3rd Time, New Country

Merry Christmas from Kabul…

2009-12-25T05:09:00.002-05:00

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…

Single digit midgets...

2009-12-20T03:36:00.003-05:00

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…

More Boondoggles and let the turnover begin…

2009-12-11T06:41:00.015-05:00

(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…

Rookie Move

2009-12-02T04:13:00.012-05:00

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 days...one 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...

Happy Thanksgiving from Kabul

2009-11-27T06:09:00.005-05:00

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…

Boondoggle

2009-11-18T05:52:00.009-05:00

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...

Overdue Pictures

2009-11-07T06:27:00.003-05:00

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

Cancelled elections

2009-11-06T06:58:00.002-05:00

Another week has gone by and it is time to post.

On Monday, DJ, Tim, Holly and I went to Bagram to see the US hospital. It took us over 6 hours to get there, even though it is only a 15 minute flight. We left early in the morning to catch a shuttle to KAIA (Kabul Afghanistan International Airport.) This isn’t like catching an airport shuttle in the states though. We ride on this shuttle in full battle rattle. It is about a 20 min ride to KAIA. We left before breakfast, so we had breakfast at KAIA. We checked in 2 hours before our flight, which was a Canadian C-130. When it was finally time to board, nothing could be carried on. We have to check everything and they put it on a pallet. When it was time for us to leave, we taxied out, and then got held for at least an hour. Our 15 min flight took us 2 hours. Once we finally arrived in Bagram, we had to wait on a bus to take us to the terminal, and then wait in the terminal until they released us. By the time we collected our bags and walked to the hospital, it was well after lunch. I don’t think I will ever complain about how long it takes to fly once I get back to the states. We spent the afternoon touring the hospital and talking with our respective peers so we could set up some specific training for our Afghan mentees. There is already a 2-week training program established at Bagram, but it is generic. We each wanted to set up specific training. 2 weeks is too long for the OT nurses to be gone from Kabul. We are already short staffed. I am trying to set up only a week of training, all of which will be spent in the OR. After supper, we spent some time at the USO, and then went to our rooms. We had temporary lodging near the hospital. We had to be back at the Bagram terminal before 0430 for our return flight. That was another “fun-filled” trip. It was a 6-hour trip to return to NKC. Our flight was on-time, but the 3-hour before flight check-in only adds to the experience. Once we got back to KAIA, we had to wait about 90 mins before we could catch the shuttle back to NKC. It was a 30-hour trip, for 3 hours of work. Needless to say, we all took a nap on Tuesday afternoon.

Wednesday and Thursday were regular days of mentoring. I discussed with the nurses about rotating through the training program in Bagram. They all want to go for a week. I hope to be able to go with them the first time or two to help with the training and make sure it is appropriate based on their needs. I have been working with the nurses for 4 months now so I have a good idea of where their individual skills are.

Thursday is our training day in the OT. We work on one or two of the basic nursing core competencies, then have a meal of bolani. It is a tradition for the nurses and housekeepers to have bolani each Thursday before lunch.

I am sure you have all heard by now that Dr. Abdullah Abdullah has boycotted the elections so Karzi has been declared the presidential election winner. It is interesting to hear the nurses talk about it. They worry about whether or not if their way of life is going to improve or not and if all the corruption in the government will be stopped. I won’t jump up on my soapbox, but I hope the international community can put enough pressure on the current Afghan government to help them make sweeping reforms and changes. The Afghans need to experience something besides war and corruption in their lives.

I haven’t had a chance to download any pictures yet, but will post them in the next few days…

Happy Halloween

2009-10-31T21:30:00.000-04:00

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.

Presidential Elections Round 2,

2009-10-24T07:33:00.006-04:00

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. http://www.nytimes.com/2009/10/18/magazine/18Afghanistan-t.html?emc=eta

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

A great meal...

2009-10-16T07:12:00.000-04:00

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.

Finally, some pictures...

2009-10-11T21:13:00.006-04:00

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).

Another week of mentoring complete…

2009-10-09T06:31:00.000-04:00

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…

Another week of mentoring…

2009-10-04T07:18:00.001-04:00

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.

Eid Mobarak 2009

2009-09-25T07:55:00.007-04:00

As far as mentoring goes, it has been an easy week since I last posted to this blog. Ramadan ended on Sunday, with three days of Eid that started on Sunday. I have included some pictures from the Eid celebration at NMH on Sunday. My team of mentors met up with leadership of NMH, MPRI mentors, and a select few of the ANA leadership. After meeting up at NMH and congratulating everyone (Eid Mobarak is Dari for “congratulations on Eid”), we formed up to see the ANA Chief of Staff review the honor guard, before meeting and shaking hands with all present. He then visited the wounded ANA soldiers and police throughout the hospital. We went to the top of the hospital to the flower room for chai and cookies.

