Through the Sand

Day 410: Mission Complete

2009-09-07T06:08:00.000-07:00

My journey has finally come to a much anticipated end. And with 10 fingers, 10 toes, 4 limbs, and my life intact I have nothing more important to say than, "Thank you Lord!" Not only for my life that He has so mercifully preserved, but also for the life lessons and the opportunity to use this deployment as a way to encourage and inspire those who may be going through their own version of a "deployment". Knowing that there were family and friends following closely along with me as I journeyed "through the sand" assured me that I was sent there with a purpose much greater than what the Army had in mind for me.

I cannot end this journey without saying "Thank you" to those people whose prayers, support, and love have allowed to me to maintain my sanity these last 13 months.

To Gemma, Max, and Maya - to my most precious gifts that God has given me. Thank you for your strength, support, love, and the amazing ability to adapt to a life without me physically in it. Every second of every webcam minute and every crumb of every carefully packaged cookie that was ever sent to me reminded me of how blessed I really am, and how much God was truly watching over me.

To Mom and Dad - thank you for your unwavering support, as even in your quiet, humble ways your love speaks volumes to me. To Mom and Dad Miranda, a special thanks for your watch and care over Gemma and the children. I will never forget your generosity and thoughtful prayers this past year.

To my Family - I wish I could personally thank all of you, but that would take a while and frankly I'm exhausted. But really, every thoughtful word that was spoken, written on a card, typed on a Facebook message or blog comment, or expressed to me via a care package was an uplifting moment that would energize me for days. Thank you.

To my Friends - It was a joy to stay in touch with and reconnect with so many of you. By the way, you are all directly responsible for my Facebook addiction. Your timely words of encouragement through e-mail or even the occasional "Like It" in response to my status changes on FB made for a more pleasant day. Thanks:)

As I sign off and maneuver my way back into the "real world" I pray that this small life snippet of what I have been through has allowed us to grow closer as family & friends. You have followed me through times of great fear, frustration, pride, happiness, sadness, loneliness, impatience, courage, and accomplishment. In sharing a time in my life when I was most vulnerable, I was reminded that through dependence on others, there is great strength. Thank you all for being a source of that strength. Thank you for seeing me "through the sand".

"Most gladly, therefore, I will rather boast about my weaknesses, so that the power of Christ may dwell in me. Therefore I am well content with weaknesses, with insults, with distresses, with persecutions,with difficulties, for Christ's sake; for when I am weak, then I am strong."
I Corinthians 12:9,10 NASB

Day 406: Gear Drop

2009-09-02T01:27:00.001-07:00

I wanted to share one of the most exhilarating days of the whole deployment...GEAR TURN IN DAY! I finally returned all the combat army stuff that was given to me, the knives, canteens, gas masks, gloves, shirts, pants, cold weather clothing, extreme cold weather clothing, wet weather clothing, extreme wet weather clothing, extreme cold & wet weather clothing, fire retardant uniforms, body armor, boots, gloves, goggles, sleeping pads, sleeping bags, hiking packs, duffle bags...EVERYTHING! Check out some of the action.

An overview shot of the whole process

So excited to give it all back!

...I know that 500 dollar flashlight is in here somewhere!?!

Found It! That was close...

With a huge sigh of relief, and a few days from being reunited with Gemma and the kiddos, I'm as high as a kite on marijuana. At this point I'm trying to relax and enjoy the downtime. The journey is almost over and I know many of you are right there alongside me for the finish...

I hope many of you have been encouraged or touched by the deployment stories as it was only in knowing that I had family and friends supporting me did I make it through. I also hope that you have been blessed by the Scriptural references as they possess great power and wisdom essential to our daily existence. I know they kept me alive!

In sharing my experiences and bringing this exciting life chapter to a close, I now realize that trials are a fact of life and not an arbitrary run of bad luck. Trials hit us often when we least expect it and usually at a time no where near impeccable. My advice is to embrace it. Know that these seemingly life-altering, energy-depleting, earth-shattering events are mere inconveniences when you look at the big scheme of things. God allows trials for the purpose of maturing us, and to prepare us for a life that pales in comparison to this one.

"For momentary, light affliction is producing for us an eternal weight of glory far beyond all comparison, while we look not at the things which are seen, but at the things which are not seen; for the things which are seen are temporal, but the things which are not seen are eternal."

II Corinthians 4:17,18 NASB

Day 403: Transition

2009-08-30T11:08:00.000-07:00

Welcome to Camp Arifjan, Kuwait, home to the Warrior Transition Program (WTP). Being deployed in an army uniform provides many challenges to a Navy sailor as we often have felt like fish out of water...hahahaha...man I've still got it! In an effort to ease the transition back to Navy life as I knew it 12 months ago, this 5 day program was set up to help us sailors relax and reflect on our deployment and how to use our experiences as a way to enhance the lives of our friends, families, and fellow Sailors. Workshops on post-deployment stress, adjustment issues, and reintegration tips are just some of the topics covered. Sounds like fun. It also serves as scheduled, mandatory "me" time in preparation for the onslaught of social gatherings, kiddo activities, and "honey do" errands that are waiting for me.

Here are the highlights of my INTENSE schedule that I have been subject to thus far:

Day 1:

Flight arrives from Afghanistan
2 hour bus ride to Camp Arifjan
Brunch
Discovery of Free Milkshakes
Did I mention FREE milkshakes
Shopping for work out gear that doesn't say "US Navy" on it
Table Tennis
WiFi internet at Starbucks
Table Tennis
Dinner

Day 2:

Cleaning my Pistol and Rifle
Weapons Inspection #1
Re-Cleaning of my Pistol and Rifle
Inspection #2
Re-Re-Cleaning of my Pistol and Rifle
Asking someone who knows what they are doing to help clean my Pistol and Rifle
Inspection #3
Lunch
Catching highlights of the US Open
Working Out
More window shopping
More Internet at Starbucks
Dinner

Day 3:

Gear Turn-In - Yay!
Weapons Turn-In - Double Yay!!
Lunch
Powerpoint Presentations/Workshop
Internet Time
Hit the Gym
Dinner

Day 4:

Interactive Workshops - sharing of deployment experiences
Down Time
Lunch
Medical Outprocessing - make sure I don't have PTSD
Post Office errands
Dinner

Day 5:

Guam or Bust!!

Day 401: Happy Birthday Maya!

2009-08-28T07:10:00.000-07:00

If you were to ask me what the most significant, life-changing event I had experienced this past year was...it would have nothing to do with my career, deployment adventures, awards, or promotions. But, it would have everything to do with the most precious baby girl that came into my life on August 28, 2008 just several weeks before I had to leave for Afghanistan.

Through pictures and the technological miracle of web cam, I have been able to watch my little girl reach her developmental milestones this past year all culminating with the celebration of her first birthday. From her first smile, to watching her crawl, then sit up, eat solid food, and eventually walk...I have been blessed with the experience of being a proud papa despite being thousands of miles away.

I still recall the moment I held her in the airport when I came home for R&R, and watching her as she looked into my eyes trying to recognize me. She didn't cry, she didn't even ask for mommy, she just stared at me as if she knew I was someone that she could trust. One of those daddy moments:)

Knowing that I will be able to hold her again in a matter of days has made this birthday that much more special for me.

Maya, I love you so much. Daddy's deployment is almost over and I'll be able to be with you for so many more birthdays to come. I hope to help you grow into a beautiful young lady who will fear God and love others. Happy 1st Birthday!

"I have no greater joy than to hear that my children walk in the truth."
3 John 1:4 KJV

Day 398: Home Bound

2009-08-25T04:06:00.000-07:00

My bags are packed and I have finally left Camp Clark. I thought this day would never come, but low and behold I am now in Kabul which is the first stop in a series of several outprocessing venues. Just to be able to sit and relax in a place where indirect fire attacks are much less frequent has afforded me the opportunity to take a huge sigh of relief!

My Ride Out of Clark

From here I'll be heading to Bagram Air Field, stop #2, and then on to Kuwait where the Navy has scheduled some much needed decompression time before we are reintegrated back into the world that I had left behind. I'll be sure to let you in on the fun when I get there!

Bags are Packed, Bagram or Bust!!

Day 393: Election Day

2009-08-20T03:19:00.000-07:00

Today, was Afghanistan's election day. In a country that has been struggling to be an independent, self-sustaining nation, and a government that is trying to give the power to the people, there is an obvious importance in the success of this national election. For us Americans, a typical election day is a short walk or drive to a local polling place, votes are cast electronically, you get a nice sticker that says "I Voted", and we are back home in time for dinner. Here in Afghanistan, people cast their vote at the risk of losing their life as anti-Afghan forces will stop at nothing to instill fear in the people and defy the Afghan government through direct attacks on districts where voting is taking place.

An Afghan Police Officer stands watch at a polling place

President Karzai on the campaign trail

Local polling place monitors, moving ballot boxes

For us Americans forward deployed in Afghanistan, we also are on high alert during election day as American bases are also targeted during this critical period. And what do you know...in the last 24 hours, we've been attacked 3 times! Glad to report that no one was hurt, but it just reminds me that there is still much to be done.

Our Election Day Bunker

He who dwells in the shelter of the Most High
Will abide in the shadow of the Almighty.
I will say to the LORD, "My refuge and my fortress,
My God, in whom I trust!"
Psalm 91:1,2 NASB

Day 391: Promotion

2009-08-18T07:59:00.001-07:00

I've experienced various milestones in my lifetime, my first day of college, completing internship, my first day as an unsupervised doctor, watching Gemma walk down the aisle, and becoming a father . In the military, we often experience similar achievements such as receiving a personal award/medal, earning a sterling evaluation, or a rank promotion. Today, I was blessed with a 2-fer. On the brink of completing my first deployment, my boss comes up to me during dinner and congratulates me on my promotion to the rank Lieutenant Commander! I thought it would be special to share this experience with my family and friends who have been following me on this long journey.

I, Michael G Mercado, do solemnly swear that I will support and defend the Constitution of the United States of America against all enemies foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, and without mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter. So help me God.

Day 386: Achievement

2009-08-13T00:16:00.000-07:00

Today, marks my final day of mentoring duties and has been a day that has been highly anticipated by many of the Afghan medical staff. Certificate presentation day:) Afghans love, I mean LOVE, being presented with certificates of achievement. If they could wear it on their uniform I'm sure they would pin it on somewhere! It was indeed an honor to present them with a small token of appreciation for the 10 months that they have worked with me.

Attention to Award!

A Job Well Done

Looking back at the things that we've accomplished: the medical training classes, working side-by-side on trauma cases, cleaning warehouses, providing humanitarian care to the local populace, and adding improvements to the clinic facility, I can honestly say that I will be leaving behind a clinic that is better equipped to accomplish it's mission than when I first arrived.

As long as we, both Afghans and Coalition together, continue to take even small steps in the direction of progress. We will undoubtedly reach the goal of having the citizens of Afghanistan relinquish control of their country, and we will finally go home.

"Well done, good and faithful servant! You have been faithful with a few things;
I will put you in charge of many things."
Matthew 25:21 NIV

Day 383: Meritorious Service

2009-08-10T23:53:00.001-07:00

Being in the Navy for more than 5 years I have seen many awards ceremonies for sailors. As a medical officer, I noticed that military decorations don't come along too often for young Navy physicians as up to this point my Navy uniform is essentially bare. Well, my time has finally come. In exchange for being away from family, friends, and being in harms way for a prolonged period of time...I get to have my first military decorations presented to me. In a way, I was reminded of the feelings that I felt during previous graduations, the sense of accomplishment, the sacrifice, the hard work, and the thoughts of the future that lies ahead.

As part of my blog entry, I went ahead and posted the official citation of the 2 personal awards I was given.

