After Action Report
TABLE OF CONTENTS 2. Executive Summary 3. Operation Overview 4. Operation Summary 11. Areas of Analysis 12. Transportation and Staging Area 13. Volunteers 14. Headquarters Coordination and Logistics 15. Mission Objectives 16. External Communications
Mozambique 2012
TEAM RUBICON, Mozambique After Action Report
EXECUTIVE SUMMARY
On September 17, 2011, Team Rubicon deployed a team of medical personnel to the remote Northern regions of Mozambique. The primary focus of the mission was to provide rural medical care and consultation to the youth population of the Missao Para Juventude orphanage located in Gondola, Mozambique, and the surrounding village’s orphanages and special needs populations. The population of the orphanage was expected to be approximately 60-‐70 children, with the expected village’s special needs populations needing care to be in the 100’s. Mozambique is a country about twice the size of California with a population of approximately 20 million people. This country has been plagued by a history of war and injustice. Malnutrition, malaria, tuberculosis, HIV/AIDS and lack of clean water take a heavy toll on the people of Mozambique. Life expectancy is low; the average person lives to be around 40 years old. It is estimated that one quarter of the loss of life is attributed to HIV/AIDS. There are over 1.6 million orphans in Mozambique, and 69% of the people live below the poverty line and reside in rural areas. Life in these areas involves extremely hard work, and women do most of it. Mozambique is struggling to rebuild and move forward, but the issues it faces are staggering. That's where Team Rubicon came in. A U.S. based non-‐profit, Caring for Orphans-‐Mozambique (CFO-‐ MOZ) provided the monthly support necessary to meet the daily needs of the children, and provide education and job training to each child by building a school, yet the medical resources within the orphanage and surrounding communities are highly limited, if not nonexistent in some areas. While traditionally outside the mission scope of Team Rubicon’s international missions, the proposal for the specific scope of work Orphan boy from Caring for Orphans-‐ Mozambique came through a direct request for aid to former Team Rubicon’s Director of Field Operations, Zachary Smith. When Smith proposed the scope of work to TR Headquarters it was decided that if the majority of the mission’s expenses could be raised independently of TR’s operational budget, then Team Rubicon would support the mission. This decision was based upon the fact that while Team Rubicon’s proactive missions traditionally focused on endangered populations in countries or regions were international aid was extremely limited, the political and geographic situation in Mozambique meant that the majority of international aid and humanitarian support rarely made its way up to the Northern regions and away from the capital city of Maputo. Through mission preplanning, it was decided that Team Rubicon volunteer Dolores Meehan would lead the fundraising efforts for the mission and be the primary liaison between TR and the Mozambique fixers. The team would be based out of the Missao Para Juventude orphanage, and its Director, Mr. Simon Mudiwa, would arrange all necessary work permits required for the team to practice medicine and transport pharmaceuticals into the country. This arrangement would prove to nearly jeopardize the entire mission as the paperwork and permits needed to conduct the mission as operationally planned
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TEAM RUBICON, Mozambique After Action Report were never actually obtained, resulting in a near complete change of operational scope in order to keep the deployed volunteers working. Without the proper authorization from the Mozambique Ministry of Health, the Team Rubicon volunteers could have easily been turned away at the airport customs in Beira, or had the thousands of dollars in pharmaceuticals they were carrying confiscated. Furthermore, the resulting lack of proper authority meant that the team would not be allowed to practice medicine within the surrounding villages of Gondola. This in turn required the team to travel extensively to neighboring provinces in the effort to continue treating populations of orphans through relationships that Mr. Mudiwa had pre-‐ established over his years working in the country. While the medical personnel were administering care to the orphan populations, Team Leader Andrew Stevens and Mr. Mudiwa were forced to liaison with outside orphanage directors on a daily basis, sometimes more than a hundred kilometers away, in the hope to secure additional work for the deployed personnel. In hindsight, the operational preplanning for the mission was lacking. Prior to the mission deploying, Director of Field Operations, Zachary Smith, and Mozambique Team Leader, Andrew Stevens, were deployed on an additional Team Rubicon mission to the Thai-‐Burma border. During their absences, the majority of the operational planning to include the procurement of medical supplies, shipment of pharmaceuticals, and confirmation of the required MoH authority was assumed by the mission Mozambique liaison Dolores Meehan.
