Day 213: Pashtun

Many deployed physicians spend their time on a large base doing mundane clinic work which often feels no more different than working at a clinic back home. One of the unique aspects about my particular job is the many opportunities to directly interact with the Afghan people. The humanitarian clinic provides a significant portion of those interactions, and allows me to better understand the Afghan culture, particularly the Pashtuns.

Although people from Afghanistan are called "Afghans", like the American "melting pot", they also have different groups such as the Uzbeks, Hazaras, Turkmans, and Pashtuns just to name a few. Each group has their own unique subculture, language, and appearance. In our region, the majority of Afghans are of the Pashtun group which makes up more than 45% of the population. Pashtuns gained worldwide attention after the Soviet invasion of 1979 as well as after the rise and fall of the Taliban. Pashtuns are primarily situated in the Southern and Eastern portions of Afghanistan that border on Pakistan as well as Western Pakistan. Insurgents, such as the Taliban and their allies, are of Pashtun origin which can explain why the region I'm deployed in is considered very dangerous. The closer we are to the Pakistani border, the higher your chances of being surrounded by Pashtuns who are members of the Taliban.

On a more informative note, understand that not all Pashtuns are terrorists. In fact, Pashtuns are a very beautiful and strong-willed people. What I first noticed about the Pashtun children was their eyes...

Just having them gaze into the camera as I took their picture provided almost a calming and soothing affect to rest of my day. Beautiful, simply beautiful...

Now on with the education portion of this blog...Pashtuns are known for their unique language, called Pashto, and their practice of Pashtunwali which is their living philosophy and traditional code of conduct and honor. Pashtuns tightly embrace these codes of honor as they provide a traditional, spiritual, and communal identity. Here are a few of their principles for living:

1. Melmastia (Hospitality) - Showing hospitality and profound respect to all visitors, regardless of distinctions of race, religion, national affiliation as well as economic status and doing so without any hope of repayment or favour. Pashtuns are widely considered to be the most hospitable people in the world and a pashtun will go to great extents to show his hospitality, so much so, that in very many recorded cases it has been observed that a they have even provided enemies with sanctuary.
   
2. Badal (Justice/Revenge) - to seek justice over time or over space to avenge a wrong. This applies to injustices committed yesterday or 1000 years ago if the wrongdoer still exists. Justice in Pashtun lore needs elaborating: even a mere taunt (or "Paighor") is regarded as an insult - which can only usually be redressed by shedding of the taunter's blood (and if he isn't available, then his next closest male relation). This in turn leads to a blood feud that can last generations and involve whole tribes with the loss of hundreds of lives.
3. Dod-pasbani (Protecting Pashtun culture) - It is obligatory for a Pashtun to protect Pashtun culture from disintegration. Pashtunwali advises that in order to successfully accomplish this, a Pashtun must retain the Pashto language since Pashto is the prime source of Pashtun culture and its understanding isn't just important but essential. Not being able to speak Pashto is often translated by Pashtun society as the inability to understand Pashtun culture, values, ethics, history and community.
4. Nang (Honour) - The preservation of honour entails the defence of one's family and one's independence, while upholding cultural and religious requirements.
5. Hewad (Nation) - Love for one's nation in Pashtun culture isn't just important, it's essential. A Pashtun is always indebted to their nation and must strive to perfect and improve it. A Pashtun considers it his obligation to defend his country against any type of foreign incursion. Defense of nation means defense of honor, values, culture, tradition, countrymen and self.

As you can imagine, the ability of Pashtuns to either be allied to or enraged with the US presence in their country is primarily based on their personal interpretation of the moral code. In the end, as long as they perceive that what they believe is in line with Pashtunwali...they are in the right.

As I thought about the concept of honor codes, I thought about the principles that I myself have chosen to live by. After getting married, one of those principles is to never leave the toilet seat up:) But, one of the most important principles is the understanding that I am not the best judge of what is truly right vs. wrong. That wisdom comes from a relationship with a living and loving Creator. And unlike Pashtunwali, His code is founded on forgiveness and reconciliation for ALL people no matter how undeserving.

What codes have you chosen to live by?

"This is good and acceptable in the sight of God our Savior, who desires ALL men to be saved and to come to the knowledge of the truth. For there is one God, and one mediator also between God and men, the man Christ Jesus."
I Timothy 2:3-5 NASB

Day 212: Artillery

Every once in a while when I get to see Maxwell on the webcam we sing one of his favorite songs together...the Infantry Song. I'm sure many of you may have heard it at church or during Vacation Bible School. It starts out...

I'm too young to march in the infantry
Ride in the Cavalry
Shoot (clap) the Artillery...
I may never spy on the enemy
But, I'm in the Lord's Army
Yes Sir!

