Sunday, November 29, 2009

Rolling Thunder

The MRAP is an awesome vehicle for getting around the battlespace. It can protect you from almost anything the enemy can use against you. But it is first and foremost a weapon. Like any weapon or inantimate object, it makes no distinction who or what incurs its wrath. Most MRAPs are very heavy, weighing between 12 and 20 tons. When the the driver looses control it can be a disaster.
The MRAP pictured above had a rollover about 2 weeks ago. From secondhand reports the vehicle was going fast and the dust from the road obscured visiblity. The vehicle hit an uneven spot and rolled completely over(They are top heavy). Thankfully and only due to Divine intervention, there were no serious injuries. The passengers dutifully strapped themselves in as instructed. Luckily the gunner was thrown clear since the crushed turret as seen above would not have been a healthy place to be situated.
Having made about 50 trips in MRAPs so far I can tell you that it is easy to become comfortable and even complacent in your operation, preparations and drills. The Commander of our base mandated that everyone on Spann take a look at this MRAP. The visual representation of 20 tons of Rolling Thunder will certainly make me more attentive to my part in the safe use and operation of this type of vehicle.

Thursday, November 26, 2009

Thanksgiving Day and Eid

It was a nice slow low key day here at Camp Spann. The almost continuous winter clouds did not open up and rain today. I did a tiny bit of work today(for those who are going to deploy, pay attention to when your Information Assurance certificate runs out, it took me three hours with our slow connection here to finish it, and had to print it off today.)

Thanksgiving Day has been celebrated usually on the 4th Thursday in November since the time of Abraham Lincoln. In retrospect we have much more to be thankful for these days then they had in 1863. While our country is not at peace, we are not at war among ourselves. In fact we are trying to assist a country under the assault of terrorists. We think of it as a family time. I am sure that many a soldier was away from his family in 1863 though. We are a nation that is truly blessed, and while we should thank God every day, it is fitting that we set aside a special day as a nation to thank Him.

First there was the food at the Chow Hall. Like many facilities here on camp, it is run by the contractor Kellog Brown and Root(KBR). While KBR and other companies like Hallyburton have had their reputations besmirched during the last 8 years of conflict, I must say they put on a nice Thanksgiving Day meal. Pictured is my Supper tray, which was very similar to my Lunch tray(I basically came back for seconds in a few hours). The turkey was good and juicy, The stuffing was very good and I got to drench it with lots of gravy. I had mashed potatoes and shrimp cocktail. I have taken a liking to collard greens since our chow hall caters to the leading unit here, which is from Georgia. I had Welch's sparkling grape juice(known as King and Queen juice to my kids) for lunch and the more traditional mixture of Sprite/7up and cranberry juice for Supper. It was funny watching some of our European allies. Their eyes lit up as they saw the bottles on the table, only to turn to a frown as they realized it was not wine. There was pumpkin pie, ice cream and cake available for dessert.
The Church Service was after supper. We had about 2 dozen faithful attend. Represented were all three US services deployed here, US contractors and allies from Norway, Croatia and Sweden.
There was even a very nice piece of special music from an irregular quartet of US, Croatian and Norway mixture. The singing and fellowship was good. It felt altogether right to attend a service on Thanksgiving Day.
Finally we come to Eid. The Afghans have started a Holiday as well; Eid e Qurban قربان‎ عيد
This is known as the Eid of Sacrifice. It commemorates Abraham's offer of sacrifice of his son Ishmael from his second wife Hagar according to Muslim beliefs. It starts with the end of the Hajj حج‎to Mecca(tomorrow). Most Afghan businesses and nonessential government work has stopped. It lasts about 4 days, so I really don't plan on hearing from my counterparts or interpreter until monday or tuesday. That's alright since I will need to spend a little more time in the gym to work off the excesses of today.
I am also most Thankful for those of you at home who support me here, or have had to double up and do the duties and tasks I would do if I were there.

