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Filtering by Tag: Afghanistan

December milestones and musings…

Hey there sports fans.  For the irretrievably bored (at work, most likely) I'll tick off a few more dates of significance.  December 3rd marked my 21st year in the Army, and December 11th marked the 5th month here in Afghanistan.  Here around the FOB we're trying to get into the Christmas spirit, myself mostly with Aeyoung's help. She has sent alot of Christmas themed decorations and the like and she also sent a couple boxes full of little presents to give to the local kids. I had one of the medics divide the gifts up into boxes for girls and boys and we've been handing them out. These kids love to get anything so they have been universally appreciative.  Here's a snap of a few kids that were in yesterday:

A bit past four months…

I'm a little late to the four month mark party, but feel compelled to mark these countdown milestones.  The last month has seen a few good developments, not the least of which is a fairly significant downturn in enemy activity in the last few days. It's been colder here for a few days and that may be the main reason. Since the last countdown milestone they have fixed the dryers in the laundry which has somewhat improved our laundry turn around time (there's no fix for the ambivalent workers employed there); and most significantly they repaired two of the treadmill belts so now I can run again.

I was a bit overly optimistic the first day and ran 5 miles in my rekindled trotting exuberance.  I paid the price of pain for several days afterwards. Luckily, my legs have been convinced that it's in everyone's best interest if they don't sit the rest of the season out and I was able to run 3 miles on Friday and feel like doing 3 or 4 today.

Another significant improvement was the arrival of my PS3 (thanks to my better half) and a modest home theater speaker system I had ordered online. We now have a high def, surround sound capable theater and video game room in the aid station. I'll upload pictures of movie night in action here in the future. We christened the new setup with the Blu Ray version of the most recent Incredible Hulk movie with Edward Norton. Watching a high def movie on a 70 inch screen with surround sound is quite sublime considering.

On the same mail truck I also received a nice desk chair for my room that has made the extended keyboard/guitar practice sessions much more forgiving to my sitting points of contact (use your imagination). With the gradual improvements it has become almost livable here. Knowing the Army, it's way past time to bring the suck to our happy home here if at all possible.  Until then, I'm going to enjoy our new standard of living.

3 Months

Depending on how you measure it, it's been 3 months since I left the US.  In some ways the time has gone by fast, but at times it does drag a bit. Hopefully the change in the weather will force the insurgents to scale back their efforts significantly. Rumours abound (they always do) that the enemy is intending to carry the fight through the winter which would be a change in strategy for them.  For a rag tag group of fighters who typically go barefoot or wear sandals, it will be quite an accomplishment just to move around outdoors here in about 4-6 weeks. Time will tell. 

The next 3 months includes Aeyoung's birthday (coming shortly), the holidays, and the start of a new year.  My plans for the next quarter are to continue working on getting better at medicine, music, and I'm going to reapply myself to finally learning my wife's native tongue (that will take considerably longer than 3 months, but I've got to start sometime).  I've got a book coming in the mail and I'm going to try and devote time each day to study. 

Hopefully the end of the next quarter will signify the halfway point of the rotation. The end of the quarter will also coincide with the arrival of another brigade and the redistribution of some of our battle space. Hopefully that will go smoothly, although I'd be surprised if it did.

October's Gone, and a Presidential Milestone…

I'm a few days late with this, but October has passed us by. It was a tumultuous month to say the least.  Things have been a little quieter the last few days. Summer is still holding on here with daily temps into the 80s although it's colder in the evening.  They finally finished the new dining facility although the quality of the food remains unchanged. November 11th is the four month mark so we're nearing 1/3rd of the tour complete. November will hopefully mark a decrease in enemy activity as the weather continues to get colder.

Back in the US yesterday, we elected our first African American president, Barack Obama.  This is obviously one of the most significant events in American history, easily the most significant political event in the last generation.  He goes into office with a democratic majority in Congress and arguably the hardest presidential task in history. He's going to have to deal with the ongoing war on terror and the wars in Iraq and Afghanistan; this will probably pale in comparison to the task of turning the economy around. It's a very optimistic time in our political landscape, hopefully the optimism will be justified.

I'm currently trying to negotiate my next assignment whilst deciding about my long term career options. In October word came out about the new bonus program for the Army PA's and it's very significant if it comes to pass. Final approval is predicted for next spring, and for retirement eligible PA's (yours truly) the amount will be substantial. With the creation of the CSRB bonus program in 2006, I had initially considered signing another contract at the expiration of the first which would lock me in until 27 years active duty. 

