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Military health outreach on Exercise ASKARI SERPENT: a discussion of clinical and ethical challenges
  1. Luke John Turner,
  2. D Wilkins and
  3. J I J A Woodhouse
  1. 3 Medical Regiment, Royal Army Medical Corps, Preston, UK
  1. Correspondence to Luke John Turner, Royal Army Medical Corps, Preston PR2 8AA, UK; luketurner{at}


Exercise ASKARI SERPENT (Ex AS) is an annual British Army medical exercise that sees the deployment of a medical regiment to rural Kenya. The exercise involves the delivery of health outreach clinics and health education to the civilian population alongside Kenyan governmental and non-governmental organisations. This article includes a post hoc analysis of the ethical and clinical challenges that clinicians faced during Ex AS, applying a four-quadrant approach to ethical decision-making. This article intends to stimulate further debate and discussion on how to best prepare clinicians for clinical challenges and ethical decision-making on future exercises and operations. We conclude that our experiences on Ex AS can provide an insight on how to develop predeployment training for clinicians. Furthermore, the universal nature of the challenges faced on Ex AS can be applied to training for future contingency operations.

  • health economics
  • rationing
  • medical ethics
  • tropical medicine
  • medical law

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  • Contributors LJT planned and drafted the manuscript with significant input and revisions from DW. JIJAW acted as senior author, providing supervision during the research phase (identification of themes) and revisions to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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