Today, I was reminded of that childhood song as I enjoyed the amazing experience of providing medical coverage for a field artillery firing mission! The word Artillery, took on a whole new meaning as I have never really seen the "big guns" so up close and personal before. First of all, it is the loudest thing you will ever hear...ever!! I near jumped out of bed the first time I heard these guns go off thinking we were under attack. The guns fire out 155 mm (for reference, a handgun bullet is 9 mm) rounds that can reach targets up to 30 miles away. It takes a lot of explosive power to send those rounds down range.


Here I am holding a bag of explosive material used to fire the artillery. Don't let the small, compressed size fool you...it packs a huge blast!! Aside from tampering with unfamiliar explosives, I also asked if I could pull the rope that causes the guns to fire...that really got me excited. Unfortunately, the target area was invaded by a herd of goats which stopped the mission for the remainder of the day. Oh well...there's always next time.

Day 205: Medevac

Since being out here I have been involved in the care of numerous casualties related to explosives. Although I'm not an adrenaline junkie, I must admit that there is a side of me that gets excited. Heart pounding rapidly, the smoldering anticipation, the rapid preparations made for a multi-victim trauma, and diving right into treating the soldiers who are fighting this war...that's the excitement of being a physician in a combat zone.

Without giving away specifics, I just wanted to show you some pictures from our most recent trauma case as this resulted in a Medevac (Medical Evacuation)!

The patient was part of a routine patrol in the Khost-Gardez or "KG" Pass when they were hit by a roadside improvised explosive device (IED) not too far from our base. There were multiple victims but only one was sent to me. We treated him for minor head trauma, shrapnel in his leg, and a large cut right next to his right eye which concerned me. This prompted my decision to ask for Medevac to ensure that his eye and head were thoroughly evaluated since I have no fancy slit lamps (for eye trauma) or CT scanners (for head trauma).


Coincidentally, we had a visiting Chaplain that day and he wandered into the clinic helping us out. Here is a shot of him praying over the patient. I thought this was a peaceful moment just before we transported the patient to the LZ (aka landing zone).


Here are a few of my medics keeping the patient comfortable as we transported the patient in the not-so-comfortable ambulance.


There was the helo waiting for us at the primary landing zone ready to fly. I put this picture in here for Maxwell...he loves helicopters! After a bumpy ride in our ambulance, we arrived at the primary LZ and quickly brought the patient over to the helicopter. It was cool indeed...

One of my favorite shots...just after the helo left. Just another day at the office!

To add closure to yet another blogger adventure, I just wanted to add that the patient ended up doing very well. No permanent injuries and he is already up and going about his business. Mission accomplished!!

Day 203: Provision

For a few weeks now, I had been growing anxious as our humanitarian assistance (HA) supplies were starting to dwindle. I had noticed that the mail runs, for weeks, had been without boxes labeled "Community Clinic". The medics and I had been working so hard sending loads of e-mail and snail mail in hopes of finding fellow Americans who could help. Perhaps it was the economy, or the boxes were lost in the mail, or the mere fact that no one really cared. I even wondered if maybe God was trying to divert my energy to other things. The situation was rather discouraging until....


... the mail run became a complete opposite of the theme from the last several months. In the midst of a drought came a flood of overwhelming support for our clinic as a result of our Christmas letter writing campaign. Almost 800 pounds worth of donations in one mail run! What an answer to prayer.


The sudden influx of supplies allowed us to have a successful humanitarian clinic as over 60 patients were able to be cared for this week. I just wanted to say thank you to the many families and organizations who have continued to make our clinic a success.

"...the Lord will provide, as it is said to this day, In the mount of the Lord it will be provided." Genesis 22:14 NASB

Day 202: Formation

In the military, we often find ways to give soldiers a "pat on the back" for a job well done as this maintains a healthy level or morale. We do this in the form of awards, ribbons, medals, badges, warfare devices, promotions...in exchange, Uncle Sam hopes for soldiers happy to re-enlist!

As a Navy mentoring team, we have been tasked to take care of the Afghan National Army (ANA) Garrison leaders and their soldiers, and one of the ways to keep morale levels at reasonable levels is to hold a certificate ceremony during their formation.

**Quick explanation..."Garrison" refers to those troops who ensure that the post is running smoothly, as opposed to the "Brigade" whose troops are involved in combat missions and trigger pulling.**

Attention!

Every week the ANA Brigade holds a formation which can be well over a thousand soldiers. During the formation, the general gives a motivational speech followed by some time to recognize the hard work of his soldiers. Well, the Navy Garrison decided that we were going to have a smaller scale formation for our ANA Garrison counterparts and their soldiers. We then presented certificates to well-deserving Garrison troops allowing us the opportunity to personally thank them for their hard work.