THE MERITORIOUS SERVICE MEDAL

For exceptionally meritorious service while deployed in support of Operation Enduring Freedom as the Camp Clark Medical Officer in Charge and Combat Clinical Operations Advisor, Afghan Regional Security Integration Command-East, Combined Security Transition Command-Afghanistan. Lieutenant Mercado's tireless efforts, dedication, professionalism, and clinical acumen greatly contributed to the health and welfare of Camp Clark personnel, and the overall success of the Brigade's mission. His performance of duty in a combat zone reflects great credit upon himself, the Combined Security Transition Command-Afghanistan, the United States Central Command, and the United States Navy.

MILITARY OUTSTANDING VOLUNTEER SERVICE MEDAL

For selfless service, and volunteering over 600 hours of his time in care of the people Khowst, Afghanistan. Lieutenant Mercado prepared an abandoned building for use as a medical clinic and humanitarian distribution center for villages in the Nadir Shah Kot district. He coordinated medical care, as triage, pharmacy, and humanitarian aid coordinator, to over 2000 local nationals and distributed over 20 tons of humanitarian assistance over an 11 month period. His tireless efforts led to the donation of an additional 10 tons of supplies in direct support of the humanitarian efforts of the clinic, local Shuras, and Spera COP which has made a lasting impact on the relations between the local populace and the Afghan National Security Forces. His volunteer service in support of the Afghan community and combined counterinsurgency efforts reflects distinct credit upon him, the Combined Security Transition Command-Afghanistan, the Central Command, and the United States Navy.

A post-awards ceremony picture with my good friend,
Verdell Mitchell

The LORD has dealt with me according to my righteousness, according to the cleanness of my hands he has rewarded me.
Psalms 18:20 NIV

Day 382: Short Timer Syndrome

2009-08-09T10:14:00.000-07:00

CASE: 31 y/o male, Navy physician who has been deployed to Afghanistan for a year in support of US Army operations. As his first deployment, he has been assigned to a small forward operation base in the Southeastern province of Khowst where Taliban activity is highly prevalent and mortar/rocket attacks are commonplace. After 10 months of mentoring Afghan Army soldiers, running into bunkers for cover, eating with plastic silver ware, being subject to dial up speed internet, and providing medical care for US troops, he has now been offered to be released from theater to be back home with his family within the next 2 weeks.

A Popular Depiction of a Short Timer's Calendar

Since that time he has been experiencing a myriad of symptoms to include a heightened increase in morale, anxiety, restlessness, euphoria, and an intense urge to do nothing. He is often seen with big smile on his face as soldiers walk by him and refer to him as, "Short Timer", not realizing that they are only exacerbating his symptoms further.

DISCUSSION: The Short Timer's Syndrome, or STS, was described and studied in the military especially during the first 2 World Wars. The STS has been well-documented in every military conflict since that time. Associated with longer tours of duty, the STS is described as a shift in morale, rise in anxiety, and a withdrawl from commitment to combat. In many cases, the soldier has lost so much combat effectiveness that they had to be moved to noncombatant positions as the end of their tour approached. The behavioral patterns noted among short timers in the military can be dramatic, such as this classic description from 1967,

"There is the period of anxious apprehension, a potentially severe syndrome of emotional distress beginning mildly two to three months before rotation,but usually occurring obviously in the last three weeks of the tour and most marked the last three days prior to rotation. Irritability seems to alternate with euphoria. Pacing is a common sign. Quiet hard working individuals who for eleven and three quarters months have put up with deprivations, long working hours, and continually increased demands will suddenly behave in a rather inappropriate manner.”

A Classic Case of Severe STS

References:

Stawicki, SP. Short timers syndrome among medical trainees: Beyond Burnout, OPUS 12 Scientist 2008;2(1):30-32.

Day 377: Peace

2009-08-04T10:34:00.000-07:00

Well I'm back in deployment mode (sort of) and ready to take on these next few weeks before finally going home:) Things have been rather slow around here as I have already passed on most of my responsibilities onto the new medical provider who arrived just before I left on leave. I actually feel rather out of place being unemployed.

Today, was actually fun as we opened up the doors of the Camp Clark Community Clinic once again to distribute the much desired humanitarian supplies in the form of school supplies, shoes, food, and water. As I stood and watched the kids with their enthusiastic smiles and infectious energy I realized that I never got to catch even a few seconds of it on video.

What you hear them saying is, Walaikum Salaam translated "And unto you, peace" , a response to the typical Muslim greeting of Salaam Alaikum - which means "Peace be unto you".

I've repeatedly used this greeting not realizing that what I was saying was so much more than a mere "hello". I was wishing them something that they have been longing for, something that I am here fighting for. As I reflect back on the things that I've accomplished during this arduous deployment I can only hope that the work that has been done here will bring them ever so closer to a life full of peace.

"Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid." John 14:27 NASB

Day 367: R&R

2009-07-25T23:53:00.000-07:00

I just finished my 2 weeks of R&R aka rest & relaxation/recuperation time with my family who is situating nicely on the island of Guam. The worst thing about being there was knowing that it would all come to an abrupt end, and I would eventually find myself back in Afghanistan:( Well, that time has come and after close to 30 hours of economy class seating I am now in Kuwait waiting for yet another cramped flight to take me back to Afghanistan.

You may be wondering what exactly did I do for the 2 weeks that I was there. If you could imagine with me the things that you would do if you were away from "normal life" for close to a year, and I would bet that your list would share some things in common with mine. Here is my R&R intinerary in no particular order...

Hugged Gemma and the kids over and over again, hugged a former military Vet, took walks in civilian clothes, ordered food from a menu, took a deep breath of fresh air, drove a car, pushed Maya in a stroller, pushed Max in a stroll, went for an outdoor jog on a paved road, arranged for our internet and phone to get installed, renewed our lease, went grocery shopping, had my Navy uniform pants tailored, picked up packages at the post office, sent off packages, went to church, sang a solo for church, enjoyed church potluck, went out to eat at most of my favorite restaurants with my favorite people, took Gemma and the kids to Underwater world, enjoyed an oceanside sunset...

...spent time with my mom who was visiting, enjoyed several servings of Halo Halo, played Nintendo Wii, watched the Food Network, read bedtime stories to Max, took Max to the library

...tried to get Maya to walk before leaving, but I wasn't successful, cleaned up the kids' play area, gave the kids baths, gave Max toothbrushing tips, changed diapers...lots of diapers, reconnected with family and friends, got sunburned from swimming at the pool, drove around the island, attended a birthday party, watched Max try and hit a pinata, attempted to ride a skateboard

...bowled a >150 game, helped Max bowl...he converted a difficult split, had the youth over for bible study, worked on helping Gemma unpack, went shopping for new sunglasses, was in awe of just how fast cable internet really is, played with Gemma's cool SLR Nikon camera, had Miyosaki Butterfish at Roy's Restaurant, had Salt & Pepper Tofu from Shirley's, walked around Chamorro Village, checked out the carnival, enjoyed the Liberation Day Parade...man I'm pooped.

Will be back home soon!

"Come to Me, all who are weary and heavy-laden, and I will give you rest. Take My yoke upon you and learn from Me, for I am gentle and humble in heart, and you will find rest unto your souls. For my yoke is easy and My burden is light."

Matthew 11:28-30 NASB

Day 350: Home Again

2009-07-09T23:20:00.000-07:00

I'm home! I'm home! I'm home! Words cannot express what I've been feeling since I held my family for the first time in almost a year. With that emotional high, I will take a break from the blog to spend 15 wonderful days with my Gemma, Maxwell, and Maya Lourdes back home on the island of Guam. No mortar attacks, no convoys, no shower shoes, no weapons...ahhh paradise!

Day 347: Journey Home

2009-07-07T00:51:00.001-07:00

As I am sitting here in my temporary hotel room here in Dallas, I finally have a chance to chronicle the first leg of my journey home...

July 3rd: First stop, a 10 minute Chinook helicopter ride to Forward Operating Base Salerno. As I was ordering a Subway sandwich, a rocket attack occurred. I hit the quickly hit the ground and pulled a civilian reporter down with me who was also in line ordering a sandwich. I think she was mad because I may have reaggravated a prior knee injury...one of the hazards of being out here I guess!

July 4th: I then caught a Black Hawk helicopter ride from Salerno to Bagram Air Field (BAF). A very scenic flight. I wish I had pictures. While at BAF I enjoyed a DQ Butterfinger Blizzard as well as 4th of July celebration lunch before flying out to my next destination...

July 5th: Kuwait...I've never been there before, but all I could think of is HEAT! I think it was 120 degrees there. It was not that exciting of a stop...lots of paperwork, briefings, customs, and crowded transient tents. The coolest thing there was a large concrete barrier of the Guam flag...reminds me of home!

July 6th: All I have is 2 words. FIRST CLASS! I finally scored some first class seating on the plane home from Kuwait to Dallas. Ahhhh...now I see what all the fuss is about. Plush leather seating with Lazy Boy recliner features, talk about comfort. Included a nice sunset view as we flew over Germany.

The first half of my journey home ended with a warm homecoming by some very grateful Dallas residents. As we walked out of baggage claim we were greeted by loud cheers, balloons, handshakes, cameras, and even candy bars. For a moment, I felt like a celebrity:) Above is a picture with some very enthusiastic kids...

Man I'm beat! Can't wait for tomorrow...Guam here I come!

Day 339: Burn!

2009-06-29T12:33:00.001-07:00

I wanted to share one of my more tangible accomplishments since being deployed here in Afghanistan as a medical mentor. One of the obvious deficiencies here at the Afghan Army clinic is their inability to properly dispose of their medical waste such as contaminated needles and other equipment that has contact with bodily fluids. Currently, all of this medical waste is thrown into the regular trash which poses a significant health risk to the surrounding community. To help curb this problem, I sought out to get a medical waste incinerator installed here on base. Although the process to request and arrange the installation was long and extremely painful, the finished product is finally here!

April 2009, the medical incinerator arrives on post!

June 9th, the foundation is completed

June 14th, the posts are placed and the fencing begins

June 19th, the incinerator is brought over to the site and the building of roof begins

June 20th, fencing is completed

June 29th, the grand opening and first test run! Oooo Ahhh!!

Talk about mission accomplished! I'm glad to see that we have the means necessary to prevent the potential spread of blood-borne illnesses. I just hope that we don't run into issues of the machine breaking in the near future! We'll see.

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

Day 338: Parting Gifts

2009-06-28T23:04:00.001-07:00

My Afghan Army counterpart, Colonel Shah Zad Gul, and his medical staff had a pleasant surprise for me just before leaving on R&R. He bought me some authentic Afghan clothing to include a hat, vest, and a festive head covering accessory that hangs down from my head to my back. He went on to tell me that this is the Afghan way of saying "thank you" to good friends. He then offered to take me for a night out on the town, Khowst City, as he thought I would blend in quite easily and getting captured by some bad guys wouldn't be likely. I respectfully declined.

I was so appreciative at such a generous gift as I know Afghans make hardly anything at all. But beyond the giving of some tangible gift, I'm blessed to see that they saw a value in having me be a part of their medical mission, and that they saw me as one of them.

As much as I have had my share of frustrating and discouraging mentoring moments, I'm glad to have been not only a mentor but also a student of their often misunderstood culture. A culture that has been tarnished by the few who continue to perpetuate their extremist views that have resulted in this Global War on Terrorism, but in my opinion a culture that has survived decades of war and poverty because of their loyalty, generosity, strong sense of family and friendship, and spiritual strength.

"In everything I did, I showed you that by this kind of hard work we must help the weak, remembering the words of Lord Jesus himself said: 'It is more blessed to give than to receive.' "

Acts 20:35 NIV

Day 337: Sacrifice

2009-06-27T07:40:00.001-07:00

Although I have seen and cared for many wounded and fallen soldiers during my tenure here in Afghanistan, nothing ever prepares you to care for a fellow US soldier who has made the ultimate sacrifice for their country. These are the experiences that have made my deployment difficult, at times unbearable.