OPERATION OVERVIEW
Mission Objectives: The mission objectives were originally focused on providing aid to a very specific group of identified persons, the children and staff of the Mission for Youth Orphanage near Gondola. This again was a very specific request that only came to Team Rubicon’s attention through an acquaintance of the former Director of Field Operations. When presented to the rest of TR’s staff is was determined that if the majority of the operational funds could be raised privately, and that if these efforts would not take away from other staff’s daily duties, then TR would find the volunteers needed to support the operational delivery. To warrant a full deployment the objectives of providing medical care to just the staff and children of the Manica orphanage would have to be expanded. Through coordination with the orphanage director, it was explained that the team would be able to use the orphanage compound as a staging ground, and after the primary objective of providing care to the earlier identified group, the team could expand the range of medical services provided to nearby rural communities. This allowed the mission to have a more justifiable reason for deploying, as these rural populations had been identified as extremely vulnerable, as well as take some of the biased reason of the original objective out of the spotlight. OPERATION NAME: Operation: Mission to Moz DURATION: 11 days DATES: 9/17/11 – 9/27/11 LOCATION: Mozambique northern regions OPERATION DIRECTIVE: Children’s Primary Health Care Clinics ELEMENTS: TR main body TOTAL VOLUNTEERS: 6 MILITARY VETERANS: 3 (Stevens, Pruschki, Costa)
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TEAM RUBICON, Mozambique After Action Report MOZAMBIQUE 2011 TOTAL CASH RAISED: LESS: CREDIT CARD FEES: NET: EXPENSES: TRANSPORTATION: EQUIPMENT: FOOD: LODGING: AUTHORIZED CASH DISBURSEMENTS: MOZAMBIQUE 2011 TOTAL EXPENSES: NET OPERATION GAIN/ (LOSS)
$9,950 (private donation) $0 $9,950 N/A N/A N/A N/A $2,000 $14,407 ($4,457)
OPERATION SUMMARY The operational scope of the Mozambique mission geared solely around the provision of pediatric primary health care, however, the remoteness of the clinical operations and the lack of overall resources would require the team to be composed of medical professionals with a high degree of third world medical knowledge. Through volunteer vetting the final composition of the team consisted of the following skill sets: A pediatric neurosurgeon with decades of international third world health care, a 30 year retired navy corpsman with a vast knowledge of running remote primary care clinics, a physician’s assistant who specialized in transplant surgery, a experience nurse whose knowledge across numerous fields of nursing would prove to be highly beneficial, a nursing student whose outreach activities prior to departure funded the majority of the operational cost, and the Team Leader possessed a strong background in emergency/disaster management and international experience. The team would be assembled from across the United States. The furthest from the rally point was the Team Leader, Andrew Stevens, who resided in Alaska. From there, Steven departed to Los Angeles where he met up with Dolores Meehan. Together the two volunteers were able to gather the medical supplies and team bags that would be required of the mission, with the exception of the majority of the pharmaceuticals, which were previously shipped to the city of Gondola, in the Manica Provence of Mozambique and would hopefully be awaiting the team upon arrival. Team arrives in Mozambique
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TEAM RUBICON, Mozambique After Action Report With supplies and team gear in hand, Stevens and Meehan headed out to LAX where they picked up the third member of the party, Nurse Nancy Campa. The remainder of the team, Dr. Glenn Castaneda, Joe Costa, and Dave Pruschki awaited the west coast contingent in JFK. Once the team was finally together the team gear was distributed between the luggage that was to be checked and the six volunteers boarded there flight into Biera, Mozambique with a brief layover in South Africa. The concern on the minds of the volunteers was whether or not the proper credentials for their ability to practice medicine with Mozambique would be awaiting them upon arrival. In the two weeks prior to deployment, serious complications regarding the county host’s ability to arrange for the proper documentation required not only to practice medicine but to transport many of the pharmaceuticals that the team would be carrying over in their team bags. Further complications arose when the team’s Mozambique host, Mr. Simon Mudiwa or the Missao Para Juventude orphanage, encountered additional complications from the local government official and questions arose as to whether or not he would still be willing to support the team while in county. Eventually, it was reassured to the Team