Monday, November 23, 2009

COMISAF on Board

It was a cool damp day on Camp Shaheen. Camp Shaheen is the Afghan National Army camp of which Camp Spann is only a small part. Usually I spend nearly all my time on Camp Spann, but not today. Today I was to standby in case a brief was needed about my mission here. In the early morning there was snow on the mountains in the distance. I really wished that I had brought my gloves or put on some long underwear.

I saw the German helicopters come in low and fast. It was a few minutes until the buses arrived. The Afghan honor guard came to attention and was inspected. He spent quite a while talking with the Afghan Corps commander and his staff. Then he was led to the HEAT trainer. This is exactly the same set up I had to go through in Ft Riley, where you practice rollover drills in an armored HMMWV. The Afghan soldiers who were going through it were laughing as much as I was when I did it. Then I actually got a look at him as he discussed issues with local Afghan Army basic training commander. Shortly after this I had the honor of shaking the hand of General McChrystal as he boarded the bus back to the heli pad.

From my observations I can confirm the descriptions of him we see in the press. He was humble and respectful. Over 90% of his time was spent talking with Afghans, as is only correct in a counter insurgency(COIN) situation. He listened much more than he talked, but when he did ask a question it was always pertinent, succinct and to the heart of the matter. He had a ease about him and was quick to smile.
Also touring with him was the Deputy Commander for Nato Training Mission- Afghanistan, Major General Ward, of the Canadian Defence Forces. Our little two man team falls under his command. He cheerily introduced himself while sitting on the bus with me. He asked where I was from and what my mission is here in Afghanistan. I talked with him about the ANP medical system and what we are doing to assist infrastructure and first responder casualty training for the ANP. He listened and was very kind in shaking my hand has he headed off to the helicopters as well. It is not an every day occurrence to have the Commander of ISAF and several other Generals all on board Shaheen at the same time.

Sunday, November 22, 2009

khaagbad, bo-ron and gel

Today was a hectic day.

We spent the first half of the day meeting with our Afghan counterparts. There are about a dozen issues in which we are moving forward. I am proud that we have worked together to come up with a syllabus and book to teach a Trauma Assistance Program(TAP) to Policemen in the Northern Region. That gets us one step closer to actually starting the course and handing it over to our Afghan friends to run on their own. TAP is a police version of the Combat LifeSaver (CLS) course which has been so popular and necessary in the US Armed Forces. It is only right that the Afghan National Police, who are taking casualties at much higher rates than the Afghan National Army, or Coalition Forces, should have this information.
We are also very close to turning over a new clinic. It is almost completed and will have many amenities that his current clinic lacks. Reliable electricity, running water, and ground floor access are the top ones that come to mind. With this new facility will come new capabilities and responsibilities.

The second half of the day was spent travelling. This is where we get our Dari words for the day. I travelled to the site of the new clinic with some engineers inspecting the facilities. I was hopeful that I could be there to supervise the turnover of keys to my counterpart. The trip was initially a slow one. A dust storm or khaagbad had moved in. It was not like the movie sandstorms where torrential winds blast huge chunks of sand at high velocity. It was some wind and lots of dust in the air. It looked like someone had burst open many sacks of buckwheat flour into the air. The lighting almost looked like it does at twilight or during an eclipse. I was hesitant to talk too much outside, since every time I opened my mouth I was rewarded with the satisfying crunch of sand on my teeth afterwards. The floor of the clinic was still wet after painting and sealant, so it will be turned over in a few days. I will probably not be able to be present during the transfer, but will be able to coordinate the process by phone.

During the trip back the storm changed from khaagbad to bo-ron. Bo-ron is rain. While I have mentioned rain a few times, this is the first real rain I have witnessed in Mazar-e-Sharif. It was not a tropical deluge, but I was soaked after walking about 200 yards. The bo-ron leads us to our final word of the day, gel. No, I am not talking about a hair care product mostly seen in the hair of our German colleages. I am talking about mud. Bo-ron + dirt=gel. Thankfully we recently got a new shipment of gravel around the camp so it is not too muddy. Now I will have a chance to clean myself and my gear after a day in the elements.