Today, our camp stood down from the usual duties to honor our recent fallen brothers, First Sergeant Blair and Sergeant First Class Dupont. Two men who exemplified and defined the meaning of valor, honor, and sacrifice.

I have never attended a Fallen Soldier ceremony until today, and although I barely knew these two men, I was still very moved. Despite the dusty and stuffy venue, the ceremony was conducted with the utmost dignity from the meticulously prepared display of the soldiers' gear and awards to the thoughtful words that were shared from fellow soldiers. These two men will be sorely missed.

In the same way that these men have willingly paid the ultimate sacrifice for their country, we are called to make ourselves living sacrifices for God as He made the ultimate sacrifice for us. As you ponder the loss of these soldiers, the families they have left behind, and their honorable service, consider the gift of life that you have been given and the potential for living that life for the benefit of others. A life set aside for the good of others is a life of valor, honor and sacrifice. That is what has been asked of us, no less.

"Therefore, I urge you, brothers, in view of God's mercy, to offer your bodies as living sacrifices, holy and pleasing to God—this is your reasonable act of worship."
Romans 12:1 NIV

Day 336: King of Pop

2009-06-26T11:52:00.001-07:00

We were prepping for an early morning convoy operation when I noticed my good friend, Mitchell, who was staring aimlessly and with a look of complete bewilderment and sadness all mixed together. I thought maybe he was dreadfully tired as he had just returned from leave and was likely still jetlagged and sleep-deprived. When I asked him what was wrong he told me, "Michael Jackson died!". I didn't know what to say. Honestly, as much as I have been entertained by the King of Pop with his moonwalks, catchy songs, and his high-pitched "eee hee or ooo hoo", I was actually quite surprised at Mitchell's distraught expression as if he had just lost a close friend. I actually felt a little guilty that I didn't share in his grief, so I decided to take a few seconds to think about which of his songs had been the most memorable for me...here are the lyrics.

"Man In The Mirror"

I'm Gonna Make A Change,
For Once In My Life
It's Gonna Feel Real Good,
Gonna Make A Difference
Gonna Make It Right . . .

As I, Turn Up The Collar On My
Favorite Winter Coat
This Wind Is Blowin' My Mind
I See The Kids In The Street,
With Not Enough To Eat
Who Am I, To Be Blind?
Pretending Not To See
Their Needs
A Summer's Disregard,
A Broken Bottle Top
And A One Man's Soul
They Follow Each Other On
The Wind Ya' Know
'Cause They Got Nowhere To Go
That's Why I Want You To Know

I'm Starting With The Man In
The Mirror
I'm Asking Him To Change
His Ways
And No Message Could Have
Been Any Clearer
If You Wanna Make The World
A Better Place
Take A Look At Yourself, And
Then Make A Change

Although many people may remember him as controversial and downright weird...I would like to think that he had a sincere desire to contribute positively to our world. Yes, he was misunderstood, chastised by the media, and hammered with rumor after vicious rumor, but despite all of that he continued to portray himself as a man who still had love to give.

MJ, may you rest in peace.

Day 333: One Hundred

2009-06-23T19:26:00.001-07:00

If anyone has been paying attention to my deployment countdown, you would have noticed that I am within 100 days of completing this deployment! Just thought I would throw it out there for anyone that may want to feel excited for me...

One Hundred Days and counting...woohoo!!!

Day 331: Dad

2009-06-21T00:31:00.001-07:00

Fatherhood has been one of the most thrilling and exhilarating experiences of my life. Being away from Maya and Maxwell, especially on Father's Day, has made me appreciate even more the blessing that comes from raising children. Although my time with them this past year has been spent primarily on a webcam, watching Maya go from crawling to standing or observing Maxwell as he shoots hoops on his toy b-ball court has given me the strength to overcome the drudgery that comes with this deployment. Before I know it, I'll be trading in guns and body armor for diaper duty and bath time.

Quality Time

Storytime!

Dad and Grandpa with Maya

I also wanted to mention a special "thank you" to my dad for the support that he continues to provide especially during this time that I have been away from Gemma and the kids.

Happy Father's Day Dad!

"Just as a father has compassion on his children, so the Lord has compassion on those who fear Him." Psalm 103:13 NASB

Day 330: Fallen Heroes

2009-06-20T08:00:00.000-07:00

Today, is a sad day as we lost one our fellow team members in the midst of battle. It's times like these that remind us just how much our heroes are sacrificing for the sake of freedom. Please keep us in your prayers as we continue on in our mission.

"He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away."
Revelation 21:4 NKJV

Day 328: Corpsman

2009-06-18T12:33:00.000-07:00

Hospital Corpsman Pledge

"I solemnly pledge myself before God and these witnesses to practice faithfully all of my duties as a member of the Hospital Corps. I hold the care of the sick and injured to be a privilege and a sacred trust and will assist the Medical Officer with loyalty and honesty. I will not knowingly permit harm to come to any patient. I will not partake of nor administer any unauthorized medication. I will hold all personal matters pertaining to the private lives of patients in strict confidence. I dedicate my heart, mind and strength to the work before me. I shall do all within my power to show in myself an example of all that is honorable and good throughout my naval career."

Crazy picture I know...

On June 17th, 1898 President William McKinley signed into law a Congressional bill authorizing the establishment of the U.S. Navy Hospital Corps. Yesterday, we honored the 111th birthday of the Hospital Corpsman. Hospital Corpsmen serve as enlisted medical specialists for the United States Navy and United States Marine Corps. The Hospital Corpsman serves in a wide variety of capacities and locations, including shore establishments such as naval hospitals and clinics, aboard ships as the primary medical caregivers for sailors while underway, or with Marine Corps units.

Petty Officer Garcia conducting IV Training Class

Be they assigned to hospital ships, reservist installations, recruiter offices, Marine Corps combat units, or joint units such as the mentoring mission here in Afghanistan, the rating of Hospital Corpsman is the most decorated in the United States Navy with 22 Medals of Honor, 174 Navy Crosses, 31 Distinguished Service Medals, 946 Silver Stars, and 1,582 Bronze Stars. There have been 20 naval ships that have been named after hospital corpsmen. Talk about overachievers!

The sole Navy Corpsman on post, Petty Officer Garcia

In my young career as a Navy physician, I have had the privilege of working with some of the brightest and most motivated medical professionals, my Navy Corpsman. Their knowledge and clinical expertise rivals any 3rd or even 4th year medical student. They are the backbone when it comes to getting my clinic duties done whether it's back home on Naval Hospital Guam or here in theater...my Corpsman lead the way! Happy 111th Birthday!!

"Heal the sick, raise the dead, cleanse those who have leprosy, drive out demons. Freely you have received, freely give."
Matthew 10:8 NIV

Day 326: Finals

2009-06-16T07:47:00.000-07:00

If anyone knows me, they would know that my all-time favorite sport is basketball. Whether it's shooting jump shots on the court or watching an NBA playoff game on TV...it is one of my favorite things to do. In addition, if anyone knows me they would know that I'm not a Laker fan and probably the exact opposite. Perhaps, it's my first impressions of a cocky Kobe Bryant or an even more annoying, no free throw making Shaq. Maybe it's the fact that almost all of my friends love the Lakers, and I simply enjoy going against the grain so to speak:)

Well, I just wanted to take a few moments to congratulate all of my bandwagon Laker fans out there...we'll see what next year brings.

Day 317: On Their Own

2009-06-07T11:13:00.000-07:00

As an Embedded Training Team (ETT) member, my overarching goal is to get my Afghan medical counterparts to perform their responsibilities on their own. The US presence here in Afghanistan has created an overdependence on our weapons, expertise, and money which we as ETT members have tried to minimize. If I had to objectively measure any kind of success during my time here, it would be in terms of what my Afghan medical counterparts have been able to achieve or implement on their own such as conducting of first aid classes for non-medical personnel, staging vaccination clinics, producing a mass casualty plan, adhering to an ongoing training schedule, and so on and so forth. In the last week, I have been able to see the progress that my Afghan mentees have been able to achieve.

We have shown them how to conduct an efficient and safe vaccination clinic following all universal precautions such as clean technique, gloves, and utilization of sharps containers.

And as you can see, the vaccinations were prepared and administered by the Afghan medics only. I purposely left my US medics out of this one and allowed myself to simply take pictures and make sure that they were not throwing their needles into the regular trash...they still needed a little coaching on that part though.

The other success story was watching their ability to teach a basic first aid class to soldiers without any medical background.

As you can here, First Sergeant Mujahid and Corporal Gul Rahman, 2 of my hard-working Afghan medics have the class under control. Way to go gentleman! My work is done...at least part way.

Day 316: Oasis

2009-06-06T11:06:00.001-07:00

Oasis

a small fertile area in a desert region, usually having a spring or well
OR
something serving as a refuge, relief, or pleasant change from what is usual, annoying, difficult

When I first arrived in country and found out that I was coming to Camp Clark, people always referred to Clark as the base rumored to have a swimming pool. As if it was some mystical oasis with magical healing powers. I guess when you see where Khowst is on a map of Afghanistan...we really are in the middle of nowhere which would make a swimming pool more of an impossibility.

Check Out my Toy Rocket!

Well, let me dispell all the speculation and rumors for everyone. The pool exists! We had the grand opening today, and we had a blast. In more ways than one has this pool served as an oasis both as a rare find in the middle of the desert, but also as a refuge from the daily reminders that we are in a war. For the 15 minutes that I was in the pool, I felt like I was on a resort vacation...aahh...what a feeling. You know, it's seemingly little things like a quick dip in a swimming pool that goes a long, long, long way to boosting morale on a deployment. Whatever I can do to get through the day, I'll take it!

I, the God of Israel, will not forsake them. I will make rivers flow on barren heights, and springs within the valleys.
I will turn the desert into pools of water, and the parched ground into springs.
Isaiah 41:18 NIV

Day 313: Follow Up

2009-06-03T06:16:00.000-07:00

Since I've been here in Afghanistan our small base has been attacked 15 times to include a combination of rockets, mortars, and improvised explosive devices. Fortunately, 14 out of those 15 times no one was hurt and the mission continued on as usual. But, the one significant casualty occurred during our most recent rocket attack as my medical team and I were urgently summoned to the the Afghan Army clinic to assess a young soldier who caught shrapnel into his chest. What made this experience so interesting was that we weren't sure if the rockets had stopped coming so we had to dash up to the Afghan clinic with our "full battle rattle" on. Come to find out, this soldier was struggling to breathe as a result of the shrapnel still stuck in his left chest. From what I could tell, he was retaining air in his chest cavity through the hole in his chest (tension pneumothorax) which required urgent decompression with a large bore needle. I had my Afghan medic pull out a long 14 gauge (very large bore) needle and walked him through the insertion of the needle over the patients 3rd rib and into the chest cavity to release the air that was building up...which, by the way, temporarily relieved his shortness of breath. At that point we quickly called for an air medevac and took him to the landing zone, and while standing there waiting to have the patient picked up I prayed so hard that no more rockets would be launched at us as we were hanging out in the open air without the safety of a bunker.

What happened to the patient? Lucky for me, I was already on a convoy mission to Forward Operating Base Salerno the very next day which was where our trauma hospital was located. So when I arrived on post, I swung by the hospital to pay him a visit, and low and behold there he was with a chest tube in place. Come to find out, that needle decompression bought him just enough time to get the definitive treatment that he needed. Talk about a follow up visit with a happy ending!

Day 311: Recognize

2009-06-01T10:20:00.000-07:00

Recognition through the awarding of personal decorations and awards has been a time-honored military tradition. It has been a method of motivation, and sometimes healthy competition amongst the men and women in uniform. At the same time, an awards ceremony often marks the end of an individual's tour of duty. Today, we recognize a team of individuals who have reached that long-awaited milestone.