Leader that Mr. Mudiwa would have the proper documentation required by the provincial health departments and would be handing over the paperwork to the TL upon arrival in Beira. This would prove not to happen. Day 1-‐2: The team arrived in Beira eager to begin their mission. Prior to being herding through customs, Mr. Mudiwa was searched out among the crowd awaiting the departing passengers. It was only at this time that the Team Leader was informed that the paperwork required to accomplish the proposed mission objectives were not yet granted. The team gathered the luggage and stepped into another room adjacent to the security screener to process their visas. Luckily, airport security must have only worked for a short period of time because by the time the team was fully processed they had left the airport. Not wanting to test fate, and have an entire mission’s worth of medical equipment and pharmaceuticals confiscated, the team quickly gathered up the team bags and stowed them away in Simon’s awaiting Toyota Hylux. With the majority of the team riding in the back of the pickup with the gear, the trip to the operational staging area was long. Upon arrival at the orphanage, the team was greeted with a separate quest house consisting of three rooms, each with an attached bath, and a communal living space/kitchen (extremely posh by TR standards). The staff and children of the camp had already bedded down for the evening, however, no fewer than 15 minutes after the teams arrival, an infant girl had been rushed into the guesthouse with severe burns covering nearly 1/3 of her body. The youth had pulled down a pot of boiling water upon her legs, and the skin from her ankles to upper thighs was quickly blistering and sloughing off. The wounds were quickly dressed, and the mother reassured. Nevertheless, based on the likelihood of severe dehydration, the team decided to transport the Dr. Castaneda and P.A. Joe Costa administering care to child and mother to the nearest hospital to receive the the burned infant continued care that would be required. Upon arrival at
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TEAM RUBICON, Mozambique After Action Report the medical facility any doubts as to whether or not the team should or should not have come was quickly eliminated. The facility staff was nearly nonexistent, and when eventually tracked down, only seemed bothered to have to treat the small child. The team convinced the local practitioner what needed to be done to aid the child, the mother and infant where given a bed and the team departed back to the orphanage. First thing in the morning, the Team Leader had to discuss what it meant not having the required documentation needed to practice medicine throughout the surrounding communities would do to the pre-‐identified mission objectives. It was decided that, no matter what, the team could begin seeing the children of the orphanage where they were being hosted, while the director of the orphanage and the team leader looked to the local government officials for approval. A meeting between the team and the local major was arranged, and though courteous and grateful for the team’s presence within his community it seemed cleared that he would not be willing to sign off on any documents allowing a team of Americans to deliver free medical aid. It was clear throughout the mission that no matter what level of government host, Mr. Mudi and TL, Andrew Steven, reached out to it would be the same story. From the local government to the provincial health officials, the continuing layers of red tape seemed to confirm the Mozambique standard. In order for the team to accomplish anything at all during their deployment, a contingency plan had to be developed to work solely within the compounds of orphanages, which the team host had a working relationship with. While this would drastically alter the originally proposed mission objectives, it would keep the team busy while at the same time allowing an extremely vulnerable population of hundreds of orphans to receive what for most for the first medical care they had ever received. The first two days of the operation centered among the delivery of care to the children Dr. Castaneda and Joe Costa and staff of the Missao Para Juventude orphanage. The volunteer staff was divided into three clinics, each run by either, Dr. Castaneda, Joe Costa, or Dave Pruscki. Nurse Campa was assigned to manage the pharmacy, while liaison Dolores Meehan was given the task of medical records and “triaging” the patients to each of the clinical volunteers’ specialties. While the team worked throughout the day in the clinic, Stevens and Mr. Mudiwa were developing a plan for the remainder of the operation, with the next stop being a larger orphanage that was run by expat missionaries, Roy and Trish Perkins. Stevens also took over the logistical operations of the mission. The majority of the pharmaceuticals needed for the proper delivery of aid were not awaiting the team as planned. Rather than holding up the delivery of aid to the clinical patients, Stevens gathered a shopping list from Dr. Castaneda and headed to the local pharmacy where
