Can't Wait to Be Home...

Monday, March 30, 2009

Day 247: DFAC

Nothing is more important to a base that it's dining facility aka "the D-FAC" (dee-fak). Soldiers, both ANA & US alike, see the D-FAC as a place where both physical and social needs are thoroughly met. Where else can you experience a warm & welcoming atmosphere, a hot meal, a succulent desert, and a nice conversation with fellow soldiers...the D-FAC is a deployed soldier's home away from home.

In an effort to maintain standards of cleanliness, one of the roles of an Afghan National Army (ANA) medical provider is to inspect the D-FAC in regards to the food and the people that are involved in preparing it. Probably the least favorite thing that I do with my ANA counterpart.

Colonel Shah Zad Gul stressing the importance of
cleanliness with the employees


We periodically do spot inspections of the employees' uniforms, shoes (I make sure they simply have them on!), face masks, hair nets, food handling techniques, and overall cleanliness of the cooking/preparation areas. Let me take you on an inspection tour...

Onions

Probably one of the more intriguing food preparation areas is the onion-cutting section. This is primarily due to the fact that none of the employees seem to cry when cutting up all of those onions. Man, I recall cutting a small onion at home and literally balling my eyes out after I was finished. The Afghan response to my question, "Do you cry when cutting those?", was "Afghans don't cry!"

Greens

Rice Rice Baby...


Motivation to become Vegetarian!

Several times have I been invited to dine with them in the D-FAC, and several times have I respectfully declined...I'm running out of excuses to avoid a meal there! Actually, the facility is very clean, but I find myself losing my appetite after walking through the large cooking area...perhaps it's the meat cutting section?!?

After the spot inspection I couldn't help but think about grabbing a bite to eat. Perhaps In-N-Out, Taco Bell, or a pizza...oh wait...I'm in Afghanistan:(

"Better is a dish of vegetables where love is than a fattened ox served with hatred."
Proverbs 15:17 NASB

Sunday, March 29, 2009

Day 246: The Egg

I apologize for going without an entry for 10 days, but sometimes things aren't as blogworthy as I would like them to be. Well, today I have something worth archiving on the good old blog.

In early Feb, I blogged about an IED casualty that we cared for in our medical clinic. Luckily, he only had minor injuries and did very well. He's a very nice gentleman who is a civilian contractor for a company responsible for providing security around various construction projects here in Afghanistan. Well, he recently returned from leave, which he spent at home in South Africa, and approached me to present a thoughtful gift of appreciation...let me digress for a moment.

Thoughtful gestures from patients are a rarity. More often than not, I have dealt with patients who can be demanding, needy, self-centered, or simply downright horrible. So one may ask, "How do you continue to do what you do?", and my answer to that would be in those few patients that have taken the time to remind me just how much of a difference I have made in their lives as result of my medical care.


...back to my story. What he presented to me was a beautifully painted, hollowed-out ostrich egg from South Africa with some very intricate artwork placed all over the egg. I thought it was the coolest thing! In addition to the gift, I had the pleasure of hearing such kind words of appreciation, but more importantly, I was reminded of the very reason why I was sent here and the differences I've been able to make.

"Pray without ceasing; in everything give thanks; for this is God's will for you in Christ Jesus." I Thessalonians 5:17,18 NASB

Thursday, March 19, 2009

Day 236: The General

In my short career as a Naval Officer, several times have I been a part of what is often called in the military, a "dog and pony show". It amuses me how tightly wound up command leaders get when an admiral, or in the Army's case, a general comes for a well-intentioned visit. Everyone else usually tries to hide....literally! This time of tension and pressure to look absolutely squared away is the reason for the rather facetious nickname.


The General

Anyways, the past several days were marked by a visit from our commanding officer, General Huber, who is in charge of all US Embedded Training Team (ETT) combat advisors in Afghanistan such as myself. Rather than staying away I decided to simply approach him, meet him, shake his hand, and ask for a quick picture. Besides, how often am I ever going to interact with an Army General in my lifetime? We even had a brief conversation. Turns out, he was a very nice man, down-to-earth, and seemed very supportive of our mission here in remote Camp Clark. I guess "dog and pony shows" aren't as tense of an experience as people make them out to be.