Today, I had the privilege of witnessing the awards ceremony for our Air Force team here on Camp Clark. In various capacities have they served our base either as battle captains, radio operators, internet/communication maintenance officers, and combat medics. Obviously, most near and dear to my heart, and at times the thorns in my side, have been my Air Force medics. For the last 6 months they have been "my team" when it comes to the day-to-day mission of the Troop Medical Clinic.

They have maintained their professionalism, poise, motivation, and dedication to the mission.

But, they have also easily fooled me and have revealed their mischievous ways along with their tendencies toward slackerism (...my word). Nonetheless, they have all grown on me, kinda like an unrelenting fungus.

Air Force & Navy like Peas & Carrots!

In all seriousness, I have grown to be proud of every one of them as each one has established their personal legacy as an integral contributor to the objectives of Operation Enduring Freedom. Whether it's providing tactical care during a 4-hour standoff against the Taliban, coordinating the distribution of over 10 tons of humanitarian assistance to poor local national children, taking charge of the Troop Medical Clinic daily operations, or medically covering down on Field Artillery missions and Mounted Combat Operations (aka convoys) - I can honestly say that they have each left this country with much more than a bunch of medals/awards. They are concluding their tour with the recognition that they are American heroes and have served their country with distinction, and for that I am truly grateful.

"Rejoice and be glad, because great is your reward in heaven..."
Matthew 5:12

Day 306: Rejuvenated

2009-05-27T11:55:00.000-07:00

If I could sum up my trip to Gardez in one word, the word would be "rejuvenating". For the last 7 months I've been working around the same people and have become woefully familiar with the surroundings of Camp Clark. You can only do and see so much on a base the size of a couple of football fields! I had to go somewhere, anywhere! And what better place than to visit the regional hospital that I refer Afghan Army patients to here in Eastern Afghanistan.

Here I am playing the tourist and taking the token picture in front of the sign! But, my trip was more than a relaxing getaway as I spent lots of time exploring the hospital and getting a feel for the scope of services that are offered at the hospital. Also, I spent some time with the Air Force medical mentoring team that was assigned to the hospital. I amazed to find that there was a US mentor assigned to almost every section of the hospital...laboratory, pharmacy, radiology, nursing, admin, medical warehouse, and an Emergency Room physician. I was so jealous since I have been a mentoring team of ONE!

Here is a picture of myself along with the entire Paktiya Regional Hospital mentoring team which was primarily an Air Force manned team.

Although I tried to get away from work I just had to be visiting Gardez when a pregnant Afghan woman, who was in labor and completely dilated, was evacuated to the hospital (see the medevac helo above). I was told that a case like this had rarely, if ever, came to the military hospital. Apparently, no one on the medical mentoring team was comfortable managing a laboring mom so they called me. It was nice to feel needed, but it did cut into my internet and tea time:)

Well, it had been almost a year since I had delivered a baby so I was a little nervous. This was also compounded by the fact that I was a foreign male performing obstetrical care on an Afghan woman which is not what they are accustomed to. After getting the patient settled in, I had learned that this was her 5th or 6th birth, she had no prenatal care, and her blood pressure was in the 200s! I popped the ultrasound on her and confirmed that the head was down and there was a fetal heart beat. So we started to push as I thought this baby would pop out in a jiffy...

Well I was completely wrong...a jiffy turned into 3 hours and mom was starting to get extremely tired which resulted in very weak pushes. We had no surgeons qualified to perform a C-section so to make a long story short we ended up transferring her to a civilian obstetrician in the middle of laboring! Thankfully, a healthy baby boy ended up being delivered hours later without a surgery or any other significant complications. Whoa...talk about an exciting patient care experience in Afghanistan.

Outside of that excitement, the rest of my trip was rather informative and relaxing. Here's a picture of me sitting at the top of a sandbag barrier overlooking a herd of goats grazing. It was actually very peaceful and soothing to observe. Overall, a very memorable and productive trip.

"Peace, peace, to those far and near, says the LORD. And I will heal them."
Isaiah 57:19 NIV

Day 304: Memorial Day

2009-05-25T19:29:00.001-07:00

Today, is Memorial Day. For most, a convenient weekend for a graduation or a weekend getaway. At least that's how I used to treat it. But as a deployed servicemember, and having personally known fallen comrades, I now have an entirely different perspective on Memorial Day.

As I was exploring my new surroundings here at FOB Lightening I noticed the flag pole area which flew flags at half mast in remembrance of fallen soldiers. As we take this time to remember the ultimate sacrifice that many soldiers, sailors, and airman have made for the sake of freedom, please also remember that conflict, in this world, still exists...and still at the expense of American lives even today. Also, recall that sin remains in existence today, and although the result of sin is eternal separation from God we have been blessed with the sacrifice of Christ and freedom from sin. I only ask that you continue to cherish and value the freedom that has been given to you at such a costly price.

"All we like sheep have gone astray;
We have turned, every one, to his own way;
And the LORD has laid on Him the iniquity of us all."
Isaiah 53:6 NKJV

Day 303: Getaway

2009-05-24T09:36:00.000-07:00

I am so excited! After almost 8 months of being on a small base around the same 150 people, who wouldn't go a little stir crazy? I decided to plan my own little "vacation" to FOB Lightening in the community of Gardez about 20 minutes, by Chinook helicopter, West of where I am located on Camp Clark. So much for a getaway right? Going from one place in Afghanistan to another...this is where a little imagination can go a long way!

Scenes from the Ride to Gardez

Gardez is where our regional headquarters is located, and where other Medical Embedded Training Team (ETT) members are planning to meet and talk about the current state of our medical mentoring mission. I also plan to visit the Paktiya Regional Hospital here in Gardez which is where I refer many of my Afghan Army soldiers for treatment. The problem is that I have no idea what their capabilities are which is always a good thing to know. I hope this trip ends up being both pleasurable and productive...Inshallah!

Day 302: Low Op Tempo

2009-05-23T19:52:00.000-07:00

Being deployed, we often forget what day of the week it is since most days are filled with the same routine. Here on Camp Clark, we look forward to "low op tempo Fridays" as this is when Afghans take the day off which means we take the day off as well! Throughout this deployment I've used my Fridays to catch up on reading, continuing medical education, cleaning my room, working out, watching a movie, doing laundry, and all the other things that I don't get to finish during the week. Well today, I had so much free time that I decided to hang out with my shopkeeper friends in the bazaar adjacent to our base.

The Tailor, Steve, and AJ

Hanging Out with AJ, Saddiq, and the tailor

Talk about a relaxing day. I'm really not used to having absolutely nothing to do, but I have been slowly finding myself bored silly at times. Well, I'll take all the "low op tempo days" I can get!

Day 295: So In Love With You

2009-05-16T05:02:00.000-07:00

It was five years ago today, that I sang to my beautiful bride as she walked down the aisle the words to this song...

You are to me, what poetry tries to say with a word
You are the song, all the music my heart ever heard
I can't escape, for the air that I breathe even speaks of you
And I'm not ashamed to say, that I feel this way

Words can't express, what I confess with each beat of my heart
And I'm overwhelmed, with the passion I've felt from the star
Our love will grow, as the years come and go I'll remain by your side
And there isn't anything that I would deny

I will stand before God, give you all that I've got
I will promise you, I'll be true
I'll reveal here and now as we both take this vow
That I am so in love with you!

And 5 years, 2 children, and 1 painful deployment later...I can honestly say that I have found the woman that I was meant to spend the rest of my life with, and I can still say that I am truly "so in love with you!". These last 10 months have reminded me just how precious her presence has meant to me, and how blessed I am to have her in my life. Thank you Gemma for the friend, mother, and companion that you are. I love you!

The Proposal at the LLUSM Talent Show 2003

5 Years of being blessed!

I'll be home soon!

"...I have found the one my heart loves."
Song of Solomon 3:4

Day 293: Finally

2009-05-14T11:04:00.001-07:00

Part of being a medical mentor to the Afghan Army involves helping them obtain the equipment and supplies they need to fulfill their medical mission. Since arriving here I've shared my trials and triumphs that have come from working with this unique culture. One of the bullets on my "Things-To-Do" list for the Afghan National Army was to get their state-of-the-art X-ray machine up and running again. Apparently, this was a gift from the US military...unfortunately a gift that would prove to be extremely high maintenance. It has been close to over a year since this thing has been working. Here are some of the problems I have had to deal with:

1. This piece of machinery is well ahead of their time as I am still working on getting them to use simple technology like thermometers, blood pressure cuffs, and stethescopes...what in the world are they going to do with an X-ray suite.

2. No one thought of the difficulty in maintaining this machine as there are only a handful of contractors who can service it in the whole country.

3. No contractor wants to come down here because Khowst Province is way too dangerous. I have heard every excuse in the book..."we can't get a flight", "we didn't know there was a machine there", "my travel visa is expired", "oh my ID is expired", "the weather is bad", "the clinic is not on our map", "our schedule is full", "let me check my schedule", eventually all I heard was "blah blah blah blah blah". Kinda like that teacher on Charlie Brown..."wuah wuah wuah wuah wuah!"

Finally Fixed!

Well after over 6 months of e-mails, phone calls, and literally begging for someone to come down here...the contractor FINALLY made it! I think the contractors drew straws to see who would make the trip here. What a lesson in patience!

"The end of a matter is better than its beginning
and patience is better than pride."
Ecclesiastes 7:8 NIV

Day 289: Mom

2009-05-10T20:00:00.001-07:00

A Biblical Portrayal of a Godly Woman: Mom

"An excellent wife/mother, who can find? For her worth is far above jewels.
The heart of her husband/son trusts in her, and he will have no lack of gain.
She does him good and not evil all the days of her life.
She looks for wool and flax and works with her hands in delight.

She girds herself with strength,
and makes her arms strong.
She extends her hands to the poor,
and she stretches her hands to the needy.
Strength and dignity are her clothing,
and she smiles at the future.

She opens her mouth in wisdom,
and the teaching of kindness is on her tongue.
She looks well to the ways of her household,
and does not eat the bread of idleness.

Her children rise up and bless her; her husband also,
and he praises her saying: 'Many daughters have done nobly,
but you excel them all!'

Charm is deceitful and beauty is vain, but a woman who fears the Lord,
she shall be praised!" Proverbs 31:10-13, 17, 20, 25-30 NASB

This is to all the Mothers in my life...Happy Mother's Day! I love you.

Day 284: Cinco De Mayo

2009-05-05T02:15:00.001-07:00

While deployed, we find ways to keep ourselves either busy or entertained. We workout, watch movies, play sports, video games, and celebrate every holiday possible. In celebration of the most festive May holiday ever, Cinco De Mayo, we put together yet another 5K race! Here are some facts regarding Cinco De Mayo and some fun pictures themed to this Mexican holiday.

Cinco de Mayo (Spanish for "fifth of May") is a regional holiday in Mexico, primarily celebrated in the state of Puebla, with some limited recognition in other parts of Mexico. The holiday commemorates the Mexican army's unlikely victory over French forces at the Battle of Puebla on May 5, 1862, under the leadership of Mexican General Ignacio Zaragoza Seguin. The outnumbered Mexicans defeated a much better-equipped French army that had not been defeated in almost 50 years.

While Cinco de Mayo has limited significance nationwide in Mexico, the date is observed in the United States and other locations around the world as a celebration of Mexican heritage and pride. A common misconception in the United States is that Cinco de Mayo is Mexico's Independence Day which actually is September 16 the most important national patriotic holiday in Mexico.

Love the Sombrero

Man I'm Beat!

Why Not Celebrate With Fellow Afghans...Good Times!

Day 280: Fellowship

2009-05-01T10:49:00.000-07:00

Afghans are very welcoming and enjoy playing the role host from time to time. In celebration of being in country over 6 months, we decided to have a party with my Afghan Army medics and interpreters. Nothing elaborate...just a combination of good food, hanging out, and learning the Afghanistan National Dance. A simple evening really. Here are some shots of our festive fellowship evening. You might see some military folks blending in with the local population...

