Day 121: Prayer

Just like the prophet Daniel knelt by his window three times a day to pray, approximately 99 percent of Afghans kneel and pray 5 times a day as part of their Islamic teaching. Their conviction in prayer is so strong that even as a military currently at war, every soldier still sets aside time in his day to pray. During my daily walks, to and from the Afghan Army clinic, quite often will I see a solider engaged in a time of earnest prayer and it has been a site that has encouraged me.


Such powerful examples of prayer have reminded me that a daily connection with God is a must. Not only in "unique" living situations such as mine, but even in our everyday routine is the power of prayer a necessity to get through the day.

My prayer today is that your prayers, to a living and loving God, will be filled with a desire to have Him take full control of every transaction, every word, every thought...every moment of every day.

"Pray without ceasing." I Thessalonians 5:17

Day 118: Spirit of Tashakor

...the Dari word for "Thanks".

Today we celebrated Thanksgiving, a time-honored American tradition in which family and friends come together for food, fun, and of course, football! What's Thanksgiving without an ultimate football tournament! And what better way to start the tournament than with an Army -Navy game. Today's game represents an enduring college football rivalry that dates back to 1908. This is about the Land against the Sea, Green against Blue, Hooah! against Hoorah!...


If you have ever played Ultimate Frisbee, this rules are exactly the same except we are throwing around the good old pigskin. The game started out pretty evenly with both teams scoring consistently. Despite our best efforts, the Army turned up the intensity, and before we knew it we were down 3 goals going into the 2nd half. But we were not going to back down! After several key defensive stops, we were able to tie up the game with only minutes left. The minutes soon became seconds and we found ourselves capitalizing on yet another Army turnover. We marched the ball down field, we found open teammates, and with only seconds left on the clock and inches separating us from victory...

...we WON!!

One of the things that made our football game unique was our audience. Since our base was too small, we asked permission to have the game on the Afghan Army base, and they were very gracious hosts. They were very much entertained at the Americans running around with a very funny looking, spiral-shaped ball.

Go Navy, Beat Army!

After a morning of high-intensity football, we were graced with a Thanksgiving feast. Even I was surprised at the spread that was waiting for us. Who would've thought that on a little FOB (Forwarding Operating Base) in Eastern Afghanistan, thousands of miles away from home, I would still experience the fun and fellowship of a true Thanksgiving meal!

Check out the spread!


There's our Garrison Commander serving Thanksgiving lunch in his shorts!


An ice sculpture in the middle of the desert...now there's an oxymoron!

Some final thoughts...

When I first found out that I was going to deploy...for 15 MONTHS...I wasn't very happy. My thoughts on the chain of events were somewhere between "huh?" and "why?", but definitely not in the realm of "thanks". I tried so hard to find that silver lining...really hard. Eventually, my questions turned into an attitude of trust, and when I finally arrived to my final destination here at Camp Clark, I can honestly say that I am truly grateful for the opportunity that I have been blessed with. Even with a living space that is built from plywood, internet that is slower than dial up, life without the presence of my own family, and the fear that comes with living in a war zone...not a day goes by that I have something to be thankful for.

Sporting my victory "medal"

I pray that all of you, my beloved family & friends, would also experience a true spirit of Thanksgiving in your hearts for the opportunities that you have been granted to serve Him, through the service of others.

"Let the word of Christ richly dwell within you, with all wisdom teaching and admonishing one another with psalms and hymns and spiritual songs, singing with thankfulness in your hearts to God." Colossians 3:16 NASB

Day 116: In His Sight

Jesus loves the little children, all the children of the world. Red and yellow, black and white, they are precious in his sight. Jesus loves the little children of the world!

There is something about the face of a child that makes us grown-ups smile. Perhaps it's their innocence, the carefree attitude, their fascination with the most simple things, their curiosity, their honesty, their ability to let their imaginations run wild! Whatever it is, they are truly a precious gift from God.


Today, we had many more patients at the local clinic than expected. We usually expect 25-30 patients, but today we had a little over 50!! The other interesting thing was that there was only 1 adult, the rest were all children! A little stressful since we only prepared about 30 "goodie" bags, but we were successful in preventing the extra children from leaving empty-handed.