Monday and Tuesday was the continuation of Eid, so we didn’t go to NMH to mentor. It was only a duty crew and our interpreters also had the time off. On Tuesday, our nurse mentors met with Rick the senior nurse for MPRI and discussed the current state of nursing at NMH. The nurses are understaffed and underpaid, but that is like all other nurses throughout the world including the US. We are trying to help NMH restaff some of their wards to help with the nursing shortage. We are also offering suggestions on how to staff some wards with shift nursing, but that is a hard sell. Some hospitals here in Kabul do shifts, but not at NMH yet.

Wednesday was back to NMH for mentoring, but it was similar to Eid. Most of the staff came into the hospital, but left early. I am working with the OT director on how to schedule cases for each day. We are trying to incorporate a new scheduling tool, which is an excel spreadsheet to better manage the individual rooms. It hasn’t taken effect yet, but he and I continue to work on it. We are going to ask the surgeons to start booking their cases 2 days in advance so we can put out a schedule 1 day prior to surgery. This way we will have better time management in the OT and can block out time inbetween each case to give the staff time to turnover the room and properly clean it. Hopefully, we can implement this schedule starting on Saturday. We will brief the surgeons during morning report.

Thursday was another short day of mentoring. Our 3 nurse mentors went to a meeting with the Senior Nurse from NMH and the OTSG (Office of the Surgeon General) so we could discuss the current nursing shortage at NMH. NMH is a 400 bed hospital, but we only have 86 nurses. Try staffing that big of a hospital with 86 nurses. We calculate that NMH needs a little over 250 nurses to provide safe and effective nursing care to the patients. We discussed ways to increase staffing, but it will take time to increase their manning document (Tashkiel). In the meantime, we hope to hire some contract nurses locally here in Kabul to help bridge the nursing shortage.

Today, jumma, (Friday) is the regular day off. I use the day to get caught up on admin and to update the blog. Tomorrow, it is back to full work days at NMH. Here are the pictures from Eid:

US Navy Medical Embedded Training Team Mentors at Eid Celebration

Dennis, myself, Joe and MG Yaftali, the ANA Surgeon General

US Nurses, Rick, and ANA Nursing Leadership

ANA Chief of Staff reviewing the Honor Guard

Bloggin' catch-up

2009-09-19T05:34:00.003-04:00

Trading covers...

This will be a long-winded catch-up blog because it has been 2 weeks since my last entry. So much has happened yet I have been seriously slacking on updating this blog. Let me recap since I posted last…

My first trip was to the Annex Hospital which is part of NMH but approximately 7 or 8 klicks away. It consists of a psych ward, a medical hold ward, and a TB ward. After our visit, we determined that it is mostly a redundant hospital and it would be better to transfer the majority of the staff back to NMH. NMH only has 1/3 of the nurses it needs to provide adequate care to the patients.

Tuesday, 08 Sep began as a regular mentoring day at NMH until a SVBIED detonated at KAIA (Kabul Airport). I was in the OR when we got the word. We didn’t know how many patients were wounded so we made preparations for mass casualties. I had to use my outside voice to stop the surgeons from starting their scheduled elective cases. We had some heated discussions, but they finally understood when I had the General, who is the Surgical Director, come into the OR to stop the surgeons. It wasn’t a long delay because we only received 3 patients in the OR. We treated those patients, then started the day’s elective cases.

The next day was Massoud Day, which was a holiday. Because the holiday was on a Wednesday, it became a 3-day holiday. When a holiday is near jumma (Friday), the government will usually give the holiday off, then give Thursday off because Jumma is already end of the week and a non-work day. Because of the holiday, I did not go to NMH, but worked on admin all day in the office on NKC.

Thursday was my moving day. I moved out of the basement room on the A-block into a room on the second floor of the B-block with a member of my team, Dennis. The room even has a window (not one that opens) but it does allow some sunlight into the room. It is the simple things like a window that makes the deployment so much better. I can’t complain about the room accommodations. The barracks on NKC are nice. It can always be worse on a deployment…

Then I had another travel day in Kabul. I got to be the CC or Convoy Commander for this trip. We left early in the morning to drop of some folks at KAIA, then drove over to Camp Phoenix. It was September 11^th, 8 years later. We attended a memorial service in the DFAC. I will always remember where I was and what I was doing when the Twin Towers were attacked and destroyed. I hope you too will always remember this day… It is one of many reasons why I am here in Afghanistan now.

After the ceremony, we spent most of the day at Phoenix waiting for our vehicles to be serviced. It is just like dropping off a vehicle at the dealer for service. We had to make an appointment, then wait around all day for the service to be completed. We made it back to NKC in the late afternoon and then attended a memorial service on our compound.

The next few days were regular mentoring days at NMH. I have many projects going at once. The Ministry of Public Health, MoPH, has developed some guidelines for all of the hospitals in Afghanistan. They are based on WHO guidelines. We are working to implement them in the OR and CSD (Central Sterilization Dept). I am also helping develop a simple spreadsheet to manage the OR schedule. We are going to try and have the surgeons book their cases 2 days prior, so the day before surgery we can put out a schedule showing the actual times of surgery. Currently, they put out a schedule the day before with only the cases booked, not the time needed. We are trying to prevent over-booking of the rooms and to force the surgeons to give us enough time between cases to properly clean the rooms and set up for the next case. This will also allow for a proper turnover of the patient for recovery. We have to slow things down inbetween cases, which in the long run will allow better patient care.

