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The following correction to this story was posted October 10: An Oct. 7 photo of a U.S. military doctor caring for an Iraqi boy ran with a story about the U.S. European Command’s efforts to rewrite its health engagement strategy based on lessons learned in Iraq and Afghanistan. The photo did not accurately illustrate the story because the doctor who appeared in the photo is not assigned to EUCOM or part of a Medical Civil Action Program, but is part of the 47th Combat Support Hospital, which is from Fort Lewis, Wash.

STUTTGART, Germany — The dental suite cost more than $200,000 to install. But today the advanced equipment, intended to make Western-quality dental care available to rural villagers in Afghanistan, sits unused and forgotten. The local dentist prefers the equipment he’s always used for oral surgery: a pair of pliers.

The U.S. military set up the modern dental equipment in 2007 in Zabul province with the best of intentions, as part of a Medical Civil Action Program, a popular hearts-and-minds mission first devised during the Vietnam War to deliver American-style medicine to suffering civilians in war zones.

But military strategists are beginning to rethink these ostensibly benevolent efforts, because so often they prove unsustainable once the troops pack up their medical equipment and leave.

“Pull back the curtain, and the Wizard of Oz is a guy with a pair of pliers pulling out teeth,” said Lt. Col. Mark Hubner of U.S. European Command’s surgeon’s office, noting how the success of the MEDCAP missions often turns on the ability of local providers to follow through. “A lot of time we’re very short-term focused,” Hubner added.

In Afghanistan, shortcomings in medical diplomacy have been cause for many missed opportunities, according to a May 2008 paper in Defense Horizons, a publication of the National Defense University.

“Too much effort is wasted on poorly coordinated Medical Civic Action Programs, where U.S. and NATO International Security Assistance Force military medical personnel deliver health care directly to Afghan civilians, undercutting the confidence of the local population in their own government’s ability to provide essential services,” the paper stated.

“Hundreds of millions of dollars have been spent on modern equipment and supplies to provide state-of-the-art medical and educational facilities,” the critique continued. “Often, however, a visit to the facility several months later reveals that it is not operating as intended, creating the perception that the government has failed.”

Now, based on lessons learned in Iraq and Afghanistan, military doctors are working to reshape their medical diplomacy efforts to ensure they leave behind an effective health system delivered by local doctors, which, in turn, should help create the stability MEDCAPS are meant to promote.

At EUCOM’s Stuttgart headquarters, planners have rewritten the command’s health engagement strategy to focus future operations on more grassroots medical training efforts.

“We’ve been trying to turn the paradigm,” said Hubner, who was previously deployed to Afghanistan and contributed to EUCOM’s new engagement strategy.

Some recent examples include a new burn clinic in Moldova, where EUCOM focused on training doctors to fill a gap in local medical services, and a new nursing school in Georgia, where EUCOM has supported efforts to help alleviate a nurse shortage.

But the evolution has been incremental.

Historically, MEDCAPS have centered on direct patient care. U.S. military doctors swoop in with their antibiotics and modern equipment, treating as many civilians as quickly as they can.

The problem, Hubner said, is that such missions were never proven effective at achieving what they aimed to accomplish — winning over the local population. Big MEDCAPS also can have the unintended consequence of discrediting the local provider in the eyes of his community, making matters even worse.

Yet, “we continue to do them up until today,” Hubner said.

To be sure, the image of a soldier caring for dozens of sick and needy children makes for good public relations and impresses commanders. But such feel-good photo ops do nothing to help people help themselves, Hubner said.

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