Not everything translates as you would think...

As you can tell from these pictures, not everything translates correctly. As I walk from the main hospital building (NMH) to the OR on the 3rd floor, I pass these 2 doors. 339 is to the right and the other is on the left actually under the stairs. I would really like to see what is on the other side of the doors...

So, let me recap what has been going on since I last posted. I continue to walk up to NMH everyday except jumaa (Friday). Only a few duty personnel are at the hospital as it is their day off. I am still not used to starting my week on Saturday. I usually start my day with the Chief Nurses meeting. All the Chief Nurses from throughout the hospital have a morning meeting for report from the previous evening. Then, I will go up to the OT (Operating Theatre) or OR. I do have an interpreter (Walid) with me each day. It makes my job easier. I am learning short phrases in Dari and most of the nurses already know short phrases in English.

As far as mentoring in the OT, the nurses are skilled in scrubbing the cases. They know how to set up the room and how to assist the surgeon. One of their drawbacks is that they only have 1 nurse to circulate 7 rooms. It keeps him very busy. In the US, we have at least 1 circulator per room. In Afghanistan, the housekeepers are the ones who help with positioning of the patients and bring the patients to and from the OT. In the US, the circulator meets the patient, reviews the H&P, and explains the procedure to the patient. Maybe one day, they will have enough staff at NMH to do this.

Now that I have been here a few weeks and had observed what a normal day in the OT is like, I can now better understand what my role will be. As I have mentioned numerous times, I am a mentor. I am not in their chain of command so I cannot tell them what to do. My role will be to offer the nurses suggestions on how to make their job easier. I will continue to help them improve their sterile technique in the OT. One of my projects will be to help them learn and develop a surgical conscience. I have written out a short paper (2 paragraphs) on what surgical conscience is and I had it translated to Dari. I will go over this with all the staff members who work in the OT. For the next 6 months, I hope to empower the nurses. It is the nurses who should run the OT. They lead by example and correct those who do not follow established protocols. I can only point them on the correct path. It is up to the Afghan nurses whether or not they want to follow it.

We continue to convoy out to some of the local spots here in Kabul. We as a team had to go to Camp Eggers last week for a briefing. I was lucky enough to be the driver for the lead vehicle. The other night, we went to ISAF for a medical BBQ. This time I didn't drive, but I was the TC (Tactical Commander) for the 3rd truck. ISAF is a NATO base. We had supper with French, Italian and British medical personnel. It was a good dinner. The Italian's cooked. I am going to butcher the spelling and labels, but we had fresh bruschetta on grilled bagel-like bread, a thinly sliced ham and other meats with cheese cubes for an appetizer followed by grilled steak. It was an awesome meal. We had several different cheeses, but being the cheese connoisseur that I am, I only remember one name, Parmesean (SP). (In my usual sarcastic self, the only cheese I usually eat is the processed American slices. I can't name most of the others...)

One last note, if you want to know what the day to day tempo is like here, watch the movie "Groundhog Day" with Bill Murray. He repeats the same day over and over again. That is what most people who are on deployment call it...Groundhog day.

I have the keys….

Here it is already a week later and I am updating the blog. I will try to add a few pictures if the connection isn’t too slow…

I would like to start by asking, “what is it exactly that I am doing here? Why is the Navy mentoring at NMH?”

Here are some interesting facts that I received from the Senior Nursing Consultant for MPRI (a NGO here in Afghanistan). Rick has been here for 3 years. First, an analogy that fits perfect:

“We are the Jetsons working in the land of the Flinstones”

· Life expectancy is 46-47

· Infant mortality is #3 in the world. Only 2 countries are worse

· Per capita income is $800 per year

· Approximate population is 32 million

· 60% of kids attend school

· 75 – 80% of all schools have been destroyed in the past 30 years. (1200 schools were built this year for a total of 9400 in the country, of which 40% are actual buildings

· Literacy – 51% male, 21% female. An entire generation grew up without school. Taliban forbade it for girls.