Wednesday, November 18, 2009

A Tribute to the ALO

Almost every time I leave Camp Spann, it is after coordinating with the ALO. ALO stands for Air Liaison Officer; The officer who books flights and schedules the convoys to and from the airport to connect with those flights. It is a fairly thankless job, which our ALO has done very well. I know that as our plans have changed, as they have done very frequently, he has always worked to support us in a thoroughly professional manner. He is a superb example of an officer working way outside his usual field while deployed and doing it very well. He went through the same training class that I did at FT Riley. In fact he was only one bunk over in our 40 man bay. He has let me sit up front during several of the convoys in MRAPs. Finally, however, he is leaving in just a few weeks. It will be quite a loss for the mobility of Camp Spann when he departs.

As is only healthy, our ALO has a good sense of humor. He has the below creed posted on the wall of his office. It may have some terms that are unfamiliar, but if you have every watched the movie A Few Good Men, you will recognize the speech the COL makes while at the witness stand. Thus, courtesy of the ALO, I give you A Few Good ALOs

Son, we live in a world that has flights and those flights need to be booked by men with emails. Who's gonna do it? You? You, Battle Captain?
I have a greater responsibility than you can possibly fathom. You weep for ISAF flights and curse the ALO; you have that luxury. You have the luxury of not knowing what I know: that your early convoy show time today, while tragic, probably saved lives and that my existence, while grotesque and incomprehensible to you, saves lives.
You don't want the truth because deep down in places you don't talk about at parties you want me booking your flights, you need me booking your flights. We use words like CONOP, Showtime and SP. We use them as the backbone of a life trying to move people around. You use them as a punchline. I have neither the time nor the inclination to explain myself to a man who rises and sleeps under the freedom of movement I provide and then questions the manner in which I provide it. I would rather you just said "thank you," and went on your way. Otherwise, I suggest that you hop in a MRAP and drive a convoy. Either way, I don't give a damn what you think you are entitled to.

Saturday, November 14, 2009

The Bug Bite that keeps giving

This photo is of a patient who came up to me about a bug bite problem. He didn't recall any bite, but the red spot had been present for about two months. He had casually inquired at the base clinic early in the process and was told to use some steroid cream on the spot, it should go away. He had done some research on the spot himself by the time he had come up to ask my opinion. I took one look and knew that a lesion like this; non-healing, ulcerated, red with a fresh looking scar was leishmaniasis. This photo was taken the day he went for specialty treatment for this problem.

Here in Afghanistan, the bite of the sand fly can carry any of several species of protozoa of the family Leishmania that can cause disease. It occurs in South America, Central America, the Mediterranean Sea, Subsaharan Africa, Southwest Asia(including Afghanistan) and India. There are three categories of Leishmaniasis: Visceral, Mucocutaneous, and Cutaneous.
1. Visceral Leishmaniasis also known as Kala-azar, is more common in Subsaharan Africa, but can also be found in most areas of Europe bordering the Mediterranean Sea. Since Visceral Leishmaniasis occurs in areas with limited healthcare access the disease can result in fevers, ascites, and is fatal within 2 years if untreated.
2. Mucocutaneous Leishmaniasis affects primarily the mucus membranes of the nose, mouth and throat. These areas scar and can essentially collapse the face, resulting in severe socially limiting deformity.
3. Cutaneous Leishmaniasis is the 'best' type to get. Progression to one of the other categories of Leishmaniasis is possible but unlikely. My patient has cutaneous leishmaniasis. It generally persists for several months before diagnosis. In some cases it will resolve spontaneously leaving a large and unsightly scar in the area. In other cases, like above, treatment can help resolve the lesion faster. Even after effective treatment that heals the wound, reactivation of the disease can occur in some patients.