ANA/US Navy Garrison Formation

As I was staring out at the formation of Garrison soldiers, I began to reflect on the 4 months that I have spent here in Afghanistan, and I can definitely see the progress that has been taking place as a result of our Garrison mentoring mission. I can only hope that the next 4 months will bring more of the same.

Navy Garrison Formation, Interpreters Included!

"Trust in Him at all times, O people; Pour out your heart before Him; God is a refuge for us."
Psalm 62:8 NASB

Day 200: Love Letters

Happy Valentine's Day everyone. Today, I thought I would spend my blog time writing love letters to some very special people...

Dear Maya Lourdes,

I miss you lots. Even though we haven't really gotten to know each other yet, mommy has been doing a great job sending me pictures and putting you on the web cam. I have been watching you grow up and have seen you roll over, sit up, laugh, smile, and eat rice cereal and squash! Since you are so beautiful, I think we are going to have the father and daughter talk about boys sooner that we think! I can't wait to hold you again. I love you. --Daddy

Dear Maxwell,

Daddy loves you very much. Mommy has been telling me that you have been such a good boy and a wonderful big brother to Maya. I am so proud of you. You are growing up so fast! I am overwhelmed by all the words and sentences that you have been learning. Keep up the good work. I can' t wait to take you to the beach, play Wii with you when mommy isn't looking, and teach you how to shoot a basketball. For now, Daddy has to finish his work on the other side of the world, so please take care of Maya and Mommy for me. I love you! --Daddy

P.S. I hope you start to use the toilet soon:)


Dearest Gemma,

I hope you enjoyed the Calla Lillies and Roses for Valentine's Day! Not only is today Valentine's Day, but today marks day #200 from the day I left for training...Wow does time fly! It has been such a test of faith to be away from you and the kids this long. I couldn't have asked for a better partner to rely on to change so many diapers. To see you in the role of a single parent breaks my heart, but at the same time, our time apart has shown me your capacity for emotional strength, patience, and unconditional love. You truly are a gift from God. Know that I am praying for you always. I love you! --Mike

"For I am convinced that neither death, nor life, nor angels, nor principalities, nor things present, nor things to come, nor powers, nor height, nor depth, nor any other created thing, will be able to separate us from the love of God."
Romans 8:38,39 NASB

Day 198: Insha'Allah

...translated "If God Wills" or "God Willing" is a popular Muslim expression. This expression, in Afghan culture, symbolizes an attitude, a way of life that defines the people of Afghanistan. A life approached with the thought that if things were meant to be done, they will be done in their own time or "If God Wills". In secularized America, that would be referred to as being "laid back".

This approach to life has driven me nuts as a type-A, results-oriented, go-go-go physician. Here is what I mean...

Dr. Mercado - "When are we going to clean the medical supply warehouse which is in complete disarray?"

Afghan Counterpart - "Insha'Allah"

Dr. Mercado - "When are we going to begin our medical classes?"

Afghan Counterpart - "Insha'Allah"

Dr. Mercado - "When are you going to order more medical supplies for the clinic?"

Afghan Counterpart - "Insha'Allah"

Dr. Mercado - "When are you going to clean those filthy patient restrooms?"

...and hence the hair-pulling begins.

Yet on the other hand, this approach has really taught me something. What amazes me about the "Insha'Allah" approach to life is that it pervades Afghan thinking while they continue to tolerate a country plagued by corruption, war, destruction, and injustice. "Insha'Allah" supports the perspective that all things: material things, money, job success, family, even death are the result of the will of an all-knowing, all-powerful God, and a will that supercedes their own personal desires.

In contrast, we as Americans, myself included, often see life as a huge checklist of things that need to get done in the least amount of time, yet we often forget to slow down and just enjoy our God-given gift of freedom and democracy. Our appreciation for even the simplest of things: friends, family, air, food, safety, education, health, God...are lost in our self-inflicted burden for increased productivity.

Perhaps, a little dose, or even a large dose of "Insha'Allah", may help us put life into a little better perspective where the will of an all-loving God supercedes our own.


Above is a picture of my interpreter Latif (left) and one of the medics, Ayub (right) preferring a prolonged session of male-bonding and hand-holding rather than getting back to work. I guess we'll get to work eventually..."Insha'Allah"!

"I can of Myself do nothing. As I hear, I judge; and My judgment is righteous, because I do not seek My own will but the will of the Father who sent Me." John 5:30 NKJV

Day 196: Makeover

It's been a few days since my last entry, as I have been coordinating a Troop Medical Clinic remodeling project. In light of several recent rocket attacks aimed at our base, I decided to seek ways to increase the clinic's efficiency in the management of a mass casualty situation. As a team, we discussed some potential improvements to the clinic which ranged from placement of medical equipment to additional storage spaces to bed arrangements...etc, etc. What we come up with was the theme of SIMPLICITY.


