A study in tropical disease prevention for this Navy Medicine physician

Story by Douglas Stutz

Naval Hospital Bremerton/Navy Medicine Readiness and Training Command Bremerton

In the bitter fighting that raged across the jungle island of Guadalcanal during World War II, more Marines were lost to disease – malaria, dengue fever, dysentery – than enemy bullets.

Lt. Cmdr. Lauren Kalodner, MD, MPH, is doing her best to ensure such a casualty count won’t happen again.

Kalodner, a Rose Valley, Pennsylvania native, was part of a Uniformed Service University educational assignment to the equatorial West Africa nation of Ghana for two weeks of in-depth field work. The Military Tropical Medicine field mission provided an ideal natural environment for increasing her knowledge to confront and prevent endemic, infectious diseases prevalent in a tropical setting.

“Participating on a field mission in Ghana is crucial for the understanding of tropical diseases because it allows for direct observation of the conditions that facilitate their spread. Local ecosystems, climate, animal and human behaviors plays a significant role in disease transmission. Immersing in the community helps healthcare workers understand cultural practices, health beliefs, and the social determinants of health that influence disease prevalence and management. The firsthand experience is crucial for developing effective prevention and treatment strategies tailored to the context from which the disease arises,” said Kalodner, stationed with 2nd Medical Battalion, 2nd Marine Logistics Group, as an emergency medicine physician.

Kalodner and others went to Accra, capital and largest city of Ghana, as well as Kumasi, the second largest city. They received instruction on how to recognize, diagnose and treat disease agents, understand mitigation strategies to help control and limit disease transmission, identify transmission modes, and understand the overlapping connection of the natural and animal environments and human disease.

Being able to help stop the spread of infectious tropical diseases which continue to cause untold casualties as well as fatalities – there were 608,000 malaria deaths in 2022 alone estimated by the World Health Organization – is significant in the light of Rear Adm. Darin Via, Navy Surgeon General and chief, BUMED recently affirming that Navy Medicine’s focus is readiness, especially with expeditionary medicine capabilities. Those capabilities call for a ready medical force ensuring there is a medically ready force.

Kalodner noted that there were several key lessons which emerged relevant to Navy Medicine’s expeditionary medicine emphasis, such as “Adaptability, the ability to quickly adjust to vary environments and resource limitations is crucial for effective medical care in the field,” she explained.

Other valuable insight gained included being culturally knowledgeable by “understanding local customs and health practices enhances trust and improves patient outcomes to function as part of a multi-national medical force. Collaboration [with] working closely with a diverse healthcare team is essential for a successful mission. Preventive care emphasizes education and preventive measures which can significantly reduce the burden of tropical diseases. Logistics management for effective planning for supply chain challenges is vital for maintaining readiness and ensuring the medical teams can operative efficiently in remote areas,” stressed Kalodner.

“These lessons enhance the Navy’s expeditionary medicine capabilities and promote a more holistic and integrated approach to healthcare in diverse environments,” continued Kalodner, adding that the training proved to be invaluable. “Unmatched. This is the best training opportunity offered to prepare military healthcare workers to prepare for tropical disease and DNBI [disease and non-battle injury].”

Her interest in Navy Medicine was fostered by the opportunity to combine her passion for healthcare with a commitment to put service before self. After completing Strath Haven High School in 2003, Kalodner graduated from Davidson College in 2007, followed by George Washington University Milken School of Public Health in 2012 and the Uniformed Services University, F Edward Herbet School of Medicine in 2018. She then completed her four-year residency in emergency medicine at Naval Medical Center Portsmouth in 2022.

“The chance to work in diverse environments, address unique medical challenges, and contribute to global health initiative was particularly appealing,” Kalodner said. “The emphasis that Navy Medicine puts on teamwork and the ability to make a tangible difference in the lives of service members and communities inspired my decision to join the Navy.”

Fast forward to the summer of 2024. When the prospect of traveling to Ghana for the Military Tropical Medicine mission became known, it was easy for Kalodner to make the commitment.

“While I was studying at Davidson College, I started taking French classes. I knew I wanted to study abroad in a unique place where I could grow my French language skills and experience a new culture,” she related. “I selected to go to Dakar, Senegal, where I studied and lived for eight months of my sophomore year of college. I loved the people and culture of West Africa. I thought doing my tropical medicine field mission in Ghana would be a great way to experience new cultures within West Africa while also furthering my knowledge of tropical medicine and international medicine.”

Before being immersed in the field, Kalodner and other students had four-weeks of virtual instruction to help prep their knowledge.

“The knowledge of disease processes and skills earned through hard work and study during the classroom allowed you to become an active participant in patient care,” said Kalodner. “The field experience helps solidify the classroom lessons through patient interaction.”

From coastal rainforest to rural village, the itinerary of Kalodner and others had them conducting water and environmental sampling and field collecting of mosquito and tick vectors. They met with Ghanian Armed Forces 37 Military Hospital physicians and medical residents to discuss treating patients with diverse illnesses from cerebral malaria to tuberculosis, as well as reviewing parasitology and microscopy of infectious diseases at the Ghana Entomology Center of Excellence. There was valued time also spent with the Ghana Military Police National Dog Academy to learn about dealing with canine-related disease transmission(s) and veterinarian services in their country.

Kalodner and others worked with Navy Medical Research Unit 3 Accra staff and U.S. embassy. They met with representatives from a host of organizations including U.S. Centers for Disease Control and Prevention, U.S. Peace Corps and U.S. Agency for International Development to learn about interagency cooperation and partnership as it relates to global health engagement.

There were challenges, which provided an instructive framework for future planning and problem solving.

“I think the elegant part of this experience was that many of the challenges I faced during my field mission in Ghana are similar to those I will face in a deployed environment. One of the biggest challenges was limited access to resources, including medical supplies and equipment. There were logistical issues, such as patient transportation difficulties and infrastructure limitations that hinder the delivery of healthcare. Additionally, navigating cultural differences and ensuring effective communication are barriers to overcome,” exclaimed Kalodner.

Yet there was fulfillment in encountering and coping with the trials.

“The most gratifying aspect was seeing the direct impact our work had on the local community and knowing that the knowledge, skill, and abilities I learned from my time in the field could have the same direct impact on American servicemembers and allies in future combats zones,” stated Kalodner.

When asked to sum up her experience Navy Medicine – which also includes having her conduct clinical sustainment shifts at NMC Portsmouth – in one sentence, Kalodner replied, “My experience with Navy Medicine has been a profound journey of service, learning, and collaboration, dedicated to enhancing health outcomes in diverse and challenging environments.”