Friday, December 25, 2009

Merry Christmas from Kabul…

I want to wish everyone a Merry Christmas from Kabul. Here I am, on another Christmas away from family and friends. Christmas 2005 was in Al Taqqaddam, Iraq and Christmas 2009 is in Kabul, Afghanistan. As I write this, it is Christmas morning here. Santa is making his way from East to West across the United States.

I only have a few days left here in Kabul, so I will recap the past few days and reflect on my time here.

Since I last posted, there haven’t been any significant events here. I have completed my turnover with Brian and Marvin. On Monday, I was the Convoy Commander for our trip to NDS hospital. It has been awhile since I wasn’t driving the lead truck. While at NDS, I introduced Brian & Marvin to the staff and we toured the OT. We changed into scrubs and I took them into the rooms so they could observe the staff during surgery. We still have many improvements to make…

The rest of the week was spent at NMH in the OT. We have done some observations in the rooms and completed turnover. Just like NDS, there is still much to be done at NMH. I did mail my last tote home. It is so much easier mailing things home rather than having to carry them in a seabag. I mailed a 63-pound tote home for $40.

Early in the week, we were hearing rumors of a VIP visit to NMH. On Wednesday, we found out it was President Karzai coming to visit. When we got ready to leave and walk up to NMH, we found out we weren’t allowed to go up. Security was extremely tight and none of us were allowed to leave the base. I did not expect to personally meet President Karzai, but I was hoping we would be able to see him. I was not happy that I wasn’t allowed to be at the hospital because the President was there. How do we win the hearts and minds if we aren’t allowed to leave the base and do our mentoring mission? Are we (the Americans) too much of a security risk? They have no problem asking us to treat and consult on high-ranking Afghans when they are sick. Makes you wonder…

Last night, I finished reading Three Cups of Tea by Greg Mortenson. I recommend that everyone read this book. I should have read it 6 months ago. The book is his personal account of his building of schools in both Pakistan and Afghanistan. We can make huge changes in both countries with schools and education. The book has really made me think and reflect on what I have been doing for the past 6 months. The nurses and doctors I have been working with, have various levels of experience. Some have been in the medical field for less than several years, and others have been practicing for many, many years. When I first got here, I did not know what my job or mission was going to be. Yes, I knew that I was going to be a Perioperative Nurse Mentor, but what exactly does that mean? All of our time in Fort Riley was spent on Army training: combat and COIN (Counter Insurgency) not what a medical mentoring mission is.

I spent the first two months here building relationships with the nurses and trying to define what my mission was. I define my mission as “what is best for the patient”. Everything I have done is to influence the nurses and doctors into doing what is best for the patient. We educate, train and mentor so the patients can get better, safer care. It is all about the patient, not personal feelings and egos. I have to work hard to teach the Afghans that the reason we try to maintain sterility and develop a surgical conscience is for the benefit of the patient: The patient is the focus of our care, why we do what we do. It is a hard concept to teach to adults who are set in their ways and have only experienced war and suffering. Many of the nurses and doctors didn’t want to do what they are doing, working in the medical field. At the time, it was all that was available to them. They were told that they would be doing the job given to them and nothing else was available.

It isn’t all bad though. Many of the younger residents, nursing students and combat medics want to learn and make a difference in patient’s lives. They want to provide safe, effective care and want to raise the standards of care in their country. We can make a huge difference in Afghanistan teaching those who want to learn, but it is going to take years. If we really do pull out of here in 2011, very little will be accomplished. It is a double-edged sword though. If the security improves over the next 18 months, then the NGO’s can come back to Afghanistan and improve the medical care. Nation building isn’t really the mission of the US Armed Forces. We can make a country safe, but the military doesn’t elect a government. It is the various NGO’s who come in and help that really builds a nation.

It took me 6 months to really figure out my job and build the rapport with my mentees. I think I could get a lot more accomplished with them, but I really need a break to recharge. My opinion on how to make this mentoring mission succeed is to do repeated 6-month rotations. By that, I mean 6 months in Afghanistan, then 6 months in the US, and then come back for another 6 months. I would work in tandem with my replacement. We would keep in touch and work together to raise the standards here. It would be a 2-year total commitment. I personally think it would work better than a single 6-month deployment or a year deployment. 1 year in Afghanistan without a break is a very long time. I think 6 months here, and then a 6-month break, followed by another 6-month deployment would benefit all. I have really enjoyed working with the Afghans, but it is tough being away. This has been the hardest deployment I have done. Some days are so frustrating, and others are awesome when I see the light bulb go on and they understand what I have been teaching and have incorporated that into their own individual practice. It is time for a personal break, to go home and be with family, but I would gladly come back here.

