Dust

Afghanistan is a land of dust. It is the universal thing which seems to be a common ground, so to speak, for this entire country. Usually people think of sand in this part of the world, but I have seen very little real sand. This soil is very different than sand. Sand has a larger particle size and is therefore heavier. It takes a significant amount of wind energy to suspend sand in the air. That is not the case with the dust here. A light breeze is all that it takes to make a lasting cloud of obscuring dust. The light fine loam that passes for topsoil here covers the surface of everything in short order. You can literally clean floors every day and get a good yield of dust each time. As I have passed by vendors of bread, fruits and butchers shops I can't help but wonder how much dirt is on the surface of anything exposed to the air, especially along a busy road. I am guessing it makes up a significant portion of the dietary intake of your average Afghan. Here at Bagram there is much more dust than I am used to at Camp Spann. I am sure the constant traffic of helos, jets, and heavy equipment contribute greatly to the cloud of dust which is constantly in the air here. If not for the clouds of dust (ghobar in dari) Bagram could be a beautiful place with some picturesque snow covered mountains in the distance. But no amount of effort by any force will control the dust in this arid land. It is just another part of the character of this country.

Another dari dust word is Khaag bad, or dust storm (when they hit they can come in fast and give an eerie lighting much like an eclipse.)

I am sure that from now on Afghanistan will come to mind when I hear the ancient phrase 'dust to dust'.

Coalition Cuisine

I still have a little more time on my hands here. Time to reflect on many things I experienced here in Afghanistan. Today's post is dedicated to food. Let's take a look at food around the Area of Operations (AO). I am limiting this entry to Coalition food and may comment on Afghan food another time.

The food of Camp Spann is provided by Kellog, Brown and Root (KBR). The food is served in a line cafeteria style. Generally it is American style heavy on the fried foods. The service at Spann was always friendly and courteous. KBR also runs the chow halls down here at Bagram and all other US run bases. The food is always plentiful and has ice cream.

Next is the contractor Supreme. Supreme is found in most large Coalition base chow halls including those on German and Italian bases. The food is decidedly European in flavor and offerings. Breakfast is usually very sparse. There are cold cuts aplenty and very good cheeses. I also think Supreme provides food at most of the State Department bases at least in the north. When there are Gurkas providing security, the Indian food is excellent at these small State Department posts.

I have also eaten at a real German chow hall. The active duty staff wear these wild checkered pants. The food is similar to that found in Supreme kitchens, but with very friendly staff. Most entrees have some form of pig in them. One night of the week they shut down the chow hall completely and serve heated German style MRE's. Most folks go to eat at the grill in the German PX on that day.

Finally to my favorite chow hall in all of Afghanistan. The Norwegian chow hall at Camp Marmal. I believe the food is catered by Sodexo. The chow hall is located in a tent despite the number of years it has been there. Although it is in a tent, it has a friendly ambiance and is a great place to eat. They do have hours posted for those of us who are not Norwegian to eat, which is only right. They greet you with incredible grace as you enter. The food is served on real plates and silverware and served buffet style. My last meal there was memorable: paella, glazed chicken served on a bed of couscous with raisins and slivered almonds. The soup was leek and potato. Altogether it is the best Coalition dining experience I have had in country.

Of course we all know the best food is home cooked. I am looking forward to eating there very much.

Still Stuck at BAF

I am still here at Bagram. All things considered it is better than the last time I was here. I am in a better tent. I know where all the chow halls and services are. I found the cleanest bathrooms in our area.

There are numerous challenges, but the most problematic is just being here. The Navy has mandated a 3 day Warrior Transition Program at Kuwait. Too bad I will have to wait 2 weeks in order to get to this 3 day program. It is overbooked for the entire month. At this point I am just ready to return and start to readust to life back home. One thing that is truly amazing are the lines. Lines for the phones, computers, food, beverages, toilets, ATM machines, and anything else you can think of. Maybe this is a final dose of deployment just to make me even more appreciative of life at home. I doubt that is possible though.

Sustainability

I made extremely good time from Mazar-e-Sharif to Bagram, but I will be stuck here for quite some time. There were still a few sailors from the returning hospital mentor team I served with on Spann here when I arrived. They left two weeks before I did. So I have plenty more time to exercise at a higher elevation and reflect.