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TEAM RUBICON, Mozambique After Action Report he was able to procure the majority of the needed supplies. This, however, no doubtingly led to much of the underestimation of the original mission budget. While in Gondola, Stevens also hit up the local markets to procure food and water for the team’s stay. The majority of the medical complications that seemed to be affecting the children of the orphanage were all common issues for the region. The majority of the children that were seen were infested with a host of parasites, often resulting in chronic and sometimes bloody diarrhea. Malaria was a frequent occurrence among the population with the average child having malaria brought 3-‐4 times each year. There were a few cases that stood out among those seen including a few children who had previously been identified as being HIV positive, which further complicated the host of issues affecting nearly every single one of the patients seen. Another was a small child who when brought to the team was told that he had never been able to walk and had been wheelchair bound his entire life. Dr. Castaneda diagnosed the child with what could be a treatable malformation and with crutches the boy should be able to learn to walk. Working with the staff of the orphanage the volunteers were able to fashion a set of crutches which would be used to aid in rehabilitating the child’s legs. Day 3: With the children and staff of the Missao Para Juventude orphanage seen to, the team moved further east into the Manica provence to the Maforga mission orphanage staffed by Trish and Roy Perkins. The couple had been in Mozambique for decades and had been held captive by the Mozambique National Resistance Movement (MNR) during the civil war. The orphanage compound was extensive. A former home to a duke, the site spread out over numerous acres and included several outbuilding used for children and staff quarters. The orphanage used to have a full medical clinic on site; however, the woman who ran the operation was forced to retire because of old age. As the locks to the clinic were opened and the Team Rubicon volunteers quickly began to set up shop, the excitement on Roy and Trish Perkins faces was unmistakable. The operation would mirror that of the previous orphanage, with the three most experienced medical professionals each in Nurse Nancy Campa and Dr. Castaneda cleaning an infected wound their own perspective examination room, a volunteer running the pharmacy, and another managing children and staff administration. Within the hour the lines of children and staff began to build and a temporary waiting area was established outside under a covered awning. The inconspicuous nature of how the team was able to work solely within the walls of Mr. Simon Mudiwa’s circle of orphanage directors was nearly compromised, as word quickly began to spread that
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TEAM RUBICON, Mozambique After Action Report the former clinic of the Maforga mission orphanage was again opened. The elderly of the surrounding villages began to arrive, and at first it was not relayed to the team that these individuals were not staff belonging to the Perkins. When it was realized that the adult populations that the team had been treating were in fact villagers not affiliated with the orphanage, the Team Leader had to gather the adult populations waiting outside and explain to them that they would not be able to be seen until the end of the day and only after all of the children of the compound had received treatment first. It was explained to the adults that if word got back to the provincial health director that the team was in fact providing medical care, it could have drastic consequences for the orphanage directors who were facilitating the delivery of care. Once the issue of operational security was addressed the team got back to work seeing patient after patient. The majority of the medical complaints mirrored that of the previous days’ work; however, there were a few patients that required additional care. The first being a small boy with a severely prolapsed rectum, the second being an elderly staff member whose finger was infected to the point that amputation may surely have been the best treatment, and lastly a villager who was affected with leprosy. While the amount of patients and staff may have easily provided for days of work, it was decided that due to the proximity of surrounding villages and the fact that the word of free medical treatment was already spreading throughout the communities like wild fire, the team would not return to the camp the following day. Instead, the generators were fired up and light flooded the small