Here are some facts about nursing as a whole:

“The education and training of nurses is a huge issue. Wars, drought and poverty have resulted in a survival mentality meaning that education has not been emphasized or funded. The educational background of most nurses in the ANA varies. Most of the nurses have attended a 3-year program either through the Ministry of Public Health or the ANA, though there were periods during the wars when nurses were trained in as little as 3 to 6 weeks. There is only one 4-year BSN program and it is in its fourth year, getting ready to graduate its first class.”

“None of the nurses have any background in the science of nursing. The mathematics and basic science classes were/are woefully lacking and inadequate. Nurse’s training focuses on the technical aspects only, and even then the fundamentals are not well practiced. Well-educated nursing faculty are essentially non-existent. They are well meaning but incapable of developing or teaching modern curricula.”

“The NMH and Regional Hospitals have begun a rigorous program of training and validating 36 Basic Nursing Competencies. Professional Development and career pathways for the nurses are currently being formulated.”

Needless to say, we have a lot of work in front of us. My group is the fourth group of mentors here in Kabal. There will be many after us, or I should say, there needs to be many after us.

Let me recap the week:

Most of the week was filled with completing turnover with the old group. They left today (Sunday).

On Tuesday, I had my first Afghan lunch at the NMH pharmacy. It was a lunch for some of the outgoing team and some of the new. It was a delicious meal. I wish I had written down the names of the dishes but it consisted of rice with shredded carrots and raisins, lamb kebobs, a meat filled dumpling, and naan (bread).

Wednesday was more turnover and my first day in the OR by myself. (Not really by myself as I have a dedicated interpreter, Walid). The Department Head of the OT (operating Theatre) is Dr. Ayobi, who speaks excellent English. He worked for 1 year at Brooke Army Medical Center in the US. He will be an excellent asset for me in helping to mentor the Afghan OR Nurses and for implementing new OT policies and procedures. (More on that as I get further into the deployment)

Thursday was a trip to Camp Eggers via Rhino. We attended an 2 hour lecture/powerpoint on driving in Afghanistan. Then it was back to NKC and actual driving of our humvees. Each person has to drive twice and be signed off by the outgoing team so we can drive.

Friday was jumaa or the Afghan day of rest. We don’t go to NMH. Instead, I got to drive for a little trip to ISAF (International Security Forces Afghanistan) and Camp Eggers. I can’t go into driving techniques on the blog but lets just say it is very different. Afghanistan doesn’t have a formal drivers license. If you can reach the pedals, you can drive. When we are driving in full battle rattle, we are constantly looking at everything around us. This includes the passengers in the humvee. Donkey driven carts, bicycles, pedestrians and every type of motor vehicle you can think of share the road. The roads are designed for 1 lane of traffic each way, but there can be 2 to 3 lanes of traffic going each way. It is not dull driving in Kabul…

Saturday was another short day in the OT. I had a nurses meeting with Rick where he discussed the current state of nursing in Afghanistan. Then, the 4 of us went to the OTSG building and had a meeting with Brigadier General Rhazia, who is in charge of all the nurses in the ANA. We had some chai and a short talk. We hope to meet with her monthly.

BG Rhazi, Holly, me, Dennis

Today was goodbye to our counterparts, hence the title, “I have the keys” both literally and figuratively. I now have half a dozen keys…It was another quick day in the OT as I went to a meeting with Dr. Ayobi. Tomorrow I am receiving some new gear for the OT ($72,000) and I needed to make arrangements to have it delivered. If I have time tomorrow, I will post on how that went. My team spent the afternoon cleaning up our office spaces and making them ours. So, just like that, a week has past. I will try to update the blog more often…

At the front of NMH

From the roof of NMH, looking behind the hospital

Mailing address

Several people have asked for my mailing address. I only got it yesterday and forgot to include it in my birthday post:

DANIEL S. MCCLURE

CSTC-A

COMMAND SURGEON - NKC

APO AE 09356

Notice there is no rank or Afghanistan anywhere in this address. This is the only way mail will get to me.

