The pediatric intensive-care unit (ICU) housed a single oxygen tank, few beds, and a lot of children in need.
Hospital Corpsman 1st Class Agossou Marcellin, at the time a General Medical Practitioner in Benin, had an impossible decision to make. Nine hours earlier, he’d admitted a seven-year-old girl with severe anemia – a complication of malaria contracted days before. Worse, the accompanying fever was boiling her, causing seizures. He treated the malaria, but without a blood transfusion, she would remain in critical condition. Her mother couldn’t afford the four-dollar cost, the father was nowhere to be seen, and Marcellin had no way to pay for it himself. To delay the inevitable, he hooked her to the tank, infusing her wearied blood with needed oxygen and she stabilized. For nine hours he waited for a blood transfusion that never came. Instead, a man burst into the ward carrying his six-year-old son, the boy’s lungs wracked with respiratory issues and in desperate need of air.
So, the impossible choice had to be made. Does Marcellin keep the girl on oxygen, giving her time for a transfusion that may never come? Or does he switch the tank to the boy, and hope the girl stabilizes on her own?
But he’d done this before. In the neonatal intensive care unit, they would share a single oxygen tank between multiple infants, rotating between babies and watching them go from blue to pink before switching to the next. Theoretically, the same could be done for the six and seven year olds.
He switched the tank to the boy, but before he could turn his head back, the girl spiraled. He frantically hooked her up again, and began chest compressions. Without oxygen, the boy stopped breathing. They both died.
“I was devastated,” Marcellin said. “I felt like I failed. My goal has always been to save lives, yet my hands were tied – I was furious and I couldn’t do it anymore. So I decided I had to actually deal with the situation, not just the symptoms.”
Marcellin was raised in Cotonou, the capital of Benin, a child surrounded by family, friends, and a community so close he calls them brother and sister. He was happy. When talking about his childhood, his Benin accent thickens and you can hear the smile in his voice. Yet, he was quick to mention the difficulties that accompanied the joy. Time and time again, disease struck. His brother was struck with malaria, but had no medication combat it. The difficulty in providing care, from emergency transport to the price of medicine, haunted him. A dream – what he would call a mission - began to form.
A full childhood and seven years of medical school later, he graduated with an internship in pediatric care and a doctoral thesis in Neonatology care. He saved lives, yet struggled to enact real change. Then, two children died over an oxygen tank and a four-dollar blood transfusion. Enough was enough. He applied for a student visa, boarded a plane, and flew halfway across the world in search of a solution.
“I felt powerless, and I knew I needed resources,” Marcellin said. “That’s why I decided to go to the U.S. – not only to educate myself more, but to build a network of aid for my home… At first, I wanted to go into public health on an international scale, work with one of the big organizations like the World Health Organization or United Nations – just advocate for Benin. But once I got to the U.S. I realized the best way I could build a network was to start practicing medicine. That way, I can build a network of physicians, hospitals, and volunteers, and channel those resources and aid back home.”
Being knowledgeable and battle-tested doesn’t guarantee a spot in American medicine. First, Marcellin had to take the U.S. Medical Licensing Examination (USMLE), which he passed. Then he applied for medical residency, which he was denied. In his words, “less than 1% of international applicants from [non-U.S. accredited] medical schools are accepted, and most acceptances go to the big medical-education countries, like Nigeria, India, and other Asian countries.”
Worse, he could only apply once a year – for someone who measures days in lives lost, the patience required was crippling. He pressed on, and at 28 years old and desperate for change, he applied for, got accepted to, and is currently studying at the University of Kansas, working towards earning a doctorate degree in Pharmacy. On the surface, it feels like a step down. Two short years ago, he was a practicing doctor. But his mission was never just to be a doctor. It was to save Benin and African lives.
Actually, being a civilian doctor wasn’t the only career Marcellin contemplated. Back in Benin, he’d been interested in joining the army – he had friends in the military, it offered steady pay, and as a medical officer he’d be that much closer to the echelons of society that could enact change. But the Benin Army recruits sporadically, and by the time the recruitment window had come, he’d already decided to leave. But the military – more specifically, the idea of service in a tangible way, still played in his mind. So, while taking the USMLE tests and applying for medical residency, he joined the U.S. Navy Reserve Corps.
The U.S. Navy Reserve Corps offers a myriad of benefits, a choice of deployment and training locations, and for immigrants, it’s a concrete path toward full citizenship. What makes Marcellin’s enlistment fascinating is what he does after joining the reserves. He deploys overseas. In the middle of getting his doctorate and paying his way through school, he deploys to Africa – first to Djibouti, then to Madagascar, to Kenya in 2022, and finally to Benin. What’s more, he’s a hospital corpsman, a rate whose ethos demands they “do no harm.” They’re uniquely dedicated to improving the lives of Sailors and those the U.S. Navy supports overseas – like Benin.