Wednesday, March 18, 2009

Day 235: Shots

Today's Mission: Vaccinate 600 soldiers in 1 day, 4 vaccines per soldier = 2400 vaccines

This was a mission that I had discussed with my Afghan counterparts weeks ago and in great detail. My medics and I decided to pay them a visit 2 days prior to the proposed vaccination clinic day to see if they had hashed out a plan to administer the vaccines. Was there a plan? Of course not! So we huddled together and discussed a plan to run an efficient shot line, and we involved every Afghan medic we could find to prepare the vaccinations in syringes prior to vaccination day which was a total of 2400 vaccines.



Team ANA Preparing the Vaccines

Long story short, every Afghan medic in the clinic ensured that the vaccines were prepared and the clinic was ready for the soldiers. Talk about pulling together as a team. I think my US medics and I were way more panicked than the Afghan Army medics as 600 soldiers was a huge number for a small clinic staff to handle all at once. But, if they were not going to panic, then why should we? All doubts aside, on vaccination day we found that the ANA medics were ready for action with all vaccines drawn up and ready for swift administration.


BAM!!...Let's Get to Work!


ANA Medic Gul Rahman administering Oral Polio Vaccine

Mission Complete: All 608 ANA recruits were successfully vaccinated in a matter of 4 hours. Talk about a preventative medical team built on speed and efficiency. Strong work!

Tuesday, March 17, 2009

Day 234: Shamrock Shuffle

I'm not a big St. Patrick's Day which apparently is a big beer drinking Irish holiday according to my fellow military members. I also recall in grade school that if you are not wearing green on St. Patrick's Day, you deserve to get hit. Other than that, I know nothing else about this notable day. Out here in Afghanistan, in celebration of this Irish tradition some proactive folks planned a 5K race right on the base. The race reminded me of Guam as 5K races are going on all the time!


It was a beautiful early morning, prime weather conditions for running. Here is a group of us Navy and Air Force folks ready to run...we're almost awake!


You gotta have the token pre-race group picture.
Love the Irish touch!


I live on a base within a base. Imagine a postage stamp on an envelope. Camp Clark (my base) is the stamp and the outer edges of the envelope is Camp Parsa (the Afghan Army base). A little over 1 full lap around the Afghan wall of the base is 5K. I remember running this course when I first arrived which also was the last time I ran it as I heard rumors of snipers hiding in the mountains. Well, I wasn't going to let that rumor stop me from enjoying this event.

I'm not much of a runner, but I have been doing it more and more as I have had lots of time to workout since being on this deployment. Although I'm not a Speedy Gonzalez, I'm still a big competitor so I wanted to see how I compared to the other Camp Clark runners.


Here I am huffing and puffing my way to the finish line!

I finished the race in 24 minutes flat which isn't too bad. I was fourth overall and what do you know...FIRST in my age group! I was very surprised. As you can see in the picture below, my 5K keepsake was a smaller replica of the Afghanistan national flag. Our complimentary T-shirts are still in the mail.


I must say that I had a blast. For those few hours of the race, I felt a sense of normalcy and contentment that I haven't felt in a long long time. It's thoughtful events like this one that keep us troops closer to home.

"Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us."
Hebrews 12:1 NIV


Day 233: Fair Winds

There's an expression of farewell in the Navy, "Fair winds and following seas". It's never easy to say goodbye to people you care about, especially on a deployment. Part of the sadness comes from forged friendships with fellow troops who are leaving, but the other source of sadness is the reality that I can't hop on the helicopter with them and simply go home.


A Final Picture of Team Navy with the Navy Jack

Today, I had to say goodbye to fellow shipmates as their tour has come to a long-awaited close (a long 9 months!). They have endured the fight and have held on to the end! It was nice to see a crew beaming with excitement as today marks the beginning of their journey back to normalcy. A life that includes family, roads without bombs, privacy, cars, silverware, restaurants - all the things that were sorely missed on deployment.


Navy Crew Anxiously Waiting For a Ride


Fair Winds...

As I helped them onto their helicopter and waved goodbye, I was bummed at the thought of their departure while at the same time comforted at the reminder that my time will eventually come. Until then, the work must continue to push forward.

To my fellow sailors, "Fair winds and following seas", your presence will surely be missed.

Sunday, March 15, 2009

Day 231: RBWT

Every year we host approximately 600-650 recruits to Khowst as they are here for basic training. The official title of this training evolution is Regional Basic Warrior Training or RBWT. My role in all this is to coordinate the first aid training for the 600+ soldiers which was done in conjunction with my all-star Afghan medics. In the picture below, you see Mohammad Ayub, probably my best-trained medic, teaching the first aid class to the recruits. My US medics and I just hang in the back, and we provide teaching tips on request. The whole class was taught in Dari so I'm assuming that it was medical stuff they were talking about.