There are a variety of confirmatory tests for Leishmaniasis: Fluid aspirate cultures, tissue cultures and exams, enzyme tests. None of these are 100% accurate.

Cutaneous Leishmaniasis is very common in Afghanistan. So common that I heard parents in more remote areas will scratch some infected tissue into a cut on the leg of children so that they hopefuly won't get the lesion on their face. Cutaneous Leishmaniasis can result in the protozoa being transferred to other open wound areas - effectively spreading it to other parts of the body.

While different categories of Leishmaniasis are treated differently, it is curious how the USA differs greatly in treatment from the rest of the world. The most effective treatment for cutaneous disease are pentavalent antimony antibiotics. These effective but side effect riddled medications have been used since the 1940's, although resistance is on the increase. For cutaneous disease most other countries in the world, including Germany, use local injections of pentavalent antimony into the lesion daily for approximately 30 days. For US forces, this is not an option. A US servicemember who has cutaneous leishmaniasis must return to Walter Reed for 30 days of IV treatment with the pentavalent antimony drug (PENTOSTAM). The side effects of this drug are significant and potentially life threatening, so patients are hospitalized for the length of their treatment. Side effects can include the usual suspects of joint pains, GI upset and fatigue. The more concerning issues are electrocardiac abnormalities, anemia, elevated liver enzyme levels and low white blood cell counts. I am not sure why the CDC and Army chose this approach. It does have a good cure rate at 94%, but the potential for causing more harm that good is not subtle. Our German colleagues think we have lost our medical minds when we discuss the differences in treatment. Some antifungal drugs can also be used to treat cutaneous disease as well.

I wish I could say the gent who's leg is pictured is the first case I have seen among US forces here. I cannot. I have seen at least 5 cases in the few months. There are also many more cases among our Coalition partners here. I have only heard of one fatality due to visceral progression of a Coalition soldier a few years ago.

So while we think about the dangers of bombs and small arms fire, please also consider that US forces overseas are at risk for a variety of diseases we usually do not encounter at home. Disease and Non Battle Injuries (DNBI) are usually the highest percentage reason that military forces are not mission capable. Overall I think Coalition forces have done well to mitigate the many risks to our health here in Afghanistan.

The good news? Prevention is the best medicine. Wearing long pants and even shirts during dusk to dawn can prevent getting a bite. Also use of insect repellant. The simplest things are often the most effective, yet without constant vigilance, the most elusive.

Wednesday, November 11, 2009

Days to Remember

The United States Marine Corps, Established 10 Nov 1775

The Virginia Military Institute, Founded 11 Nov 1839

Veteran's Day 11 Nov

Yesterday was very low key. There are no Marines stationed on Camp Spann. Nonetheless I found several brothers who wore the uniform of the finest fighting force the world has ever known to exchange birthday greetings. We have one retiree and several Guardsmen who are former Marines on the camp. The KBR chowhall was nice enough to commemorate the event with decorations and a cake.

Today I proudly displayed the VMI flag my Brother Rats sent me on the door of my office all day long, drawing several comments. I also wore my VMI '89 reunion cap as much as possible, although not strictly allowed in the uniform regulations. VMI continues going strong at 170 years of tradition unhampered by progress.

There was a short observance of Veteran's Day in the chapel tonight. Several citations for living Medal of Honor recipients were read. I realized as the Navy one was read that I was on a ship during Desert Sheild with this particular honoree. He was a very unassuming and humble gentleman. At the conclusion of the ceremony "We Were Soldiers" was shown in the chapel. It is really the first war movie I have seen while here in Afghanistan. It is a good study demonstrating the value of quality leadership. It also showed the sacrifices veterans and their families make.

Monday, November 9, 2009

A Wild Ride on a Stallion

All I can say is that today's ride made this entire Afghanistan trip worth the price of admission.

