These advances have occurred even as the mission of military medicine has expanded in the 21st century. The terrorists who provoked global conflict on 9/11 had found a safe haven within one of the many failed states to emerge after the collapse of the bipolar world, and it became clear to U.S. military leaders that the doctrine of “full-spectrum dominance” must necessarily include operations that would help to stabilize such states before their weaknesses posed a threat. Stability and support operations (SASO) aren’t new to the U.S. military, whose service members have deployed to provide stability and support numerous times, mostly for humanitarian reasons, but the 21st century has made clear that the failures of states, in addition to threatening the health and safety of people within their borders, have direct implications for global peace and security. Preventing states from failing, and helping to re-stabilize those that do fail, has become not only a moral but also a strategic imperative for the U.S. military.

The Military Health System, recognizing that one of the key components of stability is public health, adopted SASO as a stated mission in 2002, and the National Defense Strategy has since elevated SASO to be a mission on par with the military’s traditional combat missions, offense and defense. It’s a historic change in how the U.S. military sees itself: Its mission is not only to win battles, but to create space for negotiation by providing a controlled, nonviolent environment, and by providing aid to civilians. In 2003, for example, Joint Task Force Liberia, with an operational component of 3,000 U.S. Marines, deployed to help stabilize the West African nation in the midst of a civil war that had created a refugee crisis.

The U.S. military was called to West Africa again when the most widespread epidemic of Ebola virus disease in history broke out in Liberia, Sierra Leone, and Guinea in the summer of 2014. Acting on a request for help from the Liberian president, President Barack Obama ordered a U.S. response led by the Centers for Disease Control and Prevention (CDC), with a military component headquartered in the Liberian capital of Monrovia. In addition to the command-control and logistical support provided by soldiers, sailors, and Marines, Operation United Assistance featured crucial assistance from some of the world’s leading experts in the prevention and treatment of infectious diseases: Researchers and physicians from the Army, Navy, and Air Force diagnosed cases, prevented the spread of the virus, and, in cooperation with U.S. pharmaceutical companies, researched and field-tested Ebola treatments and vaccines.

“AMSUS provides a historical connection to military medicine’s past, but also a social construct, a building of trust between organizations. I personally believe that social construct is often more important than the content of the meetings.”

For six months, more than 36 patients from nine nations were treated at the Monrovia Medical Unit (MMU), a 25-bed hospital operated in the Liberian capital by more than 200 volunteer Commissioned Corps officers of the PHS. Commissioned Corps officers were the only U.S. personnel to provide direct care to patients during the outbreak – in this case, to health care workers in Liberia who had been exposed to or infected with Ebola virus. Throughout the response, the PHS worked with U.S. Africa Command (AFRICOM), the State Department, and the Navy and Air Force to provide logistics and support for the MMU and the laboratory that conducted tests to confirm the presence of the virus.

An event such as the 2014 Ebola outbreak, in which U.S. military medical personnel worked in collaboration with the CDC, the PHS, private companies, and nongovernmental organizations such as Doctors Without Borders, serves as a reminder of the need for collegiality and intellectual exchange among the nation’s federal health professionals. The forums provided by AMSUS, said Cowan, are more important than ever.

“One of the most difficult things for government agencies to do is to cooperate and communicate across organizational lines, and in particular to collaborate across the federal/civilian interface,” he said. “To an extent, they’re locked in by bureaucracy and rules that are put in place for good reason – to prevent corruption. But they’re often so strict that they hamper good work. AMSUS provides a safe neutral zone. We’re a 501(c)(3), created by Congress to help military medicine. We’re the platform to which military medicine, VA medicine, and Public Health Service medicine bring their content to share with one another in a safe place. And we can also bring the public and private sectors together in ways that neither can do without our help.”

To Cowan, the importance of AMSUS to military medicine goes far beyond the knowledge shared through its meetings or its journal. “AMSUS provides a historical connection to military medicine’s past,” he said, “but also a social construct, a building of trust between organizations. I personally believe that social construct is often more important than the content of the meetings.”

When he joined the Navy as a physician in 1971, Cowan was one of the last American doctors drafted into wartime service. He watched as the military and its medical departments were underfunded and demoralized in the wake of the Vietnam War. But as they regained their footing, he found himself with a sense of purpose he’d never felt before. He decided to make military medicine his career, much to the surprise of his friends from medical school and his residency.

“There were times during those years when it was hard to be a member of the military,” Cowan said. “But when I would go to an AMSUS meeting and they would bring the colors in, as the band was playing the ceremonial march, I would get a tingle at the back of my neck, and a feeling of pride that I was not just practicing medicine – I was practicing medicine on those people who deserved it the most. It gave a meaning to my life that for many years I wasn’t able to express very well. But I felt it. And it was in part due to the fellowship I found at AMSUS, where I would find like souls who shared my feelings and thoughts about that across services and across organizations. That helped keep me going.”