As I was watching the training class, with Ayub on a makeshift concrete platform for a stage and 600+ soldiers attentively gathered around him in a horseshoe formation...it reminded me of an outdoor church setting. The moment that I took the picture posted above, for a moment I realized how much I missed being in the calm serenity of a quiet Sabbath at church. Thankfully, the Lord has remained abundantly good on this deployment as I have had several avenues and opportunities to share my faith and encourage others through the study of the Bible. Initially, a lack of the formalized church experience had me worried...no lesson study, sermon, special music, song service...no POTLUCK :( but being out here made me realize that church isn't about the building or even fellow members...it's about a real, personal, life-altering relationship with a living God who wants his children to experience "church" all day, every day through communion with him.

"Preach the Word; be prepared in season and out of season; correct, rebuke and encourage—with great patience and careful instruction." II Timothy 4:2 NIV

Day 230: Camel

One of my medics came up with the crazy notion of taking pictures with a camel before her deployment was up. Well her wish came true! All it took was a request to our local bazaar shopkeepers and Voila!...a week later, we had a jingled-out camel brought right onto base. We totally had a blast and enjoyed an up close & personal experience with an amazing creature.


Hopping aboard the hump of a camel was adventurous to say the least. It also was horribly malodorous. But, the fun of it all kept the smell tolerable:) Who says you can't have a good time on deployment?


Whoa there...stay! Good Camel!


A Camel Close Up

Indeed, it is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God."
Luke 18:25 NIV

Friday, March 13, 2009

Day 228: Practice

As the "doc" I'm tasked with finding creative ways to train our troops in the art of combat medicine and first aid. Funny thing is...I'm no expert myself! Lucky for me, I have a team of medics, all with different experiences, to help me put the training evolution together. We brainstormed the course outline, and our goals for the students (16 total). Because we only had 1-2 hours available per day, we had to spread the course out over 4 days. Here was the break down of our class.

Day #1 - Combat Lifesaver Bag - What's in It?, Principles of Managing an Airway, Triage, Catastrophic Bleeding - Tourniquets

Day #2 - Chest Trauma - Managing a Tension Pneumothorax, Primary/Secondary Assessments, How to Call a MEDEVAC


Day #3 - IV Training and Litter Training - A change of pace from the death-by-powerpoint portion of our training workshop. Primarily a hands-on day. (see the poking above!)

Day #4 - What we call the "Capstone" event of our training workshop. The medics and I planned a "real" mass casualty scenario to familiarize our students with what a multi-trauma emergency can feel like on Camp Clark...here's the scenario...

We have a convoy which just left Camp Clark when an IED exploded just as they left the gate. 1 vehicle was directly hit, and the driver was still able to turn the truck around and come back to base. Apparently, everyone in the vehicle is severely wounded. The truck is now arriving...


The team is on standby as the truck roles in. We have 3 victims - the driver, gunner, and front passenger, all severely injured. The picture above is one of our "victims" with a severe neck wound. One of the students as well as my interpreter, Latif are assessing his "injuries" and transferring him over to a litter (what we in the civilian world would call a stretcher). The primary treatment area is the Troop Medical Clinic (TMC)...


...we pulled the 3 victims from the vehicle, and they have been carried over to the TMC by litter. We have one with a severe neck wound, another with a chest wound, and the other with severe wounds to his R arm/leg. Tourniquets were placed prior to arriving at the TMC.

While in the TMC, the "victims" are being assessed. All were given large bore IVs, chest wounds were treated, airway maneuvers were performed, and a Medevac was called over the radio. The bird is going to land in less than 15 minutes, we need to hurry and get the patients loaded for transport.


As you can see, we could only fit 2 of the 3 victims in our ambulance so the team was able to improvise in order to get the third patient transported successfully (see pic below).


There's our third "victim", strapped onto a litter and placed right on top of the hood. I thought that was an excellent method for transport.


The team did an excellent job from start to finish, from getting the patients out of the vehicles all the way to transporting the patients by ambulance to the helicopter landing zone. A job well done! If anything happens to us on Camp Clark...we'll be ready. Class dismissed!!

Thursday, March 12, 2009

Day 227: Seventy

Today, marked the largest humanitarian clinic we have hosted since I arrived at Camp Clark. Over 70 patients, primarily children, were able to be seen today, and we also had enough help to distribute book bags, coats, shoes, AND soccer balls! Although we had our work cut out for us, we all came together to make the clinic day a success.


