Saturday, October 31, 2009

Happy Halloween

Another week has come and gone here in Kabul. It has been a week of no convoys or any traveling. I think this has been the first week I didn’t go anywhere.

I started the week with an admin day where I stayed in the office and tried to get caught up on all the outstanding admin. I finished the DOTMLPF (Doctrine, Organization, Training, Materials, Leadership, Personnel and Facilities). It is a 17-page document. That took me most of the day.

Sunday, Monday and Tuesday was the ANA Medical Leadership Conference. It was hosted and run by the ANA with very minimal input from the US mentors. This was an all of Afghanistan conference. The Brigade Surgeons, Hospital Commanding Officers and Senior Nurse Officers all presented, as did some others including MG Yaftali, the ANA Surgeon General. The counterpart US mentors from throughout the country also attended. It was locally catered for tea breaks during the day and lunch was provided. Overall, it went well. There was also a local company who provided translation services. The US mentors were all given earpieces so we could listen to the Dari in one ear and English in the other. That made the conference go much quicker.

Wednesday was a regular day of mentoring in the OT. On Thursday, I did some training with the OT nurses on the core competencies. We have missed a few weeks of training, so I am trying to get them caught up. We have 6 months to complete all 36 competencies. I won’t finish with them, so I will ask the next mentor to continue the training.

Thursday night was also another earthquake but not as strong as last weeks. It was earlier too, around 2215. I was still awake so I knew what was happening this time. Now, we have experienced 2 earthquakes in a row, both on Thursday.

Jumaa (Friday) was our off day and another day to get caught up. Every now and then it is good to have a day of no traveling, no meetings or not much of anything. A day to recharge the mental batteries is always needed. Mentoring takes a huge mental toll, so when I get the chance to refresh, I try to take it.

Today was another unique day. I found out that there were 2 new sterilizers (Autoclaves) at the National Depot. Previous OR mentors had written a contract to purchase 2 autoclaves, but they hadn’t been delivered yet. The contract was written in Sep 2008, but the machines have been stuck in customs in Pakistan. The Autoclaves at the depot were purchased by the Ministry of Defense (MOD). After an hour or two spent figuring out where the ‘claves came from, I was able to get the depot to deliver them to the hospital. Now, I need to wait on the vendor to install them in CSD (Central Sterilization Department). Hopefully, they will get installed correctly in the next few weeks. It will be a huge improvement for sterilizing the surgical instruments. The other 2 are still on order so maybe before I leave, there will be a total of 4 new sterilizers in CSD.

Again, I don’t have any new pictures. You would think by now I would remember to carry my camera around with me and actually take some pictures. Hopefully, I will have some new pictures to post in the near future.

Saturday, October 24, 2009

Presidential Elections Round 2,

It’s been another odd week here in Kabul. I guess there isn’t really any reference for a “normal” week, but I will still call it an odd week. I have been on 3 convoys, the team presented what we are doing to the CG (Commanding General) and I woke up in the middle of the night to an earthquake. Lastly, Karzi agreed to a second round of presidential elections for 07 Nov. We will have to wait and see how that turns out.

The team has been back and forth to Camp Eggers three times this past week. The first time was to practice our brief for the CG. The second time was the actual brief. Not only was it for the CG, the ANA & ANP Surgeon Generals were present as were two other US Army 1-stars. There were approximately 60 people in the room. Because we didn’t have enough time for everyone to brief, only 3 from my team actually spoke. I had the tough job of pushing the arrow keys on the keyboard to progress through the slides for the presentation. The brief took 2 hours. We went to NDS in the morning before the brief and stopped at Eggers on our way back. The final time to Eggers was for our monthly “all hands” brief. This week was the first time I was in the back seat of the humvees. I was the gunner. I was the TC in the lead vehicle for the drive to NDS.

Another odd event was the earthquake. I don’t snap awake when I get woken up in the middle of the night. I thought I was dreaming. It was just before 0030 on Friday morning when the earthquake hit (you can read about it online). When I woke up, my bed was shaking. I thought I was waking up to a seizure (yes, I was completely disoriented when I woke up). You can laugh all you want to, but try waking up to your bed shaking from a deep sleep in Afghanistan and tell me what you think. The quake lasted about 30 seconds, so I didn’t think it was an explosion nor was there a big boom. It is a good story to bring back from Afghanistan though.