Where There is Time for War, There is Still Time for a Party!

Petty Officer Mitchell Dancing in His New Man Jammies

Smile!

Around the 6-month mark, people tend to hit a new low when it comes to morale. Perhaps it's homesickness, being cooped up on a small base, boredom, or fear. I thought it was a myth when someone told me about the "6-month syndrome", but you know...it's for real and it happens to the best of us. Please continue to pray for the soldiers, airman, and sailors who are out here, out of their comfort zone, away from their loved ones, and often in harms way.

"And let us consider one another, to provoke unto love and good works. Not forsaking the assembling of ourselves together as the manner of some is, but exhorting one another, and so much the more as we see the day approaching." Hebrews 10:24,25 KJV

Day 279: Goodbye

2009-04-30T12:52:00.000-07:00

Saying goodbye is hard enough, but saying goodbye to fellow soldiers while on deployment can be harder. Today, I had to say goodbye to two great friends that were part of our medical team, Capt Randall (medical administrator) and Master Sgt Davis (my senior medic of the clinic). Their 6 month tour came and went as quickly as one could say "hooah!". It was a pleasure and a riot working with these two soldiers. I wish you both the best, and want to thank you for your leadership and friendship. I only hope these next few months will go by just as fast!

Capt Randall and Master Sgt Davis

Goodbye! Man I'm so jealous.

"The LORD bless you and keep you;the LORD make his face shine upon you and be gracious to you; the LORD turn his face toward you and give you peace."
Numbers 6:24-26 NIV

Day 274: The Hill

2009-04-25T19:50:00.001-07:00

On occasion, a convoy heads into Khowst City to attend a meeting atop Matun Hill which overlooks the city. The meetings are attended by US & Afghan military leaders to discuss any security concerns. While this leader engagement is going on, the rest of the convoy crew hang out and take in the history...

You see, on Matun Hill is an old castle built by the British in the late 1800s when they occupied Afghanistan. Here are some pictures of our sightseeing adventures from the outside of the castle to the tower to a shot of the inner courtyard. One of my good friends Capt (AF) Salazar took a picture with me holding the American Flag.

The coolest part about the castle is the beautiful view of Khowst City. For a few moments, as you take in the view, you briefly forget that you are in a country that is at war. You can see the architectural beauty of the Khowst mosque, lush green fields, traffic, people in the marketplace, the hustle and bustle of everyday life.

After a bit of sightseeing and exploration of the castle grounds, the remainder of the day was spent looking for something to do as the meetings would go on for several hours. On this particular trip we decided to put together a rock throwing competition with our Afghan Police friends. These skinny guys can chuck a rock like nobody's business! After a long day of sightseeing, pictures, and rock throwing...it was finally time to head home. Talk about a rough day. I hope you enjoyed the trip.

Day 273: Lola

2009-04-24T10:42:00.001-07:00

Today is my Lola Lourdes' 93rd birthday! "Lola" is a Filipino term of endearment for "grandma" just in case you wondering. Lola Lourdes has been one of the people in my life that I admire most. She has been there for me from the beginning starting with the diapers to the medical degree to the wedding to enjoying her great grandchildren! Never have I known a person who was so selfless, hard-working, loving, kind, honest, and supportive. Lola, thank you for being the best grandma one could ever ask for. Happy Birthday! I love you!

Great "Lola" Lourdes and Maxwell

Great "Lola" Lourdes and Maya Lourdes

"I thank my God upon every remembrance of you"
Philippians 1:3 NKJV

Day 272: Life

2009-04-23T09:23:00.000-07:00

Gemma and I just started dating and we were walking from anatomy class along a path lined with rose bushes. The roses were beautiful and in full bloom. I noticed that Gemma was very enthusiastic and appreciative of the beauty and fragrance that the flowers had to offer. But I, on the other hand, was looking forward to...lunch. She asked me if I wanted to take a whiff, and I gave her the genius answer of "not really" which was then followed by what I vaguely remember as one of our first arguments.

I'm sure one can imagine how it went ...."Why don't you want to smell the flowers, aren't they just gorgeous"..."They're alright...I just don't smell flowers"..."But, I like flowers"..."That's great, enjoy the flowers and I'll just stand right here and wait for you to get your fix."..."You may not like the flowers, but I like flowers...don't you get it?"..."Get what?"..."You don't appreciate me"..."What are you talking about?"..."THE FLOWERS"...(me scratching my head, and Gemma giving me the evil eye).

That little argument taught me several things. First, I learned that if your girlfriend is passionate about something such as an object, a hobby, a talent, a project, or an extracurricular activity...then you support her 100%, even if it hurts. Second, I learned that life's simplest pleasures, such as flowers in the beginning of Spring, can easily go unnoticed especially when life is seen as a never-ending checklist of things to do and accomplish.

If there was something that the Afghan soldiers were passionate about, it was flowers in the Spring. These last few weeks were spent digging, planting, watering, and waiting in hopes of a beautiful Springtime rose bloom. Sometimes I wondered if they were more interested in their planting than their daily duties. Well, for some reason as I was walking to the ANA clinic, which is my usual daily routine, I noticed the roses in bloom. And guess what....I stopped and took the time to appreciate them the way Gemma had shown me. In doing so, the roses reminded me that even in a country that is plagued by war and corruption...there is a strength and beauty that still exists in this country which gives it life.

Me, TSgt Putman (one of my medics), Basir (interpreter), and Colonel Shah Zadgull (my counterpart) enjoying a beautiful day

Today, I literally took the time to stop and smell the roses, and I even decided to have our daily mentoring discussions outside as the flowers were so beautiful. Honestly, this was one of the most peaceful, life-is-good moments of my deployment. Thanks Gemma for the life lesson:)

"I have come that they may have life, and have it to the full." John 10:10 NIV

Day 270: Soles4Souls

2009-04-21T19:05:00.000-07:00

Shoe days are always extra special at our local national free clinic as it takes several weeks to accumulate enough donated footwear to give out to the kids. These kids walk several miles, often carrying a younger sibling, while wearing beaten up sandals or remaining barefoot. Well today we made their day as we featured footwear donated by the organization Soles4Souls which included some very cool pairs of shoes from brand names such as Adidas and Timberland. We had a blast fitting these Afghan children with shoes especially when watching their eyes light up as they stared in amazement at shoes equipped with velcro straps, colorful designs, and sometimes even little blinking lights.

Check out my new kicks!

Velcro is in!

Ready for a Race!

Stylin' Hot Pink!

I wanted to especially thank Soles4Souls for their contribution to the mission of the Camp Clark Community Clinic. Their donation of footwear, along with so many others from family and friends, has greatly impacted the quality of life of children here in Khowst Province, Afghanistan. As you can see from the pictures above, the shoes have been greatly appreciated!

Thank you, from the Camp Clark Community Clinic team

"I was naked and you clothed Me; I was sick and you visited; I was in prison and you came to Me."
Matthew 25:36 NKJV

Day 263: Hope

2009-04-14T11:24:00.000-07:00

Another week has come which means another opportunity to open our doors to the local population with the expectation of providing some semblance of hope. Most weeks are fairly routine...coughs, colds, aches, pains, heartburn, and the occasional scrape or cut. Our number one prescription is Liquid Tylenol and a package of Flintstones Vitamins. Otherwise, the kids would rather skip the health care part and jump into the toys, soccer balls, and school supplies!

But, today was different. I had the privilege of meeting 2 very special patients. The first was a 10 year old Afghan girl with Cerebral Palsy. Her father came up to me and asked me to help her talk and take away her seizures. I was heartbroken. I sat with him and took the time to explain the chronic nature of her condition. He looked at me and through an interpreter understood my explanation, I think he knew his daughter's condition was without a cure but in his heart he knew he at least had to ask. The unconditional love this father had for his ailing daughter was amazing, and the result was self-evident as you saw this young lady smile right at him.

Senior Airman Torres, Enamullah, and I

The second patient was a 4 year old named Enamullah. He was brought in by his father who is a soldier in the Afghan National Army. He described to me what sounded like shortness of breath with exertion and intermittent episodes of passing out. I proceeded to discover a very significant heart murmur. The boy's father then pulled out a crumpled piece of paper with the letters, "VSD" written on it. I quickly realized that this boy probably has a Ventricular Septal Defect which is a hole in the wall that separates the major chambers of the heart. That hole causes oxygen-depleted blood to mix with oxygen-rich blood in the heart therefore leading to a declination of overall oxygen delivery to the body. This kind of condition requires sub specialty evaluation (Peds Cardiology) and surgical care (Peds Cardiothoracic Surgery). Again, my heart broken. My only answer to this boy and his father was, "I'll see what I can do". Getting care for this boy will be nothing short of a miracle.

Here in Afghanistan, hope is one of the few things that these people have left to hold on to. Considering the horrible history that this country has endured, I'm surprised that hope even exists. Can you imagine owning nothing, living in a war zone, and walking miles upon miles barefoot in hopes of receiving a toy, school supplies, or a bag of Flintstone vitamins. I see this every week, and not one week goes by that I don't see a smile on these kids faces...now that's hope seen on a level that is nothing short of inspiring.

I ask that you please continue to pray for these people and especially pray for little Enamullah as my hope is that there is help out there for him.

"For the grace of God has appeared, bringing salvation to all men...looking for the blessed hope and the appearing of the glory of our great God and Savior, Christ Jesus, who gave Himself for us to redeem us from every lawless deed, and to purify for Himself a people for His own possession."
Titus 2:11,13-14 NASB

Day 262: Easter

2009-04-13T19:40:00.001-07:00

Easter Sunday, often celebrated with Chocolate bunnies, Easter eggs, the hunting of Easter eggs, and the cool baskets that they all come in. Well here in Afghanistan, Easter Sunday is not just another day, but a day of celebration and yet another reason to break out the Sparkling Grape Juice, festive decorations, and center pieces all themed with chocolatey Easter treats!

A Festive Easter Luncheon Awaits!

As I observed these various traditional Easter symbols I realized that none of them had to do with the true celebration of Easter, which is the celebration of the resurrection of Jesus and his victory over death. As we contemplate the meaning of Easter, may we find something to truly celebrate...not chocolate eggs, bunnies, Easter egg hunts, or baskets, but a risen Lord! And may we be reminded of a rebirth and a new life that comes as result of His resurrection. Now that's something to get excited about.

"Therefore we have been buried with Him through baptism into death, so that as Christ was raised from the dead through the glory of the Father, so we too might walk in newness of life. For if we have become united with Him in the likeness of His death, certainly we shall also be in the likeness of His resurrection"
Romans 6:4,5 NASB

Day 260: Salerno

2009-04-11T11:26:00.001-07:00

There is a term that we use on the FOB (Forward Operating Base), "fobbit". This is a label for those troops who never leave the base...ever. They are FOB-bound due to the nature of their duties or they are just plain scared of going outside the wire. Well, for the last 4 months I have been labeled a "fobbit" as I have kept myself on the FOB as the only medical provider on the entire post outside of the medics. Well, the time has come where I have just about gone stir crazy and it was time for a change of scenery, so I bid my medics farewell and took a day trip to FOB Salerno. It was a time to clear my head, but I also had a mission in mind - to meet with the medical folks at the Combat Support Hospital (CSH) as I have been working with them during Medevacs and other urgent consultations. It was time to match a face with the voices that I have been working with over the phone. So here goes the journey...

Monster Truck Action - The Cougar Ambulance!

Radio Check!

Here I am strapped in and ready to roll! Gotta check out the cool headphones...communication inside the vehicle is very important. If only we had a TV and DVD player!

Upon arrival, which was a 45 minute drive through the dangerous city of Khowst, I made my way to the CSH where I met the CSH Commander Col O'Connel and her medical staff. A very nice group of medical professionals which included administrators, surgeons, an internist, and a lab officer. I even had a chance to check out the orthopaedic surgeon in action in the OR!