Over the weekend in the afternoon, we had to move our offices around. We had to give up 3 offices to the engineers. Since we arrived here, we have gone from 8 offices to 4. We are crammed into each office. Eventually, we will move out of the admin building into new temporary spaces once they are built on the compound.

On Tuesday, 4 of us went on a field trip to KMTC (Kabul Military Training Center) to help with physicals. The Afghans were starting a new class of recruits for their Special Forces and we went to help one of the US Mentors do physicals. They came and picked us up and brought us back. After we finished the physicals, we got a tour around KMTC. It is good to do something different for a day and see more of Kabul.

Wednesday was the Chief’s Pinning Ceremonies. Two of the folks I trained with in Fort Riley were promoted to Chief. We attended the first ceremony in the morning at Camp Eggers for one, and then the second ceremony was at NKC after lunch for the other. These are very special ceremonies and an extremely proud moment for the Chief’s who were promoted. We made sure we took the time off to attend their ceremonies. On Saturday night, we will have a dinner for the 2 Chiefs to celebrate their promotions. Chiefs all over the world are promoted on the same day. Only the Navy has the special promotion from E6 to E7.

Yesterday started out as another regular day of mentoring. We went up to NMH in the morning and returned to NKC by lunch. We were eating lunch in the office when a SVBIED went off on the road outside our compound, a little to the north. Our building actually shook. You can read all the news reports online. An Italian convoy was attacked. The last report I read online reported a total of 6 Italian soldiers killed and 10 Afghans killed with an additional 58 afghans wounded. We were not immediately allowed to go to NMH after the explosion, but did make it up there within a couple of hours. I went straight to the OR. I spent several hours there until the last person left the OR. A total of 40 patients were treated in the OR. The Taliban has claimed responsibility for the attack. Another senseless attack by the Taliban on both Coalition Forces and the local Afghan’s.

Today, Jumma, is a day to get caught up on everything including sleep and relaxation. I will try and post to this blog a little more regular…

Soviet tank graveyard near KMTC

Traveling Sailors...

2009-09-04T07:50:00.009-04:00

Another week has passed and on top of the normal everyday mentoring at NMH, I have been back to NDS hospital and visited a new hospital, Kaisha. Kashia can be found on the web at: http://www.kaishahealthcare.com/

The trip to NDS was both good and bad. Good in that I finally got to observe a surgery and bad because I did observe a surgery. NDS is a new hospital, but much needs to be done to improve their nursing practices to bring up their standards of care. Surgery is done in the same manner as NMH. Nursing is both an art and a science, both of which need to be taught here in Kabul. In my opinion, nurses don’t “see” the patients, all they see is what is going on with the patient. If you ask a nurse here what the patient’s name is, they wouldn’t be able to answer, but if you ask the nurse what is wrong with the patient, I think they could give the main diagnosis. For example, I observed an open cholecystectomy (open gallbladder removal) at NDS. DJ (anes) and I showed the surgical team at NDS how we would work together in bringing the patient into the room and putting the patient to sleep. The Afghans still need to learn “team concepts”. I don’t think an OR nurse has ever assisted anesthesia in an Afghan OR. The surgical team did a good job in performing the surgery, but they need work on doing it while maintaining sterile technique. After the case, I went with the assistant surgeon to transfer the patient to Recovery (PACU) which is a nursing job but not done here. That was eye-opening. I had to prompt the nurse to put the patient on O2, which should be the automatic first step in recovery. I then worked with the nurse on assessing pain in patients and what to do. There was another patient in PACU who had ENT surgery on his nose. He was moaning in pain and I had to get Anesthesia to give the patient something for pain. We also need to teach the nurses to talk to their patients, to reassure them and let them know what is going on. When a patient wakes up from surgery, they are disoriented and it is the nurse who helps to reorient. What we take for granted in US healthcare…

As I mentioned earlier, we as a team went to visit Kaisha hospital. I was lucky enough to drive the lead vehicle again. It was a 20 minute drive to western Kabul. Mostly, it was a fact-finding mission to see how a for-profit hospital is run here. I do not know the history of the hospital, but it hasn’t been open for too long. It was a fairly nice facility and very busy. I did get to tour the OR but it wasn’t any different from NMH or NDS. All 3 hospitals use similar equipment, with NDS having the best and NMH a close second. One huge advantage Kaisha has though is a modern lab and an angio suite. Most of the doctors and nurses that we met were trained outside of Afghanistan in places such as Turkey, Pakistan and India. Another big plus is that the patients had great charts including H&P (History & Physical), progress notes, nursing notes and a MAR (Medication Administration Record). We are working hard to incorporate better charting at NMH.

