On the road again...

Now that we are past the elections, we are able to travel throughout Kabul and revisit many of the places we have been to before. During the past week, I had the opportunity to drive to ISAF for a little NATO medical get together similar to the one I went to several weeks ago, but no BBQ this time. I was the driver for the lead vehicle and it was sobering to survey the damage from the SVBIED.

I also drove when we went to NDS Hospital one day this past week. We continue to establish a small mentoring role with NDS but I am 0 for 3 on observing any surgery in the OT there. Each time that I have been there, no surgeries were scheduled. Hopefully, the next time we go in the very near future, I will be able to observe a surgery there. Once I do, I will be able to form a comparison between NMH & NDS, then try and renew the working agreement between the two OT's with regards to training each other.

I also had the opportunity to drive to Camp Eggers for a meeting about possibly building a new OR/ER/ICU and Central Sterile Processing for NMH. Some money was allocated for a new building, but not enough for a completely new hospital. We are only in the very, very, very preliminary meeting stages so the sky is the limit for the new building. Eventually, we will get reigned back in by the dollars or lack there of, but it will be awesome to help design.

In other news, I was sent a website about the Afghan Army. It has a little background on the ANA. I ask you to skim the info, but look closely at what the pay scales are near the end of the article. Most of the staff at NMH are paid very little. Those who can, also work in private practice to supplement their ANA pay. Many of the surgeons at NMH want to be done their surgeries by lunch or shortly there after so they can work in private practice the rest of the day. It is one of many problems in the medical system. The article is

http://www.understandingwar.org/themenode/afghanistan-national-army-ana

So, the big question is what did last week's elections accomplish here in Afghanistan? Did it make the situation better or worse? Most of you have seen the various articles on the net and on tv with all the individual reporter's opinions of what is happening. For now, I am only going to say that the reporters are biased and opinionated about what they want to report. From what I hear at NMH, no one is talking about the elections on a daily basis. If I ask one of the nurses what they think about the elections, they will tell me, but as a whole, they don't talk about it. They know there is corruption in the government now and they see it at the hospital. Maybe corruption isn't the best word. It is all in who you know here. There is little personal accountability. Let me explain this further. For example, a nurse is scheduled for overnight duty on one of the wards. What do you think would happen to a nurse in the states who was scheduled for duty, but didn't show up, didn't call, or didn't do anything? Here, your answer would be wrong. Even if someone threatened to fire that nurse, all the nurse has to do is go to someone they know who has some positional authority and get a letter saying they can't be fired. It is that simple.

Another example, is the soldiers get paid every month in cash. How do they get that cash to their family? Well, it depends on where the soldier is stationed and where his family lives. He might decide he needs a week off to travel to his home to give his family the money. As long as he returns with his weapon, nothing is said and it is like it never happened. The problems go on and on...

So, is it corruption? Not really by the definition of the word. Will last week's elections change anything? Only time will tell and it also depends on what alleged election irregularities and fraud can be proven. Even if proven, what will happen and what will change? A very complex question with no easy answers....

Pictures and elections

I am finally posting some pictures.

Here is a picture of the traffic one day after leaving NDS hospital. The street is only wide enough for a single vehicle with parked vehicles next to the sidewalk. Remember there are no traffic laws so if you can fit, they drive...

Here, we are waiting for everyone to get together so we can leave NMH and head back to NKC

Here is a picture of us at the back of NDS. It is Lach, Dennis, Tim, me and DJ. You can see some of Kabul in the background behind us.
Another picture of the traffic and pedestrians in the Kabul streets. Notice the bicyclist to the left of the picture.

So, here it is 2 days after the elections and no official results yet. I didn't see the big three networks (ABC, CBS, & NBC) projecting the winner in each province on election night here in Kabul. Actually, the last thing I heard was that maybe by Tuesday, the Election Committee will release some results. Yesterday, both Karzi and Abdullah were claiming victory. Only time will tell how it plays out...

Since I last posted, we had a few more incidents in Kabul. Another SVBIED struck a convoy near Camp Phoenix, where I was last week. We got 8 cases in the OR from that incident. On Wednesday, we had 1 case in the OR which was ANP CTP (Afghanistan National Police, Counter Terrorism Police.) You can look up the incident on the web. It was the ANP exchanged gunfire with some terrorists at a bank in Kabul. I won't go into specifics, but again, you can read about it online.

Thursday, was the actual elections and it was eerily quiet. No incidents that we are aware of that brought causalities to NMH. We didn't have interpreters that day as there was no public transportation in Kabul. The streets were locked down pretty tight. I did go up to the hospital with the other nurses but there wasn't anything going on. No cases in the OR. We ended up rounding together on the patients throughout the hospital with several of our docs.

Yesterday, jumaa was a typical day off. We didn't go up to the hospital and again there were no incidents that required us to go up. Today is the first day of Ramadan, so again we did not go up to the hospital as we didn't have interpreters. The hospital was in a duty only status, similar to jumaa. Tomorrow, we are back to a normal schedule.

Other than posting the pictures, not much new to report. Quiet is good...

SVBIED

I am guessing most of you have already seen and/or read the news from Saturday about the SVBIED (Suicide Vehicle Born IED) that exploded here in Kabul, killing 7 and wounding 91. When it exploded, I was at the hospital. News travels fast. Most of the nurses in the OT received calls on their cell phones letting them know what happened. Where the explosion occurred is only a long stone's throw from here (NKC). We have driven through the gates where the explosion was. In fact, 4 members of our team were supposed to convoy a little later in the morning. Fortunately, they were not on the road when it happened.