Another odd thing this week was when I went into the OT on Tuesday, the nurses told me one of the nurses had been transferred to the Lab. Originally, he trained as a lab technician, but somehow he ended up in the OT as a nurse. Most of the Afghans are always talking about the “corruption” here and how “powerful” someone is. It is all in “who you know”. I guess the OT nurse “knows” some in the ANA Surgeon General’s Office (supposedly the Surgeon General himself, MG Yaftali). The nurse wrote a letter and had it signed by Yaftali so now he works in the Lab. (Yes, I know it is screwy here). The other nurses are upset as it leaves them even more short-staffed. They asked me to see what I could do about it. I talked with my team and the decision was made to see the CO of NMH. I went and talked to him about it with my Chief Nurse (Dennis) and our team leader and both of their ANA counterparts. The decision was made by the CO to at least keep the nurse in the OT until after the election incase we have any more mass causalities.

Of course when we had the CG brief, we had our asses handed to us. We went in with what we thought was the correct format for the brief and the CSTC-A Command Surgeon had previously approved it. When we took over back in July, we were told to come up with individual metrics for our departments which were approved. The previous team had developed what is called DOTMLPF (Doctrine, Organization, Training, Materials, Leadership & Education, Planning and Facilities.) We were told not to use it or update it back in July. Of course, that is what the CG wanted us to brief him on. The DOTMLPF is rated by a CM (Capability Milestone) of 4 (can’t do anything for themselves) to a 1 (self sufficient). So now, we have been scrambling to update this document so we can do another brief in the coming week. (Got to love Army logic…)

One other item from the CG brief is the room we had it in. I took some pictures of the CSTC-A Command Patch. We wear it on our uniform. I have included some pictures of it. Now I know what it symbolizes... (See the pictures)

Other than that, I did get in some regular mentoring. I was able to have training with the OT nurses on one day and with the Ortho surgeons on another day on the OSI Ortho Table. I will need to be with them the first few times they use the table to make sure it is set up correctly. It is difficult to use and takes a good 8 to 10 times of setting it up properly to become familiar with it.

On a final note here is a good article from the NY Times about Afghanistan and General McChrystal.

It is well written from the NY Times as it is fairly unbiased without a liberal slant. I hope you get a chance to read it.

Here are a few pictures…

This is Lach, myself and DJ in front of NMH

The CSTC-A Patch

A close up of the symbolism

Friday, October 16, 2009

A great meal...

Another week in Kabul has been completed. It has been a typical week, but only out on the road once since I last posted and that was too NDS. We did roll through where the last SVBIED tried to take out the Indian Embassy. It never ceases to amaze me as to the amount of destruction explosives packed into an SUV can do. . .

One of the big accomplishments this week was finally taking delivery of a new OSI Ortho Table. This is a special surgical table used for hip and leg fractures. It allows the surgeons to use traction, and it is also big enough that the C-arm can be easily used. Every OR in the US that does ortho trauma surgery will have some type of OSI Ortho table. It got shipped here in 5 separate crates. It was a several day evolution to get it to NMH. On the first day, I went to the National Depot to meet with the vendor. All supplies get delivered to the National Depot which is near the hospital. I ended up having a long discussion with the vendor. If we unpacked the crates at the depot, there was no way we could then get the OSI table and all its pieces and parts to the OT. I convinced the vendor to deliver it to the hospital. He contracted a crane & truck to bring everything to the hospital 2 days later. On the day it was to be delivered, it took 3 ½ hours to unpack the crates and inventory all the pieces. Of course, 1 small part was missing. The vendor doesn’t get paid until all the parts are delivered and accounted for. In the next few days, I will be training the OT nurses and the Ortho surgeons on how to use the OSI table. It is a complicated table and many OR nurses in the states have difficulty using it properly. I won’t let the surgeons here use it until they attend training. It is a $130,000 table, so everyone will be trained before using it.

