Been There, Done That, Got the T Shirt/Final Post

We are back home! 447 days from the start of training to returning to the US. 87 days of training and 360 days "Boots On Ground". One day delayed due to mechanical issues, but here we are. I am thrilled! We are incredibly proud of the improvements made at the hospital while we were there. The hospital is now nationally reputed as one of, if not THE, best in Afghanistan. We made great friends with the staff and interpreters, and I get occasional emails from some of them. Although Navy represented less than one quarter of the military at our base, we made lions' shares contributions to both the quality of life and mission on base. I especially want to thank my wonderful family: Linda, my wife, who I spoke with just about every day via Skype, defense system phones and cell phones (at 55 cents a minute) and kept the home fires going; daughter Cristina who sent several touching greeting cards; son Andy who could always give me a chuckle; my sister Paula (who has a retired Navy aviator hubby) who sent numerous cards and care packages; my other bros Mark and Dave who kept in touch regularly; nephew Steve and family who sent an enormous care package in the spring; and the Oak Leaf Club of Naval Hospital Pensacola who sent care packages 3 times (other commands sent 1 at the most).
To my shipmates: Phil, who helped a "mature" doc make it through training; Captain Mark who headed our team during the year here and also helped me make it; to Chiefs Luis and Kelly who performed outstandingly as senior NCOs of the team; to "LT" our admin sharpshooter who kept us the best informed and cared-for of all; to Carl and Zack and their willing heavy labor (especially those donated books); DJ the artist; Grant the "care package monger" who got us on the list of every "America supports you" website out there; Chief Marc, my student; Chief Terry who set a great fitness example; Jim and Charlie, the kings of the OR. Especially thanks to Don, my battle buddy, bunk mate at Riley, roommate at Camp Stone and guy who always watched my six.

Final prep/Operation Medical Libraries in news

We handed in the body armor, cleaned the weapons, recycled the usable, sent home the keepers and basically got rid off most of the gear issued over a year ago back at Fort Riley. We got everything new; I know I wouldn't want to wear used gear that has sweat and Afghan dust permeating it. We also had group sessions to talk about stresses, "sustainables" meaning good stuff, and "improves" meaning areas needing corrections. A few more days and we will go west to America. How excited we all are.
American Medical News just published a story on the book donation project, Operation Medical Libraries. I'm quoted. You can see the article at www.ama-assn.org/amednews/2008/08/25/prl20825.htm.

Life in Kuwait

As I mentioned, it's extremely hot here. Mid summer reached mid 120's, so we are happy it is "only" about 115 in the daytime. We are living in leaky, dusty tents that get over 90 in the daytime even with 2 AC units running. So, we avoid the tents while the sun is up. It's comfy at night. I cleaned a bunch of dust off the filters so maybe it will run better. They have a pool in another part of the base but I'm told it's warm so no thanks. The "cold" water at the sinks and showers are ambient temperature, so even showering in the morning is uncomfortably hot. I think those actually stationed here are better off. Otherwise, lots of free time and nice recreation facilities. Starbucks, Pizza Hut, Burger King, etc., all make us feel a little closer to home. We turn in our gear soon, get some counselling and in a few days, hop the big bird home. Can't wait!

Kuwait!

After a one-day delay, we left Kabul for Kuwait on the 15th. I was up around 1 in the morning unable to sleep even though our show-up time was 6 AM. Makes for a very long day. As is typical, the loading and convoy was delay a couple of hours, but that still left lots of time for the 2 PM boarding. The airport is only 10 minutes from Camp Phoenix. So, we waited 2 hours at Phoenix, then another 6 at Kabul International Airport. Temps were upper 80's and dry so not bad. We took a C17, the big 4 engine cargo jet for a 4 hour trip. The pilot informed us about 20 minutes after takeoff that we had exited Afghanistan airspace. Hoorah!