I call this photograph - "Rod in Leg"

My Surgical Safety Nets

After a tour of the CSH, I decided to offer them a sneak peak at the Cougar Ambulance as they have never seen let alone sit inside such an impressive piece of medical equipment. Without any hesitation they were out there, cameras in hand, ready for a photo op! We all had a great time. It was nice to

Col O'Connel (top right) and the CSH Crew

Apart from my visit to the CSH, the rest of the day was spent in a state of therapeutic relaxation. There's just something about a change in scenery that puts the mind at ease...aaaah!

"For He Himself is our peace, who made both groups into one and broke down the barrier of the dividing wall"
Ephesians 2:14 NASB

Day 258: Boom!

2009-04-09T11:05:00.001-07:00

On base, nothing will ruin your day more than a Field Artillery (FA) firing mission. I had blogged about the first FA mission several weeks ago which involved long range target practice into an open field. Well today's mission was the same thing only FARTHER which translates into LOUDER! I mean much LOUDER!! We were aiming for an open field over 15 km away in order to test the accuracy of some new equipment which had arrived.

Meet BASHER and his brother BAM!

Every time a shot was fired you could hear people being startled, the buildings rumble, and troops ducking for cover thinking it was incoming as opposed to outgoing. Anyone who had initiated their daily afternoon siesta was very rudely awakened! This was all borderline entertaining:)

Well, to pass the time I decided to help out with medical coverage for this mission as injuries are very common during FA missions. Anything from cuts and scrapes from handling the complex weaponry to blast injuries/burns due to the potent explosives...luckily no injuries to report although I wonder if anyone is going to eventually show up with a busted eardrum. The coolest part was being able to pull the laniard (check out the pic above), which was the trigger mechanism for the gun and the reason for an overabundance of hate & discontent throughout the base. For me, being a part of the FA mission removed any element of surprise which therefore minimized any gasping, yelling, or crying spells in the fetal position on my part. Well, after 50 rib-rattling rounds and multiple prolonged episodes of tinnitus, the fire mission was ended and life has since been back to normal. For now...

Day 255: Homemade

2009-04-06T11:11:00.000-07:00

Nothing exciting really happened today until I opened a care package from Gemma. Homemade chocolate peanut butter chip cookies and snickerdoodles!! Not to to mention the fact that they were still moist and chewy as ever. Thanks honey, you are the best:) I never thought sharing would be so difficult!

The Air Force and I partaking in Gemma's Oh-So-Good Cookies!

Day 254: Oath

2009-04-05T10:20:00.000-07:00

OATH

a solemn appeal to a deity, or to some revered person or thing,
to witness one's determination to speak the truth, to keep a promise.

For the last several weeks the Afghan National Army has held training for new recruits here in Khowst on our base. I've had the distinct opportunity to assist in the mission readiness of these young soldiers in regards to first aid training and health maintenance. As a participant in their training, I was invited to witness an oath ceremony that the recruits participate in as a symbol of their dedication to the Afghan National Army and their allies.

The entire ceremony was in the Afghan dialect of Pashtu and was attended by several local dignitaries and high-ranking military officials. The ceremony started out with a prayer from the Koran that was sung by a soldier. After quick introductions of notable people in attendance, the oath ceremony was underway.

In front of the formation was a long table (see above) with a variety of Afghan Army weaponry (machine guns, grenade launchers, rockets). Each platoon (30-40 soldiers) marched up to the table, laid hands on a weapon (see below) and then recited, actually more like shouted, an oath of allegiance, in the presence of Allah, to the Afghan National Army. Not quite the "raise your right hand and repeat after me" approach to a military oath, but unique and frankly, pretty cool!

"Suffer hardship with me as a good soldier of Christ Jesus. No soldier in active service entangles himself in the affairs of everyday life, so that he may please the one who enlisted him as a soldier."

II Timothy 2:3,4 NASB

Day 251: Cookies

2009-04-02T07:32:00.000-07:00

Who doesn't love cookies? Better yet, who doesn't love GIRL SCOUT cookies? Tagalongs, Thin Mints, Carmel Delights, Dosidos...Mmmmmmmm delicious. Today, the Afghan kids received a special treat along with their usual goodies of school supplies, multivitamins, and clothing. We received a large donation of Girl Scout cookies for our base and decided to use a portion of that donation for the kids that frequent our free clinic. Oh man, you should see their faces with crumbs all over their lips & cheeks with pieces of Girl Scout cookie goodness all lodged in between their teeth. The only thing missing was a large glass of milk!

Enjoying a Box of Girl Scout Cookie Goodness

It's organizations like the Girl Scouts that teach our children to look beyond themselves and consider the value that comes in helping those less fortunate. Being a leader in this unique military-humanitarian mission, I've been able to solicit help, in the form of supply donations from Girl Scout troops, elementary school classrooms, churches, clubs, and other non-profit organizations. The donation boxes almost always come with personal cards written by children of all ages, and it warms my heart to see the colorful and creative words that these young kids can come up with to relay the simple message, "We support you" and "We want to help". Let's continue to teach our children about a world that has people in need and show them that there are ways that we can do something about it.

"Therefore whoever humbles himself as this little child is the greatest in the kingdom of heaven." Matthew 18:4 NKJV

Day 249: Halfway!

2009-04-01T09:49:00.000-07:00

Based on our best guess, the Navy folks that I deployed with have deemed today to be "HALFWAY DAY" as we are halfway through our deployment. In honor of this day, we decided to fly the First Navy Jack on our flagpole today. Since September 11, 2002, by direction of the Secretary of the Navy, the Navy Jack has been flown on the front or bow of Navy ships as a symbol of steadfastness and protest against terrorism and the insurgents that embrace it. The First Navy Jack will be flown until the Global War on Terrorism is over. More on the Navy Jack as per Wikipedia...

The jack of the United States is a maritime flag representing the United States nationality flown on the jackstaff at the bow (front) of it's vessels when anchored.

Since September 11, 2002, the Navy has flown the First Navy Jack, a flag bearing 13 red and white stripes, a rattlesnake and the motto "DONT TREAD ON ME", coming from the first jacks supposedly used by the Navy during the Revolutionary War. It is flown from the jackstaff from 08:00 to sunset while Navy ships are at anchor. It is required to be the same size as the union of the ensign (US Flag) being flown from the stern of the ship. The jack is hoisted smartly and lowered ceremoniously in the same manner as the ensign.

The rattlesnake had long been a symbol of resistance to the British in Colonial America. The rattlesnake (specifically, the Timber Rattlesnake) is especially significant and symbolic to the American Revolution. The rattle has thirteen layers, signifying the original Thirteen Colonies. And, the snake does not strike until provoked, a quality echoed by the phrase "Don't tread on me."

Well enough about flags...I'm just glad that I've survived the past 5 months in Afghanistan unscathed and mentally intact. Man, am I thankful to God for life and the adventures that He places in it! God has truly revealed to me a higher purpose, and He has reminded me, through Isaiah 43:2, the promise that He will see me through raging waters, through scorching flames, and even through the desert sands of Afghanistan!

"When you pass through the waters, I will be with you; And through the rivers, they will not overflow you. When you walk through the fire, you will not be scorched, nor will the flame burn you" Isaiah 43:2 NASB

Day 247: DFAC

2009-03-30T10:04:00.000-07:00

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

Day 246: The Egg

2009-03-29T11:34:00.001-07:00

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

Day 236: The General

2009-03-19T07:46:00.000-07:00

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.

Day 235: Shots

2009-03-18T04:33:00.000-07:00

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!

Day 234: Shamrock Shuffle

2009-03-17T10:57:00.000-07:00

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

2009-03-17T10:56:00.000-07:00

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.

Day 231: RBWT

2009-03-15T11:58:00.001-07:00

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

2009-03-15T10:52:00.000-07:00

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

Day 228: Practice

2009-03-13T05:35:00.000-07:00

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!!

Day 227: Seventy

2009-03-12T20:28:00.000-07:00

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

Day 220: Shura

2009-03-05T11:30:00.001-08:00

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

Day 216: Warehouse

2009-03-02T11:24:00.000-08:00

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

Day 213: Pashtun

2009-02-27T10:09:00.000-08:00

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:

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.
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.
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.
Nang (Honour) - The preservation of honour entails the defence of one's family and one's independence, while upholding cultural and religious requirements.
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

2009-02-26T10:51:00.001-08:00

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

2009-02-19T11:27:00.000-08:00

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

2009-02-17T18:38:00.000-08:00

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

2009-02-16T10:55:00.000-08:00

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

2009-02-14T11:20:00.000-08:00

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

2009-02-12T09:59:00.000-08:00

...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

2009-02-10T09:28:00.001-08:00

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

2009-02-04T10:55:00.000-08:00

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

2009-02-03T11:27:00.001-08:00

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.

Day 185: Money

2009-01-31T11:43:00.000-08:00

There's just something about the feeling of money in your hand let alone a stack of bills totaling 100,000! Well, 100,000 Afghani which is about 2000 US dollars. Today, I assisted Major Probus our "FOO" (Field Ordering Officer) in paying all the local contracting jobs on the base. Every month the "FOO" is allotted a set amount of money which can be used to purchase items, services, or improvements to the base, within certain parameters of course. It sounds like a fun job, but it is actually stressful and very time consuming. Anyways, my point in bringing up this experience is because it reminded me of how much time I have spent attempting to understand and manage money. I figure in strained economic times such as ours, a brief discussion about money would be timely.

I pity the FOO!

Back in college I was a very, very impulsive spender. I had 5 credit cards in my wallet, and I just had to have the video game systems, electronic gadgets, and name-brand clothes. I also figured that every month the only attention that my growing credit card debt deserved was the minimum payment. Several years later, I was sitting on 3000 dollars of frivolous credit card debt. Man, what happened?!?

That's when I realized how clueless I was when it came to the value of money. After staring at my Visa, Mastercard, and department store bills, I then made the conscious decision to fix it. I started financially decontaminating myself by first cutting my credit cards and turning my debt over to a debt management agency who lowered my interest rate. I put any extra money I had into paying off the credit card debt...a couple of years later I was credit debt free!

To make a potentially long blog story short, I started reading up on budgeting, investing, debt management, and financial planning. I subscribed to Kiplinger's Personal Finance, Money Magazine, and started reading books such as "The Millionaire Next Door" and "Smart Couples Finish Rich." After reading dozens of books and magazines I started to find common themes for financial success which I've basically broken down into the simple list below.

1. Pay Yourself First! - The hardest thing about saving money is getting yourself to do it! We as consumer-driven Americans are horrible savers. The best way to get started is to have it automatically taken out of your paycheck. Start small then work to a goal of saving at least 10% of your pay.

2. Pay Off "Bad" Debt - When I refer to "bad" debt, I mean consumer debt such as credit card bills, car payments, or any debt in things that have no potential to increase in value or pay dividends in the future. "Good" debt would be education debt or mortgage payments.

3. Set aside an Emergency Fund - Losing a job is always a possibility - getting laid off or injured are all too common reasons for suddenly being unemployed. Saving 3-6 months of your current monthly debt is a great rule of thumb when deciding on the amount of money to place in your emergency fund. The fund should be easily accessible and should not be touched for any other reason than financial emergencies (health care bills, sudden car repairs...NOT for an emergent need to have a Playstation 3)

4. Maximize your 401K contributions up to your employer's match - find out what your employer matches and contribute, at a minimum, that amount. It's a no brainer...free money.

5. Maximize Roth IRA Contributions - read up on tax advantaged individual retirement accounts such as a ROTH IRA. A Roth account can consist of any combination of investments. The money placed in a Roth are "after tax dollars", in other words this money is from your net pay after Uncle Sam has taken his share. The great thing is that all the investment income and potential growth inside the Roth IRA will be able to withdrawn tax free! There are rules such as maximum contribution limits per year, and a minimum retirement age indicating when money can start be withdrawn.

