduated high school, she was on a waiting list for citizenship with an anticipated 10-year wait.

She entered the workforce working as a medical office receptionist. While at work one day a Spanish client arrived to obtain medical records. The client, who had been a doctor in Spain, entered the office in a U.S. Army uniform. He told Nogueira and a doctor at the clinic about the Army program that let him obtain his citizenship and medical credentialing for the U.S.

“That sparked my interest in the Army, but I wasn’t a doctor nor nurse so I didn’t think I could do it. Then I thought maybe, I’d go become a healthcare provider so one day I could possibly be in the army, get my citizenship, and give back,” Nogueira said.

After careful consideration and research Nogueira discovered the program wasn’t exclusive to healthcare, but also had linguistic opportunities for Portuguese speakers. A few days later, a friend in the U.S. Air Force took Nogueira to a U.S. Army Reserve recruiter.

She also had concerns about life as a woman in the Army and how she’d be treated since she was not yet a U.S. citizen.

“At first I thought the Army would be a very ‘macho’ place, [but] over time [I] found the Army to be an empowering place for women. It helped me push through gender barriers. It showed me that even as a woman you can be mentally and physically tough while using critical thinking skills to [accomplish] the mission,” Nogueira said.

Now an operating room specialist (68D), Nogueira had zero formal medical skill or experience; however, from the skills and certifications obtained in her Army journey she has a new found ability to assist so many people.

Although uniquely different paths, these three Citizen-Soldiers are working daily during this MEDREX not only perfecting their military readiness, but making positive change in the lives of Chadian citizens.

Their stories outline the importance of connection, in each of their journeys someone entered their life and impacted their futures. This is not much different than what occurs during the medical readiness exercises.

“I love being in the Army. It took me, just a girl from Rio, and put me in an operating room and now I get to travel the world and I get to give back in my community. I get to come to places like this [Chad] and see a whole other side of healthcare that I’ve never seen before.” said Nogueira.

MEDREX is a partner lead, U.S. enabled program, planned and executed by U.S. Army Southern European Task Force, Africa (SETAF-AF), that allows military health professionals from the U.S. and African partners to exchange medical practices, procedures and techniques that build and strengthen treatment capabilities, resulting in lasting relationships between the partners.