We had two big visits here this past week, both on Wednesday. The first was the US Navy Surgeon General. He met with his Afghan counterparts during the morning, then toured the hospital in the afternoon. He also took an hour and a half out of his schedule to visit with us in our office. He met with the team and we had a good question and answer session. After his visit with us, the second visitors came. A group from Outback Steak House and Carrabba’s Italian Grill came and cooked supper for us. What an awesome thing to do for the troops and it was the best meal we have had in theater. They cooked Ribeye & NY Strip steaks, 3 different pastas, Blooming Onions, Calamari, Fresh rolls, baked potatoes, rice, vegetables and soup. For dessert cheesecake and carrot cake. They even brought their own servers to bring the rolls, calamari and blooming onions to the tables. The next time any of you visit Outback or Carrabba’s in the states, thank them for coming to Afghanistan. The meal was the highlight of the week!!

On Thursday, there are no cases booked in the OT. It is a day to get caught up on cleaning. I got to eat some bolani, which they told me is an Afghan favorite food. From Wikipedia: Bolani is a vegetarian flat-bread dish from Afghanistan. It has a very thin crust and can be stuffed with a variety of ingredients, such as potatoes, spinach, lentils, pumpkin or leeks. We had potato in the ones I tried. It is good.

Other than that, nothing new to blog this week. Today we didn’t have to go anywhere for once. It makes for a good jumaa when we can sleep in and not travel anywhere. We got to actually enjoy the reduced battle rhythm day.

Whereas I posted the new pictures earlier this week, I don’t have new ones to post. I hope to get some pictures of the training on the OSI table that I will post.

Sunday, October 11, 2009

Finally, some pictures...

This is what happens when you don't wear your helmet getting in and out of the humvee. Should have ducked more...and yes, the armor is a little bit stronger than my bean.

Some stuffed animals going for a ride in my IBA

Here is some video of lunch time driving in Kabul. I am driving and Dennis is the TC (Truck Commander).

Friday, October 9, 2009

Another week of mentoring complete…

I am back on my normal schedule of trying to post on each Friday, so it has only been 5 days since my last blog entry. I didn’t post any new pics last time and I don’t have any for this entry.

My trip to NDS this week went well. I had the NMH Chief OT Nurse and another OT Nurse meet me at NDS. We met with the NDS OT Nurses and discussed cross-training between facilities. It was decided that the NDS nurses would travel to NMH. Hopefully, we can get this started soon. One NDS OT Nurse should come to NMH for a 2 week period. It will take the first few days to get all the admin completed so the NDS nurses can get onto the NMH campus. Then, they will spend 8 to 10 days training with the NMH nurses and myself. It should work out well.

The rest of the week was regular mentoring at NMH. Getting the medical consumables continues to be one of my hardest tasks. Everyday, we run out of something else. We have a special emergency fund of money we can use to purchase items for the ANA. We get a small cash allowance each month. This week was the first time we were actually able to draw the funds. I have used a portion of the cash to purchase disposable surgical masks and hats. One of our interpreters also has a business. He goes into the local bazaar to purchase the masks and hats for us. I had him get 3000 masks and hats, which should last us three months. I hope our regular shipment gets here by then. I ordered 9000 masks and hats the first week of Aug and I am still waiting to receive them. It took many weeks just to get through the American chain of command to be approved and funded. Once funded, a contract is awarded to a local vendor who then gets consumables and delivers them to us. If they are buying the consumables from the US, it can take another 6 weeks with shipping.

Thursday, started out as a regular day of mentoring. After I completed the Nurses Morning Meeting, I went outside to receive the surgical masks. That’s when a SVBIED exploded near the Indian Embassy and the Afghan Ministry of Interior. We made preparations at NMH for a mass causality, but we didn’t receive any patients. The explosion was several miles from NMH (near NDS hospital) and the wounded went to local hospitals in the area. The last count I heard was 17 dead and close to 80 wounded. The Taliban have claimed responsibility.

