Philip Grey, The Leaf-Chronicle

FORT CAMPBELL, Ky. – A briefing and training session at Fort Campbell on Thursday was both a confidence builder and a reality check for 101st Airborne soldiers soon bound for Liberia.

The few soldiers in the bleachers at Dreyer Field House surreptitiously checking their smartphones at the beginning of the training were soon focused on Capt. Tyler Mark's briefing on what they would be facing, and Ebola was just one item on the list of West African dangers.

"A lot of you have been deployed to Iraq, Afghanistan, been shot at, blown up; you've been through all that and survived," Mark began. "Well, forget about all that. The environment you're going into is very different. The threat rates – the stuff that can kill you – is much worse."

That got everyone's attention – fast.

Mark, who is the 101st Airborne's Force Health Protection officer, then gave a quick situation rundown on Ebola.

As of Oct. 3, 7,400 people in the region had been infected. Half have died.

On a continent of 1.1 billion people, that might not seem to be an enormous number, but the trajectory of the disease and the death rate are why members the 101st Airborne and other Army units are deploying to contain it now.

Ebola basic facts

Ebola isn't easy to contract in a society that takes hygiene products, frequent washing and a modern medical infrastructure for granted. That isn't the case in West Africa.

It is passed through direct person-to-person exposure to bodily fluids, either through broken skin or mucus membranes, and while the disease is not airborne, a sneeze that is close enough to spray someone or any contact with a cut or the vomit of an infected person can pass the virus, which enters the bloodstream and literally causes the body to eat itself.

And while a stoic attitude toward illness or injury is generally considered an admirable trait in the military, Mark stressed that on this mission, it's absolutely a wrong answer.

Soldiers were told to immediately report any of several symptoms – fever, muscle or joint pain, headache, vomiting or diarrhea.

Soldiers were told that most of them will have little to no contact with the local inhabitants. The risk of contracting Ebola is considered low.

One soldier asked if Ebola is potentially mosquito-borne.

"No," said Mark, emphatically. "With the numbers of mosquitoes there, if it was, everybody in that area would be dead."

But there are other, more well-known diseases in West Africa and the chances of contracting some of them are high without taking proactive measures against them.

Some of the proactive force protection measures for the mission may seem extreme, but the briefing made it clear they are necessary.

Other dangers

The good news was, you can't get Ebola from food, air, water or mosquitoes. The bad news was, in West Africa you can get a lot of other diseases from those sources that will kill you or make you extremely ill.

Soldiers were cautioned not to eat anything not provided by the U.S. Army.

Unlike some other deployments, there will be no sampling of the local cuisine, since almost every water source in Liberia is contaminated with raw sewage. Even locally-produced ice is off-limits.

The entire continent of Africa, and particularly West Africa, is also considered "Highest Risk" territory for some of the world's worst diseases, as well as being home to a host of dangerous wildlife.

Mark tugged on his uniform blouse and said, "Assume that everything not wearing this is trying to kill you."

Malaria is the biggest worry. The Army has already experienced the reality that large numbers of soldiers threw away their malaria-preventing medication prior to deploying to Iraq and Afghanistan. Mark made it clear that wasn't an option on this mission.

The malaria attack rates in West Africa are 25 to 50 percent higher than anywhere else, and 17 percent of all deaths in Liberia – much of it swampland – are due to malaria. Liberia has a strain of malaria that can kill in 72 hours.

Beyond malaria, there is a laundry list of other diseases most people have only heard of in movies. Among them – yellow fever, cholera, typhoid, hemorrhagic fever, HIV/AIDS, hepatitis A and B, and Lassa fever. The latter Mark described as Ebola-like, "with the added benefit of being airborne." Fortunately, it's rare.

There won't be any swimming or wading, either, due to water-borne parasitic worms that carry schistosomiasis.

Some of those diseases are already present here, and vaccines have been developed for most. Mark told the soldiers they'll be feeling like pincushions after they get their shots.

Unique deployment

A point that was repeatedly stressed: There will be no pets or mascots, as every animal is considered potentially infected with something – especially rabies.

There are poisonous plants and venomous scorpions, spiders and snakes to worry about as well, including the black mamba, whose bite can kill in 20 minutes, and the puff adder, which is less deadly, but more common and likes to go everywhere humans go.

Even the soil is considered potentially dangerous, but due to the low level of development in the area, the air is clean and not considered life-threatening.