We landed in Kuwait about 6:00 PM local just before sunset with the temp about 115. We boarded buses for the 2 hour ride to Camp Arifjan where we do all our check-out. Most of us were pretty beat by this time but we still had to unload all of our bags, about 1000 of them. So we spent 2 hours in the dark 100 degree heat sorting sea bags, frame packs and back packs, then hauling them to our hot and dusty tents. I finally hit the rack after midnight local, over 24 hours after I got up. Still a bit loopy, but only 5 days to go! We are safe as well; no shooting is going on here.

Memorial

During my year in west Afghanistan, we lost two American military from our base to hostile activity. One was a soldier who died in a firefight far to the south just before Memorial Day. The other was a Navy Corpsman (our version of medics) within the last week during activities far to the north. The first made our Memorial Day on Camp Stone that much more profound. The latter was observed even here in Camp Phoenix. Over 100 assembled to pay respects. Two of our Navy enlisted, one a corpsman, formed the honor guard. The National Anthem was played; the chaplain, another senior officer and the senior Navy Chief Petty Officer all spoke of this fine young man. The role was called; 3 others from Herat answered "Here, Chief"; the fallen sailor's name was then called three times with no answer. 21 gun salute was followed by taps. We could then each go forward to give our respects with a slow salute. Many left mementos to be forwarded to his widow and parents. I left a Command Coin from Herat. God bless this young man, his family, the suffering people of Afghanistan and our great country that believes in things worth dieing for.

Weather report

Kabul is not as dusty as Herat, seeing that it's the largest city with lots of buildings to block the wind. A helicopter landing on the exercise field did raise an impressive cloud of dust though. However, you can usually smell smoke from the wood fires used by locals for cooking. And don't be downwind when they pump out the portapotties. Sunny, a few clouds, highs low to mid 90's, about 70 at night. High altitude as well, over a mile above sea level. I was really gasping on a 5 K run this morning. Kuwait will be close to sea level but highs will be around 115 and lows in the mid 80's. We hear they have a swimming pool there.

Keeping productive

Doing lots of internet stuff, even keeping up with the bills at home. Watched some movies, working out (not easy 6000 feet above Navy, I mean sea level) and shooting the breeze with the guys I trained with. Most of the 160 from who trained with us at Ft. Riley are now back. I completed some online med education. Finally, I visited the clinic here at Camp Phoenix and they were happy to have a volunteer. So, I've attended a couple of clinic sessions to take the load of the current providers, teach a bit to the medics and get re-familiar with the online medical record AHLTA again. Home in 12 days, or, as my erstwhile roommate would say, 11 days and a wakeup!

Pictures

That's the "A Little Travelling Music" stance from Jackie Gleason as "away we go" in front of my empty rack. Next is my roommate Don, myself and our team leader CAPT Richerson in front of the HUMVEEs that took us to Herat Airport. The third photo shows the exit from Camp Zafar, the ANA base adjacent to ours. This takes us out to the main road to the airport. Finally, a shot of the control tower at Herat Airport with "goodbye" in Dari and English.
Not much to do here in Kabul, so I work out, read, watch movies and do online medical education. Home in 2 weeks!

Back at Phoenix

Camp Phoenix is the main HQ for US and coalition forces in Kabul. We convoyed from Camp Stone near Herat to the airport Sunday morning on August 3, our last look at our home for the last year. We saw the mud hut villages and locals tending a flock of goats along the way. We flew out on an Italian C130 (4 engine prop plane) packed in cheek and jowl for the over 1 hour flight to Kabul International Airport (yes, we call it KIA). We hung around for a few hours before our convoy took us over to the base. We are billeted into the same sorry grubby tents as we were when we arrived last 1 September. The difference is we have a lot of down time and we are headed home.
The last week in Herat had 100+ temps every day. We are now at 6000 feet above sea level so it is several degrees cooler, low to mid 90's. Kabul still has substantial air pollution, but we are obviously happy to be here.
I will spend some of the time working on an article with 3 other family docs around the world for American Family Physician journal on caring for military and their families when returning home from deployment.