Interacting with the Afghan children has been an immense blessing for me, and a joy for the ANA medics as well. Above is one of the medics posing for a quick photo-op as the kids wait their turn to be seen.

I think of my children all the time. Every time I teach a child a "high five" or "thumbs up" or how to wave "goodbye", I am reminded of my precious kiddos, Maxwell and Maya . I sometimes imagine what my homecoming will be like...maybe Max will be speaking in full sentences and will have conquered his potty training (no pressure honey), and perhaps Maya will be running full speed to greet me. Those are the thoughts that keep me going...

But, until that time comes, I will embrace every opportunity to minister to these precious children as they are seen as precious in His sight!

"Permit the children to come to Me; do not hinder them; for the kingdom of God belongs to such as these." Mark 10:14 NASB

Day 114: Morning Rounds

One of the things about my mentoring job that I enjoy is morning "rounds". This is where I gather all the medics and go from bed to bed discussing the patients that are on the ward. I try and make suggestions and maybe go over some physical exam pointers. Like I've mentioned before, the approach to diagnosis and treatment is very different here. Most of the professed "doctors" in the clinic never went to any formal medical training. Many of the "docs" have a background in pharmacy so they are very good at throwing the medicine cabinet at patients, but not at taking thorough histories or performing physical exams. It's like having brand new medical students!

Where did my medics go?

I swear I had a crowd of medical officers and medics gathered around me, and taking in all the medical wisdom I had for them. I guess we'll have to save working on the attention span issues for another day.


Here is a picture of myself followed by Dr. Ainullah, who is actually the lab officer/senior physician (used loosely). Here we are during morning rounds evaluating a patient with right lower quadrant abdominal pain. As I reviewed the chart I noticed...a brief history (in Dari), good...a FULL set of vital signs, great...a completed urinalysis, excellent...and when I asked about a physical exam...a blank look. So I decided to take some extra time to demonstrate a basic abdominal exam which Dr. Ainullah found to be a rather novel idea.


After rounds, we went for a visit to the lab which is Dr. Ainullah's domain. Here is a quick peek at the lab and his lab tech, Said Kamal. I can probably count on one hand the number of lab studies that can be performed in this lab, but it's a start.


Despite the many frustrations that I may encounter at the clinic, I can always count on one thing. A nice warm cup of chai! It's the Afghan way. Cheers!

"And the things that thou hast heard of me among many witnesses, the same commit thou to faithful men, who shall be able to teach others also." II Timothy 2:2 KJV

Day 113: Retention to Relief

...more specifically, urinary retention. Today, I had a very interesting patient case. He's a 21 year old, Afghan Army soldier who had been able to urinate for over 12 hours. He came to the clinic complaining of excruciating suprapubic pain along with an insatiable urge to pee:( Poor guy! After discussing the case and reviewing the history with the medical officer on call, we went ahead and attempted a foley catheter placement to empty out his bladder...multiple times.

You are all probably wondering what can cause this problem...I'm no urologist, but I could come up with a few possible causes for his issue. Foreign body (ouch!), drugs (Decongestants are notorious), or meatal/urethral stenosis (small caliber "plumbing"). Large prostates can also be the culprit, but not in 21 year old males so I spared him the rectal exam. Lucky me!


After discussing the possibilities with the duty officer, we went ahead and did a physical exam (PE's are an uncommon occurrence with the Afghan docs). I'll spare you the pictures, but what I found was a very narrow meatus (pee pee hole) which made it near impossible for me to place any of the catheters we had available (they were all too large in diameter). We ended up sending him to a nearby US hospital who had the equipment for this type of issue. As you can see from the picture above, he was good-to-go in no time! Today, we transferred him to Kabul to see the urologist. Hopefully, they will offer him some permanent relief...

"Comfort, yes, comfort My people!
Says your God." Isaiah 40:1 NKJV

Day 112: Rodeo

Today was "Rodeo Day", a day set aside for "rounding up" key people who provide essential services that are not available on Camp Clark on a daily basis. This requires us, as the Garrison staff, to provide an armored convoy to round up and escort these individuals to the base. This is just one of the many ways we strive to keep morale high and despondency to at least a bare minimum!

