Andy Robertson: A different theatre

AS the world remembers the start of World War I a century ago, the Australasian Military Medicine Association prepares to commemorate 100 years of military health care.

The association’s 23rd annual conference, which will be held in Sydney on 17–19 October, has added meaning as Australia is once again involved in combat operations in Iraq.

Australian doctors first became involved in WWI on the Royal Australian Navy hospital ship Grantala, which departed Sydney for Rabaul, New Guinea, on 30 August 1914, arriving on 13 September to treat sick and wounded troops from the Australian Naval and Military Expeditionary Force.
    
In other theatres of war, Australian Army Medical Corps doctors and Australian Army Nursing Service nurses were deploying as part of the Australian Imperial Force, which sailed from Albany, WA, in early November 1914. At sea, the first substantive naval battle took place between HMAS Sydney and SMS Emden on 9 November 1914, with Fleet Surgeon Leonard Darby and other health staff treating more than 70 wounded Australian and German personnel.

One hundred years on, military health services remain a critical part of military operations. The many changes that have occurred over that period have included a move away from the large full-time uniformed medical departments of World Wars I and II to smaller, operationally focused Australian Defence Force (ADF) health services with a mix of permanent and Reserve personnel.
 
The focus today is on permanent ADF health personnel who provide necessary primary care and limited secondary care and medical evacuation services to operational units in the field, as well as giving specialist operational health advice to commanders in the field and at the headquarters level.

Depending on the deployment, these permanent ADF personnel have been supported by a wide range of Reserve specialist health personnel. In recent years, this support has included deployment of specialist orthopaedic, general surgical and intensive care reservists to conflicts in Iraq and Afghanistan; specialist aeromedical evacuation and other health specialist assets to various disaster responses and humanitarian assistance initiatives, such as US-led Pacific Partnership; emergency physician and primary care support to border control operations; and specialist health support to national and international military exercises.

As a Naval medical officer with more than 35 years of service in the ADF, including as a specialist Reservist for the past 11 years, I have witnessed the evolution of the ADF health services from the relative calm of the 1980s to the more frenetic demands of the past 10 years.

Recruiting and retaining both permanent and reserve health practitioners remains a challenge for the ADF. Service in the military health services is not for everyone — there are medical, psychological and physical fitness requirements; discipline and obligations of being a member of a military force; the public service element; and potential strains on family, relationships and external careers — meaning that only a small subset will volunteer.

The rewards for such service, however, are great, with many of the permanent and reserve health staff being able to make full use of their training and expertise in managing health care in a range of different scenarios and places, from conflict to humanitarian assistance to disaster response.

In my specialist area of disaster medicine, we have worked closely with ADF health colleagues in the past 10 years responding to a range of national and international disasters, from the joint military–civilian deployments to Pakistan in 2010 to the more recent Haiyan typhoon in 2013.

The Australasian Military Medicine Association conference will look back to the health legacies from WWI and more recent conflicts, and forward to the challenges of providing health support for military operations into the future.

Providing such support as either a permanent ADF member or as a Reservist remains critical as we look to the future. It’s a role that health practitioners of all persuasions may like to consider.

 

Dr Andy Robertson, CSC (Conspicuous Service Cross), PSM (Public Service Medal) is the Deputy Chief Health Officer and Director, Disaster Management with the WA Department of Health. He is a specialist public health physician and medical administrator, and is currently a captain in the Royal Australian Navy Reserve, AMMA Councillor and Editor-in-Chief of the Journal of Military and Veterans Health.