Once again, Merry Christmas to all…

Sunday, December 20, 2009

Single digit midgets...

All of the new team is here and we have begun turnover. I have just over a week left in Kabul, then I begin the long journey back to the states, and eventually home. It has been a busy week.

Last Friday, we drove to KAIA after dark (supper time) to pick up half of the new team. When we got there, we learned that the team had been delayed in Bagram and wouldn’t get to KAIA for a few more hours. We drove back to NKC. I drove lead with Dennis as my TC. It has been a long, long time since we have driven in the dark. Needless to say, there aren’t many streetlights in Kabul.

On Saturday, we drove back out to KAIA in the morning to pick up the personnel from the previous evening, with me in the lead vehicle and Dennis as my TC. We brought them back to NKC and helped them move all of their gear into their rooms and showed them around our little FOB. The new team trained at Fort Polk instead of Fort Riley. Fort Polk has taken over the METT training mission.

On Saturday night, I was able to go out for a few hours. I was lucky enough to go to one of the NGO’s house, Dr. Larson. He has been coming to Afghanistan since 1970, doing various missions as a civilian. It was Joe, Dennis, myself and 2 others from Camp Eggers who got invited to his house to have supper with Dr Larson and his wife. We had an appetizer (ashak), followed by borani and the main dish of quabeli. Dr. Larson’s wife is an excellent cook and we ate like kings. We then had fresh fruit for dessert and sang some Christmas carols before leaving for the evening. It was the best Afghan meal I have eaten here in Kabul. They rent a house and Mrs. Larson goes to the local market to purchase their food.

On Sunday, we were treated to another meal, this time at NDS hospital. The CO invited the mentors to have lunch with him. There were 12 of us who ate with the CO and other members of his team. It was another good meal, but not as good as the previous evenings meal. After we got back to NKC we killed some time, then we had to drive to Camp Eggers to pick up the rest of the new team. They convoyed from Bagram, but got dropped off at Camp Eggers. I know, it doesn’t make sense…

On Monday, we began turnover with the new team. They have 22 people compared to our 15. The RFF (request for Forces or the manning document) has changed somewhat. They have additional corpsman and technicians but fewer providers. WE had a team meeting to start off the morning, then they toured NMH as a group. After lunch, we began individual turnover. There is both an OR nurse and a scrub technician on the new team. Hopefully, they will be able to accomplish more than I have. The Afghan nurses can learn a lot from the scrub tech. Marvin is a senior first class from Portsmouth, VA and the nurse, Brian is from Jacksonville, FL. We worked together when I was in Portsmouth.

Tuesday was our first day in the OT. I introduced them to the mentees and we did a basic orientation to the OT. The new team got a “Welcome to Kabul Afghanistan” when a SVBIED detonated around mid-morning. It was within a kilometer of NMH. We all felt and heard the explosion. The glass in the windows shook, but none broke. The new team got to see the mass casualty response. We received 4 patients in the OT. We finished by lunch. My interpreter, Walid, gave me some traditional Afghan clothing. I can’t remember the Dari word for the clothes, but everyone calls them man-jams. Here is a picture of me standing next to Wais:

Wednesday was another day of turnover. On Thursday, the new team had to go to Camp Eggers for more checking in and driver training. We had to convoy them there. It took us 2 trips to transport them. This time, I got to drive an up-armored Chevy Suburban. Dennis and I stayed with the new team to help them at Eggers. We came back to NKC for lunch, then the old team had to go to Eggers for our monthly “All Hands” meeting. The new team was “hailed” and the old team “farewell”. We had one of the chiefs at Eggers help us get everyone back to NKC so it only took 2 trips to move both teams. We can fit 7 people in the suburban.