Camp Clark at sunrise on Rodeo Day

A perfect morning for a "Rodeo", yee-haw!

In your head you are probably asking, "so who do you bring?". If I had it my way, I'd bring some designers from HGTV to rebuild and furnish our wooden B-Huts and chefs from the Food Network to take over our dining facility. As much as Bobby Flay would be cool to have out here, the people we bring out are just as equally, if not more, important.

If you haven't already figured it out from previous blog entries, mail is extremely important. Part of our "rodeo" is not only picking up care packages, but also bringing a postal worker who inspects and handles outgoing mail. With Christmas coming, these postal folks are going to have their work cut out for them!


What's a person to do without cold hard cash! Even out here in the middle of Afghanistan, cash is still king. ATM and credit cards are non-existent at the bazaar so how else are we going to buy those hand-sewn Afghan rugs and imitation Rolex watches? It's Military Finance to the rescue! With a simple signature and an ID Card, I am able to obtain cash which will then be taken out of my next paycheck...genius!


The military wouldn't be the military without a barber. This is probably the most sought after service of them all. Some people will wait in line for 2 hours, eagerly anticipating that clean cut fade, flat top, or shaved head that typifies us as military members. Can't let those side burns get out of hand!


The other group of people that we will bring are the chaplains, our experts in spiritual warfare. Most bases will have a chapel and regular weekly services, but since we're too small we don't have that luxury. We usually bring a Protestant Christian minister and Catholic priest depending on the availability and demand. I decided to attend the short Protestant "service", which ended up being a congregation of ONE!

Hopefully, this has given you a small glimpse into how we, as deployed military members, prevent ourselves from going insane or worse! Stay tuned...more to come!

Day 110: The Mafia

Today, we celebrated yet another group of Navy folks, on their way out of here, with an awards ceremony. Congratulations to them on a job well done!! As a junior officer in the Navy, it has traditionally been a "chief" (senior enlisted) who would pull me aside and remind me that my uniform is out of regulation, or my leave paperwork needs to be corrected, or my evaluations need polishing. Since being out here in Afghanistan, it has been the chiefs, recognized today, who politely told me where to find office supplies, who helped me put my bed together, who gladly helped me install some shelving, who pretty much took care of me when I first arrived. And the funny thing is...they were all Filipino and were dubbed the "Filipino Mafia"! They were like "uncles" to me:) I truly appreciate their hard work and commitment, the recognition they received today was much deserved. They will be surely missed.

Fair winds and following seas!

Chiefs Arandia, Culas, and Ferrer, aka the "Filipino Mafia"

But love your enemies, do good to them, and lend to them without expecting to get anything back. Then your reward will be great, and you will be sons of the Most High. Luke 6:35 NASB

Day 109: Faces

Just like a picture is said to be "worth a thousand words", so is a face. After putting together another free local national clinic, I felt that today was different. Actually, a "good" different. As Americans fighting the war in Afghanistan, we are trained to conduct humanitarian missions always with an "ANA face". In other words, we do all the leg work then step aside and allow the ANA soldiers to hand out the goodies, and the ANA doctors/medics to be the frontline providers of medical care. When I say "leg work", I am really referring to all of the donated medicines, vitamins, clothing, toys, and school supplies from the generous households, churches, & organizations back home. We are all in this fight against terrorism!


During the last several local clinics, I noticed a very relaxed and unmotivated group of Afghan soldiers and medics standing around, and not really seeing the value in interacting with their own countrymen. But, today was a vast improvement. The doctors and medics were proactive in checking people in, and addressing their medical concerns. The soldiers of the security force were holding the children's hands, and helping them with their overloaded goodie bags. It was a very heart-warming site to see and an ANA "face" that I hope the children will associate with peace and security:)

An ANA soldier handing the boy a teddy bear!

A soldier showing a local boy how to read a calendar

Some of the "faces" of the Afghan National Army (ANA)

For many of us who are Christians, we are the face of a living and loving God. We can be the "face" of hope, compassion, service, and love in world that is war-torn from sin.