The Afghans at NMH had an awesome response. They were prepared to receive causalities within minutes of the explosion. They did receive some, and effectively triaged and treated them. The hospital has had too much experience in causality treatment. They have know nothing but war for the last 30 years. I would like to think that they won't have to receive anymore mass causalities in the near future but...the election is on Thursday and the Taliban continue to make threats against the elections.

Not much new to report over the previous week. I did get out on Friday to convoy over to Camp Phoenix. We took the humvees over there for maintenance. We were gone for several hours. It is good to get out eventhough I do go up to the hospital almost everyday.

I don't have any new pictures to post either. I am still waiting to get some of the pictures from several other members of my team. Once I do get the pictures, I will post some. However, I do have some more interesting facts about Afghanistan, more reasons as to why we do what we do:

The Ministry of Finance asserts that in the post Taliban Afghanistan, per capita income has increased from USD 70 in 2001 to USD 300 in 2008. However, Afghanistan is still ranked as the fourth poorest and most deprived country in the world, and the poorest country in the entire Asia-Pacific region, according to the Afghanistan Human Development Report 2007. Decades of conflict combined with a number of serious earthquakes, consecutive droughts and other natural disasters have had dramatic impacts on the Afghan population. Those affected are the poorest demographic, equally split between the countryside and urban areas.

Since the fall of the Taliban and the end of major combat, economic growth has been rapid. There has been a strong recovery, although from a very low level of activity, accompanied by an improvement in some social indicators. In the past eight years, millions of Afghan refugees have returned to their home country and school enrolment has continuously increased, particularly among girls. Significant progresses have also been achieved in the health sector, evidenced by the massive success of consecutive vaccination campaigns. However, despite the economic recovery, Afghanistan still ranks very poorly on all social indicators. According to the latest report by the Afghan Independent Human Rights Commission (AIHRC), about ten million people suffer from severe poverty with a large number earning less than 1 USD a day. Human poverty in Afghanistan is a multidimensional problem that includes inequalities in access to productive resources and social services; poor health, education and nutritional status; weak social protection systems; vulnerability to disasters; human displacement and gender inequality.

While there is no exact statistic about the rate of unemployment in Afghanistan, it is believed that some 40% of the country’s estimated 30 million people are jobless. This high rate of unemployment has driven thousands of Afghans to neighbouring Pakistan and Iran in search of jobs. Unfortunately, this situation increasingly benefits the Taliban, who commonly seek recruits among the jobless with offers of money.

According to the World Bank, in 2009 only 13% of Afghans have access to safe drinking water, 12% to adequate sanitation and just 6% to electricity. In rural Afghanistan, which supports the agriculture sector, the main industry in Afghanistan, the lack of technical and infrastructure capacity, including clean affordable energy, maintains a high level of socio-economic insecurity. Despite large agricultural potential, the country is missing rural entrepreneurship, market linkages, access to financing and technology and a strong private sector to create job opportunities.

Kind of sobering, isn't it....

Not another Fobbit

I know I have been seriously delinquent in updating my blog. Here it is already the 10^th of August. Wow, time flies when you’re having such fun. NOT!

My team has also picked up another mentoring job at another hospital here in Kabul, NDS Hospital. NDS stands for National Defense Service, which is similar to our CIA. I went to the hospital once last week and again today. It is a relatively new hospital. If it wasn’t for the signs in Dari, it could be any small, rural hospital in the US. It is a very nice facility. I will of course be mentoring the OR nurses. Last week, we went in the afternoon and there were no cases in the OR. I met the nurses and we began to build a working relationship. When I went back today, again there were no scheduled cases. All of the hospitals in Kabul have begun to cancel all elective cases. They want as many empty beds in the hospitals as possible for the elections next week. No one knows what will happen during the elections and it is better to be prepared with lots of empty beds in the hospitals.

On this past Saturday, I went to the US Embassy here in Kabul for a short conference. That is a nice piece of property here in Kabul. They even have an outdoor pool, but we did not go swimming. Hopefully, we schedule a little down time for a swim.

I continue to work with the OR nurses at NMH. One of the Nursing processes in all of the ANA is to work on 36 basic nursing competencies. On Monday’s, the nurses have training on one of the competencies. One of the OR nurses will attend the training, then train the other nurses on Thursday with my help. Once they have completed all 36 competencies, they receive a certificate from BG Razia, the Chief Nurse for the ANA. They are also trying to make a cash bonus for this program.

In the OR, we are working on developing surgical conscience, sterility, and how to clean instruments and the rooms after a case. This is inbetween trying to obtain supplies (medical & surgical consumables). My team doesn't have an Ortho Doc so I am trying to coordinate the ortho gear too. Always busy. Getting consumables requires a walk to the National Depot and hopefully they will have what we need. If they don't, then I contact local vendors to get quotes, then we write a contract. This takes at least 30 days to get the supplies. Nothing is quick in Afghanistan.

I read an interesting article this past week, "The 800 pound Gorilla: The Interrelationship of Culture, Economics and Security in Afghanistan."

http://smallwarsjournal.com/blog/2009/08/the-interrelationship-of-cultu/

It is a unique perspective. I hope you enjoy it.

Oh yeah, about the title of this post, Not another Fobbit. Military personnel who live and stay on the FOB (Forward Operating Base) and never go outside the wire, are called Fobbits. (This is what I was when I was in Iraq). I am lucky enough to get off of NKC everyday. When I walk up to NMH, that is considered going outside the wire. The OR nurses ask me often to go out in Kabul with them. I only wish it were that easy and safe. I would love to see Kabul from their perspective.

I will try to update the blog more often and with more pictures. We took pictures at NDS today, but it wasn't with my camera. When I get the pictures, I will [post them. The picture I posted today is my team and our humvees in the parking lot of NKC. We are missing 2 people, but we can never get all of us together for a photo...