6. Give Generously - Don't forget that the blessing of money is not just in the accumulating of it, but also in having the opportunity to give it away for the benefit of others.

"A good name is to be chosen rather than great riches, loving favor rather than silver and gold." Proverbs 22:1 NKJV

Day 184: Tofu Delight

2009-01-30T10:07:00.000-08:00

I didn't start out as an advocate of that wobbly block of soy protein we have come to know and love as tofu. Actually, I detested the concept of soy protein, and saw it as a miserable substitution for meat. Well, fast forward several years, add a vegetarian wife, and a maturation of taste buds and Voila!...a tolerance, actually, a sincere desire for tofu!!

On Guam, tofu was prevalent and I enjoyed a variety of tasty preparations from Thai, Chinese, Vietnamese, Japanese, and even Chamorro cuisine. At home, Gemma was a virtuoso at preparing tantalizing dishes with tofu as the star attraction.

Unfortunately, the military won't touch meat substitutes, such as tofu, with a ten-foot pole. Apparently, it's a morale thing or so I've been told...happy soldiers eat real steak and real beef cheeseburgers. Without meat, the battle is lost...or at least the illusion exists that meat is the key to happy healthy soldiers.

Well, to throw a monkey wrench into the daily routine of hot dogs, ribs, burgers, and steak, I opened a care package from Gemma which had 2 boxes of extra firm tofu, the only problem was convincing the contract chefs to put a dish together for me.

Fortunately, the head chef, Chef Greg Jones, was a Seventh-Day Adventist who enjoys cooking vegetarian meals and has a lot of experience with tofu. So we put our heads together to come up with a tasty dish, actually I just said "as long as there's lots of garlic in it I'm good". He ended up making a Spicy Garlic Tofu and Mixed Vegetables dish that was tastier than most Chinese restaurants I've been to. I couldn't believe it, a tofu dish in an United States Army dining facility in Afghanistan!!

"Whether, then, you eat or drink or whatever you do, do all to the glory of God."
I Corinthians 10:31 NASB

Day 180: Protector

2009-01-26T11:53:00.001-08:00

As a physician, my mission is to be the protector of life for the troops that I am serving with. Although I'm not the one pulling the trigger nor am I the one planning the aggressive operations, I'm the one who makes life-or-death decisions when someone is seriously injured, I'm the one who has seen, up close and personal, the physical consequences of war, I'm the one who keeps an eye out for those who may be suffering from combat stress, I'm the one who ensures that the soldiers are trained up on basic first aid, I'm the one who ensures that every contingency operation has appropriate medical personnel/equipment, I'm the one who has eyes on every soldier's overall state of health. From that perspective, I see myself as the "protector" of the troops and that makes my job extremely rewarding. But, taking on the role of "protector" means not only taking on the physical ailments and injuries of my fellow troops, but also their mental stresses and emotional vulnerabilities that they experience from being in a deployed environment. Insomnia, depression, familial problems, post traumatic stress, anxiety...the list goes on, and daily do I have to muster up the strength to tackle those issues over and over again. This is all amplified by the fact that no one around you knows what that really feels like. That's where my job can get tough. That's where the "protector" needs to be protected!

One of my friends pointed me to Psalms 144, in light of the recently delivered "air mail", as a source of encouragement. It's a beautiful Psalm and a reminder that I serve a God who protects his people...even those who may forget that they need protecting. I hope this passage will encourage you in your own personal battles, and be a simple reminder that those battles are never fought alone.

PSALMS 144

Blessed be the LORD my Rock,
Who trains my hands for war,
And my fingers for battle—
My lovingkindness and my fortress,
My high tower and my deliverer,
My shield and the One in whom I take refuge,
Who subdues my people under me.

LORD, what is man, that You take knowledge of him?
Or the son of man, that You are mindful of him?
Man is like a breath;
His days are like a passing shadow.

Bow down Your heavens, O LORD, and come down;
Touch the mountains, and they shall smoke.
Flash forth lightning and scatter them;
Shoot out Your arrows and destroy them.
Stretch out Your hand from above;
Rescue me and deliver me out of great waters,
From the hand of foreigners,
Whose mouth speaks lying words,
And whose right hand is a right hand of falsehood.

I will sing a new song to You, O God;
On a harp of ten strings I will sing praises to You,
The One who gives salvation to kings,
Who delivers David His servant
From the deadly sword.

Rescue me and deliver me from the hand of foreigners,
Whose mouth speaks lying words,
And whose right hand is a right hand of falsehood—
That our sons may be as plants grown up in their youth;
That our daughters may be as pillars,
Sculptured in palace style;
That our barns may be full,
Supplying all kinds of produce;
That our sheep may bring forth thousands
And ten thousands in our fields;
That our oxen may be well laden;
That there be no breaking in or going out;
That there be no outcry in our streets.
Happy are the people who are in such a state;
Happy are the people whose God is the LORD!

Day 177: Resilience

2009-01-23T10:41:00.001-08:00

If I had to choose one word to describe the days events I would choose the word, resilience. Defined as, "having the power to return to it's original form after being stretched, bent, compressed, or altered in any way; to recover readily from adversity".

Dining Facility 0700 this morning...

Last night, at approximately 1030PM, our base was attacked by a rocket which destroyed a wall in our dining facility. Just 2 nights ago I was watching the presidential inauguration and grabbing a snack along the exact same wall that was blown up. Scary when I think about it. Also, I sleep only a few hundred yards away from this building. Actually, I'm doing OK...it all happened so fast, a loud boom, a bum rush for the bunkers, and a sigh of relief. Praise the Lord no one was hurt. The amazing story to come out of all this is to see how quickly we can exercise our resiliency. You see, we as Americans are not very accepting of defeat, we were not going to allow this seemingly depressing situation bring us down.

Dining Facility 1230 this afternoon!!

In a matter of hours, our beloved KBR civilian contractors were on the job. Their sole mission, to take care of the soldiers and maintain the morale of the troops through their food services and base maintenance services (electrical, woodworking, engineering, janitorial, etc...), and this particular group on Camp Clark in nothing short of legendary. Rumored to be one of the best and most skilled KBR units in Afghanistan, they were put to the test. And you can see from the pictures above, they were determined to serve lunch in the very dining hall that was destroyed only hours before. Well guess what...I didn't have to take a to-go box!

Sitting here thinking about the last 24 hours, I thought of all the ways God has tried his people...Abraham, Joseph, Moses, Job, David, Daniel, Peter, Paul all come to mind...all men of faith, all men of burdensome trials, all men of great resilience. And now I find myself realizing that He is trying me, allbeit in ways seemingly unimaginable. He continues to steer my faith through bends and stretches in every direction, but through His strength have I found myself unwavering and resilient to my faith in Him.

To my beloved family & friends, please believe me when I say that I thank you for all the prayers that you send up to heaven every day. From the pictures above, please know and believe that they are continually being answered.

"Brethren, I do not count myself to have apprehended; but one thing I do, forgetting those things which are behind and reaching forward to those things which are ahead, I press toward the goal for the prize of the upward call of God in Christ Jesus." Philippians 3:13,14 NKJV

Day 176: Soccer Ball Faith

2009-01-22T07:29:00.000-08:00

Today, we saw 45 patients today in our local national clinic, and the clinic went very well. We were able to improve the clinic flow as well as the distribution of humanitarian assistance items resulting in a less stressful, more enjoyable time.

I had to add the picture above. Here is the ANA Security Commander placing shoes on what looks to be a bundle of clothes disguised as a human being! Gotta love the kids:)

I decided to allow a handful of soccer balls to be distributed to local Afghans...man are they a hit, and man can kids beg and beg and beg and beg...and beg. To be fair, and to keep myself from being tackled, I allowed my Afghan Army Security Commander to pass out the soccer balls. What was touching to me was how he came to picking the lucky children. He chose to give the balls to the children who had lost their fathers during this conflict against the Taliban. I was really touched and thought that it made for a very fair decision to give it to those boys. Check out our picture above as these boys sport their new athletic look!

Thinking about those boys I couldn't help but think of the possibility of being forever separated from Gemma, Max, and Maya. To many of you back home, I'm sure that every news blurb, heard or seen, about a bomb going off in Afghanistan is a strong reminder of just how dangerous this war in Afghanistan really is. Being right in the middle of it, I have prayed that my fear be turned into faith, and the Lord has seen me through some very intense experiences. Isn't it wonderful that we serve a God who watches and protects us always? Thoughts from a soccer ball...

"Be strong and of a good courage; be not afraid, neither be thou dismayed: for the Lord thy God is with thee withersoever thou goest." Joshua 1:9 KJV

Day 174: Relax

2009-01-20T12:08:00.000-08:00

I have officially been in theater for 3 months! The last couple of weeks have been a blur. I've been so busy balancing so many tasks at once not even realizing that I have barely given myself enough room to simply breathe and relax. As a leader, I have made it a point to give my own medics at least 1 full day off a week, but for me I always seem to find something to work on or someone to take care of. Well today, I kept things low key...here are couple of relaxing moments to help us all release some of that tension...aaahhh!

Check out the winter scenery!

Digging in our stash of shoes and prepping for our next local national clinic day

During my rare moments of relaxation, I sometimes find time to daydream about the things that I miss from home. Things that I will probably never see or experience until I set foot back on US soil such as...

Spicy Tuna Rolls...

The Beach...

...or the Cheesecake Factory

I think the images of relaxation are enough to get me through the next 3 months. Time for me to get back to work!

"Be still and know that I am God." Psalms 46:10 NIV

Day 173: Cut It Out!

2009-01-19T09:34:00.001-08:00

One of the difficulties of this deployment is the inability to maintain my medical skills. It has been months since I have delivered a baby, performed any suturing, or provided care for a hospital-bound patient. Seeing active duty folks with back pain, ankle pain, and shoulder pain day in and day out gets old after a while. Well, today I had my chance to spice it up!

Patient Case: An Afghan Army soldier wanted to get this lump taken out near his right ear. He reported no significant pain or drainage, but it had been increasing in size over the past several months. He mentioned that it had been cut open in the past, but it has recurred multiple times. He desires to have the lump removed. The lump is soft in consistency and non-tender.

Diagnosis: Sebaceous Cyst or Epidermal Inclusion Cyst

This was not only a valuable mentoring opportunity, but also a chance for me to reacquaint myself with certain medical skills such as minor skin procedures & suturing. From the mentoring side of things it gave me a chance to teach the Afghans the concept of "sterile technique" since their concept of "sterile" is washing their instruments in the sink like last night's dishes.

Back to the cyst...Epidermal Inclusion Cysts or "EICs" commonly occur on the face, back, or chest. They are walled off capsules that are filled with a substance called keratin. The reason for their recurrence is the failure to remove the cyst wall after draining out the keratin build up (another mentoring point).

After prepping the room and going over some sterile technique pointers, we were ready to go! Here are some pictures of our cyst removal party.

My medic, Ayub (scrubs)...my interpreter, Latif (the hard core shades), and myself working on removing an EIC

A shot of the cyst wall being removed. I hope I don't gross anyone out!

Look at the pretty sutures!

The procedure went extremely well and the patient was very grateful. I was able to mentor the ANA medical staff on minor procedures, improve the ANA medic's suturing skills, and address a medical issue other than low back pain or a cold. It was a win-win for everyone!

Day 172: Motivation

2009-01-18T11:13:00.000-08:00

Every Sunday, the Afghan National Army post here at Camp Parsa has "formation". This is where all the soldiers gather together and hear words of encouragement and motivation from their brigade commander, General Esrar. Today was a rather special day as certain soldiers were chosen to receive special recognition for their hard work for their country. I was especially proud that 2 of the Afghan medics that I have been training and mentoring were from the select few that were recognized today.

Center Stage at the Brigade Formation

Front of the Formation

Congratulations, Mohammad Ayub!