We are also beginning to establish many new projects at NMH. In the OR, I helped the OT director translate a document that we have passed out to all the doctors who enter the OR, some basic guidelines. I did the “tough” part of typing the English and he had the even tougher part of translating to Dari. It ended up being 11 pages long on how to enter the OT, hand scrubbing, gowning & gloving, universal precautions and surgical conscience. Hopefully, it will help to change some of the bad habits that have been going on for years.

Another project is trying to establish a preop holding area. This includes anesthesia and the surgeons. We will bring the patients to the preop area so anesthesia and the surgeon can check the patient prior to surgery, and it gives the OT nurses time to make sure the room is ready with all the correct gear. In addition, we are trying to incorporate a preoperative checklist that reminds everyone of the steps needed to ensure a safe surgery. I borrow heavily from the World Health Organization (WHO) website. Afghanistan is a member state of WHO and we as a team are trying to incorporate the WHO standards of care into NMH. The Afghans at NMH do many of the steps already. Now, we want them to use the checklist and document all of the steps to help ensure patient safety.

Other than what I have already mentioned, it was a typical mentoring week. The OR is doing more cases everyday now that the elections have passed. Eventhough NMH is on reduced working hours for Ramazan, the OT is busy, scheduling 8 to 12 cases a day. I can only imagine how busy it will be in another few weeks…

I guess I have rambled on enough for this entry. I have also included some pictures:

The surgery I observed at NDS

The "expert" lead driver

Kaisha

Another typical scene in Kabul

Why we don't speed in uparmored humvees

Typical pedestrians and traffic thoughout Kabul

Approaching Massoud circle

On the road again...

2009-08-28T07:29:00.002-04:00

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

2009-08-22T07:52:00.007-04:00

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

2009-08-16T07:44:00.002-04:00

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

2009-08-10T08:05:00.003-04:00

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...

Not everything translates as you would think...

2009-07-29T10:31:00.002-04:00

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….

2009-07-19T11:30:00.005-04:00

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

2009-07-12T12:09:00.003-04:00

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

2009-07-12T12:03:00.001-04:00

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

2009-07-07T07:59:00.001-04:00

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...

2009-07-04T07:41:00.000-04:00

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….

Packing

2009-06-29T13:53:00.000-04:00

Well, I am back at Camp Funston at Fort Riley. The I-stop was great!!! I spent a week at Myrtle Beach in a condo on the 12th floor overlooking the Atlantic. Diane and I took in a couple of shows but mostly relaxed for a week. We then drove to Maine and completed many projects around the house that needed to get done. The deck and front porch got stained on the only 3 days of sunshine we had. I reclaimed some of the yard back with a chainsaw, bush hog, chipper and lots of sweat.

I am only here at Funston for less than 48 hours. Today was mostly little events like drawing our weapons out of the armory, H1N1 (Swine Flu) screening and having our ID cards swiped at the deployment center. We also had to finish packing. Our marching orders are everything in 4 seabags, a rucksack and a carry on. We are flying commercial tomorrow to Baltimore after a 2 hour bus ride to Kansas City International Airport. We have to play the typical TSA rules because we are flying commercial. We are going to Afghanistan with weapons, but we can't carry on on liquids or knives. Silly isn't it....We will spend 8 to 10 hours in Baltimore inbetween flights because we have to get all our gear from the commercial terminal and take it to the military terminal. I guess Baltimore Airport will make a little money off of us as we will all have to rent those little carts to haul 4 seabags, a ruck, carryon and weapons cases. In all the packing, I have about 3/4's of a seabag of personal gear. Everything else was issued and we have to take it with us.

After this post, I don't know when I will have internet access again to update the blog. I should be in Kuwait in the next few days depending on flights, delays and time shifts forward. All I know for now is that we are leaving Tuesday morning from Fort Riley, never to return to Kansas.....

Training Complete!!!

2009-06-05T16:45:00.000-04:00

This is the last post and picture for a little while. I completed the training at Fort Riley today. The Army even gave us certificates stating that I have "Successfully completed Military Transition Team Training for Class 71." Now it is time for some needed R & R before deploying. The Navy is flying us back to parent commands (where we are originally stationed) for a little time off before we go, then flying back here to Fort Riley. We are leaving all of our gear in our lockers. Let me recap the week...

Monday was another day on the range where each of the 2 Navy teams practiced Mounted Combat Patrol OPs. I was the gunner again and got to fire the M240. It took most of the day and that was it for Monday.

Tuesday was spent planning for our Capstone Exercise which took place on Wed.

Wednesday was the big Capstone, which covered everything we have learned in training. It started off at 0530 as each Navy team convoyed up to a FOB (Forward Operating Base) where we linked up with an Afghan Commander and his troops. Our mission was to convoy to 3 separate towns where we had to conduct different types of meetings with the townspeople. Some of the townspeople were Anti-American. By the time we had been through all three villages, we had been attacked several different times. We returned fire and also treated the "wounded". All our ammo was blanks. We finally returned to Camp Funston around 1500 and our day was done except for cleaning the weapons.

