US Air Force Coordinates Medical Mission in St. Lucia

In early 2024, U.S. Air Forces Southern sent a professional surgical team to the island nation of St. Lucia. Their mission was to provide safe and efficient hemodialysis treatment for the country’s underserved population through arteriovenous grafts and fistulas.

Editor’s note: An arteriovenous graft (or AV graft) is a surgery to connect blood vessels artificially via a synthetic tube. An AV fistula connects the blood vessels directly without implanting additional material.

“When I got to Air Forces Southern, there was a mission called the Lesser Antilles Medical Assistance Team (LAMAT),” said Col. Brian Neese, mission coordinator and board-certified family physician since 2008. “This was an opportunity, beginning in 2022, to engage with important countries in the Caribbean and build partnerships. In 2023, that team completed a multidisciplinary mission to St. Lucia that featured emergency medicine physicians, dentists, etc.”

That 2023 mission was based in St. Lucia’s Owen King European Hospital (OKEH) and allowed for the establishment of direct relationships with hospital leaders. One of the most important connections made was to Dr. Lisa Charles, OKEH Director of Clinical Services.

“I’ve been in the health sector in St. Lucia for 25 years,” Dr. Charles said. “When medical teams visit, the first mission isn’t as impactful as subsequent missions because the team must be on the ground to understand the population’s needs. When [Dr. Neese] asked what we needed [for a subsequent visit], we had to think carefully.”

Dr. Charles and her team suggested that the Air Force’s next mission focus on AV grafts and fistulas to improve the health of hemodialysis patients. Only one surgeon on the island was capable of that procedure and a backlog of 50+ patients had developed.

“Within six months, I got a call saying two vascular surgeons were willing to come to St. Lucia. The mission just took off from there,” she said.

Dr. Neese, who submitted the 2024 mission as a Performance Improvement (PI) activity to the American Board of Family Medicine (ABFM), coordinated funding and connected vascular surgeons and other medical professionals to the mission. “I wasn’t boots on the ground. I was concerned with leveraging the 14-person medical team to its fullest,” he said.

Once the project was deemed feasible, Dr. Neese set up a planning call to establish timelines and build the clinical team. He also organized a site survey in St. Lucia, submitted project proposals to the Department of Defense, and worked with leaders in St. Lucia to finalize the integration of personnel, equipment, and supplies. One of the most important calls of the mission was reaching out to vascular surgeon Dr. Devin Watson.

“I was transitioning to the reserves when I got the call. ‘Hey, would you be interested in doing a humanitarian mission?’ I said, ‘Absolutely. Sign me up,’” recalled Dr. Watson. “My experience with vascular surgery in rural areas has been that you must do a needs assessment before you jump in with two feet. That affects our budget, and vascular surgery can have a very expensive footprint. Each graft is about $1,500.”

For three days in January 2024, Dr. Watson and a small team met with upwards of 30 dialysis patients, nurses, on-site nephrologists, etc., to get an understanding of the needs of the population. They used a portable ultrasound device, plugged into Dr. Watson’s iPhone, which allowed for the mapping of blood vessels and arteries to determine the best surgical entry point for each patient.

“Dialysis generally involves filtering and circulating blood for a three-hour period, three days a week. Through surgery, we intentionally connect the vein to a peripheral artery in the forearm or upper arm to increase blood flow. This allows nurses to put two needles into the patient simultaneously to pull blood out, filter it, and return it to the body,” explained Dr. Watson.

The primary mission took place from February 24 to March 7, 2024. In two weeks, the LAMAT successfully completed 48 surgeries, improved supply management, and educated OKEH medical personnel on vascular surgery.

Isabelle Pierrot, OKEH Deputy Director of Nursing Services, was instrumental in coordinating that experience between hospital staff and LAMAT. “This was really an opportunity for our team to participate in pre-op care and learn new aspects of caring for nephrology patients,” she said.

Dr. Watson praised the OKEH staff, saying, “Everyone gelled and integrated very quickly, which I found terribly impressive and rewarding. I’m still finding it difficult to believe we did almost 50 procedures in two weeks. Not only did it make me realize why I went into medicine to begin with, but it reaffirmed why I went into the military, to be able to do things like this.”

“What struck me most about Dr. Watson and his team was their willingness to work alongside our team exactly where we were. It was phenomenal and, by the end of the mission, there were tears all around. I was really moved to see how they bonded,” Dr. Charles said. “It’s important to remember that there were no alternatives for these patients. They were so grateful.”

Dr. Neese summarized the success of the mission within his PI submission, noting that “the pre-op process transformed by becoming more organized with enhanced communication throughout the department before the patient reports to surgery; the strong educational opportunities offered during the mission enabled the Host Nation medical professionals to perform more vascular surgeries on their own.”

LAMAT will return to OKEH in March 2025 to conduct a formal evaluation of this year’s mission impacts and reinforce gains made for the patient population.

“What do we get out of this?” asked Dr. Neese. “We have to go into very unique environments and figure out how to succeed. This is a way for us to have these experiences, think critically, and be creative while working in a resource constrained environment. It’s important to build relationships, and those don’t just disappear when the two weeks are over.”

He continued, stating, “We’re planning to go back next year, and the conversations we’re having now are not at all like the conversations we were having in 2022. There’s refinement, and we hope the potential impact gets better and better. This has been a great relationship for us, and we want to continue to build on that.”

Thank you to Dr. Neese, Dr. Watson, Dr. Charles and Nurse Pierrot for sharing this story of medical intervention with ABFM. We look forward to seeing your continued progress in the region.

“We’re planning to go back next year, and the conversations we’re having now are not at all like the conversations we were having in 2022. There’s refinement, and we hope the potential impact gets better and better. This has been a great relationship for us, and we want to continue to build on that.”

Aaron Burch serves as Editorial Content Manager for the American Board of Family Medicine. He has been writing professionally in the health care field since 2014.