Marines in Iraq Crack Code for Effective Medical Engagements

By Marine Corps Sgt. Trent M. Lowry
Special to American Forces Press Service

Oct. 7, 2008 - Even though less-frequent small-arms and roadside-bomb attacks have reduced their combat role here, the Marines are still at the tip of the spear on another battlefront. In the ongoing effort to win the hearts and minds of Iraqis in western Anbar province, Regimental Combat Team 5 has been engaging local citizens with one of their most effective weapons systems: Marine Corps medicine.

"We discovered the value of Marine Corps medicine anecdotally by observing the results that occurred when I went to my first key leader engagement," said Navy Cmdr. (Dr.) Michael G. Swanson, regimental surgeon for RCT 5 and a resident of Temecula, Calif. "We fell into using medical engagements, and what was an afterthought that met with small success has grown into a fundamental requirement for operations."

The use of RCT 5's medical assets has paid dividends for the command, which has been able to take advantage of the position of physicians and corpsmen as medical professionals and caring individuals who have helped the command gain the trust and respect of sheiks, mayors and civic leaders in the province.

"I can assure the Iraqis that we have their best interests at heart," Swanson said. "I feel obligated to both of my roles. I adhere to the Hippocratic Oath to provide medical care to the Iraqis and earn their confidence, but I can still honor my duty to Marine Corps medicine by using my medical position to support counterinsurgency operations."

Swanson took a circuitous route to his current position in the military. Enlisting in the Army and expecting ground combat duty, Swanson had never intended to become a doctor.

"I didn't want to be a medic at all. I wanted to be infantry, but my test scores were too high and the Army hoodwinked me into becoming an infantry field medic," said Swanson, whose decision to join the Army was motivated by the distinguished, decorated service of his grandfather in World War II and that of his father a generation later.

Swanson made the most of the opportunities the medical field offered. After leaving the Army as a staff sergeant, Swanson took advantage of a Naval Reserve program and studied nursing and business administration at the University of Northern Colorado in Greeley, Colo. After Officer Indoctrination School in Newport, R.I., he was commissioned an ensign in the Navy.

Swanson got his first experience with treating Iraqis while deployed during Operation Desert Storm, where he and his small-ambulance detachment treated more than 260 enemy prisoners of war in an eight-day period, far more casualties than those suffered by coalition troops. He later took advantage of the Health Professionals Scholarship Program to attend medical school at Western University of Health Services in Pomona, Calif., where he earned his doctor of osteopathy degree.

After serving tours with two Marine reconnaissance units and then a post as chief of residency at Naval Hospital Camp Lejeune, N.C., Swanson returned to California to work in San Diego for the Navy. However, Swanson said, he knew his heart was with the Marines, so he worked to get orders to 1st Marine Division, and from there to 5th Marine Regiment.

"My job is to be the advocate for the health and safety of the Marines and sailors, to certify to the commanding officer the health and fitness of his command and to support the Marine Corps mission and objectives as set forth by the commanding officer and his staff," said Swanson, who developed that definition to summarize his view that, though there are no medical personnel organic to the Marines, when a sailor in the medical field is assigned to a Marine unit, he belongs to Marine Corps medicine.

Being an integral part of Marine Corps medicine is what drives Swanson and his corpsmen. When the RCT 5 commanding officer, Marine Corps Col. Patrick J. Malay, noticed the effects Swanson and other medical personnel could have on engagements with civilians, he had the foresight to integrate the "docs" into the civilian-military operations, Swanson said.

"I look at it as taking our capabilities and using them to support the commanding officer to help the full spectrum of the operation, with medicine as just a part of shaping the success of the mission," Swanson said.

At the heart of Marine Corps medicine's contribution to civilian-military operations is the cooperative medical engagement. The medical personnel meet with Iraqi physicians and learn what the people need. Then the Marines and doctors provide the specific assistance requested, so the people of Anbar province get the help that is of most value to them.

"We have perfected a system out here," Swanson said. "We ... ensure gains in stability in the area by meeting the needs of the Iraqi security forces and the civilians."

For instance, one sheik, a leader in the Haditha area, had trouble communicating with Marines, even through interpreters who always had to repeat themselves loudly. The sheik had severe hearing loss, and after Swanson examined him and arranged for a coalition audiologist to see the sheik, a hearing aid was presented to the sheik. As gratitude for the improvement in his quality of life, the sheik opened communications and the Marines were able to gain broader access to the area.

"Another thing we've created is the concept of the rural health engagement," Swanson said. "We take Iraqi physicians from the cities to the rural area, and bring aid out to the Iraqis in the region. We're careful, though, to let the rural people know that they're receiving aid through the advocacy of their physicians and key leaders and from the efforts of the civil affairs teams."

Marine Corps medicine wasn't always as integral to the overall mission. Not so long ago, the main responsibility for medical personnel was emergency first aid for battlefield casualties.

"When I first got to Iraq, I was exposed only to front-line medicine," said Navy Petty Officer 2nd Class Michael G. Bundeson, assistant leading petty officer for RCT 5's regimental aid station, who is serving his fifth deployment to Iraq and has experienced the gamut of operational tempos here. "When we were taking casualties, our goal was to prolong life long enough to get them back to the rear for surgery and further medical care. We lost a lot of Marines, but we worked hard to save the Marines."

Bundeson's first deployment was with 3rd Battalion, 5th Marine Regiment, during the offensive effort at the beginning of the war. Since then, Bundeson has served with 2nd Battalion, 4th Marines; 1st Battalion, 1st Marines; and RCT 5's personal security detachment, in addition to his current duties at the aid station. He's taken two bullets and several pieces of shrapnel in performing his duties of treating Marine injuries.

Now, Bundeson said, he sees the gains that have been earned by the blood of coalition forces and Iraqi security forces. Swanson said Bundeson is one of the corpsmen who makes the current mission work.

"I can definitely see the progress in this country; it's a lot quieter now, but I'm always vigilant," said Bundeson, a Roseburg, Ore., native who recently passed his 10-year mark in the Navy. "This is a good feeling, that the Marines are doing all this. We're making progress. The Iraqis are not afraid of us, and see that we're here to help. We're earning their support and respect."

The progress hasn't always been easy. Some people in remote areas of Iraq don't yet fully trust coalition forces. After talking to key leaders in Nazrah, one such town with animosity toward Marines, Swanson and the Marines were able to negotiate setting up a rural health engagement.

"Not only were we effective, we were successful in gaining their confidence enough that they allowed male doctors to examine female patients," Swanson said. "[That] was the first time I've seen that happen. We've become valued and trusted when we show them that we are concerned with their needs."

Bundeson agreed. "It's like a bank account – you keep putting in the deposit -- in this case trust is the currency -- and it will continue to grow," he said. "If you lose that trust, that's making a withdrawal, and you've got to keep putting more deposits in to get that trust back."

While the battle is not yet won, the visible successes are promising to Swanson.

"We've created sustainable efforts that continue to grow," he said. "It has set us apart from other units and has allowed us to have more far-reaching and permanent effects on the center of gravity, but we've just scratched the surface of what we can do."

(Marine Corps Sgt. Trent M. Lowry serves with Regimental Combat Team 5.)