Friday was not a regular jumma. We had to go to Phoenix for vehicle maintenance and to start training the new team on driving. Instead of me driving the lead vehicle, I was the TC. We had the new team drive. We spent 10 hours at Phoenix waiting on the vehicles. Before they would work on them, we had to take them to the wash racks. Of course, there were lots of MRAPS in line in front of us and the temp was below freezing. The wash rack was icing up. It was “fun” power-washing the trucks while standing on ice. Once the trucks were finished, we drove back to NKC. Of course, it was dark on the return trip, so the new drivers got to learn in the dark.

Saturday, was another day of turnover. The entire team had a meeting with the CO of the hospital. After that, the nurses went to the OTSG to have a meeting with BG Rhazia, the Commander of the ANA Nurses. We met her when we first started our tour. It was another combination meeting. The new nurses were introduced, and Holly and I said our goodbyes. The tour is winding down and the goodbyes are beginning. Only another week, and we leave Kabul…

Friday, December 11, 2009

More Boondoggles and let the turnover begin…

(As always, the internet is not cooperating very well. I posted the blog entry on Friday, but had to come back on Saturday morning to finish uploading the pictures.)

Shortly after I last posted, the OT staff had a small luncheon. This was on last Thursday. Dr. Ayobi treated us all to lunch. I don’t know the exact Dari word for what we ate, but the called it “hamburger”. I would call it an Afghan wrap. Here is a picture of a half eaten wrap:

Here are some pictures from the luncheon.

On Saturday, we went to the depot for a going away luncheon for the Air Force Logistics (“Log-E”) mentors. It was a big gathering of almost 40 people. Here is a picture of the food we ate: (It was delicious)

On Monday, we took our normal trip to NDS, but I was a passenger this time. After our mentoring, the team dropped of DJ, Tim and I at the airport (KAIA) for a trip to Bagram. The US Air Force Hospital (Craig Hospital) has a 2-week training program for the Afghans. I took the Chief OT nurse, DJ took one of his anesthesia residents, and Tim took a pharmacy tech.

Flying in theater is always a chore. Once we got to KAIA, we checked on our flight. We found out we were booked on a non-existent flight. That made us happy. We asked to go standby on a later STOL flight. It was the best flight we have had here. We went to the counter and checked in and then dropped all of our gear to be palletized. We didn’t have to wear IBA or helmets on the flight. It is like flying on a real commercial plane, only small. There is only 30 seats or so. The biggest limiting factor is weight. We have to weigh all of our gear and ourselves. From the time we checked in until the time we landed in Bagram, only an hour had gone by. It was an awesome flight and didn’t take hours upon hours.

After we arrived, we got rooms and met up with the Army mentor at Craig hospital. Yes, it is an Air Force Hospital, but the training program is run by an Army nurse. I spent all of Tuesday, Wednesday and half of Thursday in the OR with my nurse. There was also another OT nurse from Kandahar going through the training.

We left on Thursday to return to NKC. Whereas Friday is the weekend for the Afghans, they left on Thursday afternoon to return on Saturday morning. We could only stay for this week as we are going to begin our turnover with our replacements. They haven’t arrived to NKC yet, but are on their way. They have been delayed a few days because of flights. It took DJ, Tim and I almost 10 hours to get back. In Bagram, you have to show up 3 hours before the flight to check in. We were booked on a STOL flight back to KAIA. We checked in our 3 hours prior, but 1 hour before the flight was too leave, they cancelled it. We had to scramble to get on a C-130 to return. We got the last flight of the day. We boarded the C-130 about an hour before we were due to leave, but sat on it forever. We had to wait on a 3-star general, who showed up about 15 mins after we were scheduled to leave. We finally left about 45 mins late and finally got to KAIA. We were on the C-130 for over 2 hours for a 15-minute flight. Traveling now is miserable. I can only imagine what it will be like after another 30,000 troops are in country. Once we got to KAIA, we had to scramble around to find a ride back to NKC. We only waited about 20 mins before we lucked out and caught a ride. By the time we got to NKC, it was 10 hours after we went to the airport in Bagram. 10 hours travel to go 70 km. I can’t ever complain once I get back to the states and fly commercial. Nothing they can do will be worse than flying in theater.

