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Home arrow Psychology arrow Psychiatrists in Combat: Mental Health Clinicians Experiences in the War Zone

Reporting as Division Surgeon

Division Surgeon is a misnomer. Many assume that this is a surgeon from the operating room, resulting in a quizzical look when a psychiatrist is introduced. Division Surgeon is the senior medical officer for the Ground Combat Element (GCE), the infantry, within a Marine Air Ground Task Force (MAGTF). The Division Surgeon is a special staff officer under the cognizance of the G4, the general staff officer in charge of logistics.

I expected a few comments about being the General’s Psychiatrist, but being the Division Surgeon during the preparation for the first invasion of another country in decades would not be an easy role to fill regardless of medical specialty.

The staff of the Division Surgeon was small, in accordance with the expeditionary mission of the Marines. Deploy quickly, stabilize and then go home. Surgeon, Psychiatrist, Medical Administrator, Environmental Health Officer and a few Corpsman were at headquarters, the rest were assigned to battalions and regiments. An Assistant Division Surgeon had been appointed from one of the second year GMOs (General Medical Officers). Like his contemporaries, he had completed his internship and had accepted a tour with the Marines planning to return to his residency program.

Predeployment

The Russians were “Beaten by the Bugs” in the Middle East (e.g., infectious diseases). We were given Professional Military Education (PME) to review the lessons of their failed occupation. Medical could not let these mistakes be repeated. Preparation would be the key to success.

Pre-deployment focused on readiness, training, and rehearsal. The people and equipment had to be ready. Appropriate training had been given. Everyone had to know what was expected of him or her, and they had to have a chance to rehearse their role. General Staff Planning Conferences developed courses of action from which the CG would build the battle plan. Field exercises would serve as dress rehearsals for the invasion, verifying requirements and identifying necessary changes.

Everyone had to be issued required NBC (Nuclear Biological Chemical) gear. This was a huge logistical exercise. Gas mask, eyeglass inserts, antidotes, and training were only the start. All members required pre-deployment medical and dental screening to make sure they had no limitations.

Drills were modified to deal with anticipated threats. Hikes and runs added Kevlar body armor to gear lists. “Gas Mask Thursdays” forced all members to don their gas masks to understand the claustrophobia and difficulty in performing such mundane tasks as using a phone or talking to an office mate.

Pre-deployment briefs were mandated to familiarize those deploying with what to expect and what was expected. Identified environmental threats were met with preventive measures. Uniforms had to be treated with the insect repellant DEET. The Marines had just adopted the new MARPAT (Marine Pattern) digital camouflage uniform, but if everyone didn’t have it, no one could wear it. The result was additional uniforms needing to be treated to repel the bugs.

Medications needed to be obtained and distributed. The choices for malaria prophylaxis were either Tetracycline or Mefloquine. Neither was perfect, but malaria was a worse option. Tetracycline often caused gastrointestinal (GI) symptoms and increased sun sensitivity. Mefloquine was feared by many due to the mental status changes some Marines had during DS/DS. Compliance would be a concern.

Smallpox vaccinations had to be given in response to the renewed biological threat. The vaccination had not been given in decades, so administration was unfamiliar and anxiety provoking. Data of compliance was closely monitored, tracked, reported and reacted to at every level.

OPTs (Operational Planning Teams) and IPTs (Integrated Process Teams) were conducted. Coordination with other MSCs (Major Subordinate Commands) and higher headquarters required extra effort with correspondence, requests, phone calls, and meetings. Unfortunately higher headquarters often had difficulty supporting plans and frequently felt they had better ideas. I couldn’t help but reminisce of my father’s salty advice about opinions and “assholes.” Maybe the military hadn’t changed much over the years. Maybe the people weren't that different either. Information systems were not linked, since peacetime security for IT (Information Technology) differs from secure systems. It was busy and pressured.

Flights were assigned. I left early on Valentine’s Day, leaving Valentines for my sleeping family. The flight would be long, but most felt relieved to get on the plane bound for Kuwait, where the staging for invasion was being completed. The rehearsal was over—“showtime!”

 
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