Take for instance our small exam room (see above). What we noticed was that there were shelving and tabletops arranged in a hodgepodge sort of way with some shelves nailed to the wall, some cubicle shelving on the floor, a corner table, and no real organization to the medical equipment that was available at the bedside. It also felt a bit crowded with 2 beds in one little room.


After a few minutes of brainstorming and several hours worth of elbow grease, we were on our way to a more efficient yet simple exam room. As you can see, we now have all the shelving up off the floor and all onto one wall. This allowed for more space to evaluate our patients and kept our medical equipment arranged in a way that was easily accessible.


Now onto our larger exam room/trauma room (see above). The first thing you may notice is that there is only 1 bed whereas there were 2 beds in the smaller room...duh...I know, what was I thinking. Also, there was shelving on one wall that was barely used, cubicles on the adjacent wall and floor, and a table with haphazardly arranged exam room equipment. Not quite the efficiency I was looking for.


Check it out! We now have everything staged on a single wall with plenty of space for 2 beds and room to spare. The single wall of cubicles are now equipped with all the necessary trauma and routine exam room equipment needed for our day-to-day operations. The equipment is organized so that all needed airway, bleeding, and circulation equipment are grouped together for easy access. Don't you just love simple.

Well, I hope you enjoyed this makeover project as much as I did. If only I had some quirky interior designers, sponsorship from Sears, and a bus...

Day 190: Be Prepared

You know the Boy Scouts motto, "Be Prepared". As a small team of one physician and 8 medics, we are always learning, training and reviewing trauma scenarios in order to keep our clinical skills sharp in the event that we get overwhelmed by US casualties (knock on wood). In the last 3 weeks, the motto "be prepared" were words to live by as we have experienced 3 rocket attacks with 2 hitting into our base as well as 3 roadside bombs discovered on the access roads leading to our base. We have also assisted in several trauma situations with our Afghan counterparts. Fortunately, our US troops have not suffered any injuries as of yet.

Petty Officers Lyon and Garcia Taking Care of Battlefield Wounds
IED Blast, Feb 4th, 2009

But, on Feb 4th 2009, our level of preparedness was taken to yet another level. That morning, I heard a "boom"and was told that a convoy of South African security contractors were hit by a roadside explosive just outside our base. That meant that they were all coming to our base and we needed to ready...I heard of 3 people then 5 people...the reality was that no one knew since we had lost communication. With what little info we had we were on it, and we transformed our little clinic into a trauma-ready emergency room within minutes...we had airway, suction, IV fluids, tourniquets, bandages, and medical personnel ready to go! I must say I was very impressed...the Boy Scouts would have been proud.

Luckily, we ended up with only 1 injured soldier while several others were taken to other facilities. He had cuts on his face from shattered glass, but overall he was did well. I actually found his working out in the gym several hours later! Once again, another close call and a reminder that anything can happen at anytime.

Going back to the lesson preparedness, I thought of the parable of the 10 virgins in Matthew 25. The story of 10 women, all well-intentioned, and all invited to a wedding celebration. The difference was their level of preparedness to keep their lamps burning...half were ready and half were complacent. This resulted in half taking part in the celebration and the others being left behind.

Rocket Attack #2
Jan 31st, 2009

The parable is as plain as can be. How many more warnings do we as well-intentioned Christians need? How many more "rockets" and "bombs", in the form economic crises, global wars, and disasters, need to explode around us before we realize that we need to be prepared for a new heaven and new Earth? Hopefully, not too many more because before you know it time has run out.

"Watch therefore, for ye know neither the day nor the hour wherein the Son of man cometh." Matthew 25:13 KJV

Day 189: Super Bowl

Quite often, our days get jumbled together and we all get caught up into our daily routines of work, sleep, eat...work, sleep, eat...to the point that we don't even know what day of the week it is anymore. But, even though there's always work to be done there's always room for Super Bowl Sunday...or in our case Super Bowl Early Monday Morning! Who could pass up the good old American tradition of friends, junk food, and football, even if kick off is at 3:30 in the morning! Granted, I'm not a fan of the Arizona Cardinals, the Pittsburgh Steelers, or waking up at an indecent hour for a football game, but I felt the need to break up the monotony of my routine and just enjoy the company of fellow soldiers and football fans.

Football Fans Enjoying the Super Bowl


Here I am Missing It All!

I hope everyone back home had the time to enjoy the Super Bowl as much as I did (at least some of it!). After the game, I had to muster up what little energy I had left to open up the clinic. By about 2 PM I was ready for a nap, at 5 PM I still had a meeting to attend but was ready to keel over, and then...good night.