clinic. The volunteers worked tirelessly into the late evening until Retired Corpsman Dave Pruschki and Dr. Castaneda working sick call at the Orphanage of the Sparrows every last patient was seen. As the team began to pack up their equipment and load it into Simon’s awaiting Hylux, the children of the orphanage began singing hymns which seemed to wash away the exhaustion of the day’s work off the face of the weary team. Day 4: It was decided that the team would spent the day tending to logistical and administrative issues following the 16 hour workday of Day 3. The team drove into Gondola to again track down the health department approval for medical practice with no availability. The pharmaceutical supplies were found to be stuck in customs and would not be arriving until the following day. So, taking inventory of the supplies left on hand and what the team seemed to be burning through rapidly, a stop at the local pharmacy was in order to restock the team’s medical resources. The last stop included printing off additional patient record forms and photocopying the forms from the previous days as to leave a copy with the orphanage directors.
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TEAM RUBICON, Mozambique After Action Report Day 5: With the clinical sites within Manica province complete, the team would have to continue pushing east to find work, this time it would be the Orphanage of the Sparrows, located in Nhamatanda of the Sofala Province. Unlike the previous sites, the orphanage in Nhamatanda was located directly within the center of a bustling community. The compound was surrounded by heavy brick walls, the structures were overcrowded and destitute, and a river of human excrement flowed through the center of its footprint. The team established clinical stations underneath a corrugated sheet metal awning, while the children pulled up benches to create an ad hoc waiting room. The condition of the children was comparatively worse than the previous locations. Severe environmental health issues, skin disorders, and HIV positive children seemed the norm, with the average child fighting malaria outbreak at least 5-‐6 times a year. The team proactively treated Dr. Castaneda treats a child while the waiting patients look on whatever illness they could with the materials they had on hand, as well as, created thorough medical history reports for each of the children to leave with the orphanage director, Pastor Daniel. Following the days clinics, the team was able to check out the local market and in search of indigenous food and local crafts. Day 6: Using a contact provided by Pastor Daniel, the team was able to secure another day’s worth of work. The team would head further east to town of Micuzi. There the team would meet up with Pastor Daniel’s contact of Pastor Bongo, who ran a rural aid station where local populations including close to 100 orphans would receive supplemental food and aid. This would be the most remote operational location of the entire mission. Nearly 20 kilometers off of the highway, the center was nothing more than a few mud structures and two trench latrines. Quickly following the team’s arrival local populations quickly began to gather. It was explained to the gathering populations that the team’s priority of the day would be to treat the children, then any acute adult care that was identified within the crowds. The team established their aid stations within one of the circular mud structures, while the pharmacy was set up under a tarp, strung up between the truck and a nearby tree. The patients gathered quietly around the dwelling, circling around the structures as the day’s sun moved across the horizon, each of them patiently waiting to hear their number called out, which was assigned during the earlier triage process. The team was also able to treat not only the children, but their caregivers, mostly grandmothers. The issues were similar to the majority of the cases that the team had been treating all week, with the exception of a few. One adult male who had been patiently waiting to be scene had a
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TEAM RUBICON, Mozambique After Action Report severe skin disorder, with nearly 100% of his body covered in what could only be described as calloused scales. Prior to leaving the site, Pastor Bongo asked the team to stop by the major of the Micuzi’s dwelling (which was a few kilometers away) because he was quite ill. The team packed up the bags, threw on the pharmacy and med kit backpacks and made their way to the major. Upon arrival, it quickly became clear that this individual was indeed quite ill and mostly likely would not live to see the end of the year. His body had been ravaged by AIDS, and his foot had become grossly infected with warts to the point that it had swelled up to resemble a bloated balloon. The team cleaned and dressed the infection, and injected the man with antibiotics to aid in