On a special note, the 10 Navy men in my barracks plotted an "event" on our Army brethren who share our barracks. They get up earlier than we do on most days and turn the lights on. We got up at 0200 on Thursday morning without waking up the Army. We turned on the lights, sounded several air horns, then played General Quarters over a megaphone. Once everyone was awake, we started signing the second verse of Anchors Aweigh. Once we were done singing, we turned the lights back off and went back to sleep. Most of the Army guys took it in stride and laughed about it. It was done in fun.

On Thursday, we turned in our personal weapons to the armory, then turned in all the crewed served weapons and HMMVEEs. Of course, we hadn't cleaned the crew served to their satisfaction, so we spent another hour cleaning the weapons. We finished by lunch and had the rest of the day off to start packing.

Today, Friday was our deployment ceremony. WE had to be there at 0730 and were done by 0830. The Army printed up programs, but left half of our team out. Each service had to sing its fight song as part of the ceremony. Of course, the Navy went last and the music wouldn't play.We sang the first verse of Anchors Aweigh anyway and ended it with "Go Navy". We weren't going to be denied signing our fight song! The rest of the day was spent finishing packing and resting. We will load a bus at 0130 on Sat morning to go to Kansas City Airport to fly back to parent commands.

All in all, it has been a pretty good time here at Fort Riley. After a little time off, we will be ready to begin our mission mentoring and advising the Afghan National Army.

Fishing Pictures

2009-06-02T11:33:00.000-04:00

As promised, here are the pictures from Sunday's fishing:

Rob, Andrew, and Dennis with his catfish

Rob and his catfish

Rob, me and Andrew cooking the catfish on the grill

End of Week 7

2009-05-31T19:35:00.000-04:00

This is my team (1/2 of all the Navy in my class)

It is now Sunday and week 7 is complete. Only 5 days left of training.....

Week 7 was interesting. On Tuesday, we drew our weapons from the armory, then had a morning class on how to plan Urban Ops (Operations). After lunch, we went out to the range and did SRM (Short Range Marksmanship). This is where we became familiar with shooting the M4 from many different positions. We walked towards the target while shooting, turned our backs to the target then turned back around to shoot, and also turned to shoot the targets from both our right and left sides. We also did transition shooting. This is a double tap with the M4 (2 shots), then letting it fall to our sides (on our sling while always maintaining positive control of the weapon) then a double tap with the M9. This was repeated over and over. Then, we shot another range where we got up from the prone position, ran to a building, shot a double tap out of each window standing with each shoulder, then ran from the building, shot kneeling from each side of a barricade, then ran to our final shooting position where we shot standing while resting the non-firing arm on the hood of a blazer. It was fun.

On Wednesday, we went to another range where we learned and practiced Battle Drill 6. This is how to enter and clear a building. We only learned it. We are not proficient at it. It can take a team at least a month of doing nothing but Battle Drill 6 everyday for a month to become proficient. We broke off into Team 1 and Team 2 and took turns entering buildings. The final building had 2 "insurgents" firing rounds at us. We used wax bullets and fired back. Needless to say, we need alot more practice....

On Thursday, we had a mounted combat patrol class in the morning, then used computer simulations to practice in the afternoon. Again, another item our team needs to practice. We have some basic concepts, but need to practice, practice, practice.

Friday and Saturday were more lectures. We had an Air Force LT COL and a civilian doctor from CSTC-A Command Surgeon (Combined Security Transition Command Afghanistan) come talk to us about what is going on in Afghanistan now in Medical. I will be working for CSTC-A once I deploy. They gave us background information on what the overall plan is to ramp up the Afghanistan Medical System for ANA, ANP and civilians (Afghan National Army, and Afghan National Police). They gave us some reference cds with extra info for us to go through.

Today was another half day of fishing out on Milford Lake. It was myself, Dennis, Andrew and Rob. I don't have the pictures on my computer yet but will post them later on this week. We had our best day of fishing and landed about 15 fish including 2 big blue catfish. We kept the catfish and brought them back to the barracks. We cleaned and filleted them, then dipped them in batter and fried them on the grill. We lit some charcoal, heated some oil up in an aluminum roasting pan and fried the fish. Best catfish I have ever ate....then again, it was the first time I have been out fishing and someone caught some catfish. One more additional note...we caught the cats on lures we were using for bass. That is unheard of. You never catch catfish on lures....

I will post again later on this week....GRADUATION ON FRIDAY!!!!!

Memorial Day

2009-05-25T20:51:00.000-04:00

Week 6 is complete and Week 7 has begun as I return to Fort Riley. I was home for the weekend after a 96 hour liberty. (Now that I am doing the Army thing, I have to call it a 4 day pass). We ended training on Thursday after lunch and a group of us headed to Kansas City. We had supper in the Power and Light District in downtown Kansas City, then spent the night at the Econlodge before flying out early Friday morning. It was a great break to fly home to Maine.

Week 6 was a week of death by powerpoint so no new pictures. We were in class all day learning about COIN or CounterInsurgency Operations. At least that will be the last week of day long powerpoint lectures. Other than that, not much to update on the blog....