Today, jumaa, was another trip to Phoenix for more vehicle maintenance. This time it was for the radios in the humvees. I ran into the Alabama National Guardsmen again who I trained with at Fort Riley. They are still waiting for a new mission. I was lead driver again. That has been my spot lately. Whereas Jumaa is the only day off for the Afghans, traffic is light in the morning, but picks up later in the day. Nothing like driving down a one lane road in a humvee with vehicles on each side of me (the road is slightly wide enough for one vehicle, but the Afghans will drive 3 wide). It is even better when traffic is backed up so we sit there with a vehicle on each side of us… heading towards a Police checkpoint that only 1 vehicle can get through at a time. There are no stop signs at intersections either. Next time I am out on the road, I will see if we can get some pictures of the traffic. We also travel through traffic circles. This is where we really need to pay attention. Most of the local drivers won’t even slow down as they approach the circle so we need to watch each road that comes into the circle to see what the drivers are going to do. It is a unique way to drive. It should be interesting when I return driving stateside again. I am sure it will take me some time to get used stop signs and traffic lights again, let alone not cruising in an up-armored humvee…

Sunday, October 4, 2009

Another week of mentoring…

It’s been about 10 days since I last posted to this blog. No big steps taken since the last entry but I can recap. Mostly it’s been a normal week of mentoring with a few trips.

Last Saturday, I went with Holly & Kelly to the pre-school/daycare at the Poly-clinic which is on the NMH campus. The staff at NMH can bring their children to the daycare while they are at work. There can be anywhere from 50 to 80 children per day. Someone had sent Holly a box of stuffed animals and school supplies, so I helped her carry it and distribute it. It is like Christmas, giving the kids the stuffed animals and school supplies. I stuffed a few of the smaller animals into my magazine pouches on my IBA and gave them out to the children as we saw them. The children very much appreciate the goodwill.

I also drove when we went to NDS for a day of mentoring. I like driving the Humvees through Kabul. We leave a little earlier in the morning so we can beat the traffic. I brought the OT Nurses at NDS much of the same reference material I give to the nurses at NMH. I have given them information in both English and Dari. My next project is to get the Chief OT Nurse from NMH to talk with the Chief OT Nurse at NDS so we can set up some cross-training between the two hospitals. I have talked to each separately and both are excited to train their staffs together. I should be able to facilitate a meeting between the two in the very near future. NMH is busier than NDS and does more cases, so we are going to try and bring the NDS OT nurses to NMH. NDS has a newer facility, so the NMH nurses want to see NDS.

Most of the rest of the week was spent on another project for the NMH OT. We are trying hard to establish a new OT schedule, which I mentioned in my previous entry. I made copies of the new scheduling worksheet and we handed them out in the surgeon’s morning meeting. They all agreed to use this process, but none have actually submitted their schedule this way yet. I am not sure where the disconnect is. I need to go to the doctor’s morning meeting again and re-address this to ask why.

Another project that goes along with the schedule is getting the ortho docs to only schedule 1 case at a time. They currently do 2 surgeries at the same time in one big OT room. One day last week, I went into that room and came unglued on how the cases were progressing. It was like going back in time…and they had forgotten everything we have discussed. I have to get them (Ortho) to develop a surgical conscience and do what is best for the patient, not what is easiest for the surgeons. We will be having a big meeting this week with the Heads of Ortho, Surgery and the OT with their respective US Mentors. We are going to take 1 of the tables out of the room so they can only operate on 1 patient at a time. I am not going to limit the number of cases, only limit them to 1 case in 1 room at a time. They will need to operate on more days per week, and if necessary, we can give them an additional room as time permits. It seems like an easy solution, but it will take much discussion and compromise.

I also spent 2 days going back and forth to Camp Phoenix as the lead humvee driver. We had a small incident with one of the antennas for the ECM getting bent. The maintenance shop at Phoenix tried to repair it the first day, but weren’t completely successful. We had to go back again the following day to have it replaced, and we had the antennas upgraded and replaced on all three vehicles. We spent most of each day at Phoenix, waiting on the vehicles. The first day had a bazaar on base and we spent some time walking around. As I was walking, I ran into one of the Army guys I trained with at Fort Riley, Morris. He was in my barracks and we went fishing together while in Kansas. His team is from Alabama and I made some mention of them in my blogs from Riley. They are currently being retasked to a new mission. They have been in Kandahar since arriving in theater, and are now spending a little time at Phoenix inbetween missions. It was good to see them and swap a few stories.

Other than that, not much else to blog about. Over halfway now through the mentoring mission. Hopefully, all we are teaching will be sustainable…

Sorry, no new pictures this week.