We will begin our turnover in the next day or two and will be leaving NKC in a few weeks. Normally, turnover (RIP/TOA) is only 10 days, but they are getting here a little early and we can only go through the Warrior Transition Program in Kuwait on certain days. It is a scheduled class, so we have extra time to turn over. Turn over is such a good word…

Wednesday, December 2, 2009

Rookie Move

I have two quick updates for the blog. The first happened on Monday on our trip to NDS. As usual, I was driving the lead HMMV with Dennis as the right seat. We left early morning and arrived to NDS without incident. We didn't do much mentoring as it was the first workday after Eid. Most of the Afghans greeted each other, had hugs and handshakes, then spent the rest of the time drinking chai and discussing Eid.

My rookie mistake happened when we got ready to leave. I started the HMMV and let it warm up while I was putting on my gear. I climbed in the seat, then saw what I thought was white smoke coming up between my legs. Needless to say, I didn't spend alot of time looking at the color or trying to figure out what it was. I thought "FIRE" so I immediately shut off the truck and bailed out the door. I hadn't closed the door yet. I turned around and looked back into the truck and didn't see anymore smoke. What it really was, was my rookie move. I somehow hit the dry chemical fire extinguisher which is under the seat. If you look closely at the picture, you will see the brackets where it belongs. My boots and the floor of the truck turned a nice shade of pink from the chemical. Yes, I received a little teasing from that...

Andrew holding the dry chemical extinguisher
You can see the extinguisher bracket next to the seat
Me, my "Pink" boots and my rookie move...

On Tuesday, I finally flew my Maine State Flag here at NKC. Les helped me raise it and Dennis took the photos. This flag was flown over the state capital in Augusta, then sent to me when I was in Iraq. I flew it in Al Taqqaddam when I was there. Now it has flown in Afghanistan. I have signed certificates for each time it has been raised. They will look good on my wall once I retire.

The Maine Flag under the American Flag, next to the Afghanistan Flag at NKC

All three flags and me
Les and I holding the Maine Flag after we flew it.
So, I have blogged two tales for the past two as a rookie move, and one of me raising and flying the Maine State Flag.

On a better note, we have received official word that December will be our last month in Kabul. Our replacements should be returning from their I stop and beginning the long journey here in the next few days.

Some of us did get up to watch President Obama deliver his speech from West Point about his view of the Afghanistan War and the new troops coming here. It was televised live here at 0530. I am glad he is sending additional troops, but my only question is where are they going to live? Every place I have been here in Kabul already has too many people for the facilities. I can't imagine things are any better elsewhere in the country. I hope someone is thinking this through...

Friday, November 27, 2009

Happy Thanksgiving from Kabul

First, I want to wish everyone a Happy Thanksgiving from Kabul Afghanistan. Our team took the day off from mentoring. Actually, we are taking a long weekend off from mentoring at NMH. Not only did we have an American Holiday, the Afghans are having one too. This weekend is another EID. The EID will end on Sunday, so it will be back to mentoring on Monday. Of course, we have lots of admin to catch up on over the weekend.

Prior to our team celebrating Thanksgiving together, we took some team photos:

This is the entire team Thanksgiving morning (Navy battle rattle with Santa hats)

Combat Nurse Mentors...

So, let me recap the past week. Last Thursday, was the President Karzi’s inauguration. We didn’t mentor on that day. In fact, our security posture was increased, so we spent the day on NKC. Everytime we were outside a hardened structure, we had to be in full battle rattle. That makes for a long day. There are many people here who don’t leave our little FOB. I don’t know how they do it. I get off the FOB at least 6 days a week for mentoring.

Saturday and Sunday were regular days of mentoring at NMH. I continue to do much of the same thing everyday, working with the OT nurses in the rooms and trying to help them raise their standards of care. Sometimes, it feels like I am swimming up stream. Everyday that ortho has surgery, I am discussing something with them. My biggest concern is to get them to only do one patient at a time in the room. I think I might have finally convinced them to do only one patient at a time. It wasn’t because it is what is best for the patient. The Ortho Surgeons want me to help them purchase some new instruments. I told them the only way I would purchase the gear is if they change their practice. They have told me they would only schedule one patient at a time after EID. Only time will tell. In the meantime, I haven’t ordered any new instruments.

