By C. Todd Lopez
GUATEMALA CITY, Guatemala (Oct. 31, 2022) -- Healthy bones and muscles were just one of the goals of the recently concluded HEART 22 mission, which finished up last month in Guatemala.
The Health Engagements Assistance Response Team stood up in mid-July in Honduras. As part of that operation, the soldiers and airmen of Joint Task Force-Bravo out of Soto Cano Air Base, Honduras, led U.S. military medical professionals on a mission in Honduras and Guatemala to provide dental, orthopedic and ophthalmology services to citizens in those nations.
Air Force Lt. Col. (Dr.) Jacob F. Riis, an orthopedic surgeon stationed at Davis-Monthan Air Force Base, Arizona, was a big part of the HEART 22 mission.
"We specialize in treatment of conditions of the musculoskeletal system," he said. "It's bones, muscles, joints, tendons and ligaments. My primary focus in the military is with sports medicine, which, again, focuses primarily on the shoulders, hips, knees, and ankles."
Riis also does trauma work, which he said was the primary focus for him during HEART 22.
In Honduras and Guatemala, Riis said his role was a kind of "advise and assist" type of mission. As part of the HEART mission, he said he worked alongside national partners in both Honduras and Guatemala, including medical professionals there, as well as medical residents, on cases that might have already been scheduled.
But the difference, he said, is that in his work in the United States, the patients he'd see were past emergency care. If they'd experienced trauma, he said, his patients in the U.S. would have already been through the emergency medicine department.
"The trauma that I see has already been kind of managed at an emergency department, and then, I come along later and do the surgery, which is not an urgent procedure," he said. "[As part of HEART 22], we're in bigger hospitals. And, so, the trauma and things that we're seeing are more like what I would see in a larger hospital in the states. It's all within our purview, but it's a little bit higher-level of injury and a little bit more complicated surgery than we would do on a day-to-day basis in my outpatient clinics."
Like the ophthalmologists, Riis said his work as part of HEART 22 involved more partnering than humanitarian work.
"I would characterize it as information exchange," he said. "There are international standards for management of trauma. And all of the hospitals we worked in were aware of those standards. And so as opposed to maybe an operation where we come in and set up a tent and we bring all of that equipment and we just bring patients in and knock them out, this is more of we're working alongside them."
As part of HEART 22, Riis said he found himself being asked to weigh in on and participate in treatment of trauma patients that he knew either Honduran or Guatemalan orthopedic surgeons could handle, but that they wanted another set of eyes on.
"I've had several physicians, both in Honduras and Guatemala, ask me to help them with more complicated sport medicine cases that they certainly could do themselves, but they'd like to have somebody else who does things a little bit differently walk them through the case," he said. "Then, we get to obviously experience some of the limitations that they have and, in some ways, support in areas where we can. It was less of a set up a tent and run the place and more of come alongside and just demonstrate that we're strategic partners with them."
What HEART 22 showed Riis was how to operate in an environment that doesn't have all the things he'd have back in the U.S. That's something that might come in valuable to him as a military doctor as part of a U.S. combat operation.
"It's good exposure to operating in a little bit more austere environment than we're typically used to," he said. "In my practice in the states I kind of have what I want, when I want it all the time. We've been exposed to a system here that has some limitations. They're not limitations to prevent you from doing patient care. But they're limitations that if you weren't able to adapt, you'd find it difficult to provide consistent care. That perspective has been helpful because if I were tasked to run an austere clinic, then I would have already had the experience I've had here to know how to manage with a little bit less than I'm used to."
As part of HEART 22, he said, he saw that everybody on the U.S. team was able to adapt to the different environment.
"I think that's probably the biggest takeaway," Riis said. "There are some things that they have to do because they have limitations here that I probably wouldn't do in the states; not that they're wrong, it's just different. But that perspective has probably been the most valuable thing, I would say."
Another takeaway from HEART 22 was the importance of working within the system already in place, such as for finding necessary medical supplies. Riis said sometimes there's a mindset that the U.S. must bring in a lot of U.S.-procured supplies and dump them and expect recipient nations to make use of them. But that isn't always the case.
"What we found on this mission -- particularly in ortho, and I think also in dental and maybe ophthalmology -- is that sometimes using local supply chains and developing relationships with the country's system, which already exists and already functions really well, that we can leverage that in the future and maybe tailor the missions to make them even more hard-hitting and also more efficient in terms of monetary and fiscal responsibility," he said.
What also made an impression on Riis, he said, is that the U.S. military can be more than just a fighting force.
"It's opened my eyes up to the opportunities and the impact that we can make outside of some of our primary missions," he said. "I was fortunate to be involved with special operations for several years, and there's obviously an emphasis in asymmetric warfare -- in winning hearts and minds and building up communities and developing relationships -- which sometimes is lost in the bigger military picture."
As part of HEART 22, he said he was impressed that the Air Force, Army, and other components of the U.S. military were able to come together to support a mission focused on partnering.
"We're not here to just dominate your system or change you to doing the things that we always want to do, we're here to work alongside you within your system and within the setup that you have already in place," he said. "We don't have to come in and do things necessarily our way. But we can share and grow together ... I think that that's the most valuable thing that I've seen from this type of operation."
Relationship building was also a big part of HEART 22, Riis said. And after working in both Honduras and Guatemala, he said he was able to build lasting professional relationships he thinks might come in useful later.
"We certainly have built relationships and opened up doors for, I think, future opportunities in these places," Riis said.
Over lunch one day, Riis said one of the doctors he worked with told him the HEART 22 experience had been better than other similar experiences in the past with other foreign nationals or even U.S. teams.
"For me, the indicators of success are that ... one, they want us to come back. Two, I get text messages and WhatsApp images in follow-up from fellow surgeons," he said. "[They say,] 'This patient's doing well ... here's a video of him walking after we did surgery.' For me, as a physician and surgeon where my primary job is to take somebody who's unable to do something and then make them potentially able to do something again, the biggest indicator of success is getting that feedback from others, the surgeons that I worked with."
The HEART 22 mission kicked off in Tegucigalpa, Honduras, in mid-July and closed out in early September in Guatemala. About 50 U.S. military medical professionals and support personnel from both the Air Force and the Army participated in the operation.