I’ve recently returned from Peru with the non-profit foundation, Team 5. Team 5 Foundation is comprised of Special Operations medical practitioners, survival experts and civilian ultra-athletes. The five person team ventures to the most extreme, overlooked and remote locations in the world to provide medical assistance. While the primary mission of Team 5 is humanitarian in nature, this trip also included a specific teaching element. For this mission, I was tasked with teaching Tactical Combat Casualty Care (TCCC) to over two dozen Peruvian Special Operations medics from the nation’s Army, Navy, Air Force, and Marine forces. The opportunity provided a unique perspective to both instruct and work alongside the Peruvian military in a single week.

The following is my personal experience and take away from working with Team 5 and Peru’s elite commando medics.

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It’s evident from the first five minutes of instruction that the class was highly motivated, yet under equipped. Of the twenty-seven men in attendance, all were highly attentive with notebooks open, two had an Individual First Aid Kit (IFAK) and none had what’s considered an equipped aid-bag, by US medic standards. The first question asked to the class is, “Who has treated a trauma patient in combat?” Half of the class raised a hand in response.

Fully stocked IFAKs provided by North American Rescue were distributed to the students, and a baseline for extremity hemorrhage control is established. The average time to effectively apply a tourniquet to a limb designated as having an arterial bleed is over two and a half minutes. This is a potentially fatal time standard for a femoral bleed.

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Knowing more than half of the preventable deaths on the battlefield are a result of extremity hemorrhage, and the lack of equipment for advanced trauma interventions in the field, this task became the primary focus of the course. Secondary focus was the second most common killer on the battlefield, tension pneumothorax (collapsed lung). These two injuries account for roughly eighty percent of preventable deaths on the battlefield.

By the end of the third day of training, the average time to tourniquet placement was just under thirty seconds and the average student time on assessment and treatment of a multi-system trauma was just over four minutes total. This includes tourniquet application, wound dressing, identifying a tension pneumothorax and performing a needle decompression.

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Simultaneous to conducting TCCC, the other members of Team 5 conducted multiple surgeries, including seven cleft lip repairs and one cleft palate repair on local children. Following the course, the Peruvian military transported the team to multiple remote villages. It was through these movements we learned more about the conflicts the Peruvian military is facing on a daily basis.

Two distinct military threats are currently present in Peru. The first is the steady rise of narcotics trafficking. Peru has been a cocaine and coca exporter since the 19th century. Most of that trade has been conducted legally with the United States until about a hundred years ago when the drug was made illegal in the US. The drug was made illegal in Peru in the late 1940’s, launching the conflict between growers and the government. Until recently Peru’s role in the trafficking industry had been primarily confined to growing. However, with the intense scrutiny placed on refinement operations in Colombia in recent decades, the role of Peru’s cocaine industry has increased.

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The second threat to the Peruvian military is a communists guerrilla group known as the Shining Path, who declared war on the state in 1980. While in Peru, I sat with a sympathizer of this organization who claimed it is the government who are profiting most from narco-trafficking, citing examples of times when government officials used official aircraft to smuggle drugs out of the country. The Shining Path has become stronger in recent years due to their ties with the illegal drug trade, an interesting fact given the capitalistic nature of the drug trade.

While providing aid to a village in the heart of the most conflict-affected region of the country, (Apurimac, Ene and Mantaro River Valley – VRAEM) our team received a classified brief from the top regional commander on tactics currently used by the Shining Path. Among these is kidnapping women from local villages for use as incubators. The women are raped and made to have children who will be raised to follow the beliefs of the organization. I spoke with the Two-Star General on the ground just prior to conducting an aid-clinic. As we made our foot movement toward the village, his men conducted a raid in the area and seized significant amount of explosives, including bricks of C4, weapons and equipment used in the production of cocaine, just miles from our location.

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Our small medical team was provided a security element of thirty to forty Peruvian Commandos through our entire time conducting humanitarian aid in the area. It was evident the soldiers on this detail were highly trained, motivated, and serious about the threat level in the region. When asked, the General stated they view the VRAEM as their country’s Vietnam.

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The tail sections of narco planes shot down by Peruvian forces.

The government of Peru has responded to the narco trade by incentivizing growers of coca leaves to plant different cash crops such as cocoa and bananas. This is not a simple transition, however, since coca leaves have long been a part of Peruvian culture, dating back to ancient Inca civilizations. Coca leaves are used in religious ceremonies as well as daily consumption throughout the country. Coca grow operations are not only legal in Peru, the collective voice of the growers is a strong political force. The Peruvian military currently targets other necessary ingredients in cocaine production, as well as the runways and planes used by drug traffickers rather than directly eliminating coca fields.

With the help of the Peruvian military, Team 5 was able to treat 540 clinic patients, de-worm over 500 patients, treat 45 dental patients, perform surgery on 11 locals, distribute 100 pairs of reading glasses to those in need, hand out 150 solar powered luminAID lights to villagers without power, and teach 27 medics life-saving techniques… in a week.