Monday, 30 April 2007

Week 15--A Week to Forget

Some weeks should pass without comment. Too hard, too dark, too sad.
Week 15 is one such week.

I'm sure there will be others.

Phillips Out.

Tuesday, 24 April 2007

Week 14--Afghanis I Have Known

I was going to write a long entry about all the Afghanis I know and work with here at FOB Salerno and in Khowst. However, as I gathered information and talked to my Afghan friends I realized that the last thing they want is their name and/or picture posted on the internet. The same technology we use to keep in touch and share our lives with friends and family, the insurgents use to target the Afghans who work with the Coalition Forces. I'm sad to say that I personally know of many, here and in Iraq, who have been killed just for working with the US Army.

So, I'll tell this story without pictures or names. In a place where suicide bombers and assisinations are common, it's just too dangerous to do it any other way.

Here in Afghanistan I work with Afghanis every day. It's one of the most rewarding parts of my job. I've changed since my tour in Iraq, so I have a more objective view of my "terps", as they are called here.
So far I have found the them to be smart, reliable and hard working. The ones who work with us here on the FOB are now familiar with American culture and idiosyncrasies. The ones we work with outside the FOB are curious and reserved, but interested in learning more about America and Americans.

Most of our patients are Afghani. It's probably split almost evenly; soldiers and civilians. The Afghan Army Soldiers are, as you imagine, tough fighters. But what I didn't expect is their "esprit de corps". Just like US Soldiers, when they wake up after surgery their first question is, "when can I go back to my unit?". Just like US Soldiers, their commanders and leaders call to check on them and visit them in the hospital. They seem to be loyal; to Afghanistan, the army and their unit. The way ahead for us is making their Army self sufficient. There can be no freedom or progress without security. We are doing our part by ensuring they get excellent trauma care when they are wounded or injured.

The other half of our patients are civilians; both elective cases and trauma. The elective cases are the best; we relieve suffering, improve quality of life and train the Afghan healthcare providers all at the same time. The Afghani doctors, nurses and medics with whom we work provide much of the care to our afghani patients. In this way we increase their capabilities and set them on a path to independence in the health sector.
The trauma cases are not as nice, but sometimes very rewarding. Afghanistan is a violent, dangerous place and trauma is common. Just this last weekend the news reported two bombings in Khowst. Most of the patients are treated at local hospitals, but sometimes we can assist them if the number of injuries or the nature of the injuries exceed their capabilities. In many cases we are able to save lives and ease suffering after senseless, violent attacks. And no matter the outcome, I have received nothing but thanks and gratitude from patients and families of patients for the treatment and care we provided.

Our Afghani staff consists of doctors, nurses and medics. They work with us in all aspects of patient care. We could not do our job without them. As a miniumum, they translate between English and Pashto. Often they provide patient care alongside US providers. Of course, many of them would love to travel to the US to study or live, but they also retain a hope for their country, a hope for the future and a hope for their children. Like security, healthcare is essential for this country to move forward and improve.

The Afghanis I deal with "outside the wire" are totally different. They are understandably guarded, since they never know who is watching or listening. But still, I find them interested in all things American and optimistic about the future. Khowst Province is poor, and it has seen decades of continuous conflict, but it is undergoing a transformation. New schools, new homes, new roads, new hospitals and clinics are all easy to see. Afghanis still shop and travel, marry and have children, all with one eye on the past and one eye on the future.

One important note: I rarely deal with any Afghani women. I've worked with one female Afghani doctor and I routinely see female Afghani patients in the clinic and on the ward. But in all instances, they remain quiet and as covered as possible, even during a physical exam, even in a patient bed on the ward. I remember one trip into Khowst where we entered a courtyard, accompanied by our Afghani host, where several women were waiting, uncovered. They paused just long enough to watch us enter the courtyard, then covered their heads and faces and exited the courtyard as quickly as possible. On another occassion I was talking to a doctor as he conducted some patient teaching with a female patient in the clinic. The patient sat on the bed, completely covered from head to toe, with her husband beside her, while the doctor relayed his instructions and recommendations through the interpreter. It's just another part of living and working here in the Islamic Republic of Afghanistan. It's just another reason to rely on our interpreters and Afghani healthcare providers when we are treating and dealing with Afghani patients.

Overall, this is a great job. It's easy to get depressed; the days are long and work never stops and I miss my family. But it's also easy to see the progress we are making and the lives we are changing. The American people should be proud of the job the Soldiers, Sailors, Airmen and Marines are doing here and all over the world. The represent the best of America, and they do it under less than ideal circumstances.

