U.S. Army Central

Army surgeon lectures on nerve agents in Kuwait medical exchange

By Army Sgt. 1st Class Doug Roles, 28th Infantry Division | Task Force Spartan | May 08, 2018

AL JAHRA, Kuwait --

Dr. Hessa Alkandari (left), a physiotherapist with Kuwait Military Hospital; and Lt. Col. Dr. Gregory Johnston (second from left), 28th Infantry Division surgeon, pause for a photo after serving as speakers in the latest monthly medical exchange May 3, 2018 at the North Military Medical Complex. They are joined by Lt. Col. Andrew Franzone, division chemical, biological, radiation and nuclear (CBRN) protection officer; and Sgt. Maj. Michael Reep, CBRN NCOIC, who attended to hear Johnston’s presentation on the history of nerve agents. Alkandari spoke on the importance of prescribing exercise as part of patient treatment.
Dr. Hessa Alkandari (left), a physiotherapist with Kuwait Military Hospital; and Lt. Col. Dr. Gregory Johnston (second from left), 28th Infantry Division surgeon, pause for a photo after serving as speakers in the latest monthly medical exchange May 3, 2018 at the North Military Medical Complex. They are joined by Lt. Col. Andrew Franzone, division chemical, biological, radiation and nuclear (CBRN) protection officer; and Sgt. Maj. Michael Reep, CBRN NCOIC, who attended to hear Johnston’s presentation on the history of nerve agents. Alkandari spoke on the importance of prescribing exercise as part of patient treatment.
Dr. Hessa Alkandari (left), a physiotherapist with Kuwait Military Hospital; and Lt. Col. Dr. Gregory Johnston (second from left), 28th Infantry Division surgeon, pause for a photo after serving as speakers in the latest monthly medical exchange May 3, 2018 at the North Military Medical Complex. They are joined by Lt. Col. Andrew Franzone, division chemical, biological, radiation and nuclear (CBRN) protection officer; and Sgt. Maj. Michael Reep, CBRN NCOIC, who attended to hear Johnston’s presentation on the history of nerve agents. Alkandari spoke on the importance of prescribing exercise as part of patient treatment.
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Dr. Hessa Alkandari (left), a physiotherapist with Kuwait Military Hospital; and Lt. Col. Dr. Gregory Johnston (second from left), 28th Infantry Division surgeon, pause for a photo after serving as speakers in the latest monthly medical exchange May 3, 2018 at the North Military Medical Complex. They are joined by Lt. Col. Andrew Franzone, division chemical, biological, radiation and nuclear (CBRN) protection officer; and Sgt. Maj. Michael Reep, CBRN NCOIC, who attended to hear Johnston’s presentation on the history of nerve agents. Alkandari spoke on the importance of prescribing exercise as part of patient treatment.
Photo By: Sgt. 1st Class Douglas Roles
VIRIN: 180503-Z-ZI573-011
The top doctor for the 28th Infantry Division paired up with a Kuwaiti physiotherapist May 3 to be this month’s speakers at an ongoing medical exchange at North Military Medical Complex, Kuwait. Lt. Col. Gregory Johnston, M.D., division surgeon, lectured on the history, effects and treatment of nerve agents while Dr. Hessa Alkandari from Kuwait Military Hospital spoke about the need for practitioners to view exercise as medicine.

Their presentations continued a series of medical symposia that dates back to 2017. The goal of the exchanges is to share knowledge while developing relationships between medical complex soldiers and staff and U.S. Soldiers deployed to Kuwait as part of Task Force Spartan. Johnston spoke first and detailed how the use of nerve agents as a weapon has evolved over time.

“Chemical weapons have been around since time immemorial,” Johnston said. “The roots of using poison as a weapon go back thousands of years.”

“Chemical weapons had a big reintroduction in the First World War when the Germans used chlorine gas,” he added. “And at that time, initially, there was no personal protective equipment.”

History repeats itself. It will happen again. We have to be prepared.Lt. Col. Gregory Johnston, M.D.

Johnston, a Pa. Army National Guard soldier, delved into the molecular composition of organophosphates (nerve agents) and explained their effects on the body. He said atropine continues to be the first best treatment but cautioned that some doctors may dramatically underestimate how much is needed to combat an insidious substance that can seep into pores and turn dermal layers into a reservoir of toxin that continues to poison victims days after initial exposure.

Johnston also talked about the importance of immediate decontamination measures. He said warm, soapy water is an effective first step since it chemically reacts with organophosphates, neutralizing them. 

Surprisingly, ingredients for making nerve agents, such as Sarin gas, can be purchased through websites, Johnston noted. He said that nerve agents of today are more potent than the first generation of chemical weapons. Whether it’s by terrorists, such as those who released Sarin gas in the subways of Japan, or more conventional military methods, such as the recent gas attack in Syria, Johnston feels the future use of nerve agents as weapons is a matter of when, not if.