...for the LORD seeth not as man seeth; for man looketh on the outward appearance, but the LORD looketh on the heart.
I Samuel 16:7 KJV

Day 108: Border Patrol

Today, I decided to take a break from my usual mentoring duties with the Afghan Army, and ventured out on a conop with the Afghan Border Police (ABP) and their US Army mentors. The Afghan National Security Forces (ANSF) encompass several forces to include the Afghan National Army (ANA), Afghan National Police (ANP), and the Afghan Border Patrol (ABP). One of the biggest issues in Afghanistan is a lack of oversight of the Afghanistan-Pakistan border. Many of the Taliban insurgents reside in Western Pakistan and they come and go freely across the Eastern and Southern Afghanistan border smuggling weapons, opium, and IED producing materials. This is why both the Eastern and Southern portions of the country are considered the most dangerous. The Taliban would love to be able to have a stronghold in these parts of the country. We hope the mentoring that we are providing to the ABP will deter the enemy's plans.


I was asked to tag along on this road trip because the ABP do not have an on-site medical provider. The poor Army medic has been getting inundated with coughs, colds, back pain, stomach pain, knee pain, headaches, toothaches, depression, and so on and so on...and some complaints have been well over his head. I thought this would be a great opportunity to help out these soldiers who don't have access to medical care.


When we arrived there was immediately a line of police officers and civilian workers. Everything I saw was essentially "bread and butter" acute care stuff with everything from back pain to reflux. Our most popular pharmaceutical treats included Tylenol, Zantac, and Dental hygiene kits. And just like most medical mission trips, the presence of a dentist would've been nice...there was a lot of teeth that needed pulling!

A civilian worker's son who was curious about my camera!

The most enjoyable part about all of this was that I didn't have to boot up an electronic medical record, write a note, or worry about official patient complaints or lawsuits. And everytime I saw a patient, they always left very grateful with what little medications and time that we had.


After a couple hours of "urgent care", we had lunch with Major General Molkheil, the ABP regional commander. I don't routinely hang out with generals so I definitely had a memorable experience. I apologize for the silly picture, but I couldn't resist! We had tasty Afghan food, which I am glad to say, has not affected the consistency or the transit time of my "No. 2's".

I would have to say that today proved to be a productive, fun-filled day. To be able to interact with and meet some of the basic medical needs of these ABP soldiers was indeed an honor and privelege.

Which now of these three, thinkest thou, was neighbour unto him that fell among the thieves? And he said, He that shewed mercy on him. Then said Jesus unto him, Go, and do thou likewise. Luke 10:36,37 KJV

Day 107: Change

If there is anything that is going to impede the progress of our mission, it is the reluctance to change. Many of the ANA leaders have been in their positions for years, and have had experience that dates back to the mujahideen. Unfortunately, in their eyes there is no more room for improvement or there is no more energy to push for improvement. Lucky for me, there is now a new clinic director and he seems to bring a strong desire for change that I am all for...


Here is a picture of Captain Baryalai, he is the dental officer/pharmacist/physician assistant and sole English-speaking Afghan in the clinic. A bit of a renaissance man. One of our projects is to get him some dental tools to go with his new nifty dental chair. Unfortunately, dental readiness isn't a priority in the Afghan National Army.


The other project that we are working on is the putting together of a training classroom. As you can see, the classroom is a bit crowded with the desks and chairs all crammed into this tiny space. The clinic has several larger rooms which have been taken up by officers who are doing everything they can to not get kicked out. With the new clinic leadership (and my prodding), there is going to be a little reshuffling of the clinic space, and a larger training classroom may actually be a reality!


This last picture is a classic. Here is the former clinic director, Major Zahid, solitaire champion. Personally, I think he is a nice guy, but after being in the military for over 30 years, I would be burnt out myself with only video games on my mind:)

"Can the Ethiopian change his skin or the leopard its spots? Then may you also do good who are accustomed to do evil." Jeremiah 13:23 NKJV

Day 106: Blessed

My last blog entry relayed the excitement that comes from receiving packages. Out of the several I received, nothing touched me more than finding drawings and photos courtesy of Gemma and the kids!