Thank you and may God Bless You.

Until next time....

Tuesday, 17 April 2007

Week 13--The Beginning of a Long, Hot Summer

Well, another week has flown by. At this rate, I’ll be home before you know it! Well, maybe not. If the Army keeps extending tours they’ll eventually have to make this a PCS move! I wonder when they will start to build the family housing?

This week went fast, but it ended on a sad note. One of the best things about a deployment is the friendships you make; friendships forged in shared suffering. One of the worst things is when those friends leave. This week my friend and comrade-in-arms, COL Don Sawyer, departed, on his way back home.

He was my Chief Surgeon and a great partner in commanding this hospital. He will be missed. And he left as he arrived, in the middle of a busy time, filled with casualties. He worked in the operating room almost until the end, almost until his plane departed. It reminded me of the episode in MASH where COL Blake is leaving, but the casualties keep coming and everyone is too busy to say a proper goodbye. And finally everyone realizes that there is no right way to say goodbye and sometimes a simple salute is the best farewell for a Soldier.

But this week also had its positive moments. We had a return visit from one of our patients. The boy pictured below is Zaidullah, one of our burn patients from several months ago. At one point it appeared he might lose his foot to infection, but this week he was back and walking! And wearing shoes! It’s nice to see a success. Thankfully for Zaidullah, we have a wonderful orthopedic surgeon and she was able to save his foot and give him hope for a productive life. As a trauma hospital we don’t always see the results of our hard work. And with the Afghan patients follow-up care can be difficult. The nice thing about surgery is that is can be very definitive. In our clinic we identify problems that can be resolved surgically, hopefully with minimal follow up care. It allows us to improve quality of life without requiring frequent trips back to our clinic, which can be expensive, difficult and dangerous for our Afghan patients.

This girl is typical of our Afghan patients.

I’m always amazed at how nicely dressed they are when they come to our hospital. I’m still not sure if they are wearing their “Sunday best” to visit the American hospital or if this is everyday attire. I do know that kids around the world love their parents and enjoy toys, books and games. I watch the kids cling to their parent’s legs, pull on their hats or glasses and calm down when they get back in their parents arms, just like kids in the US. With this little girl, I thought it was interesting to see her with “Curious George” as she sat outside our clinic waiting to be seen. I remember Curious George from my childhood (many moons ago!), so I just had to get a picture.

One other recent patient was the girl pictured below. She’s from an Afghan nomad family. She lost her arm when her family’s tractor hit a landmine. Several other family members were killed and the tractor was destroyed. Lucky for her, she only lost her arm. This is just one example of the patients we see; innocent victims of wars past and present. We were able to save her life, and give her a chance. Hopefully one of the many NGOs operating here in Afghanistan will be able to provide her with a prosthetic arm. Unfortunately, amputees are not uncommon in Afghanistan, so although there are a lot of organizations providing help, there are always more patients than capacity.

On a brighter note, the construction of the new hospital continues. It seems like it’s ahead of schedule to me, but that’s probably just because I am excited. It is rising like a forest in an empty lot beside the existing hospital. It started with the big dig (pictured below)
and has risen to be a forest of steel and concrete (as seen here).
Before you know it there will be floors and walls and, eventually, a roof. And someday we will be working inside a hardened structure, but we will always remember our days in the “original” Salerno Hospital, the tents and wood floors and walls that have stood so well for so long, through too many patients to count.

And finally, on another happy note, I turned 45 last Friday! I celebrated one more birthday away from home; one more birthday deployed. We celebrated in traditional Salerno Hospital style, with Afghan cake and the singing of Happy Birthday in the EMT tent. Then we all went back to work. With all the extensions across the Army, I just hope I am home in time to celebrate my next birthday with my family! I like it here, but enough is as good as a feast.

Take care. God bless you all and may God Bless America.

Monday, 9 April 2007

Week 12--Khowst Province

Another week has gone by, and it’s time for another post to the blog. I'm posting on this, my new site, as well as my old site, right now, but this will be my last week to post on both. I like this site because it allows me to imbed the pictures into the text, and I can upload the pictures myself! But I may still need picture girl, because my internet continues to be SLOW and unreliable. And that’s the internet at the office! Check out my new blog site at:

This week I was thinking about our neighborhood, Khowst Province and Khowst City. Around here, paved roads are the exception rather than the rule. There’s a lot of money flowing in to Afghanistan, and lots of improvements are evident, but there is still a lot of work to be done. This picture of the road outside the FOB is typical; a dirt road, but with construction and improvement evident.

