Army medical personnel go through “medical skills training” at Ft. McCoy. Part of this phase of training includes detecting and reporting possible signs of abuse.

Nestled among towering pine and evergreen trees about five hours north of Chicago, Fort McCoy in Tomah, Wis., has none of the physical characteristics of Iraq’s dry, dusty, barren landscape. But it is here, in “cranberry country,” where the Army trains its nurses, physicians, and medics to care for detainees at Abu Ghraib prison and Camp Bucca, the largest U.S. detention facility in Iraq.

Geography aside, Fort McCoy soldiers have roughly replicated the detention camps in Iraq by clearing land, building bunkers, setting up concertina wire and chainlinked fences, and fashioning guard towers from wood. A tented combat support hospital (CSH) set up on the base’s grounds contains most of the medical equipment found in combat-zone hospitals in Iraq.

Nurses, medics, and physicians of the 21st CSH from Fort Hood in Texas spent two weeks at Fort McCoy in April learning how to safely provide health care to detainees in Iraq. And nurses from the 344th Task Force, who have been stationed in Iraq for the past year, spent 72 days training at Fort McCoy last spring.

Using the faux Iraqi surroundings, the medical teams simulated numerous scenarios they might encounter while in Iraq. For example, on the afternoon of April 18, medics, nurses, and trainers gathered at “the wire” to pass medications at Camp Liberty, the simulated Abu Ghraib setting. The medical personnel, playing themselves, stood on one side of a tall link fence. Inside the enclosure, local teenage boys wearing red T-shirts, who took on the role of detainees, milled about.

Medics pass pretend medications to teenage boys roleplaying as detainees through a fence at Ft. McCoy. The practice adds to the safety mechanisms in place for both Army personnel and detainees in Iraq.

Staff Sgt. Rose Balsamo, a trainer with the 3rd and the 335th Training Battalions, told the participants what to do. “You’re going to go up and get your meds,” Balsamo told the boys. “But I’ll tell some of you not to take the meds, for whatever reason.”

To the medics, she said, “If a detainee refuses his meds, don’t spend a lot of time trying to change his mind.

“But tell him the (medical) consequences of not taking it,” Balsamo continued. “Some of them (detainees) have done some bad things and they’re going to take advantage of lapses in security.”

The mock detainees, led by their camp leader, were called one by one to the fence. The medics checked the detainees’ wrist bands and their own patient lists to ensure they had the correct patients. The medics asked detainees to open their hands, palms up, to make sure they were not carrying anything that could be used as a weapon. The detainee was then given the medication.

The pills, looking suspiciously more like SkittlesTM candies than tablets or capsules, were passed to the detainees in white paper cups in between the spaces in the fence. Detainees were given water to swallow the pills, and they were then asked to open their mouths wide so medics could make sure the pills were swallowed. Because pills can be hidden in their cheeks, even with their mouths open, the medics also had the detainees use their fingers to pull their cheeks further apart.

Then the medics asked detainees, through the camp leader and security assistance, to open their hands, palms up then down, fingers spread. They also were instructed to push up their sleeves. Detainees were dismissed only after the medics were satisfied that they had swallowed their pills.

Education via immersion

Capt. Wilfredo Corps explains to the teenagers their role in the training sessions at Ft. McCoy.

The Army calls this type of training “theater immersion training.” Fort McCoy is currently the only base at which medical personnel can be trained in the care of detainees.

“Every bit of training here is pure detainee operations,” says Army Reserve Maj. Leah Eubanks, one of the officers in charge of the training. “We already know they (personnel) are good nurses, physicians, and medics; they just don’t have the knowledge about detainee health care.”

Lt. Col. Nancy Robles-Stokes, RN, assistant chief nurse at Abu Ghraib for the 21st CSH, says, “We’re learning to do our work in a more secure environment.”

The training consists of several phases. The first phase is “soldier skills training,” such as weapons qualification, convoy operations, and tactical military training, says Lt. Col. Joseph Keary, one of the senior observers/trainers who led the training and validation of the 344th Task Force before it left for Iraq.

The second phase is “medical skills training,” which encompasses the
treatment of potential detainees and
use of the military medical equipment found in combat-zone hospitals. An important element of this phase focuses on detecting and reporting possible abuse. Any medical personnel who suspect a detainee has been abused must report his or her suspicions to the criminal investigations division, and a complete investigation ensues.

First Lt. Michelle Racicot, RN, who will work in the ED at Abu Ghraib, says her new mission “gives me a chance to reclaim our image and to do the right thing.”

The final phase, or medical readiness exercise, consists of detailed scripts of potential situations the nurses, physicians, medics, and other health care personnel might encounter in Iraq. They replay scenarios over and over again until the training standard is met, says Keary.

In one scenario, a key leader is “killed” and the remaining personnel must determine who would take charge, he says.

Eubanks developed the detainee training from the ground up by researching correctional health care and talking with medical personnel who had been in Iraq. Using this information, she created medical charts for approximately 300 imaginary detainees using forms, such as the mental health assessment sheets printed in both English and Arabic, found at Abu Ghraib and Camp Bucca.

The training is fluid and continually updated from lessons learned from soldiers already in Iraq and Afghanistan. For instance, the medical training was changed to include a greater emphasis on burn care, says Keary. Medical units previously in Iraq found they were caring for many Iraqis with burns caused when Iraqis, who often cook with open kerosene burners, used gasoline by mistake. This circumstance had not been factored into training immediately after the initial phases of the war and were not expected when the first medical units went to Iraq, says Keary.

From Abu Ghraib and Camp Bucca, nurses of the 344th Task Force praised the training they received at Fort McCoy a year ago.

“The training provided at Fort McCoy could not have been any better,” Lt. Col. Theresa Mercado-Sconzo, RN, head nurse of the ED at Abu Ghraib and a finalist for Nursing Spectrum’s 2006 Excellence Awards in the “community service” category for the New England region, said in an e-mail interview. “When we arrived [in Iraq] and started working in the hospital, we felt like we were back in Fort McCoy. The training plan put into place prepared us clinically and SOP [standard operating procedures]-wise.”

Members of the 344th lived in the recreated base during their training, which was mentally and physically challenging. During the training, nurses had to wear individual body armor that weighs about 30 pounds, says Lt. Col. Leslie Rice, RN, chief nurse of the unit. Soldiers from other units who did not wear the body armor before arriving in Iraq complained of shoulder and back pain, she says.

“The training at Fort McCoy allowed me to formulate the mindset that I would be in a combat zone surrounded by danger in many forms,” Maj. Linda Zajicek, RN, wrote in an e-mail. “I familiarized myself with my M16 rifle and was able to qualify and take apart my weapon and reassemble it with ease. I also realized the importance of being physically fit and have become more fit, thanks to the training I received.”

Fort McCoy will continue to provide theater immersion training for Army soldiers, including nurses, who are scheduled for duty in Iraq.

“I don’t know if you are ever prepared to go into a war zone, but we were better prepared than most,” says Zajicek.

As of this writing, nurses, physicians, and medics of the 21st CSH are at Abu Ghraib and Camp Bucca undergoing orientation with their colleagues from the 344th Task Force. The 21st CSH, now called the 21st Task Force, will be stationed in Iraq for one year.