The day started slowly, with cold rain, mud, and a still uneasy queasy feeling after battling a persistent case of moderate GI illness. Blah. Yes, the cold weather and precipitation had draped the surrounding hills and mountains in picturesque clouds and misty blankets of snow. Yes, it was very different than familiar Camp Spann. But being sick, cold and away from my 'home away from home' was starting to wear thin on me. We dutifully packed and assembled much as we had done yesterday. The German Air Officer put it best "The Runway is under water". After having our luggage checked, we assembled three different times throughout the day.

#1, Good, you are here, report back at 1000

#2, There will be no planes today, perhaps we can get some helicopters report back at 1130- (the previous day getting helicopters meant less seats, so we got 'bumped' off the roster. The helicopters were reportedly old MI-8 Russian types which did not inspire confidence.)

#3, Report back here when you hear the loudspeaker announcement (Since we could not tell what was being said in German, we just shambled back to the assembly point with all of our gear when we heard any announcement)

Needless to say at this point I was feeling low and had mentally prepared myself for another day of trudging through cold mud and sleeping in a cold tent.

Imagine my suprise when the Air Officer instructed us to get into the Armored vehicles to meet the helicopters (I think he was feeling sorry for us). When we arrived I found an old friend awaiting me. The Sikorsky CH-53 Sea Stallion is the veritable airframe that has transported innumerable Marines over the 30+ years of its life with the USMC. Here in the northern region of Afghanistan, the Germans fly a new and improved CH-53GS model suited for the harsh dust environment and able to provide heavy lift even to the altitudes in Badakshan. With typical German efficiency we had our luggage stored and secured.

I hope to always remember this flight. We flew Nap Of the Earth (NOE), which in laymans terms means as fast and as frightfully low as is humanly possible. The rear ramp was open so I had a good view as the hills and mountains of Afghanistan unfolded like a book or a travel brochure. The pilot seemed to almost scrape every hill, ridge and mountain as we passed over them. We were between 5 and 50 meters from the ground for the entire flight to Konduz. It is an intimate, unvarnished way to see and appreciate the land and people of Afghanistan. There were solitary farm mud huts, hillside villages, miles and miles of tilled fields to be seen. I really had a hard time convincing myself that we were in a country at war. We got so close I could probably tell you the gender of each of the thousands of goats we saw. We were so close you could smell Afghanistan: the fields, the livestock, the fires warming the houses and baking naan. Every now and then I could see the second helicopter follow in our wake, shadowing us along our route. Several times I looked out both sets of side windows and saw canyon walls on both sides. We streaked past snow covered meadows, mountain streams, and forbidding steep mountains. Even in the hinterlands there were women in burkhas. Occasionally as we careened over a ridge the goats and sheep startled and ran panicked to their shepherds. I saw a fox run for cover. There were many communal holes in the sides of the hills like rabbits or marmots might make. The speed was intoxicating and the view was phenomenal. It was the best way to see the real Afghanistan. Any amount of pictures cannot truly impart the feeling of exhilaration, thrill and wonder I felt during this ride.
Like any good ride, it came to an end all too soon. At the Konduz PRT we refueled and remounted the Stallion for a more leisurely trip over the desert. I saw some camels and a hawk on this leg of the journey. It was getting dark when we landed at Camp Marmol. Our luck further held out, there was a patrol headed for Spann as soon as we got off at the passenger terminal!
These last photos are from near the Feyzabad base before the cold front moved in.

Sunday, November 8, 2009

Fayzabadفيذ آباد

Feyzabad is the largest city and the provincial capital of Badakshan. The population of Feyzabad is approx 50,000 and is located about 4000 ft above sea level. Badakshan is one of the largest and least populated of Afghanistans provinces. It is the province which the English and Russians made with the finger which stretches out to touch China. The German led Provincial Reconstruction Team (PRT) base is near Feyzabad at the site of an old Russian air strip along the Kokcha river.