Lt. Col. Dr. Gregory Johnston, division surgeon, 28th Infantry Division, Pa. Army National Guard, speaks about the history, effects and treatment of nerve agents May 3, 2018 at the North Military Medical Complex. Johnston’s lecture was part of an ongoing monthly medical exchange program.
Lt. Col. Dr. Gregory Johnston, division surgeon, 28th Infantry Division, Pa. Army National Guard, speaks about the history, effects and treatment of nerve agents May 3, 2018 at the North Military Medical Complex. Johnston’s lecture was part of an ongoing monthly medical exchange program.
Lt. Col. Dr. Gregory Johnston, division surgeon, 28th Infantry Division, Pa. Army National Guard, speaks about the history, effects and treatment of nerve agents May 3, 2018 at the North Military Medical Complex. Johnston’s lecture was part of an ongoing monthly medical exchange program.
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Lt. Col. Dr. Gregory Johnston, division surgeon, 28th Infantry Division, Pa. Army National Guard, speaks about the history, effects and treatment of nerve agents May 3, 2018 at the North Military Medical Complex. Johnston’s lecture was part of an ongoing monthly medical exchange program.
Photo By: Sgt. 1st Class Douglas Roles
VIRIN: 180503-Z-ZI573-008
“History repeats itself. It will happen again. We have to be prepared,” Johnston said.

Another health threat just as debilitating in the long term though not as scary as chemical weapons is the impact of sedentary lifestyles and poor diet. Alkandari is on a mission to fight related ailments such as arthritis, heart disease and diabetes by making exercise part of the prescription.

She spoke on the global Exercise is Medicine health initiative managed by the American College of Sports Medicine (ACSM). The medical movement encourages primary care physicians and other health care providers to include exercise when designing treatment plans.

“Exercise is as therapeutic as medicine,” Alkandari told the audience. “It makes changes in the heart itself and increases cardiac output.”

Alkandari reviewed the “FITT” approach to planning exercise regimens based on frequency, intensity, type and time (duration). She also reviewed the use of patient questionnaires during consultations and expressed her hopes that the Exercise is Medicine initiative will take hold in Kuwait which has one of the worst per-capita rates of diabetes. 

Dr. Hessa Alkandari, a physiotherapist with Kuwait Military Hospital, speaks about the global Exercise is Medicine initiative May 3, 2018 at the North Military Medical Complex. Her presentation was part of the latest in a series of monthly medical exchanges between U.S. Army providers and doctors at the complex.
Dr. Hessa Alkandari, a physiotherapist with Kuwait Military Hospital, speaks about the global Exercise is Medicine initiative May 3, 2018 at the North Military Medical Complex. Her presentation was part of the latest in a series of monthly medical exchanges between U.S. Army providers and doctors at the complex.
Dr. Hessa Alkandari, a physiotherapist with Kuwait Military Hospital, speaks about the global Exercise is Medicine initiative May 3, 2018 at the North Military Medical Complex. Her presentation was part of the latest in a series of monthly medical exchanges between U.S. Army providers and doctors at the complex.
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Dr. Hessa Alkandari, a physiotherapist with Kuwait Military Hospital, speaks about the global Exercise is Medicine initiative May 3, 2018 at the North Military Medical Complex. Her presentation was part of the latest in a series of monthly medical exchanges between U.S. Army providers and doctors at the complex.
Photo By: Sgt. 1st Class Douglas Roles
VIRIN: 180503-Z-ZI573-009
Alkandari is president of Kuwait Diabetes Association and a pediatric endocrinologist at Dasman Diabetes Institute (an affiliate of Kuwait Foundation for the Advancement of Sciences). Johnston practices for the Department of Veterans Affairs and previously worked in emergency medicine. He has twice deployed to Iraq, as a brigade surgeon and as a trauma chief, and served as the officer in charge of a Kabul clinic while deployed to Afghanistan.

The May event was the latest in a series of medical exchanges begun in May 2017 by Col. Nawaf Jandoul Al-Dousari, medical director of the Al-Jahra North Military Medical Complex, Kuwait, and U.S. Army Col. Thomas Koertge, division surgeon for the 29th Infantry Division.

The two became acquainted in 1997 at Virginia Commonwealth University School of Dentistry and reconnected years later as Al-Dousari was practicing at North Military Medical Complex and Koertge was deployed to Kuwait with the 29th’s headquarters and headquarters battalion (HHBN) while it served as the headquarters for Task Force Spartan. The two dentists hoped to develop and deliver a continuing education lecture series for medical professionals assigned to the complex and U.S. military medical personnel serving in Kuwait. They collaborated with then-Area Support Group-Kuwait (ASG-K) Command Surgeon Lt. Col. Ronald Wells to make it happen.

Col. Brian F. Malloy, MD, now serves as the ASG-K command surgeon at Camp Arifjan and has helped continue the vision of Koertge, Al-Dousari and Wells. He now coordinates the monthly events and is glad that the series has taken root. 

“This event evolved from that relationship. One Kuwaiti provider speaks and one U.S. Army provider speaks,” Malloy said. “This venue also provides us a place to make introductions and plan future presentations.”

As an example, soldiers with the 28th HHBN’s chemical, biological, radiological and nuclear (CBRN) protection cell – who attended to hear Johnston’s lecture – had the opportunity during the luncheon portion of the event to speak to Kuwait Land Forces officers about a possible presentation on CBRN preparedness and casualty management. 

For next month’s event, military dentists from Camp Arifjan will travel to the complex for a day of observation.


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