U.S. soldiers serving in Iraq have health worries beyond guns, car bombs and improvised explosive devices. There's also heart disease, hypertension, allergic rhinitis and weird rashes, to name just a few of the less immediately life-threatening conditions acute care nurse practitioner Tobin Hill sees at the Ivory Combat Clinic near Kirkuk.

A member of the Army National Guard, Hill was deployed to Iraq in December 2004. His unit provides health care to soldiers, civilian contractors and other foreign nationals in the area - in a clinic that's "basically a tent under a bunker," says the 19-year veteran.

The goal of the clinic is to keep the fighting force where the action is, instead of shipping injured or ill soldiers out of the field for treatment. As fighting has transitioned to nation building, Hill has also trained Iraqi paramedics, treated prisoners at the Iraqi-run detention center, and organized local firefighters to respond to mass casualty situations.

But Hill still finds the time to practice preventive care and to educate patients just as he would in civilian life. "Sometimes the preventive nature is in recommending having some tests done when [patients] return to the States," Hill says, "but I always review family history and have initiated lots of antihypertensive and lipid-lowering medications out here."

Recently, Hill got "a good academic review" with a group of interesting cases. "Soldiers came down with a very high fever (higher than 104 degrees), headache, nausea and vomiting. Since our lab capabilities are limited, a workup for fever of unknown origin cannot be done," Hill explains.

Using available resources, Hill determined that the soldiers' urinalyses, blood chemistries and white blood counts were normal but that their platelet levels were less than 100. He treated the patients with Cipro 750 mg/day and observed their progress. All symptoms resolved in about 3 days, allowing the soldiers to remain with their units.

Until May 2005, the Army maintained a forward surgical team on the base where Ivory Combat Clinic is located. That saved Hill a trip out of Iraq for his own emergency appendectomy. After his surgery, he spent a night in his unit's patient holding area and then 2 weeks in his quarters before returning to work. Now, Hill would send any patients requiring a surgery consult to a small Air Force hospital nearby. The Air Force surgeons would perform minor procedures on site or evacuate more serious cases.

Hill says the cases he's seen in Iraq have reinforced for him the value of good history taking and physical exams. With limited resources and consultation opportunities in Iraq, he's learned to trust his basic health training. "This experience has given me more confidence that I'll be able to carry into my civilian practice," Hill says.

A nurse practitioner for just a year and half, Hill practiced with a cardiology group in Auburn, Wash., before going to Iraq. Hill enlisted at age 17 and spent almost 12 years as an Army photo journalist. During the first Gulf War, he volunteered for combat lifesaving training, and a physician assistant told him he would make a great nurse.

"That started the whole process," Hill remembers. When he returned to the states, he worked as an EMT while preparing to enter a 2-year nursing program. Next he held a position in a hospital critical care unit while finishing his bachelor's degree. He then applied for a direct commission as an officer in the Army Nursing Corps.

After about 3 years, "I decided I needed to grow some more," he says. "I read an article in a nursing journal about acute care nurse practitioners, and I decided I was going to become one." And he did, completing the adult primary care and adult cardiovascular programs at Duke University at the same time.

Reflecting on his range of experience, Hill considers the military the perfect path for a career in health care. "If I could do it all over again, I would," he says. "The military is hurting for medical personnel, and I strongly encourage anyone to take the challenge."

- Tobin Hill was released from active duty on Feb.5 and is back practicing with his cardiology group in Washington. Jill Rollet is a senior associate editor at ADVANCE for Nurse Practitioners. Reach her at jrollet@merion.com