Do No Harm in Global Health Engagement.

This manuscript examines the principle of "Do No Harm" in DoD Global Health Engagement (GHE) efforts. It highlights the potential positive and negative consequences of health investments and explores how unintentional harm is addressed in a global health context. The manuscript also discusses the involvement of the U.S. military in global health and the concept of dual loyalty faced by military GHE practitioners. The goal is to understand the challenges of doing no harm and identify methods to mitigate or avoid unintended negative consequences in DoD GHE activities.

Utilizing a "Crawl, Walk, Run" Training Model to Enhance Field Sanitation Capabilities for Peacekeeping Forces: A Recommendation for the Department of Defense Global Health Engagement Enterprise.

INTRODUCTION: DoD Global Health Engagement (GHE) planners can follow a number of models to effectively plan and execute successful GHE activities. One recommendation that could provide a significant return on investment for the DoD GHE enterprise is to utilize a "Crawl, Walk, Run" training model to build or enhance a specific medical capability for a Partner Nation (PN). Through the African Peacekeeping Rapid Response Partnership (APRRP) program, U.S. military medical subject matter experts serving as instructors for a Field Sanitation Course (FSC) delivered to the Senegalese Armed Forces (SAF), gained first-hand experience of the positive outcomes that resulted from incorporating this training model into the DoD GHE process. MATERIALS AND METHODS: The SAF completed three APRRP-led, in-person FSC iterations: May 2019 (crawl phase), September 2019 (walk phase), and February 2020 (run phase). Approximately 1 year after the completion of the in-person FSCs, in the midst of the COVID-19 pandemic, USU's CGHE offered a Field Sanitation Virtual Engagement to augment the FSC, emphasize specific field sanitation topics, and discuss lessons learned with the SAF on the deployment of their Level 2 Hospital. RESULTS: Before deploying their Level 2 Hospital during the COVID-19 pandemic, the SAF conducted a base camp assessment and found multiple ways to apply the knowledge and skills learned through the APRRP FSC to address issues related to waste management, pest control, and personal protective measures to protect against COVID-19. The SAF's progress in strengthening and institutionalizing their field sanitation capabilities can be seen by their execution of their own variation of the FSC-in preparation for their deployment, the SAF conducted three of their own FSCs, which closely resembled the APRRP-administered course. CONCLUSIONS: The "Crawl, Walk, Run" training model demonstrates an excellent teaching method that develops PN instructors so they can train more personnel in the long-term, thus building both capacity and capability. This gives the PN the opportunity to sustainably institutionalize a course, allowing them to continue training it in perpetuity. Implementing this training model flexibly to adapt to the differing needs of each PN and each line of effort would increase the success of DoD GHE activities when training PNs. It would also ensure the PN has the capability to sustainably institutionalize a course and can independently train future cohorts through internal iterations of the course.

Cross-cultural communication capabilities of U.S. military trainers: host nation perspective.

A survey was conducted to assess trainee perception of the cross-cultural communication competency of U.S. military trainers and their satisfaction with the training they received. Findings from the survey show that U.S. military trainers rely significantly on local interpreters. This indicates variability in the ability of the trainers to communicate effectively with host nation partners, the variability being dependent on the capabilities of the individual interpreter. The findings illustrate the importance of providing military health personnel with training on how to work effectively with interpreters. The use of supplementary resources such as electronic translation devises when the interpreter is not capable of conveying health-related training information with the desired level of accuracy is recommended. Expanding the availability of general cultural training, which provides baseline information on local values, traditions, and customs in addition to health-specific cultural orientation, is also recommended to help military health trainers customize their training content and methods to fit the local environment.

Global health language and culture competency.

This article presents findings from a survey conducted to examine the availability of foreign language and culture training to Civil Affairs health personnel and the relevance of that training to the tasks they perform. Civil Affairs forces recognize the value of cross-cultural communication competence because their missions involve a significant level of interaction with foreign governments? officials, military, and civilians. Members of the 95th Civil Affairs Brigade (Airborne) who had a health-related military occupational specialty code were invited to participate in the survey. More than 45% of those surveyed were foreign language qualified. Many also received predeployment language and culture training specific to the area of deployment. Significantly more respondents reported receiving cultural training and training on how to work effectively with interpreters than having received foreign language training. Respondents perceived interpreters as important assets and were generally satisfied with their performance. Findings from the survey highlight a need to identify standard requirements for predeployment language training that focuses on medical and health terminology and to determine the best delivery platform(s). Civil Affairs health personnel would benefit from additional cultural training that focuses on health and healthcare in the country or region of deployment. Investing in the development of distance learning capabilities as a platform for delivering health-specific language and culture training may help ease the time and resources constraints that limit the ability of Civil Affairs health personnel to access the training they need.