And the improvements are very necessary. This flooding is on that same road, after just a few days of rain. Without a four wheel drive vehicle and a snorkel it is impassable. We made it with Hummers, but even then it was scary.

Here’s what the improved roads look like. Paved roads are a wonderful thing, when you can find them. But just to the side of every paved road are the same mud buildings and dilapidated infrastructure. When I asked my interpreters about speed limits in Khowst City they just looked at me and laughed. When I asked about traffic lights, laughter again. I am told that there are only three traffic lights in Afghanistan, all in Kabul, the Capital city. This is probably an exaggeration, but if so, probably not by much.

But still, improvement continues. This new house in Khowst is not unusual; a beautiful new house (with walled compound, of course!) on an unpaved street next to a flooded low water crossing. Signs of progress are everywhere; rows of Jingle Trucks bringing in new items for sale, a “home depot” type lot with lumber, bricks, rocks, firewood and fixtures, new construction and new jobs. We can’t buy our way out of this war, but people who are busy working have less time for fighting, and less inclination to do so, we hope.

We take a lot for granted; power, water, safety and security to name a few. In Khowst City they get 4 to 8 hour a day of power, usually in the evening. If you want more, you get a generator for your home or business. Of course, running water requires electricity so most homes and business use water tanks on the roof to provide gravity-fed water for drinking and cleaning. Safety and security? Well, in a place where suicide bombings and automatic rifle fire are common, safety and security are not taken for granted.

And still, the patients continue to come. These two little girls represent the future of Afghanistan. Hopefully they will be like Germans and Japanese children from 50 years ago who remember kind American Soldiers who took care of them and gave them candy. We can’t win this war unless we love the Afghan people, and there’s no better place to start than with the children.

Thanks for reading and praying and supporting all of us over here, and back home.

Sunday, 1 April 2007

Week 11--Life on the FOB

Well, another week has passed. And Spring has finally sprung here on FOB Salerno. The tree outside my "hootch" (our generic name for our living quarters) went from buds to leaves in just a few days. And the weather is spring-like. Saturday was a beautiful day all day, until a thunderstorm blew in and blasted us with high winds and rain. Stuff went flying all over the FOB, including our new satellite dish! Fortunately no one was hurt on the FOB and no major damage to equipment was reported. And Sunday was back to clear skies and sunshine. It was a nice day to relax and get ready for another long week.

This week my travels took me to some different areas of the FOB. It's easy for me to forget that not everyone has it as good as I do, on this FOB or on the many smaller, outlying FOBs. In fact, most of the Soldiers on FOB Salerno still live in the "tent city" pictured below. The tents sleep 8 to 12 Soldiers; the fewer the better, of course. All have wooden floors and many are sectioned into cubicles with wooden walls or curtains.

And Soldiers decorate their areas, each according to his or her own tastes. "Hootch Art" is a popular way to decorate. The wooden walls make a perfect canvas. I thought this picture would make a good tattoo; then I found out that is was a reproduction of the artist's own tattoo, so I guess I was right! As time goes by the tents are being replaced by "brick and mortar" buildings, so the quality of life continues to improve for Soldiers on FOB Salerno.

The FOB is not big, but it's still too big to walk everywhere in a timely manner. And of course sometime you need a truck to carry everything from point A to B. For the Salerno hospital we have only two ways to move things; our gators and our Hillbilly Hummer. The John Deer gators are the most common method of driving on the FOB. But when the load is too big, it's time to use the Hillbilly Hummer. It may not look like much, but it's big and it runs and it's all we've got. Of course, I'd never leave the FOB in it, but it's great for around the FOB. I'll have to do an entry on all the different vehicles I see here on the FOB. Toyota pickup trucks, up-armored Hummers, gators, Land Rovers and Land Cruisiers all compete for space on the dirt roads of FOB Salerno. But the most common way to get around on FOB Salerno isstill the most basic; walking. It's great exercise and it doesn't require a license or helmet or ground guide.

Finally, the hospital construction continues. They started with big holes in the ground, and now have progressed to a "forest" of columns. It won't be long before we see a foundation and floors and walls and a roof. I have no doubt now that the Soldiers who replace us will move directly in to a brick and mortar hospital and that we will be the last occupants of the hospital in the tents. It will be a great day, but a little sad when you think of the hundreds of staff and patients who have worked and played and lived and died in the existing hospital. We'll need a suitable ceremony to honor those who have gone before us and all they were able to accomplish with so little. I'm proud that we've been a part of that legacy.

As always, thanks for reading the blog and supporting the Soldiers and families of our Armed Forces. If you have any questions or comments or suggestions, I welcome your input.