combating the wound, but the man just quietly wept as he became overcome with the pain of his illness. With not much else that could be done for the man the team said their goodbyes and left back to Gondola. Day 7-‐8: The team would be leaving Mozambique the following day so it was arranged to move back to the coast to Beira, where the team would meet and tour staff of the local teaching hospital in efforts to secure connection that may make working in Mozambique easier in the future. The team was able to meet with an expat doctor who taught at the school/hospital and he explained that no matter how hard the team would try, the likelihood of securing government approved permission to practice medicine would be close to impossible. He in fact had been there for nearly three years and was only able to perform clinical operations because it had the cover of teaching. The volunteers were however able to tour the facilities and gain a better understanding of the medical capacity available within the more established urban centers. While the hospital had modern facilities with highly trained staff, these levels of care was definitely not reaching any of the rural communities the team visited during their stay. Day 9-‐10: The following morning the team departed Mozambique and began the long flight home. While the operational scope of the mission changed quite drastically, the team left feeling as though the mission was a success. It was quite obvious that the patients seen be the team throughout the operation were in need and that those needs were not available and/or being provided to them by the established medical systems within the country. It was not a glamorous mission be any means, but it did serve the purpose of bridging the gap in care, a core principle of Team Rubicon’s operational objectives. Half of the team departed home as the flight reached the east coast of America, the remaining three pushed on to California and their perspective home of records. The team leader was able to briefly stop by the ongoing regional leadership conference and debrief TR headquarters personnel on the successes and failures of the mission. Team gear and the remainder of the operational funds were exchanged, and the TL returned to the airport to fly back to his home of record of Alaska.
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TEAM RUBICON, Mozambique After Action Report
AREAS OF ANALYSIS 1. Transportation 2. Staging Area 3. Volunteers 4. Headquarters Coordination 5. Logistics 6. Mission Objectives 7. External Communications
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TEAM RUBICON, Mozambique After Action Report
ANALYSIS
TRANSPORTATION
SUMMARY
There were two issues regarding transportation that could have affected the mission negatively. The first being that the transportation of all six team members, plus three interpreters and team gear in one Toyota Hylux pick-‐up truck meant that on average 3-‐4 volunteers would be riding unsecured in the back of a truck, moving at highways speeds on roads that were littered with potholes and damage for sometimes multiple hours each day. This greatly increased the operational risks associated with the pre-‐ planned mission. Secondly, the team’s constant need to adjust increased travel time and meant a large increase in operational expenses. What would have been a limited costs relating to fuel expenses, the operational budget was sometimes having to provide full tanks of gas every one or two days depending on where the team was working.
RECOMMENDATION
Further preplanning regarding the team’s capability to practice medicine solely within the Manica province would have identified the fact that the originally presented scope of work was not realistic or possible. Operational funds could have been pre-‐identified to either cover the additional of fuel expenses into the operational budget, or preferably provide the team with another vehicle as to reduce the huge increase of safety risks associated with motor vehicle accidents and unsecured passengers travelling within the vehicles bed.
ACTION
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Always consider the size of the team when arranging transportation in the operational setting. Each volunteer should be provided with the capability to secure themselves with proper safety equipment when travelling; otherwise, the general risk to the volunteers’ safety is greatly increased.
STAGING AREA
SUMMARY The team was staged within the Mission for Youth orphanage in their own structure. The structure consisted of three bed rooms each with an attached bath (no plumbing, but toilet and showers provided with stored water), and a large common area with attached kitchen. The staff of the orphanage was extremely accommodating. They provided the volunteers of the mission with everything from water for the restroom barrels to freshly cooked dinner no matter when the team finished and arrived back in the complex.