43rd birthday in Kabul

Today is my 23^rd birthday in the US Navy out of 43. I was trying to figure out what percentage of my birthdays I have actually been home and it wasn’t a high percentage. I am guessing that maybe I have spent 7 or 8 birthdays in Maine and 3 of those were while I was in nursing school in Fort Kent. And no, I don’t tell anyone when my birthday is

Let me bring you up to speed since I last posted. I left Bagram on 09 Jul. I started very early in the morning and it was another “fun-filled” event getting here. I started around 0200 when I got up out of bed. We started loading bags on the truck around 0230ish then did the 5 minute drive to the airfield. We unloaded all of our bags except for 3 when they told us to reload the bags back on the truck. This is 4 seabags and a rucksack for 25 people. They drove the truck onto the other side of the fence/gate so we could unload our bags again but this time onto a pallet. We had 5 rucks too many that wouldn’t fit on the pallet. I was one of the lucky ones who had to carry the ruck and backpack onto the plane when we finally loaded it around 0730. It was a 20 minute flight to Kabul International Airport. We unloaded our bags once again, but this time we had to carry them through the airport and separate them. Only 16 of us were going to New Kabul Compound (NKC). The others were going to Camp Phoenix and Camp Eggers. Their bags and rucks were loaded first, then ours were loaded. We climbed into a Rhino, which is similar to an up-armored Winnebago. It is one of the troop carriers the Army is now using in country. It is a comfortable ride. It only took us 10 or 15 minutes to get to NKC where we unloaded our bags in the parking lot. We then carried them several hundred yards and sorted them by owners while we waited for berthing. Our counterparts were off the compound at a meeting. We walked around NKC while we waited and then went to lunch. After lunch we started the RIP/TOA (Relieve in place, transfer of authority). Around mid afternoon, we had our berthing assigned and took our bags to our rooms. Hopefully, this will be the last time we move until we complete the tour.

A little about NKC:

It is a very small compound in the middle of Kabul. If you walk inside the perimeter, it is just under a klick (kilometer). There are 2 hardened barracks which most of us are berthed in. Originally, it was supposed to be 2 man rooms with 2 sets of bunk beds and 2 small lockers but there are already more people here than rooms. Most of the rooms are 3 personnel. One set of bunks are occupied by 2 men who each get a locker. The other person gets the bottom bunk and the top bunk for storage. All of us who got into the barracks are the third man, so it was top bunks for all of us. There are also GP tents set up for the overflow of personnel. These will eventually be taken down as the Army is now erecting RLB’s (Relocatable Buildings) which are similar to the conex barracks used in Iraq. I think they are 2 man rooms but I haven’t been in any of them. (When I was in Iraq, we still lived in the SWA huts).

I walk out the back gate to go to work at the ANA NMH (Afghan National Army National Military Hospital). Whenever we go outside the wire, we must wear full battle rattle (IBA, helmet, eye protection and small arms with loaded magazines inserted). Once I get to NMH, I take off the IBA and helmet, but the M9 stays on my hip including in the OR. For one, there is no secure place to lock up our weapons.

Yesterday (Saturday) was my first day at NMH. I toured the hospital with my counterpart Mary, who I am relieving, and Both the new and old Chief Nurses, Dennis and Chris. NMH was built by the Soviets when they occupied Kabul. I don’t know the full history of the hospital yet. As I learn the stories, I will share them. The Afghans are doing the best they can with what is medically available. The soldiers are extremely tough and brave. Let me give 2 examples of what I saw. One soldier recently had his right leg amputated above the knee. He was having a dressing change without any medication. He was stoic, but it hurt him. In another room, I met 2 Afghan soldiers who were burned. They were part of the group who were out looking for the missing American soldier from last week. Their tent had caught fire, and the officer was burned on his face and arms while rescuing his fellow soldiers who were also burned. They get very little pain medication because it is hard to get.