On a side note, I ask that you reflect on what Memorial Day actually means....

End of Week 5

2009-05-17T22:03:00.000-04:00

It is Sunday night and the end of another “tough” week at Fort Riley. (As some of you know, I can be sarcastic at times.)

Monday was another day on the range. We got up early and convoyed out to the range to qualify on the M4 and the M9. The Army qualifications are much easier than the Marines and Navy. The Army does a “Tactical Qual” which is only getting rounds downrange and hitting the target. All you have to do is wait for the target to pop up then put one round in it to knock it down. None of the putting so many rounds into the rings and adding up the score. Each target knocked down is one point. One round for one target. The M9 was 30 targets and the M4 was 40 targets. We did the M9 range, then went to the M4 range and zeroed the iron sights then the M68 scope. Once zeroed, the M9 qual was 20 rounds foxhole supported (standing in a cement foxhole and resting the rifle on sandbags), 10 rounds lying prone in the dirt without sandbags, then 10 rounds kneeling. We were done by lunch. We went back to the range later that night for M4 night quals using the PEQ-2. This is using a laser mounted to the M4 and our night vision googles. Too easy (that is a new Army saying…too easy). It was 20 rounds foxhole supported (just like the day shoot) then another 20 rounds from the foxhole but without resting the rifle on sandbags. Shooting at night consists of looking over the M4 with the NVG’s, putting the laser on the target, then squeezing the trigger. Again, too easy.

Tuesday was some classes in the morning followed by shooting the M19. We each shot 32 rounds. See the video…

Wed was another day of classes, learning how to call in Fire Support with a practical exercise that was computer based. After work, I went for a short flight with Andrew. He has his own plane. We flew around the base, then went to Topeka. I got to co-pilot on the way back. Andrew is also a flight instructor. I got to fly the plane for take-off (with his assistance of course.) That was fun, but don’t think I will ever be a pilot or own my own plane.

Thursday was another day of classes. This time we learned about Laws of War and Rules of Engagement. Another day of death by powerpoint.

Friday was yet another day of powerpoint lectures in the morning. This time we learned about detainee ops and how to “Tactical Question.” After a short lunch, we got to don all our gear, then convoy out for a practical engagement of a town. My truck crew got to kick in the door, search the house, and collect evidence. I t took about 90 minutes, then we were done for the weekend.

Sunday was a “tough” day of fishing on Milford Lake. Fort Riley has a marina on the lake. We rented a boat for $55 for 4 hours and 4 of us went fishing for the afternoon. (Now you probably understand some of my sarcasm).

3 more weeks of class then goodbye Fort Riley and goodbye Kansas….

End of Week 4

2009-05-10T11:18:00.001-04:00

{Shooting the SAW}

I know it has been too long since I last updated my blog so I will catch everyone up. Week 4 has mostly dealt with crew served weapons: M2 .50 cal, M240B machine gun and the M249 SAW (Squad Assault Weapon).

Monday was an easy day. We were off during the morning, and only had 2 leader’s engagements in the afternoon. This is where our team “interacts” with an Afghan team. We have to work out some given scenarios.

On Tuesday, we were issued our Team Humvees, radios and crew served weapons. I am the gunner for my truck, so I have the M249. We have 4 trucks on Team 2 (Black Beard) and 3 trucks on Team 1 (Neptune). Black Beard 1 is the lead truck, Black Beard 6 is the team leader and second truck, then Black Beard 3 and Black Beard 4 (my truck). The Army has cut some corners with our training so we only have 1 up-armored truck. My truck leaves a little to be desired… it is extremely fun in the rain. Black Beard 1 & 3 have the other weapons, each with a M240.

Wednesday consisted of classes on the weapons, how to tear apart and put back together, and how to load. No real instruction on how to use. We also had classes on the M4 and the M9.

Thursday was the longest day of training. We mustered outside at the trucks at 0515 so we could convoy to the range. Per normal training, there was a lot of hurry up and wait. We were at the range with an Air Force Team so there was close to 100 of us shooting. The range was 10 lanes, each with a Humvee and a weapon. Everyone shot the 50 cal, then the M240 and finally the M249. We finished the day shoot around 1600, then convoyed back to the barracks for supper. Lunch was an MRE. We then proceeded back to the range at 1830 for night quals. We shot the both the 50 cal and the M240B with thermal scopes. We finished the shoot and left the range around 0400. By the time we got back to the barracks, parked and put everything away, it was 0500. We showered and napped for an hour. We had to be at the armory by 0800 to clean all the weapons we shot. It was only supposed to be a few hour evolution, but took all day. We finished around 1600. We ended up going 36 hours with an hour nap. When I finally got to bed Friday night, I crashed for 11 hours.