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TEAM RUBICON, Mozambique After Action Report
RECOMMENDATION
The housing/staging area provided for the mission met and /or exceeded any expectation of what could have been provided for the team given the orphanages limited resources.
ACTION
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No action required.
VOLUNTEERS
SUMMARY
As a primarily medical heavy mission, it was decided early that the model for the team would not need to consist of the traditional VERT model. Given that recommendation, a team of highly qualified medical practitioners were assembled. The medical officer for the team was a pediatric neurologist with numerous international third world medical deployments under his belt. The remainder of the medical volunteers consisted of a Physician’s Assistant, specializing in transplant surgery, a retired Navy Corpsman with considerable field clinical care experience, and lastly a 30 year pediatric nurse who well presented the operational capacity of the field work took it upon herself to manage and control the field pharmacy. The remainder of the team consisted of the team leader, whose background focused primarily on emergency and disaster management as well as security, and the team’s liaison and finance officer who was also currently attending school for nursing. By and large, the team’s composition was more than adequate to meet the needs of the identified mission objectives and adapt to those presented as the situation developed in country.
RECOMMENDATION
While the volunteers vetted to conduct this specific mission adequately in order to met the need of the mission, it would be a suggested practice to incorporate further one-‐on-‐one vetting by both TR headquarters and the identified mission TL. Also, it must be recommended that every volunteer who is vetted for international deployment be able to provide a specific skill to the scope of work that the distinct mission requires. Having volunteers attached to a team specifically because they aided non-‐ operational components, such as fundraising, is not a best practice that should be repeated.
ACTION
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Increased volunteer vetting. Develop and offer specific trainings required for international deployments. Broaden coordination between HQ and team leader with identified volunteers prior to mission departure. Often times what looks good on paper is not what is replicated in the field. 13
TEAM RUBICON, Mozambique After Action Report
HEADQUARTERS COORDINATION
SUMMARY
The coordination between the team and headquarters was limited from many causes. Both the missions Team Leader as well as the Director of Field Operations in the weeks prior to the missions deployment were on another international mission for Team Rubicon in southeast Asia. This was a crucial time in the pre-‐planning process for the mission, and the lack of dedicated communication resources proved to be a serious issue. It was during this time that the issues regarding the lack of proper documentation to deliver medical care in Mozambique came to light. In their absence the preplanning of the mission as well as the coordination of the contacts within Mozambique was controlled by a volunteer who in hindsight did not have the capabilities to take the lead in such a crucial time. It was upon the Team Leaders return from Southeast Asia did he find out that the mission was being considered for cancelation and that the coordinator tasked with the coordination had placed a hold on crucial operational components including the shipment of the pharmaceuticals. RECOMMENDATION Regarding the non-‐reactive nature of the mission, there was no need to expedite the timeline of deployment until all of the pre-‐planning pieces that would prove crucial were confirmed. The back to back nature of the team leader’s deployments did not allow him the capability to monitor and coordinate crucial requirements of the operations, which in turn proved detrimental to the primary mission objectives. It would be recommended that for a non-‐emergent mission such as the delivery of primary medical care to endangered but not acutely endangered populations, the operational pre-‐ planning of such a mission should be begin no earlier than 6 months prior to deployment. Furthermore, international team members/leaders must not be over committed to multiple missions within such close proximity to one another. ACTION • Establish and follow a strict guideline for the development and timeline for noon-‐emergent proactive mission. Do not over commit volunteer resources if the majority of the work can be accomplished at the staff level. Do not delegate authority of missions to volunteers who have had little to none operational planning experience and expect them to accomplish what fulltime staff should have provided months prior.