I also met the Afghan Chief nurse. We went to her office and had some Chai (Tea). The Afghans are very social. When meeting with someone, Chai is almost always offered to the guests. You have Chai and socialize before conducting any business.

Today, I went to the hospital to begin my orientation to the OR. Instead, I ended up going to an OTSG (Office of the Surgeon General) meeting for several hours with the Chief Surgeon from the Operating Theatre (Operating Room). One of the NGO’s was helping to prioritize all of the different departments in getting some new medical equipment. There is a small pot of money available to the different departments. The Doctors need to fill out some paperwork justifying what they need and why they need it, then the Surgeon General will make a decision on what they can buy from the pot of money. (I don’t know the complete story as some of the meeting was lost in translation). I have an interpreter who works with me. He is an Afghan doctor who speaks English. Unfortunately, they can make more money as an interpreter than they can as a doctor in the Afghan Army. (This is one of the overall items they hope to fix, the varying pay scales.)

For the rest of the week, I will continue the RIP/TOA. I know I am slacking on posting some pictures. Hopefully, I can post some this week.

One last note. The Afghan work week begins on Saturday and goes to Thursday. Friday is the only day off. This will take a little getting used to. Actually, there is much about this deployment and mentoring the Afghans that will take much getting used to. As I learn more about my job and expectations, I will continue to blog and share interesting stories and some Dari words….

Salaam aalaikum – Hello (Peace be upon you)

First stop in Afghanistan

Well Toto, we’re not in Kansas anymore...

After all the time I spent in Kansas, I had to finally make a Wizard of Oz quote. I have lost track of days after all the traveling, but I am still not to my final destination. I am currently in Afghanistan, at Bagram Air Base awaiting a flight for the next leg of my journey.

The trip from Kuwait began on Saturday night and ended on Sunday morning. It was an all night evolution. We started around 2000 with staging our bags by our tents. When the truck got there at 2030, we loaded up our bags then got on the bus for the quick bus ride from Camp Virginia back to Ali Al Salem. Of course, we waited around multiple hours. Around 2345, we unloaded our bags from the truck onto a pallet for the flight. We waited another good hour and finally boarded a bus out to the flight line. We finally boarded the C-117 around 0130. I was one of the lucky ones and sat on a jump seat along the sides of the plane instead of being packed in the passenger like seats in the middle. I am a wide person, especially with body armor on, so I was more comfortable in the jump seat. Once we took off, it was a little over a 3 ½ hour flight to Bagram. I, like most people, was able to nap on the flight. We got to Bagram around 0730 local time. I am now in the Afghanistan time zone, which is 8 ½ hours ahead of eastern time.

Of course it took us over an hour to get off the plane and through the inprocessing so we missed breakfast. We had to unload our bags off the pallet onto a truck then board a bus to our current tent. It is a transient tent. Everyone here is waiting on flights to their next destination in Afghanistan. All the bottom bunks were taken, so we got top bunks including all the O-5s in the group. Rank has very little to do with where you sleep in Bagram. Most of the bottom bunks are occupied by lower ranking enlisted Army and Air Force with senior Navy on the top bunks. Got to love how things work in Afghanistan. It is first come, first served for most everything.

I stayed up the rest of the day so I could get a long night of sleep. I ate supper at 1700 and was in bed by 1800. I woke up around 2330, but took an ambien to get back to sleep. I slept until 0500, almost 11 hours of sleep. It was much needed sleep and I am almost used to the time difference.

At least it is 30 degrees cooler here with highs only in the low 90s. The evening temps dip down into the 60s. The air quality is surprisingly poor here with dust and pollution. The local water is also unsafe to drink so everything is bottled water even brushing teeth. The showers have clean potable water, but it is still unsafe to drink. Safe for washing, but not safe for drinking.

