1. Describe how this mission increased readiness for operating in a limited resource environment.
2. Explain similarities and differences in practice patterns that were noted and how they may or may not have significantly changed the outcome for patients.
3. Briefly describe practice patterns that could be adopted for limited resource environments that would result in acceptable outcomes during future similar operations.
A cohort of six active duty officers (two U.S. Army dermatology residents; one U.S. Navy pediatric resident; one U.S. Navy family medicine resident; one U.S. Navy comprehensive dentist; and one U.S. Navy family and pediatric nurse practitioner) participated in the Military Tropical Medicine (MTM) Course 2025 Field Mission to Brazil. Officers were sourced from separate commands spanning from San Diego, California to Rota, Spain. They denied prior experience in global health engagement in riverine operations nor had worked together previously. All had completed the MTM virtual Tropical Medicine didactic course; travel requirements; individual medical readiness requirements and prior to travel in accordance with USSOUTHCOM; NMPLDC; and JFTR requirements. They embarked on the Brazilian Navy Oswaldo Cruz-class ship at Manaus, Brazil. Over 1000 kilometers were travelled on the Rios Negro and Blanco with 11 health engagements. Each U.S. officer partnered with a Brazilian Officer and observed similarities and differences in practice patterns. Brazilian medical staff assigned to mission consisted of 3 general medicine doctors, 2 dentists, 1 pharmacist, 3 Nurses, and 1 radiology tech. Care was provided ashore and afloat to indigenous people of remote villages along the rivers. Medicine and supplies were move ashore using small boats. Total value of medications dispensed in Brazilian Real: $7.001,11. Total number of medications distributed: 16842. Total patients served: 645. Total number of procedures: 9323. After disembarking after 20 days afloat, the officers visited the Instituto de Pesquisa Clinica/Doctor Heitor Viera Dourado Foundation of Tropical Medicine in Manaus. Clinical cases encountered during the mission included but were not limited to helminthic infections, bat bites, pregnancy, hyperlipidemia, hernia, dental caries, dental patient with internal resorption, dental patient with malposed premolar, pediatric patients with eczema, anxiety, foreign body in soft palate (fish bone), wrist fracture, leishmaniasis, malaria, sporotrichosis, histoplasmosis, tuberculosis. After action discussions from the U.S. officers validated that knowledge of disease outbreak potentials (i.e. Chagas, malaria, leishmaniasis) in remote tropical regions as well as care of orthopedic; obstetrical; dental; dermatological; behavioral health and commonly encountered primary care conditions in the field mission prepared the force for similar operations in a limited resource environment. All indicated that experiences gained through observing differences in practice patterns (of their Brazilian counterpart) with due consideration for ethical treatment of human beings may significantly change outcomes for future patients they encounter in similar situations. These included dental Atraumatic Restorative Technique as well as dispensing of medications to treat commonly encountered primary care conditions that have minimal laboratory monitoring and are relatively benign. All officers identified acceptable outcomes for adoption in limited resource including planned follow-up at next scheduled health engagement as well as referral to local clinicians. All concurred that care in a remote and austere setting with limited logistical support requires Enterprise strategic collaboration between partner naval forces. Relations between US and host nation had been strengthened, patients were provided medical and dental care in austere environments, and the U.S. officers increased their understanding of tropical diseases and in turn shared their own specialty knowledge with their Brazilian colleagues.