So, in 2023, Marcellin volunteered to support exercise Obangame Express 2023. Officially, he’s the medical support for the U.S., partner and ally service members operating in Benin. Unofficially, and arguably more importantly, he’s a four-language regional translator, a cultural liaison, and a spokesperson for both Benin and the U.S. Navy.
This next part is multi-faceted – up until now, the focus had been on Marcellin’s medicine. While medicine has been his vector, it’s not his goal – that’s saving lives. Hence why when asked about his support for the exercise in Benin, he doesn’t mention medicine. Instead, he talks about maritime security.
Obangame Expres 2023, at its core, is about reinforcing Western Africa and reducing illicit maritime activity; i.e. piracy, smuggling, and terrorism. These intrusions are not just dangerous nuisances to civilians at-sea – they cripple economies. Piracy reduces profit. Smuggling reduces tariffs. Terrorism reduces trade. No trade, no tariffs, no profit – no money for infrastructure, education or medicine. No money for a four-dollar blood transfusion, or extra oxygen tanks.
This money will inevitably either flow through, or stop in, the Gulf of Guinea. The Gulf is vast – stretching from Senegal to Angola and covering approximately 6,000 km of coastline, it is one of the world’s critical shipping zones. Everything from oil and gas to goods from central and southern Africa flow through this region, along with the approximately 1,500 fishing vessels, tankers, and cargo ships dotting its waters on a daily basis. The waters are one of Western Africa’s most important economic assets, and accordingly, one of its most exploited by illicit actors. This sentiment is expressed at every turn by each of the major players in the exercise, and was reiterated by U.S. Navy Cmdr. Tim Meyer, an exercise-zone lead and Marcellin’s officer in charge during the exercise.
“[This exercise] provides an excellent opportunity to strengthen regional cooperation and share tactics, techniques and procedures for addressing maritime security challenges,” Meyer emphasized. “It’s by building these enduring relationships and increasing interoperability that maritime security in the region will be maintained and improved.”
On Marcellin, Meyer doubled down.
“His participation in this iteration of Obangame Express in Benin has been instrumental for establishing new relationships, as well as strengthening current ones,” Meyer said. “His ability to communicate in the local languages assisted in facilitating in-depth information exchanges. His knowledge of the local area and customs has allowed the team ease of access to accomplish the mission and integrate with partner nation personnel at a deep level… increasing our ability for communication and interoperability.”
But Obangame Express 2023 is not just Africa. Many western countries are participating in the exercise. They each have technology, equipment, and military power to spare, but no context in which to deploy it. Sailors like Marcellin give them that critical context. Equally important, Sailors like Marcellin help unite four continents in a human, personal way.
“The first day in country, we went to the Benin Maritime Operations Center [the overall command-and-control of the regional maritime domain] and met the Benin Navy team,” Marcellin said. “They’re speaking English to the other guys, but then I turn and start speaking French [Benin’s official language]. Instant surprise, an American speaking French! I say, ‘What, you don’t see my name?’ And they say ‘Yeah! We were wondering if you were from Benin!’ From there, the room went from stiff to pure excitement. It helps. It helps move our agenda, to get things done.”
And the bridge-building doesn’t stop there.
“Then we go to downtown, to get some good Benin food, and the people see my name – Agossou,” he said. “People are coming up, asking me where I’m from, and I laugh and say here! I’m from here! This is a Benin name. I can feel the change – they feel like there’s affiliation. I think it helps strengthen that relationship. I’m happy being able to help in this way, to achieve that overall mission.”
Marcellin is now a man of two homes – Benin and the U.S. He’s served both. He’s brought his sister and mother to the U.S., and has regularly visited the five relatives remaining in Benin – not to mention that community he loved dearly growing up. He’s visited Africa too many times to count, on and off mission, but when asked, he said this assignment during Obangame Express 2023 was special.
“This is a real sense of fulfillment,” he exhaled. “I think I have reached my goal, at least partly. Being able to come back, to be helpful, not only to the U.S. but to African nations too – I feel like I’m doing something good, something to be proud of, to be satisfied with. It’s a feeling of achievement.”
So what’s next?
“Next is to develop a better partnership,” he said. “However I can, any opportunity to strengthen the partnership between the U.S. and Africa. To collaborate however I can, to make Africa safer, to build the network… It’s a noble mission, and I want to be part of that. With the increased security comes the non-government organizations, U.S. and global aid organizations that can really help Africa build a better health system… I have a lot to offer – languages, culture, knowledge of the continent, both African and U.S. medical training. I’m looking for any opportunity to build a bridge, whether it’s the U.S. Navy, or other government organizations. I’m fired up! I’m ready for it.”
Conducted by U.S. Naval Forces Africa (NAVAF) and sponsored by U.S. Africa Command (AFRICOM), OE23 is designed to improve regional cooperation, information-sharing practices, and tactical interdiction expertise to enhance the collective capabilities of participating nations to counter Illegal, Unreported, Unregulated (IUU) fishing and other sea-based illicit activity.