However, after nearly a year with a regular unit I was all but dead set against remaining any longer in the Army. Now, after being deployed for four months I have begun to feel different. Most of my dissatisfaction last year had to do with the typical primary care and predeployment mission that dominates stateside military healthcare operations.  The overwhelming majority of patients we treat in the states either don't need medical attention, or are trying to use a medical issue as a means to avoid doing their real job. That will never go away, but after practicing real medicine on a predominately truly sick and injured patient population, I have garnered a new appreciation for my work.

That experience, combined with the changing political landscape and the tentatively planned troop reductions in Iraq have actually got me feeling optimistic about the Army again.  The ongoing struggle here in Afghanistan and the likelihood of continued (albeit decreased) violence in Iraq essentially guarantees that combat deployments will be a regular part of Army life for years to come. However, the optempo may very well decrease to the frequency of one deployment every 3 or 4 years (or even longer) if the positive gains continue. 

My current contract expires in October 2010, when I would be eligible to retire with nearly 23 years active duty.  I can stay in without doing anything since I have to request retirement for it to actually happen.  I'll have essentially one year to think about it after returning from this deployment. The Army typically recommends requesting retirement a year ahead, but no less than 90 days. I'm hopeful that a lot of uncertainty about the next several years (for the military) will be cleared up after President Obama completes his first year in office.  If things continue to improve, I might decide to stick around for another four years.

The return of the tubular…

Our favorite thoracic shrapnel patient returned after about a month in the hospital for a check up.  He is the patient that I put the chest tube in and then shamelessly hammed it up for the after picture. He is doing very well with no residual pain or loss of pulmonary function.  The scar is still impressive enough for him to get sympathy dates, though. Not sure if he's tried it yet. 

Chest Tube after web

A really bad 24 hours…

We lost our civilian doctor, Dr. Rahullah who had been an integral part of our clinic here. He is on my left, explaining the patient’s prognosis to her father. He apparently was killed because of an inter-family rivalry although that isn’t confirmed. He was a man who had risen so far above his upbringing and spent seven years of his life in medical school and had been working in our clinic for less than a year. As unique as doctors are in the states, they are even more special here in Afghanistan. This is a typical outcome for those who put their lives on the line to help the people of Afghanistan.


A Brief Video Tour of Camp Blessing

What follows is a very scrunched and degraded version of a few clips of my current home. I'm limited by bandwidth and the fact I'm using a military network. You will probably need Quicktime to watch this. More professional (read, interesting) clips will be put together in the future, but I don't know if I'll ever be able to upload them while deployed. They'll probably be put together after I return to the states. The best part is, I'm putting them on this website as opposed to forcing everyone to watch them during the holidays. See, I am thoughtful.

Is that a tube in your chest…

or are you just happy to see me?  A couple of action shots of a guy who had what was apparently a shrapnel wound to his posterior thorax that resulted in a hemopneumothorax (blood and air in the chest cavity, compressing the lung).  We started an IV, gave him some pain meds & antibiotics, and I placed the chest tube seen here.  We evacuated him to our forward surgical team and he's doing well according to reports.  Yeah, I don't exactly look professional in that first shot, but we tend to joke around a lot during traumas, especially after we have stabilized the patient and know that they're going to do alright. 

I had assisted with a few of these during PA school, but this was the first trauma patient that actually needed a chest tube that I put in myself. During OIF 1 we just never got anyone with penetrating chest trauma that really needed a chest tube.  It's surprising just how hard you actually have to push to penetrate the pleural lining, but it's very obvious once you do. After penetrating and opening the hole up with hemostats there is a great rush of air (in the case of a pneumothorax) and blood (if there's a hemothorax as well) and the patient usually immediately begins to breathe easier, which this one did.  That also explains the last picture (I probably needed a face shield). I'm sure I'll get several more under my belt before I'm done here.

More action photos…

These are 3 pictures from when I tapped a kid's knee last week. The first is me prepping the knee, then it's me and SPC Strain not posing, and finally Dr. Paresh Patel (the battalion surgeon and an ER doc by trade) also not posing. The tap was negative so we ended up just treating him for an overlying cellulitis that resolved after a few days.

The vacant stare and protruding tongue are products of Ketamine, an anesthetic agent that works very well for short procedures. We have to use it fairly often for young children because they get so distressed by the environment and the procedures we perform here.  We use local anesthetics first, but they usually still get very upset by the process so we often sedate them.  These kids get what I call the "Ketamine Stare" where they lay with their eyes open staring, but they are unaware of what's going on. I put on a little Pink Floyd first and with the Ketamine onboard, send them to the Dark Side of the Moon.