One of the things I am considering is Sustainability. In particular how will Afghanistan be able to sustain what has been started. In general the best approach to most issues or problems is to find a low cost-high return solution(IE not always the way we do things in the US). There is much effort being placed on Afghan National Security Forces (ANSF) force generation and infrastructure development. What I have not seen or heard about is economic development or income programs for the country of Afghanistan.

This is concerning since whatever progress, programs, or forces we build and equip here will need to be funded for the long term. Who is going to pay? I fear it will be American and Coalition taxpayers. There are resources here in the country such as agriculture, mines, and textiles. If these areas are not developed and appropriately taxed by the Afghan government I do not see how it will financially survive. There is no income tax here. There is no sales tax that I have witnessed. The only taxation I have heard about is on contractors. As an example if NATO funds a 5 million dollar project and awards the construction to a contractor, then the contractor must pay 20% of the price to the Afghan government. So out of the 5 million dollar project, 1 million goes directly to the Afghan government. If this is the only income generation other than direct grants from the US and other Coalition governments, the government of Afghanistan will indeed be trouble after our support dissipates.

So while building cost effective solutions at all levels is important to improve the lives and services of the people of Afghanistan, a long term funding plan so that this country can afford all that is being built up is just as important.

Spann Nostalgia

It was on New Year's Day when I truly realized it is time to start heading home. While I am reassured that I have contributed in some small way to the progress of Afghanistan, it is difficult to leave with some projects half done. Luckily the military is a team sport. In this case a relay team sport. I have turned over all my projects and information to the new member of the team. I have passed the baton . There remains much more to be done for medical support of the police in this region, but I know the team will make tremendous progress this next year. I am ready to return home to my family, co-workers and patients.

So while I am thrilled with the prospect of going home, I felt a certain amount of nostalgia as I walked around Camp Spann today. Some of these memories are pleasant and will be easily remember. I ate my last dinner in the chow hall. I wrote my last blog entry in the MWR computer room. I made my last stop in the Chapel to say goodbye. The view of the mountains in the distance is alway relaxing as well.

There is also another group of memories that I might choose to forget. My feet will not miss the huge rocks that make up the gravel

all around camp. Be thankful I only am displaying a picture of the port-a-potty from the outside. They most certainly will not be missed.

So I today I present to you a collage of the more mundane aspects of life on Camp Spann.

The doves are still nesting every night at the bath house near my hut.

Afghan Doctor

Doctor can be a very deceptive title in Afghanistan. When most people in the US speak of a doctor, they are speaking about a Medical professional with a doctorate degree in Medicine who has a license to practice medicine. Here, as with many things, the lines of differentiation blur to the point of becoming a continuum of gray space. I have been introduced to many Afghans who refer to themselves as a doctor. In truth most are acting in the capacity of a physician, but they usually do not have training in medicine. The term Doctor is used for both Medics and Medical Doctors(MD). It can be very confusing for all involved including the patients.

To be fair, the Afghan Medical Education system has had some hard knocks in the past few decades. Under the Taliban learning of most types was frowned upon and women were strictly prohibited from studying medicine. Now there are at least 4 internationally recognized medical schools in Afghanistan and several others that are not recongnized. Most schools subscribe to the European model 7 year training program. The bachelors and doctorate degree are combined into one program. Overall the system is lecture heavy and light on interactions with actual patients. Out of the 7 years, only one is spent in hospitals and clinics observing or assisting with patient care. This system produces doctors who know the lecture type details and pathophysiology of disease, but may lack the experience in practical application to patients. The most prestigious and well respected institution of medicine is Kabul Medical University. With as many as 400 students a year going through clinic rotations at Kabul hospitals, it is difficult to imagine they get the same level of involvment in patient care that we experience in the US as students.

Specialty training is also very different in Afghanistan. Specialty training is more like an apprenticeship than a program of structured learning. There is no set time to complete the training. Doctors work under a specialist (surgeon, internal medicine, anesthesiologist) until their preceptor determines they know enough to be on their own. There is no board certification testing or validation to a governing body. While this seems to work well for some specialties (surgeons in particular are widely accepted as being very well skilled) others not so much. For instance, I have seen ENT specialists who do not seem to know how to use an otoscope to check the ear canal and tympanic membranes. While this apprenticeship style of post graduate training is very different for us to accept, it works most of the time for the Afghan people. What is more it is the only system they have for right now.

Are you confused yet? If so I have adequately explained what is meant by the term Afghan doctor.