I don’t have anything to do except wait for a flight. I have walked around the base with some of the other sailors. We can only go to the PX so many times. There are several MWR buildings where we can watch movies, make phone calls and use the computer. The internet is too slow to upload pictures but I can at least update the blog.

There is no self-service laundry here, only drop off laundry with a 72 hour turn around. That is too long for my laundry as we could leave at any time. Instead, I washed some clothes in the shower today and have them drying on my rack on hangers. Eventually, I will be able to get some real laundry done.

I seem to be rambling on and on…maybe I am not as used to the time zone as I think I am. I will post another update when I can….

Kuwait...

Happy Fourth of July from this desert wasteland known as Kuwait. This is my third day here. I will be continuing on my journey to Kabul very soon.

The trip here was very eventful. I kept a timeline of the travel here which will follow. The first times are all eastern time annotated with (e). The other times are the local times in various times zones I traveled through. When I left Kansas, I was on central (c) time. Germany is annotated with (g) and Kuwait with (k). Kuwait is 7 hours ahead of Eastern Time and Kabul will be another 1 ½ hours for a total of 8 ½.

I began my journey on Tuesday 30 Jun and here is the timeline:

0900e/0800c stage bags for bus (Fort Riley, Kansas)

1015e/0915c load bags on bus & trailer

1039e/0939c Roll out from Camp Funston to KCI (Kansas City Airport)

1300e/1200c arrive KCI, unload bags for Southwest, took over an hour

1535e/1435c board Southwest for BWI, full plane scattered all over

1543e/1443c push back from terminal

1750e arrive BWI. Gets bags and haul across airport to AMC terminal

1930e done checking in

2030e through security

2205e begin to board, plane overweight, some civilians asked

to leave. Flight attendants can’t complete head count

accurately. Recount multiple times. (Ryan Air)

0058e Close doors

0100e push back from terminal. Take Ambien

0600e wake up from ambien

0911e/1511g arrive Ramstein Germany, deboard for refueling

1110e/1710g reboard

1153e/1753g push back from terminal

1219e/1819g Plane actually takes off

1724e/0024k land Kuwait International Airport. “Ramp congestion”

waiting to park. Temp 103

1836e/0136k at “gate” (parked on tarmack for US Military)

1852e/0152k after H1N1 screening, board buses

1915e/0215k buses roll to staging area

1923e/0223k arrive staging area (little piece of sand surrounded by

concrete barriers.) Temp 93

2141e/0441k leave staging area on bus for Ali Al Salem

2236e/0536k Arrive Ali Al Salem. Have quick formation, then everyone goes

through line to have ID cards swiped through computer.

Meet Navy LNO who didn’t know we were coming.

2330e/0630k go to breakfast

0000e/0700k unload bags from truck. Sort bags. Restack bags. Load bags

back on truck to go to Camp Virginia

0053e/0753k load bus to Camp Virginia

0115e/0815k unload bags into tents

As you can tell, it was a long, long flight. Everyone who goes to Iraq and Afghanistan goes through a similar flight. It will be the same going home, just in reverse order.

If you noticed, I started this blog with the desert wasteland known as Kuwait. There is nothing here at Camp Virginia except for sand. We are living in GP tents on cots. It gets very close to 120 during the day and cools down to upper 80’s to low 90’s during the night. It is very hot. Anyone who says it is a dry heat not the humid heat has never been to Kuwait. Yes, there is no humidity, but you are always sweating. It is so hot that when it cools down into the 70’s at night in the tent with the ac, it is cold. I actually have to sleep in my sleeping bag to stay warm. A week ago when I was in Maine, I would call 70 degrees at night hot. A 50 degree temperature swing during the day is a lot.

Well, that is all from Kuwait. I don’t have enough bandwidth to post any pictures. The internet connection is too slow. Hopefully, the internet will be better in Kabul.

Next stop Task Force Phoenix in Afghanistan….