LOGISTICS
SUMMARY Logistics relating to the mission proved to be a serious concern that could have easily resulted in the mission’s success, or lack thereof. The failure to secure the proper documentation prior to the team’s departure may have resulted in the confiscation of not only the team’s pharmaceutical, but medical equipment as well. The failure to ship the remainder of the pharmaceuticals that were not to be hand carried until the last minute resulting in the team not having the proper medications to treat the
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TEAM RUBICON, Mozambique After Action Report identified illnesses they encountered. This then led to a considerable increase in operational expenses as the required drugs and monitoring supplies had to be procured at local pharmacies. RECOMMENDATION Increase pre-‐planning efforts to decrease the likelihood of similar issues of lacking proper authority to conduct key operational objectives. Develop and/or refine proper medical supply kits and field pharmacies. These kits should be standard and have within them the capabilities to meet the needs of traditional medical responses, with the options for supplementary additions based on operational need or geographic region being included. ACTION • Construct proper medical deployment kits for international operations. Further coordinated preplanning efforts to ensure operational objectives can be met, and issues that are encountered are not in direct correlation with poor logistical planning.
MISSION OBJECTIVES SUMMARY The mission objectives pertaining to the mission were originally focused on providing aid to a very specific group of identified persons, that being the children and staff of the Mission for Youth Orphanage near Gondola. This is a very specific request that only came to Team Rubicon’s attention through an acquaintance of the former Director of Field Operations. When presented to the rest of TR’s staff is was determined that if the majority of the operational funds could be raised privately, and these efforts not take away from other staff’s daily duties then TR would find the volunteers needed to support the operational delivery. To warrant a full deployment the objectives of providing medical care to just the staff and children of the Manica orphanage would have to be expanded. Through coordination with the orphanage director, it was explained that the team would be able to use the orphanage compound as a staging ground, and after the primary objective of providing care to the earlier identified group, the team could expand the range of medical services provide to the nearby rural communities. By doing so this allowed the mission to have a more justifiable reason for deploying, as these rural populations had been identified as extremely vulnerable, as well as take some of the biased reason of the original objective out of the spotlight. RECOMMENDATION The reasons for choosing this mission may not have always relayed back to Team Rubicon’s primary mission statement. There was a heavy influence from volunteers and staff whose primary objectives may have been more personal in nature and less in relation to the identified need. While the population of the Mission for Youth orphanage was by no means healthy to the standards of a first world country, they did already work through numerous other non-‐profits to ensure that the orphanages primary goal of care and Christianity was able to continue. If given effort, far more vulnerable populations even within the same region of Mozambique could have been identified.
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TEAM RUBICON, Mozambique After Action Report For the above mentioned reasons, mission proposed to Team Rubicon must undergo careful scrutiny to ensure that resources and time are not be wasted and that by deploying TR will be specifically able to bridge a gap in critical care. Personal influences for deploying to specific regions or to aid certain populations must no carefully weighed against numerous other factors prior to acceptance. ACTION • Vet proposed mission objectives more carefully taking into account the identified vulnerable populations, proposed mission objectives, and strain on resources. Use already developed country vulnerability matrixes to ensure that the identified need of the mission cannot already be met through the resources or partner agencies already in the area of operation. Only decide to deploy after carefully weighing all factors.
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EXTERNAL COMMUNICATIONS
SUMMARY The majority of the external communications relating to the mission were posted long after the mission’s completion. It was decided that since the mission was not of emergent nature, the need to keep social media posts at real time would not be necessary. Also, due to the mission’s close proximity to another TR mission, Thai-‐Burma II, media relating to Mozambique could wait until the mission’s completion. The timeliness of producing that media was another issue. The lack of a dedicated photojournalist/media volunteer on the mission meant that these duties would have to fall on that of the team leader. Having deployed for TR in two back to back missions, the volunteer had underestimated the amount of work that would go into the development of the operational write-‐ups and narrative reflections. Combining that with his professional workload, which due to the consecutive deployments was nearly two months, the media for the Mozambique mission was delinquent in its’ delivery.
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TEAM RUBICON, Mozambique After Action Report
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