On my door I posted some drawings that my budding artist of a son, Maxwell, meticulously scribbled. I also pinned up some prints of Max's hands and Maya's feet...how priceless:) I really, really miss them!!


The coolest gift was a countdown calendar that Gemma put together on Snapfish.com. Lots of great family photos both recent and not so recent. Thanks honey! It has really spruced up the back of my plain wooden door.

What a joy and a blessing to receive such timely gifts especially on the Sabbath. Such reminders of the way the Lord has blessed me with a supportive wife and healthy, beautiful children has done nothing but reassure me that he is truly watching over me!

For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end.
Jeremiah 29:11

Day 105: Special Delivery

For many of you, I'm sure that the thought of being away from everyone and everything that is closest to you is just down right hard! Factor in the possibility of being attacked at anytime by terrorists, and now the situation may seem utterly hopeless. Everyone here seems to have their ways of coping... frequent calls home, reading, dominoes, poker, movies, basketball, ping pong, the treadmill, internet, Facebook. But, if there is one thing that really keeps a soldier, airman, or sailor going...it's MAIL!! Whether it's a letter, card, or care package...nothing puts a smile on our faces faster than those tangible reminders that there is someone at home who is thinking about us.

Here is one of our hard-working petty officers unloading the mail off of the 5-ton


A shot of our "post office" (built into a large iron box called a "connex" box) and our mail handlers sorting the eagerly anticipated mail

Here I am with my very first care packages, some stuff from Bed Bad & Beyond and Amazon.com!

Just because I'm in Afghanistan doesn't mean I have to rough it for a year. Gotta have my "creature comforts" like Superman bed sheets, a down comforter, a feather bed, ping pong paddle, and basketball shoes:) I'm still waiting on my mini vacuum cleaner and floor lamp...I'm also considering a flat panel TV...just kidding...actually....

Day 104: Happy Birthday Honey

Happy Birthday to you!

Happy Birthday to you!
Happy Birthday dear Gemma!!!
Happy Birthday to you!....

And many more.....


Happy 21st Birthday....I LOVE YOU:)

Day 103: Comfort Zone

As a Family Physician, encountering clinical cases that are out of my comfort zone is not uncommon. The nature of my specialty allows me to provide initial evaluation and management of most patient care complaints from patients of all walks of life. At the same time, we as "gatekeepers" to the subspecialty world trust our specialist colleagues to provide a higher level of care when we have surpassed the boundaries of our clinical "comfort zones".

As a family physician practicing on the island of Guam, I have already encountered numerous patients that have forced me to practice out my comfort zone. Cases have included patients with ST-elevation MIs (bad heart attacks) without access to coronary care facilities or cath labs, post-coronary bypass grafts placed in my 15-minute clinic slot, bipolar disorder, and chronic pain from metastatic nasopharyngeal cancer.

As a military-trained family physician in Afghanistan, I have now crossed way out of my comfort zone as a significant portion of my clinical responsibilities includes prehospital and tactical field trauma evaluation and management. It's one thing to go through the trauma training courses, but it's another thing to encounter it for the first time....without my specialty safety net!


Several days ago I was called to our little ER on base to evaluate an ANA soldier who was injured by an IED blast. He had significant head trauma and had a Glasgow Coma Scale of 9 (not good). I must admit I was very nervous, not only because I was your average family physician, but because I was the ONLY physician. Also, by Afghan standards, American doctors know all and can heal all.

I proceeded to the clinic with a medic and we did as we were trained. The Afghan medics did the best they knew how with the limited supplies they had. As a mentor, I tried to use the case as a teaching tool for the Afghan medical staff rather than simply taking over the scene. Starting with the primary survey, going through the ABCDEs, reassessing ventilatory techniques, and conducting a secondary survey, we methodically treated the patient. Once again, I have never led out in a code let alone a real-life trauma scenario...several episodes of ER came to mind, and as much as it would have been cool to ask for a "trauma panel, C-spine, abdomen, and pelvis", that was just not going to happen in my podunk Afghan clinic.

To make a long story short, we did what we could for the patient and successfully packaged him up for transfer to the nearest trauma center. Reflecting back on the whole thing, it was only by the grace of God that I was able to maneuver my way through that clinical scenario. I'm sure He will guide me through many more.