Monday was another trip to NDS. It was rainy and cool. It is the first time we have had rain during the day. I have attached some quick videos of driving through the streets. The first one is on the way to NDS. We are heading down a one way street.

(The internet connection is not co-operating, so I will try to post the videos at another time)

The second video is on our way back from NDS. It is another one-way street, but notice how much heavier the traffic is. I am driving the lead vehicle in both videos.

Tuesday and Wednesday were more regular days of mentoring. Nothing special on those days either.

One last big item to report. Our reliefs have graduated from their training at Fort Polk and are enjoying some time off on their I-stop prior to making the journey here. I am guessing that we will see them here in a few weeks, then turn-over, then our journey home. Almost time to start the official countdown, but no solid dates yet…

Wednesday, November 18, 2009


I know I am a little late on posting to my blog, but I returned from a boondoggle out to Mazar-e-Sharif in the Northern provinces. I even have some pictures to post with this entry.

First, let me recap last week. We did make a normal trip to NDS. It was actually a clear, cool morning which is a rarity here in Kabul. The pollution is so thick that it is very rare to see the distant mountains. So, here is a picture of the snow-capped mountains, west of Kabul. This picture was taken last Monday. I haven’t seen the mountains since.

From NDS looking west

This is looking past NMH from NKC

This is supposed to be a picture of me in front of the snow-capped peaks...

Me as the lead driver trying to ease through traffic and pedestrians in Kabul

Other than that, it was a normal week of mentoring. There are always little things to work on and improve in the OT.

Friday was another violent day here in Kabul. The Taliban used a SVBIED outside Camp Phoenix a little before 0800. There were no American casualties, but there were injuries. You can read about it online. Here's hoping the Presidential Inauguration will be less violent than the actual elections.

Now, for the boondoggle...

Early Saturday morning, several of us left to go to Mazir-e-Sharif (MES) to visit the US Mentors there and help with some assessments of the ANA Regional Hospital there. It was a long trip. We spent 4 or 5 hours at KAIA before we finally left on a German C-160. We made a stop in Kundez, then arrived at Camp Marmal, which is the German base an airfield. The flight in to land was different. We wear our IBA & Helmets on the plane. When we are getting ready to land, it is like we drop out of the sky. The IBA becomes 200 pounds, it gets difficult to breathe and it gets hot. That is from all the G's we are pulling for evasive maneuvers to land. needless to say, there were multiple people using the air sickness bags. We arrived 3 hours late. We were supposed to get on a convoy to Camp Spann, which is where the US Mentors are located. The convoy was leaving as we were getting off the plane. We didn't know it was the last convoy of the day, so we had to spend the night at Camp Marmal in transient tents. Here are pictures of the German and international memorial:

On sunday morning, we got up early to eat breakfast and catch the convoy to Camp Spann. Well, Holly and I got bumped for a Canadian General and his entourage. There wasn't enough room for all of us so we got to wait another 5 hours for the next convoy. Finally, on Sunday afternoon we got a ride on the convoy to Camp Spann. It is riding in the back of MRAP's. I wouldn't want to do it everyday. It is an hour convoy. We had maybe one-half hour of daylight left once we got there. I know most of the mentors that are in MES, so we had supper together and swapped war stories.

On Monday, we had a chance to see the regional ANA hospital. It is a new facility, less than 3 years old. We helped the Chief Nurse there with some assessments, then it was time for lunch. After lunch, it was jump back on the convoy to Camp Marmal for our Tuesday flight.

We had an very early show time for our flight back to Kabul, 0510. We left about 2 hours later and once again stopped in Kundez. We got off the C-160 for 30 minutes or so and stood on the runway before getting back on and flying to Kabul. The evasive maneuvers weren't quite as drastic as the previous flights, but people were still getting sick. We had to wait around at KAIA for a little while until we could catch a ride back to NKC. We got back around lunch. It was a long trip, but well worth it to get away from Kabul for a few days and see more of Afghanistan.

It is almost time to begin the countdown for leaving here. Once our replacements graduate from Fort Polk, I will begin the countdown...

Until next week...

Saturday, November 7, 2009

Overdue Pictures

Me, Andrew, Holly and DJ at Bagram (on the roof of the hospital)

The team sitting around waiting for the "All Hands" at Camp Eggers