{Shooting the M240B}

{Shooting the 50 cal}

Saturday and Sunday were days off. Gary Sinise and the LT Dan band played an USO show here at Fort Riley on Saturday night. We went to the concert and it was a great show. Prior to the concert, we tailgated with our Army bunk mates at the barracks. If you have time, go to http://www.ltdanband.com/

{Gary Sinise in gray t-shirt on bass guitar}

Monday will be another day at the range, this time shooting the M4 and M9. Hopefully it won’t go until 0500 again.

Happy Mother’s Day…

Shooting the SAW movie

Week 3 Humpday

2009-04-29T21:02:00.000-04:00

Another week has passed since I last posted, but not much has happened in training. No new pictures to post.

After I finished CLS (Combat LifeSaver), I moved into 3 days of Advanced Med. It was 2 days of powerpoint, and 1 day of trauma lanes validation. In the morning, we had individual testing on the mannequins which consisted of placing 2 thigh tourniquets, a chest seal over a sucking chest wound and needle decompression, starting an IV which fails so progress to I/O in the sternum, and airway management with a combitube which also fails, so then an emergency cricothyroiodectomy is performed. This of course is performed in the dark with full battle rattle, a headlamp and simulated wartime conditions in under 15 minutes.

The afternoon broke us up into 8 man teams. We went outside in the mud and rain with full battle rattle and paintball guns. We had to rescue (3) 180 pound mannequins out of a "burning humvee" with only 1 folding stretcher and 1 SKED stretcher (like a plastic sled to drag a patient). We had to perform multiple interventions and drag them all over the "trauma lanes" full of obstacles. It wasn't as much fun when we did it, but the instructors video taped it and we watched it as a class and had some laughs.

The rest of the week is basic commo class, which is powerpoint lectures followed with hands on training with the radios. We have some time off this weekend (Fri/Sat/Sun) because division has not gotten any DUI's. Next week the fun begins with each team receiving 4 humvees and the crew served weapons which we will qualify on. Nothing like a good day of shooting the big boys out on the range. I will try to post some pictures next week out on the range.....

Week 2 Hump Day

2009-04-22T19:42:00.000-04:00

Here it is hump day of Week 2 of Combat Advisor Training. This is me in full battle rattle prior to HMMVEE training today. This is awesome gear to wear in the Kansas heat. In the few weeks that I have been here, I have already gone through all four seasons. They day after I got off the plane, it snowed. Today was upper 80's.

So, let me catch you up on the training. Last week was the continuation of death by powerpoint. We finished our lectures on Saturday and had Sunday off. We got together as our team and had a steak barbeque.

Monday was a day of IED training. We spent the morning in class/lectures learning all about IED's then spent the afternoon in the field practicing what we learned.

Tuesday was HMMVEE driver training. We drew our weapons early Tuesday morning, then hiked out to the driver training course (only about a mile) in full battle rattle. We spent the afternoon learning how to drive and practiced sitting in all the various positions as we took turns driving. We also did the HEAT trainer. It is a mock up of a HMMVEE wear 4 personnel get in it in full battle rattle. Then, we do a complete 360 degree rotation, then another 180 degrees. We are upside down and are required to escape. It is as easy as opening up the armored door, undoing the seat belt, then rolling out the door. It was fun with lots of laughs. In my group, I was sitting in the left rear seat. I was the first one out, then the driver got out. The 2 on the right side couldn't get out. I tried to help them out by going around to their door, but they were combat locked. You can't open them from the outside. They ended up getting "rescued" by the instructors. It was still fun.

We broke for supper, then went back to HMMVEE training after dark. We all had a chance to drive with night vision googles on. Another first for me. That is what makes this training so interesting and fun. It is all new experiences.

Wednesday was another day of driving. We did small mounted combat patrols. We went out in 4 HMMVEE's at a time. I was the gunner, getting the fresh air. Another day of fun training....

Tomorrow is back to death by powerpoint. We start a 3 day class on Combat Life Saver. It is basic buddy first aid. I hope our team of Navy Doctors, Nurses, MSC and corpsmen can get through it......

Camp Funston

2009-04-13T20:32:00.000-04:00

On Thursday, I had the welcome to Camp Funston and 40 man open bay barracks. My 25 man Navy Team has been scattered throughout the different barracks. In fact, we are in 5 different barracks. Nothing like Team Building Army style. In my barracks, we have 10 Navy in 5 sets of bunks in the middle of the bay. We are sandwiched inbetween the Tennessee National Guard and another Army unit. (I can't remember where they are from).

Thursday was a complete cluster. We checked out of the barracks at 0600, then had weapons draw around 0800. The Navy went first. We each have the latest M-4 (newer version of the M-16) with a collapsible stock and new scope. We were also issued a M-9 (9mm pistol). We hung around until almost 1400 before we came to Camp Funston. We had a brief, then moved into the barracks and turned in our weapons to the armory. We won't see them again for a few weeks. I have been issued a total of 3 seabags of gear and a full rucksack plus a seabag of my own personal gear. Good thing we are traveling light.

Friday was half a day of lectures, then off Sat & Sun.