Heat injuries are also a concern in an area where the temperatures regularly hit 100 degrees with 70 percent-plus humidity.

Another difference with this deployment – beyond the fact that Green Beans, Burger King and Popeye's aren't going to be on site anytime soon – is that, at deployment's end, there will likely be a 21-day quarantine period before anyone gets to come home. That's for the protection of everyone back home, and not just from Ebola.

Because of that quarantine period, mid-tour leaves for this deployment – which may last a year – may not be in the cards.

However, both Marks and 101st Airborne Division spokesman Lt. Col. Brian DeSantis said that the quarantine period is not carved in stone.

"The 21-day piece is still being worked at the (Washington) D.C.-level," said DeSantis. "I'm sure that over the course of this deployment, there will be a decision made about leave, but right now we're prepared to go up to 12 months and stay over there until we're ready to transition all of these abilities we're bringing to the government of Liberia, or we have to hand this off to another DoD (Department of Defense) headquarters."

"That's still being worked at the four-star level as to how that process (leaves) is going to work," said Mark in a post-briefing interview. "But most personnel probably won't get R&R because of that 21-day period. It's unfortunate, it's a little bit of 'suck' on our end, but I think most of the 'Joes' are comfortable with ensuring we don't risk infecting civilians."

Precautions

Despite the list of other diseases, Mark said that Ebola is still the number one risk, because of the rate of infection and high death rate.

"The other diseases have treatments, and the mortality rate is much lower," he said. "I can't say that 21 days, that there's not going to be anything in your system, because there are other diseases that have a much longer asymptomatic period. They won't show symptoms, you can't test for them, etcetera, but those diseases are much less infectious and easier to treat. A lot of them are here as well, but just in a higher concentration in Africa.

"The potential public health risk is considerably lower."

Has the potential for mutation of Ebola into an airborne version come up in the course of conversations with the Centers for Disease Control (CDC) and other organizations?

"That conversation has come up," Mark said, "and the 'what-if' scenarios of 'what do we do if this happens?'

"It is scientifically possible but highly improbable."

101st Airborne Division Surgeon Lt. Col. Christopher Warner, asked if all possible precautions have been taken to his satisfaction answered, "Absolutely. Our soldiers are being prepared to recognize the unique threats Africa brings that they haven't faced in prior deployments in other areas of the world.

"We're making sure that they have the proper equipment, that they're trained to use it to keep themselves and the unit safe and to remain effective doing our job. Beyond just Ebola, we're making sure they're protected against other environmental exposures in this very hot area where we're going to have lots of mosquitoes...

"We're immunizing them, making sure they have the proper (protective medications) and we'll have medical assets on site to make sure they're cared for."

The mission

"Our mission," said DeSantis, "in support of the USAID-led effort, is to, one, build Ebola treatment units, which are being built to identify Ebola patients, as well as care for them. Two, our mission is to train health care workers who will be the actual ones to treat Ebola patients, to staff those treatment units. That's our two missions."

For this mission, called Operation Unified Assistance (OUA), the 101st contingent is primarily headquarters personnel to coordinate all of those efforts and medical personnel to train medical workers.

The 101st Airborne is only one of several Army units deploying for the mission, which is being conducted with a lot of help and expertise.

"There's a huge synchronization piece to this," DeSantis said, "and it doesn't just include our units, but also USAID (United States Agency for International Development), CDC, a whole bunch of organizations outside the government – Doctors Without Borders, World Health Organization (WHO), all those groups that have been over there for at least a year."

Training

Following the briefing, there was extensive training on how to wear the protective gear – protective masks, boots, gloves (two pairs minimum and three pairs recommended) and Tyvex suits.

Every soldier was required to don the gear and go through the decontamination process, aided by West Virginia Army National Guard full-time personnel of the 35th CST (Civil Support Team) and CERFP (Chemical, Biological, Radiological, High-Explosive Emergency Response Force Package) personnel.

The equipment displayed on Thursday will likely be part of the package that goes with the 101st, although a much simpler decontamination set-up can also be made using standard cleaning supplies like bleach and other items the Liberians will find easier to procure.

Ultimately, once the basis of an acceptable medical infrastructure is created by the 101st and other military units, the hope is that the Liberians and other nations in the region can take over the mission.

Philip Grey, 245-0719

Military affairs reporter

philipgrey@theleafchronicle.com

Twitter: @PhilipGrey_Leaf