A new month

It's now September, so another calendar month is gone by.  August was a fairly good month in retrospect. I left Jalalabad on August 6th and came to FOB Blessing which has turned out to be a positive change in most aspects. I'm pretty happy with the living arrangements, and I have settled into a comfortable routine here.

In the last month I have seen more serious trauma than I saw during my whole OIF deployment. That statement must be qualified by the fact that we didn't have a steady supply of local nationals that we were seeing and Iraq hadn't really heated up yet during my time there.  After four years in Occupational Medicine I was feeling pretty rusty on trauma management, but just a few weeks here can knock a lot of rust off. Yesterday, I placed a chest tube in a local national that was hit by shrapnel and then we evacuated him to Jalalabad for further care.

Things to look forward to in the next month include the completion (hopefully) of the new dining facility which will result in the relocation of the MWR facility to the former mess hall area (which will allow more room) and possibly a small PX being put into the previous MWR facility. September and October are still fairly busy from an operational standpoint, so we will probably continue to get a steady flow of trauma patients.


More Pics from Blessing

Some assorted views about the camp. The first is the view out the back porch of the aid station. The area below is a volleyball court and the wall is the perimeter for the main camp area. Outside the wall is the small flight line where helicopters land and they store fuel and other supplies. 

The second picture is the of the little shop and ANA (Afghan National Army) meeting room which is adjacent to our front door. The shop sells mostly copies of movies and music and assorted electronics. I hear he can get about anything you ask for if you give him a couple of days.  So far I haven't broken down and bought any movies (they're 2$), as we have plenty to watch on our computers and in the aid station.

The third picture is of my living area. Narrow to be sure, but it's actually pretty functional.  The nicest thing about it is it's my own private area and it's part of a room I share with our doctor and platoon leader (both of whom are very good neighbors so it's nice and peaceful).  I have my little sitting area and a place I can play guitar, use my computer, etc. at floor level. My bunk is up high and I've got a small light for bedtime reading.  There are plans in the works to get the local carpenter to build a desk in the back (where the 4 drawer chest is located) and build a frame to keep the bunk up high. Our platoon leader already has this setup, so we should get it eventually but we have to wait for other higher priority projects to get completed.

The last picture is of yours truly during one of those deployment highlights, the opening of a package from home.  Aeyoung sent a bunch of candy and school supplies for the local kids, but she didn't forget about me and included a lot of nice toiletries (awesome towels) and some music and game magazines as well as snacks. Everyone looks forward to the resupply flights that come about every four days in the hopes of getting mail from home.

The Zen Masters of Afghanistan…

or ninjas, or firewalkers, or whatever other badass pain insensate icon you can compare to these kids. Here’s a couple more of our stalwart local patients.

The little boy with the interesting headgear and gator (it was raining and we needed to keep the dressing dry) was hit on the top of the head with an axe, according to the story we got. Luckily, it must have been a very lightweight axe as it only penetrated the skin and didn’t reach the bone. He was completely lucid and not showing any neurological defects during the hour he was with us. I threw some stitches in and off he went. He got the gator because he sat there as stoic as a supreme court judge the whole time without complaining or moving. Yeah, these kids are tough. We still get the occasional hysterical screaming kid, but we get more of these kids with zen like patience and bearing.

The little girl behind the old man lost her right eye and suffered shrapnel wounds to her face and leg. I treated and stabilized her initially and then we evacuated her to the forward surgical team where she stayed for a few days. She is on a list to get a replacement eye prosthetic (glass, I think) which will probably be performed in Kabul when it eventually happens. She was another monk like patient; she cried a little bit but otherwise didn’t squirm or fidget during the whole process of cleaning up her wounds and bandaging them. Normally we would have sedated her, but since she had head trauma, we couldn’t give her anything that would cloud her clinical picture.

She’s too young to realize the magnitude of her loss, but the day this picture was taken (about 10 days after the event) she was smiling and playing with her sister and responding to me when I talked to her.

The toughest kids in the world

These children in Afghanistan have a very hard life by any standard, especially by Western standards. Almost daily we are seeing children with significant burns, blunt and penetrating trauma, or infections that have progressed much farther than they would in the US. This little girl is about 3 years old and she was burnt when she apparently knocked over a boiling tea kettle. She was brought in about 12 hours after it happened. We sedated her and cleaned up her burn and dressed it. We arranged for her transfer to a burn center in Kabul and she flew out yesterday. She'll probably do okay in the long run, but it's hard to see these kids going through all the suffering they do when some simple safety measures could prevent these accidents.