Terry and his forklift to the rescue!

A special thanks to our maintenance shop for pumping enough soccer balls, and to our contract forklift driver, Terry, for transporting the box of soccer balls over to the clinic. One of the few times that a forklift truly saves the day!


The Garrison Commander and his entourage

On the ANA side, we had a larger-than-usual ANA contingent to include 3 medical providers, 1 medic, 8 security soldiers, and a a surprise visit from the ANA Garrison Commander and his staff. I think the sea of Afghan children may have overwhelmed him.

Dr. Zahid and his patients

I can recall several clinic experiences where the patient load was less, but my stress level was more. But, for some reason today was a great day. I really felt like we all came together to work as a team. From the US troops, US civilian contractors, interpreters, and ANA soldiers/medical staff - everyone contributed a significant part to the success of today's clinic.

Medic Said Kamal enjoying his time in the coat room

It's days like this that make me feel like I'm making a difference. To see US and Afghan soldiers working together...that's what this mentoring mission is all about. Unfortunately, feel-good days like this come few and far between out here, so for now I'll take it!


"Let the children alone, and do not hinder them from coming to Me; for the kingdom of heaven belongs to such as these."
Matthew 19:14 NASB

Thursday, March 5, 2009

Day 220: Shura

Shura is the Arabic word for "consultation". Many Muslims believe that Islam requires that decisions made by and for Muslim society be made by shura of the Muslim community. They believe that that is the basis for implementing a representative democracy. With that being said, the elders of Khost province felt it necessary to hold a shura between community leaders and the Afghan National Army in Khost in an attempt to discuss the security issues in our area, more specifically the increased enemy activity occurring along the KG Pass. Over 800 local leaders, Afghan Army leaders, and US Army leaders attended the shura (what we would probably call a "conference") in hopes of finding solutions to the growing security problems in our area. High profile events such as shuras, that bring together local leadership, often make prime targets for bombs, so I hung around the shura grounds praying that the meetings would be conducted without any uninvited interruptions.



Shura Attendees

Thankfully, the shura was conducted without incident and everyone left safely. As high-profile as it was, it seemed that the local leaders were more interested in eating and dancing more than listening to the speeches on security. You should have seen the excitement when the Afghan marching band came out, a sea of Afghan soldiers dancing the Afghan national dance...reminded me of line dance routines from a wedding reception, only without women!



The National Dance of Afghanistan

It was a site to see indeed, not just the dancing, but to see Afghan soldiers, in the middle of a war, taking the time to simply have fun.

"There is an appointed time for everything, and there is a time for every event under heaven.. a time to mourn and a time to dance." Ecclesiastes 3:1,4


Monday, March 2, 2009

Day 216: Warehouse

Being a mentor to the Afghan National Army (ANA) has it's share of trials and triumphs. Sometimes it feels like I'm taking 2 steps forward followed by 3 steps back! The US mentor I replaced gave me a forewarning of not to expect too much when it comes to advocating for process improvement. In other words, change even when it is indeed necessary, is not always welcome. In the eyes of the ANA, they are thinking "if it isn't broken, why fix it?", but the reality is that everything is broken and everything needs fixing. Also, even if the ANA know that there is room for process improvement, sometimes just plain old laziness makes for a successful roadblock to any suggestion for change. Nonetheless, the mentoring mission must go on, and the hope for lasting positive change still remains. So to contrast my cynicism...let me share my warehouse experience.


The medical team along with some interpreters scoping out the damage

Well, if there was any mentoring project that was passed on to me with the words of "good luck!", it was the medical warehouse! Actually, the 10,00o square foot storage facility was nothing more than a gigantic stockpile of medical equipment simply tossed into a large building, with the idea of organizing, cleaning, and taking inventory being nothing more than an afterthought for the last several years. Just check out the pics!


More damage that needs scoping

As a clinical mentor, I never thought I would be sweeping floors, moving extremely heavy boxes, or organizing a warehouse full of medical equipment. It's really not that fun. In addition, I never thought I would get my ANA medics to eventually take over the upkeep of the warehouse once we got it all cleaned up. Once again, even less fun. The moment they began to see the progress, I then found a more motivated group of ANA medics willing to take charge. Several weeks later, I was watching my ANA clinical staff taking inventory and organizing the equipment all on their own. Talk about an ANA mentoring triumph!


The ANA medics and US medics bringing about change!



The Fruit of Our Labor

"With people this is impossible, but with God all things are possible."
Matthew 19:26 NASB