"Hear my cry, O God; attend to my prayer. From the end of the earth I will cry to You, when my heart is overwhelmed; lead me to the rock that is higher than I." Psalms 61:1,2

Day 102: Team Physician

It is often said that there is no "I" in T-E-A-M, and I have found that to be especially true out here where the mission is dependent on setting "me" aside and putting the goals of the collective first. A prime example is our preparation each week for our free clinic which was held today. It takes the effort of the whole base medical team to adequately prepare for such an event.

Riding the Ambulance with Air Force Medics Styles-Glen and Jones

Throughout the week, several large boxes of humanitarian assistance (HA) donations arrives on base. This has been a successful endeavor through the efforts of my predecessors in sending out electronic flyers requesting materials to friends, family and organizations. As much as it is exciting to receive donations, it is also a lot of work! We have to use our ambulance to drive to our base post office, load the ambulance, then take the boxes to our designated storage facility. Once at the storage area, we open the boxes and sort out the various donations which can range from shirts, shoes, school supplies (paper, crayons, pre-sharpened pencils, markers, erasers), toys, stuffed animals, jackets, deodorant, dental hygiene products, chapstick, soap, and candy.

After restocking our inventory and assessing the needs of our clinic, we move the necessary items from the storage area, via ambulance, over to the clinic which is at the other end of the base. Items that need continual restocking at the clinic include toys, various school supplies, jackets, stuffed animals, and blankets.


Once we arrive at the clinic, we then put together "goodie bags" for the children, seperate the clothing by sizes, and sort the toys out based on gender. We also restock the pharmacy as needed with the most popular items being children's multivitamins (gotta love Flintstones), Tylenol, Motrin, Cough/Cold Meds.

On clinic day it takes the collective efforts of our interpreters, ANA(Afghan National Army) medical providers, ANA soldiers, and our own medical staff to make the clinic run smoothly. The villagers are met at the gate and searched, escorted to our clinic by ANA soldiers, signed in by our interpreters, and then basic medical care is provided primarily by ANA medical providers. Although we provide all the elbow grease to prepare for this clinic, as the US counterparts to the ANA, we will step aside and allow ANA personnel to provide the medical care as well as give out the free items. This allows the local population to slowly build their confidence in the Afghan military presence which in turn lessens their desire to support the Taliban.


As a physician, I have found that my profession doesn't always have to be about intriuging clinical cases, complicated hospital patients, or challenging in-office procedures. Being out here where people are ecstatic to be given a used jacket, a toothbrush, paper/pencils/crayons, hand-me-down toys, and a moment of my time...I have found that putting "me" aside has made me more of a physician that I could ever be.

"I am the vine and ye are the branches, he that abideth in me and I in him, the same bringeth forth much fruit for without Me, ye can do nothing." John 5:15 KJV

Day 101: The Few the Proud

Today, marks the 233rd birthday of the United States Marine Corps (USMC)! Originally organized on November 10th, 1775 as the Continental Marines, the USMC has been involved in every American conflict since the American Revolution. Their role is best described as "Naval Infantry". The USMC utilizes the mobility of the United States Navy to rapidly deliver combined-arms task forces or MAGTFs (Marine Air-Ground Task Forces). Their amphibious warfare tactics became the cornerstone of the Pacific campaign of WWII. In other words, Marine units have capabilities that overlap elements of all the various armed forces. They have infantry and aviation capabilities and everything in between.


Administratively, they do fall under the Department of the Navy, but operationally, they function independently. Although, they do rely on the Navy for transportation, training, and logistics (i.e. there are no such thing as Marine doctors only Navy doctors).


As the smallest branch of the armed forces under the Department of Defense, these courageous men and women are truly "the few and the proud".

Some famous Marines: John Phillip Sousa (composer), Drew Carey (new host of the Price is Right), Senator John Glenn (astronaut), and even Orville Burrell (aka. the reggae artist, "Shaggy").


Above is today's picture of the dining facility here on base, and decorated specifically in honor of the Marine Corps Birthday. As you can see, we really know how to party!