The Place of USU Among America's Allies: Reflections From the Surgeon General of the Canadian Armed Forces

As the first alumnus of the Uniformed Services University (USU) to be appointed a Surgeon General, it is with gratitude and respect that I reflect on what that great institution means to Canada and on my perceptions of what it means to other U.S. allies. Few developed western nations maintain health sciences universities dedicated primarily to defense, and none to my knowledge offer its students USU's comprehensive extent of academic, research, and military opportunities for excellence. While the education it provides is extraordinarily valuable to Canadian and other allied students, the mutual understanding and friendships established are equally so. Both elements support allied integration and alignment within the North Atlantic Treaty Organization (NATO) and other coalitions, and the expertise gained by Canadian USU alumni has long helped them provide a high standard of medical support to U.S. and allied forces in operations. Among allied students who have studied at USU, the Canadians have perhaps been most comfortable and derived the most direct benefit since most do not perceive the United States and Americans as being foreign—slightly different because of an historical divergence, but siblings of the same family and same mother. In turn, Canadian students are certainly not treated like foreigners at USU, and the faculty members who have made special efforts to welcome and support them are far too numerous to name. Most Canadians have American relatives, and even USU's founding sponsor, Congressman F. Edward Hébert, was distantly related to my Acadian wife. On all the important things, we share the same aims, values, culture, and characteristics, a phenomenon that is reflected practically in common standards and reciprocity in most areas, including the health sciences. Many thousands of Americans, including Victoria Cross winners, served with Canadian forces before formal U.S. participation in the two world wars. Many thousands of Canadians, including Medal of Honor winners, served with U.S. forces from the Civil War until the present, and there is enough intermarriage between U.S. and Canadian service personnel to cause headaches for both nations' career managers. To my surprise upon receiving a big hug from former U.S. Joint Special Operations Command Surgeon and USU alumnus, Col Jim Czarnik, he explained it as a gesture of appreciation for how U.S. and Canadian troops and medics always ran together toward the sound of blast and gunfire in Afghanistan rather than away from it. Our staff at the Canadian-led Role 3 Multi-national Medical Unit in Kandahar never wept more than when they lost an American serviceman or service woman. We not only integrate closely in medical domains, but in virtually all arms of the service, with Canadians serving as Deputy Commanding Generals of the U.S. Army's Corps, Royal Canadian Navy ships integrating seamlessly into USN battle groups, and the RCAF and USAF providing common air defense inside each other's airspace under the uniquely bi-national NORAD Command. In deployed operations, the common experiences, approaches, friends, and acquaintances of U.S. and foreign USU alumni facilitate their rapid collaboration as effective teams functioning as if they came from the same military service. For example, Canadian graduate LCol Paul Eagan worked closely at NATO Training Mission Afghanistan with USU alumni Maj Susanne Cooper, CDR Cindi Sikorski, Col Mark Krautheim, and Lt Col Lynn Shinaberry to develop tailored medical education programs for the Afghan National Army (ANA). Their USU bond led to immediate trust, common understanding, collaboration, and the success of this joint Canadian–American effort. Among other achievements, they produced and delivered the first Afghan Flight Surgeon Course, modified and delivered a USAF course on disaster management to senior ANA medical leaders, and established a residency program in public health and infectious diseases for the Armed Forces Academy of Medical Sciences (AFAMS) and Ministry of Health. The residency program particularly highlighted USU's expertise and the esteem with which it is held by the Afghan military and civilian leadership: of several Canadian, U.S., and UK curricula and training approaches that LCol Eagan proposed, the Afghans seized on those developed by USU, whose reputation as an institution of academic and military excellence they knew well and respected. Dr. Jeff Longacre, USU Vice President for Affiliations and International Affairs, played a key role in formalizing a link between AFAMS and USU, and both the ANA Surgeon General, MG Wardak, and the AFAMS Chain of Command were very grateful for USU president Dr. Rice's support for this affiliation. Among many U.S. medical staff who served with the Role 3 hospital in Kandahar, USU faculty member LTC Aaron Saguil served many months as head of primary care, as a dedicated and skilled mentor to the ANA, and in other roles. He was among several U.S. medical personnel whose extraordinary performance beyond the call of duty earned a formal commendation from the Canadian Chief of Defence Staff, who had previously been Deputy Commanding General of U.S. III Corps and of the Multi-national Corps in Baghdad during Operation Iraqi Freedom. Canadian and allied USU alumni regularly encounter their U.S. colleagues with joy on deployment or at other NATO or coalition activities, fondly remembering the warm friendships and great support they received at USU. Among Canadian alumni, some are now leading our national military programs in communicable disease control, occupational and environmental health, medical intelligence, CBRN medical defense, public health dentistry, and other areas. They are always in close collaboration and alignment with their U.S. counterparts. When working within the Canadian forces or with our British, Australian, and continental NATO allies in operations or in NATO committee work, our USU graduates stand out as leaders in knowledge and analytical capability, particularly in the application of health sciences to the military operational context, thus helping perpetuate USU's international reputation for excellence. There is often an indication of understanding among allies upon learning that the Canadian officer who so impresses them studied at USU. Even the Deputy Surgeon General of the Chinese People's Liberation Army, who controls a number of military medical universities, was very interested in my USU experience when visiting Ottawa in 2006, highlighting the international breadth of USU's renown. USU faculty are particularly recognized as military health authorities across NATO, such that their participation in Alliance activities is considered to ensure success. When I chaired the NATO Research and Technology Organization's committee on Health, Medicine and Protection, for example, the Research Task Group on Military Suicide chaired by USU's Dr. Marjan Holloway's was perhaps the best organized and most popular of the many under my watch, not only from a scientific perspective but also from an operational and diplomatic standpoint. From the perspective of America's allies, USU's role in allied diplomacy, alignment, and interoperability is as important as its contribution to the military and medical education of their students. Foreign students return to their nations not only with a greater understanding of best military medical practices and organization, but a deeper recognition of how the United States is one of the greatest forces for good in the world. As small as the Canadian forces are relative to those of the United States, this recognition motivates us to further cement Canada's commitment to supporting the United States diplomatically, militarily, and in any other way we can. USU's Canadian alumni are especially keen to support this great university in gratitude for its contributions to the health of our troops and the defense of our country. There is no greater honor than to be a graduate of this extraordinary institution, the best of its kind in the world, which has contributed so much to saving lives and protecting the health of members of the U.S. armed services, those of its many grateful allies, and distressed civilian populations. All current and past USU students should recognize the great advantages they enjoy by virtue of the superb preparation they were afforded in leadership and in the application of the health sciences to extraordinary circumstances, as well as the great opportunity and honor of serving their country. On behalf of alumni from allied nations, I thank and congratulate USU, its President Dr. Rice, and its entire faculty for their unique and critical contributions to the protection of our armed forces. In offering an assurance of Canadian goodwill and support, I look forward to USU's next 40 years of accomplishments and contributions to health, defense, and allied solidarity.

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