1. PURPOSE: This bulletin is prepared to assist commanders in under standing the preventive medicine programs of this command and to provide them with information relative to health matters in the Dominican Republic.

2. GENERAL: U.S. Military Forces have repeatedly experienced widespread if not epidemic illness when deployed to areas of high disease endemicity such as the Dominican Republic. The most recent example was the experience in Lebanon when diarrheal disease reached critical levels particularly after messes opened and due entirely to poor personal hygiene and unit sanitation. Americans at home live in the most sanitary environment in the world, and hence have lost the natural immunities to disease that peoples from less sterile areas possess. We may be tough and capable soldiers, but from a disease standpoint we are the most vulnerable nation on earth. Our soldiers simply cannot survive when exposed to conditions that other peoples live with daily. There are many diseases prevalent in the Dominican Republic which our troops are highly susceptible to. The information which follows will hopefully assist commanders in planning the control programs within their units and may be used to brief troops on the health hazards they face in this area.

Following are the most significant diseases which our personnel will encounter in this area. This is by no means a complete list, but the entities below are of such prevalence that only careful control measures will eliminate otherwise inevitable infection.

HEPATITIS (Yellow Jaundice) is very prevalent in this area and indeed the local authorities expect an epidemic because of the interruption of usual sanitation services. It is spread by contact with hepatitis patients or the ingestion of food and beverages contaminated with feces. Convalescent

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patients can continue to pass virus in their feces for months. This is a very serious illness, sometimes resulting in death, requires long convalescence, and may produce permanent liver damage. MAIN DANGER: Local food, beverages, and ice, eating with dirty hands.

HOOKWORM exists in DOMREP. This parasite enters the body through the skin--particularly the feet of persons walking barefoot over focally contaminated soil. All soil in the Dominican Republic should be considered contaminated with feces. MAIN POINT: Don't go barefoot here.

MALARIA, DENGUE, FILARIASIS and other mosquito borne diseases. Although the Dominican Republic has had a good mosquito eradication program going for several years, malaria, dengue and other mosquito borne diseases still exist here and these are diseases to which Americans are particularly susceptible. With the onset of the rainy season, the mosquito population will increase rapidly. Malaria suppressive pills MUST be taken by all personnel without fail - one tablet every 7 days to include 6 weeks after return to the United States. To facilitate control the command has established the policy that pills will be taken with the breakfast meal each Monday. Malaria pills have no effect on dengue or other diseases and are not the exclusive answer. Insect repellents and other insecticides and nets should be used. The command will take steps to insure the issue of nets to all personnel.

VENEREAL DISEASE. VD is prevalent in the Dominican Republic. Medical data indicates that syphilis occurs in 15/0 (1 in every 7 people) of the population and gonorrhea in an even greater number of people. This is an astronomically higher rate than is found in U.S. populations. We cannot legislate morals and non-fraternization and continence are almost impossible to enforce, but troops should be informed of the fantastically high risk they are taking with sexual contacts here.

SCHISTOSOMIASIS. A number of blood parasite diseases exist here which enter the body through the skin from contact with contaminated water. Flare is little danger from swimming at ocean beaches, but inland streams must not be used for wading, bathing or swimming. One case has already been reported.

INTESTINAL PARASITES of several varieties are endemic to the Dominican Republic. These enter the body with contaminated food (dirty hands, dirty mess gear), contaminated water or ice (soft drinks, snow balls, local ice, etc.) or by the ingestion of raw or rare pork or beef. Troops must not consume food, beverages or ice from other than approved sources, and as yet there is no approved source for food or ice. The Dumbo brand of soft drinks have also been found unacceptable.

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RABIES is widespread here and control measures sketchy. All personnel must be absolutely forbidden to handle local animals, wild or domestic. The mongoose is identified as a specific reservoir of this disease. Any individual bitten by an animal must be immediately evacuated to the 15th Field Hospital for further treatment and evacuation.

Almost without exception, the sanitation practices of units of this command have been worse than poor thus far. Improvement is mandatory or serious disease problems will shortly occur. Major points of emphasis should be these:

FLY PROOF LATRINES. Where boxes are used, there must be no open places for flies to enter the box or pit. Where slit trenches are used, each defecation must be completely covered with dirt (both feces & paper). Flies that crawl on feces also crawl on food, mess gear and hands.

HAND WASHING FACILITIES. Some means of washing hands must be devised for use near latrines and at meal times.

GARBAGE and rubbish should be collected, burned and/or buried.

VECTOR CONTROL DETAILS. Each company size unit is required by Regulations to have a Vector Control Detail. Many such individuals have been trained in units of this command. Now is the time and this is the place to use them. Fly and mosquito control measures around troop areas can significantly reduce hazards.

The command recognizes the multiple tasks that units and individuals have been called upon to perform as well as the adverse environment in which we are operating. But these many tasks will be made no easier by the loss of significant numbers of men as a result of disease. Such a loss is inevitable unless the sanitary standards and the preventive medicine practices of this command change radically and immediately. The staff is moving ahead as fast as possible to find acceptable sources of food, beverages and ice, as well as recreational and laundry facilities. Until these sources are available locally procured products must be denied

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The Surgeons Office has Preventive Medicine experts who will be happy to offer such technical advice or conduct surveys as commanders may desire to assist them in their unit control measures.

FOSTER C. McCALEB

MAJOR MC

USFORDOMREP Surgeon