Congratulations, Wahid Aagha!

In the US military, we desire ribbons & medals, but in the Afghan National Army they cherish certificates. So today, a small number of selected soldiers were presented with a certificate of appreciation for the sacrifices they have made for their country. My 2 medics that received an award were beaming! This is very timely as the ANA medics that I have been working with have been expressing concerns that they do not feel appreciated by their officers and leaders which has translated into low morale. But, between my motivational pep talks and the certificates, I think we can infuse some positive energy into them yet!

Day 170: Sixty's a Crowd!

2009-01-16T02:54:00.000-08:00

Today, was a rather stressful local clinic day. Taking this on has had it's challenges. The uniqueness of this endeavor involves dealing with Afghan soldiers, Afghan medical staff, and Afghan interpreters. They are all great people, but even they want a piece of the humanitarian giveaway action. It was frustrating to discover that soldiers were sneaking into our coat room, doctors were taking medicines, and now even my interpreter bringing his children to the clinic knowing full well that he makes an exorbitant amount of money compared to some of the local villagers. This was all topped off with the ANA security forces letting over 60 patients (a new personal record) through the gate which was over 20 more than expected! Also, we are starting to run low on shoes and bags which means we may not be able to give as much away for next week...can you feel the tension.

Showing off her new pair of shoes

Look at my new tiger gloves! Roar!!

But, after taking a deep breath and contemplating the happy, smiley children...I realized that it's not worth sweating the small stuff. If the Lord wants us to continue on with this clinic, it will happen in His time. Until next week...

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

Day 168: NYFD

2009-01-14T12:32:00.001-08:00

A few days ago we held a special flag raising ceremony for the Afghan National Army Fire Station here on our post. Their old flag was a tattered piece of cloth, so ripped and faded that no one even knew what was printed on it. In an effort to replace their old flag, one of my fellow Naval officers, LT Zeller e-mailed a request to the New York City Fire Department (NYFD) Commissioner for a flag that can be flown for the fire station here in Khowst.

Presenting of the NYFD Flag to the ANA Fire Department

The Chief of the Fire Department and his staff with their new flag

The flag now flies every day as symbol of bravery, and an iconic reminder of why the United States is fighting in Afghanistan. The Chief of the Fire Department commented (through an interpreter), "I am committed to peace in the Khowst Province of Afghanistan, and my team will never forget the sacrifices made by fellow firemen in New York on 9/11." What a testament to the mission that we have been called to complete here in Afghanistan.

"For He Himself is our peace, who has made both one, and has broken down the middle wall of separation." Ephesians 2:14 NKJV

Day 166: The Courier

2009-01-13T11:15:00.001-08:00

The first issue of the Camp Clark Courier was officially released this month. It's a newsletter dedicated to informing the citizens of Camp Clark on the happening events around the FOB...with a touch of humor.

I made Camp Clark history with the first Ask the Doc column. The brief article is not quite as sophisticated as the New England Journal of Medicine, but at least it's fun out here. Check out the article below...

Question: What's the big deal about exercise?

As military service members, the often painful ritual of "PT" can be a bit of a love-hate relationship. We know it's good for us, but at the same time, our flawed human nature prefers the caloric bliss of Big Macs, chocolate shakes, and the feel of a remote control. But, have you really ever thought about the benefits of exercise? For starters, realize that 25% of adults do not engage in any leisure physical activity.

Based on a US survey of 6300 adults and children in 2004, 55% of waking hours were spent on sedentary behaviors. In other words, we Americans prefer to chill.

See if any of these facts motivate you: regular exercise decreases the risk of cardiovascular disease through it's beneficial effects on lipid profile (decreases bad cholesterol, increases good cholesterol), blood pressure (10-15 point reduction), and blood glucose control (prevention of diabetes). Regular exercise also decreases the risk of breast cancer and certain intestinal cancers. It's benefits on anxiety, stress reduction, and smoking cessation have also been proven.

So what's the right "dose" of exercise? Well, the American Heart Association and the American College of Sports Medicine recommends moderate intensity exercise (brisk walk, walking stairs, gardening, raking leaves, leisurely swim, washing cars) 30 minutes a day for a minimum of 5 days per week as a guideline.

There is no real consensus on the utility of achieving a certain percentage of your max heart rate (220 minus age). According to people much smarter than I, endpoints indicating an "adequate" degree of exercise include sweating, breathlessness, and fatigue...duh! Bottom line: hit the gym, start a garden, volunteer to clean HUMVEEs, just do something to break a reasonable sweat. Doctor's orders!

Day 165: The Fall

2009-01-12T10:59:00.000-08:00

It had been a long day. Other than my usual clinic hours, I had meetings to attend, inventories of newly acquired medical supplies to sort through, and humanitarian clinic preparations to oversee. The last thing I needed to hear was, "Doc, Airman Ramirez just fell through the 2nd floor and landed onto the barber shop floor below."

Poor Barber Shop:(

Apparently, the good Airman Ramirez was doing his computer networking job of hanging coaxial wire in one of our buildings. Most of the floor is sturdy, but the wire he was hanging required walking around parts of the floor that were not so sturdy. Well, he hit a soft spot alright. He found himself falling right through the floor and onto his back...about a 10 foot drop. The scary thing was that he fell into the barber shop which had a Masterlock securing the door from the outside. He was locked in which delayed our ability to get to him in a timely manner. By the time I had figured out a way around the lock, I could here Airman Ramirez laughing behind the door. Perhaps he was enjoying a rather surreal chain of events.

Airman Ramirez posing for a souvenir shot after falling through the roof...ouch!

Well, he ended up having some bad bruises on his back, but overall he is doing very well and enjoying his new found popularity. Lessons learned for today: #1 watch your step, #2 better to fall on your back than onto your head, #3 even on a bad day...laughing makes everything better.

"The angel of the Lord encampeth round about them that fear him, and delivereth them." Psalms 34:7 KJV

Day 164: Cleaning Up

2009-01-11T10:38:00.001-08:00

Our mission as Afghan Army medical mentors is to train and advise our counterparts, and enabling them to become a competent, motivated, self-sustaining army. Sounds noble in theory, but it is a slow and often frustrating process. Don't get me wrong, I enjoy my mentoring job, but I sometimes feel like I'm talking to school children. Numerous times have I found myself nagging the medical staff about cleaning hospital bed sheets, putting needles in the sharps containers, or not giving antibiotics for every runny nose. Certain things I can let go, but when I discovered the condition of their medical supply closet...they had crossed the line!

Ayub and A1C Torres clearing shelves

We're scheduled to have an inspection team arrive on the 15th of January, this inspection will provide a "report card" as to how well the ANA clinic will be able to function without US mentoring. One of the biggest threats to their success is their hodgepodge organizational techniques. My persistent pleading to reorganize their supply room (which looked like it was hit by a tornado) was met with a shrug of the soldiers and an offer for a glass of chai. Well, today I had no choice. Action was the only option so I brought my medical team into the clinic, and we started the reorganization project for them...virtually from scratch.

An organized mess!

In the picture above, we laid out the medical supplies from the supply closet, inventoried the items, and restocked their emergency room with supplies from the closet.

For now, we at least sorted the equipment into reasonable categories. We no longer had ortho splints and foley caths mingling together, nor did we have unopened needles and syringes scattered all over the place. You can see phase 1 of our close reorganization project above. Stay tuned for phase 2...

Day 162: Casualty

2009-01-09T10:37:00.000-08:00

My medics have barely been here for a week and they are already trauma veterans. It all happened very fast...I was trying to teach one of my medics how to use cryotherapy to treat some hand warts when my senior medic ran into the clinic telling me that several Afghan soldiers were hit by a roadside bomb and the ANA clinic was requesting our assistance. So in a matter of minutes we went from hand warts to battlefield trauma!

The medics did a great job mentoring our Afghan clinic medical staff in taking care of their injured soldier who had almost 50 shrapnel wounds as well as a broken left humerus (upper arm). What I wanted to teach my medics was that, as American "advisors", we are here to guide and mentor, not to do their job for them even though we want so bad to show them "American medicine".

We eventually eased our way into assisting with the care of the soldier. After fishing out some pieces of shrapnel from his back, we prepped him for transfer to a nearby trauma hospital for a surgical evaluation. Fortunately, the soldier is recovering well.

After the trauma care was completed, I gathered all the medical staff, US and Afghan, and we discussed the things that went well and the things that could have been done better. We in the military refer to this as a "debrief" or an "after action report", the Afghans saw it as an encroachment into their tea time. Nonetheless, I think the Afghans did admit that some tweaking needed to be done in certain areas. In the world of Afghan mentoring...admitting to the need for change is a huge step in the right direction!

Day 161: Mandozai

2009-01-09T10:26:00.000-08:00

Today, I coordinated our first Afghan local national clinic featuring the new medic crew. They really enjoyed themselves this first time around.

From the fitting of coats for the children, to the sizing of shoes, to the medical care, to the passing out of goodie bags...all parties involved had an experience they will remember for a lifetime.

Major Probus passing out sweets to the kids

The children that came to the clinic were from the community of Mandozai which was hit by an SUV loaded with explosives taking the lives of 14 children and injuring over 50 Afghans on December 28th. It's virtually indescribable to imagine the living conditions that these local children endure, but to see their smiling faces as they leave our clinic tells me that we are well on our way to completing our mission here in Afghanistan.

A sneak peek at the "goodies" for the patients

Posing with Afghan children

It's amazing what you can learn from children. In my own parental adventures I've discovered that children can be the most resilient of human beings. Being around these Afghan children, I am dumbfounded at the strength, resilience, and courage these Afghan little ones have displayed as they choose to walk several miles, often through dangerous terrain and with the risk of being exposed to Taliban, in order to pick up some Flintstones vitamins, a coat, shoes, stuffed animals, and some school supplies. May we live a similar courage and strength which will allow us to discover God's unique purpose for our lives.

"Thus says the Lord, your Creator...'Do not fear, for I have redeemed you; I have called you by name; you are Mine!' " Isaiah 43:1 NASB

Day 160: Newbies

2009-01-07T18:07:00.000-08:00

One of the expressions used in the Army is the phrase, "down range", which simply means being out there in the trenches where the fighting is happening, what some may refer to as the "front lines". Compared to many other bases in Afghanistan, our base is considered one that is "down range". Well, there are pluses and minuses with that. The plus side is the fact that the base is usually small (150-200 people) and the general personality of the populace is one that is laid back. The big minus is that troops intended for our base often get snatched up by units that are, for lack of a better phrase, "up range", therefore leaving us stretched for manpower . The administrative battle to ensure that the 3 medics that are leaving me are replaced with not 1, not 2, but 3 living, breathing, competent medics was a battle that I was not intending to lose.

To make a long story short and after many phone calls and e-mails to higher headquarters later. The rumors and the talk of the possibility of getting replacement medics turned into the real thing.

Go Team!

Well, here is a picture of my new team of young, eager medics. Together we will be covering the medical care of the US troops as well as the medical mentoring of the Afghan National Army troops. The medics bring a lot of skill sets with them as some have a wealth of experience in ambulance/inpatient care, pediatrics, tactical medicine, nursing, computer science, teaching, and even funeral directing (that probably covers most of our bases!). I think we have a pretty strong, well-rounded medical team. It will be fun to treat them like my young medical students...actually, although many of them don't have a college degree, their clinical medical knowledge and experiences far outweigh the experiences of a typical 1st or even 2nd year medical student.

Sgt Hodgett and SSgt Farris treating a "casualty"

To break them in, I went ahead and set up some training scenarios for my new medics. Surgical lubricant and Raspberry Crystal Light can really bring some of these scenarios to life! It was fun to review some of the basics in being a combat lifesaver. In the picture above is Sgt Hodgett and SSgt Farris working on a patient with an amputated left arm. Sorry it's a little graphic but that makes the training fun!