Feyzabad is along the path of the old Silk Road. It is a place of interesting landscapes. The glacial river is the cleanest river I have seen in this country. The rolling hills nearby are obviously farmed and now bare except for the scavenging herds of goats. Even the chaff has been carted off the slopes to make mud bricks. The herds of goats and sheep can be seen leaving early in the morning to spend the day grazing high on the mountain. Every evening they come back down to the safety of the valley. The roads here are much improved in the past few years. There are many building projects and bridges being constructed. We had a good view of the local Buzkashi field while we were travelling to the clinic site. There are at least 5 tiers of hills and mountains in the distance. The highest ones to the east are at least 12,000 feet high and have snow on them.

The people are different than those found in either Kabul or Mazar e Sharif. While there are Tajiks and some Uzbek features to most of the people, there are also a good number of people who resemble the Aryans with caucasian features. The people appear to be poorer, but more productive and peaceful than other areas of Afghanistan.

I have had plenty of opportunity to study the surrounding hills and mountains. Largely because we have been rained in. It has been raining for the past 30 hours. When we got here all was the usual dust and the weather was cool and refreshing. Now there are huge mud puddles that can get a SUV stuck. Perhaps the planes will be able to fly tomorrow.

Friday, November 6, 2009

Headed East

I know I haven't posted anything for a few days, so I at least wanted to give a quick update on our current trip. We have made it after a few days of travel to Feyzabad, which is in Badashan province. It is a beautiful mountainous area with glacial rivers. We are here to look at the construction of a new ANP clinic. Like any good fact finding trip it has brought to light many more questions than answers. Hopefully I will be able to post photos and more information in a few days.

Sunday, November 1, 2009

Jack of All Trades

Some days I am limited to office work. Other days I spend all day travelling. Then there are days like today when I do many different tasks in one day.

Mentor- Today we went downtown to meet with our ANP Counterparts in their clinic. We had the usual niceties and discussion of how well our families are doing. Then we went through our list of discussion topics. Our counterparts were very gracious and gave us some Baklava which they pronounce Baghlava. No matter how you pronounce it, the Shirini (sweets) were good. We had such a good time that I made it to the mythical 3rd cup of chai, which indicates a good and lasting relationship. We continue to make progress and pass useful information.

Contractor- Today I supervised an engineering site assessment for my counterparts clinic. I know nothing about Engineering; so I delegated, or subcontracted as much as possible. I had one soldier(airman) investigate the electrical system of our counterpart's clinic to see if we can assist with their power difficulties. I had another soldier(airman) take down grid coordinates from a GPS to see if a planned larger clinic will fit in his current site. It all went well and I got all the information that was needed. Perhaps we will now be able to build a new facility or at least upgrade the capabilities of the current one.

Soldier- Of course I carried the usual total 88 lbs of gear: weapons, armor and and medical equipment. We(my gear and I) went up stairs, in and out of vehicles, in and out of various doorways. The most challenging and fun was maneuvering through crowds of children who thought I might have candy to distribute.

Doctor- I actually did some physician business today. I consulted on a case with my mentee while visiting him. I brought up the topic of overprescription of antibiotics which is one of my favorite topics in any country. We had a short discussion with no resolution, but an exchange of points of view on the subject. I am confident the patient will be fine in either case.

MRAP crew member- I once again rode in the front seat. I won't really claim that I did too much in this regard, but I did utilized the communications equipment and even sent a message to the command center. Otherwise I made sure the passengers were strapped in tight and the doors were locked. I also had the honor to walk in front of the MRAP as we entered the various compounds and guided them safely to a parking area.

Courier- We picked up some medications for a patient with a severe illness at the nearby hospital. It was a vital, but not too demanding a task. I got the box, verified the medicines, and transported them from one base to another in a door to door fashion. Hopefully they will be of benefit to the patient.
Thats about it for today. For some reason I feel a little worn out. I hope you all have a safe and fruitful All Saints Day as well.