My wife is more popular than me…

and she’s not even here. Aeyoung sent a big package that I received yesterday and it had quite an assortment of candy and snacks that she asked me to give to the children that come into our clinic. As the picture below proves, she’s now held in high regard by the locals. The jury is still out on me since I usually am approaching them wearing gloves and carrying syringes and scalpels. It’s amazing how comparable a tootsie pop is to fentanyl.

I’m in demand…

This is a picture of the front door to the aid station at Camp Blessing.

I’ve been in Afghanistan for about five weeks now, the last two at a new base with a different battalion after one of my peers had to be replaced. I was moved to one of the infantry battalions at Camp Blessing, which is in a more remote and contentious area in A-stan. I actually find the life here much preferable to the last place I was at (Jalalabad). The weather here is a bit cooler, the aid station we occupy is a permanent cement structure that keeps the temperature cooler and more stable around the clock, and everything that I would need to do is within about 300 meters walking distance (aid station, dining facility, gym, laundry, bathroom). We see mostly local national children here and we get to do surgical procedures mostly on a daily basis. Lots of abscesses and skin infections with the occasional trauma thrown in. In the two weeks I have been here, we have had two mascals (more patients than we can treat at one time) although in both cases there were only two “serious” patients so both the doc and myself were able to manage them within our scope. We’ve intubated four patients, and put in four chest tubes (one guy got two). We’ve seen everything from shrapnel, to GSW (gunshot wounds) to MVAs (motor vehicle accidents).

We also see alot of kids with burns and other questionable blunt trauma injuries. It’s not uncommon for children here to be running around open fires with cookpots full of boiling water and other dangerous substances. Safety practices are essentially non existent so we see alot of stuff you wouldn’t see in the states. Personal hygiene is also not a priority here so we see alot of infections that wouldn’t normally occur in the US. I wouldn’t have thought it, but I find the work here quite agreeable. I normally prefer the steadiness of occupational medicine but there is definitely a different vibe to seeing people with true objective illness and injury as opposed to the typical sick call patient we see in the US. When you see a 6 month old kid with an eyelid full of pus the size of a golfball, it’s not even a question as to whether or not they deserve your attention. So many of the problems here are correctable with an intervention or two so it’s much more satisfying when you treat them and then see them get better. And they are almost universally appreciative for the help.

This is opposed to the typical soldier on sick call who has some sort of minor musculoskeletal issue that will only get better with time and a small amount of effort/common sense on the soldier’s part (which is often lacking). There are plans to get a new PA to replace the one that left and theoretically that would mean I get sent back where I was, but I am beginning to think it would be better to remain here. The work is real, the living is better, and time is going by faster while I’m here. Time will tell.

The first few weeks…

are now gone by. I am currently in Jalalabad, Afghanistan working out of a consolidated treatment facility colocated with a forward surgical team. We have moved two different times already, and are due to move again when they finish building new housing and a clinic. That’s due to happen in Sep/Oct but I will probably miss it as I am getting ready to backfill for a provider from an infantry unit that is being sent back to the states. Hopefully I will still have connectivity where I’m going, but I won’t know until I get there. I intend to upload some photos and video when I get the chance.

Staying Connected

I type this post from a MWR (Morale, Welfare, Recreation) center on Bagram Airbase in Afghanistan. I’ve been in country a few days after a 22 hour journey from Texas. We’ve been staying in tents and going through some required inprocessing and training. We are due to depart for our permanent(ish) home for the next 15 months later today. Right now things are really heating up in Afghanistan as they cool down in Iraq. Just two days ago there was an insurgent raid of Taliban and other foreign soldiers on a small outpost (this is all over the news, btw) which resulted in 9 American deaths and 15 American casualties. It’s the largest and deadliest attack on US forces in 3 years. We will be providing the medical care at the base where the 15 were evacuated to. They were stabilized and then evacuated onto a military hospital in theater. I’m still not sure how to feel about the way things are going. In some ways I am motivated to hopefully be part of taking the fight back to the enemy and making the Taliban and their allies pay for this attack. Right now I’m also mostly just wanting to get to our permanent home and to get settled into a routine. I’m still not sure exactly where my permanent home will be, and probably won’t know that for several days. And of course that can easily change as the mission changes. I will continue to update the blog with entries and later with photos once I can get full connectivity.

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The countdown commences…

I leave for my extended sojourn in a few hours. It’s now nearing midnight on the 10th of July. I expect to be gone for 15 months, returning in October of 2009. I plan on regularly updating this blog when I get the chance, if I have connectivity. If I don’t, this may be the last post for a long time. I appreciate all expressions of support and prayer from those who gave them. I will be keeping in touch as best I can.