Pediatric diseases and operational deployments.

Many nations now export military health as a proactive arm of the nation's contribution to the maintenance of international peace in trouble regions of the world; and all nations are called upon from time to time in emergency and disaster situations to help out in their regions of interest. Children and young teenagers constitute some 50% of war-stricken populations. This paper explores this increasingly important role of military medicine from the point of view of a practicing pediatrician and career doctor-soldier. Many international operational deployments undertaken in the last 5 years have required the insertion of pediatric clinical and preventive health resources. Deployments to Rwanda, the countries of the former Yugoslavia, Somalia, Bougainville (in Papua New Guinea), Irian Jaya (in Indonesia), and the Aitape tsunami disaster response (the Sepik region of Papua New Guinea) have all necessitated major pediatric interventions. In some operational deployments, in excess of one-third of patient and clinical contacts have involved the care of children, including clinical treatments ranging from life-saving resuscitation to the care of children with both tropical and subtropical illnesses. They have also involved mass immunization campaigns (e.g., in Rwanda) to prevent measles and meningococcal septicemia. In developing countries, at any time approximately 1 to 4 teenage and adult women is pregnant; and of these, 1 in 15 is suffering a miscarriage during any 2-week period. The implications of this audit are that service members must be multi-skilled not only in the traditional aspects of military medicine and nursing but also in (a) the developmental aspects of childhood; (b) the prevention of infectious childhood diseases by immunization and other means; (c) the recognition and management of diseases of childhood; and (d) the management of the normal neonate and infant, especially those orphaned in refugee disaster and other emergency situations. Doctor-soldiers hold special credentials to be advocates for the protection of children caught up in armed conflict and its aftermath. In this context, advocacy to ban anti-personnel land mines is topical, because unfortunately the more than 2,000 deaths and injuries each month involve children and their families, often injured long after the cessation of hostilities. Pediatric issues are now the business of all who serve in the health disciplines in the broader profession of arms.