I am attending a 60 day course entitled Afghanistan Combat Advisor Development Course. This course will enable us to be a Foreign Security Force Advisor and a member of an Embedded Training Team (ETT). We spend the rest of our time here learning basic Dari (the Afghan language) and various aspects of the Afghan culture ontop of Army training. As I progress through the course, I will give updates on what I am learning. This week is an hour of Dari, followed by powerpoint presentations and discussions.

Today we went for our first walkabout on Camp Funston in pt gear and IBA (Individual Body Armor). It was a short 3 mile walk. We will continue to build up our conditioning and progress to full battle rattle.

This should be an interesting 2 months.....

The Big Red 1

2009-04-07T21:01:00.000-04:00

So, here I am at Fort Riley starting to get ready for more training. I arrived here on Sat after a 3 hour flight from San Diego. I had the rest of Sat off and Sunday off. We started drawing gear on Monday. It will be a 3 day evolution. There are 25 Navy personnel here, and over 200 Air Force in our class. My team consists of doctors, nurses and MSC (Medical Service Corp - lab, pharmacy, hospital administration and others). It is all Officers.

The routine during the inprocessing is lots of hurry up and wait with lots of downtime. I have been to the gym on Mon & Tue during the normal work day due to all the downtime between sessions. I know that won't continue as we get further along in the training cycle.

Currently, I am living in a 2 man room. We have a common entrance and shared bathroom, but separate rooms. Each room has a bed, locker and desk. Later on this week, we will move into 40 man open bay berthing with bunk beds (don't be jealous).

Kansas weather has been interesting. When I got here on Saturday, it was almost 70 but very windy. Of course it got down below freezing and snowed on Sunday (didn't stick). The wind was still blowing up to 40mph and only in the low 30's. If you remember from my previous posts, we could only bring 1 seabag. In the 1 seabag is no warm clothes. We wear regular clothes here after the work day. I have 1 pair of jeans and 1 long sleeve shirt. No room for anything else. I did wear the Navy PT sweatshirt to try and stay warm on the walk to the chow hall. Oh, I can't say chow hall anymore. Now that I am on an Army base, it is the DFAC (dining facility). It has been down in the teens at night. It warmed up into the upper 50's today and will be warmer the rest of the week. Of course we will be issued the cold weather gear tomorrow after it warms up.

Sorry for not posting any new pictures. I will after I have all my gear. I will have 4 seabags of gear including IBA (Individual Body Armor).

Look at Dave and Anne's blogs for comparison (under links). They have 3 weeks of training and I have over 60 days. As I progress through the training, I will post some of the various evolutions and training regimens.....

Goodbye San Diego and DCU's

2009-04-03T22:19:00.001-04:00

This is me, Dave and Ann in DCU, BDU, and Digital Desert Uniforms. This is the last time we will wear them . We have now been issued the Army ACU. We took the picture in ACU's after our last muster today at 1500. They put out our flight requirements for tomorrow (Saturday).

When we were issued the uniforms, they gave us 4 complete uniforms, 2 sets of boots, and enough crap to almost fill a sea bag. What they forgot to tell us, is we are only allowed to leave here tomorrow with 1 sea bag. So, everything I had already brought in my sea bag had to be condensed into 1 seabag. Needless to say, I shipped 2 boxes back to Diane today via UPS. She will ship it to me once I get settled at Fort Riley.

Tomorrow is the flight to Fort Riley. I will check out of my room and take my seabag to the truck. We will be flying NALO (military flight). It should be another long day.

I need to finish condensing and packing my seabag. I will post again from Fort Riley....

The Deployment has begun...

2009-04-01T18:20:00.000-04:00

I am now in sunny San Diego at NMPS processing for my upcoming IA (Individual Augmente) deployment to Afghanistan. I will be relieving a Navy Perioperative Nurse serving with the Army in Kabul. I left Hampden on 29 Mar at 0500 EST. I flew from Bangor to Philly to Phoenix to San Diego. I got to the base around 1600 PST so it was a 14 hour trip. The inprocessing began as soon as I arrived with medical screening. It took 2 hours to finish medical and get a room in the CBH (Combined Bachelor Housing).

Monday was a fun-filled day of processing, uniform fitting, and lectures/powerpoint presentations in the auditorium. There are about 200 sailors of all ranks here getting ready to deploy to Iraq and Afghanistan. We started at 0600 and finished around 1600. I ran into 2 other Perioperative nurses I know, Dave Davis who was with me in Portsmouth, and Ann Ashton currently serving with me at Camp Lejeune.

Tuesday was another fun-filled day of medical processing. Eventhough I had already done multiple medical processing in Camp Lejeune, I had to be rescreened for everything. I ended up getting Tdap and MCG vaccinations and spending 5 minutes with an IDC for final processing. This of course took 6 hours of waiting for 10 minutes of processing. When I finished for the day, Ann, Dave and I took the train to historic downtown San Diego for some authentic Mexican food.

Wednesday was a catch up day for all the personnel who didn't complete the screening on Tuesday. It was an off day for me. I had to muster at 0800, but had the rest of the day off. Nothing big on Wednesday except for starting this blog.....