Getting Ready

Same title as the first post on the blog. We've sent most of our gear ahead of us to our redeployment base near the capital. The picture shows the sea bags for a couple dozen Navy folks ready to RIP out (Replacement In Place). We're completing paperwork, cleaning our weapons, saying good bye. We will have a "Hail and Farewell" to greet the new Navy team and God speed the "old" team. We have not had a formal awards ceremony since not all have been approved by the Navy. We all get several additional ribbons like the NATO ribbon, Afghan Campaign ribbon, and the Overseas ribbon. We will likely have ceremonies for individual awards back at our commands. More posts to come as we move along the redeployment path.
Also shown is a war trophy, an SUV taken when a Taliban leader was captured about 80 miles south of here. I drove it over to the hospital to see a serious patient after hours about 4 days ago; it's right hand drive, but no problem.

Hospital Farewell

The hospital outdid itself with the biggest party ever given there (well, it's only 2 years old). They moved all the chairs into the lobby to say farewell and give thanks to the 13 Navy on our team leaving soon. Each of us received certificates from the Corps Major General Jandalar (shown), who is in charge of the Afghan Army for all of west Afghanistan. The hospital commanding officer Col Alcozai also presented certificates signed by him and the Surgeon General, Major General Yaftali. We received either a jama (loose Afghan clothing) and a beaded cap or a rug. I received a nice wool rug, hand stitched in Herat, depicting the two hemispheres with America and Afghanistan, and clasped hands showing friendship. One photo shows me receiving it from the CO. A wonderful gift. We had to miss part of the ceremony caring for an ICU patient, but it was quite special anyway. We bid farewell to our good friends and take pride in making the Herat Regional Military Hospital the most highly reputed in the country.

Welcome new team

Welcome to the hospital to the new Navy Medical Embedded Training Team! They arrived after 60 hours of travel from Kansas to Herat. We helped them unload, got them dinner and then they showered and zonked. We gave a general tour the next afternoon at the hospital. The following morning, we took our individual replacements and started showing routine duties at the hospital. Shown is the new team in the ICU. The subsequent morning, we did quick rounds and then took them on the obligatory tour of the bakery where they make the flat bread, naan, in fired ovens. Shown are CDR Boehnke who is replacing (shown) LCDR Sylvester as chief nurse mentor. Also shown is CDR(Select) Gutierrez, an emergency medicine doc and my replacement. Finally is a picture of Dr. Gutierrez and one of the OR nurses; they have a striking resemblance that all the hospital staff commented on. It was quiet at the hospital for the first few days. Then 3 ICU admissions over 3 days: a bleeding ulcer, an elderly man in liver failure, and a girl badly injured by a vehicle (she should make it). Two admissions occurred at night and they requested we go over and help assess. So, a busy few days, but that is atypical. Good intro though.

Images

Some pictures to remember the camp by:
A couple of our corpsman like to cook up something on their own using a hot plate. Friday is the usual day since it is our off day. Spam is a frequent ingredient as is rice (one of the corpsmen is Filipino). Shown are the usual suspects enjoying a bread from the DFAC under the shade of an old parachute.
The sign is painted on a "jersey barrier" set in place to prevent vehicles ingress and also as a shield. It is a no-parking zone with 25 push ups as the tow-away fine.

Welcome!

Our replacements have arrived, a team of 13 Navy officers, chiefs and petty officers. They left Kansas and arrived here about 60 hours later after stops in Ireland, Kyrgyzstan, Kabul and Bagram. They looked bright eyed and ready to roll. Our team took about 10 days to get here due to in-processing in Kabul that will be done here for the new team. They'll have a chance to settle in, then we will take them to the hospital in a couple of days. Home in less than 4 weeks now.
Shown is our last full moon here at Camp Stone about a week ago. I thought it was a nice shot. We get pretty clear skies here and can see the Milky Way in the late evening.

Operation Medical Libraries Donation

On 22 July, close to a ton of books and journals were donated to the Herat Regional Military Hospital and the Herat Medical Faculty of Herat University. These were provided by Operation Medical Libraries (info@operationmedicallibraries.org email or website operationmedicallibraries.blogspot.com) under the tireless leadership of founder Valerie Walker at UCLA.
The Dean, chairs of surgery and medicine and two other senior faculty visited the hospital and were thrilled to receive such a large and much-needed donation. Shown is Dr. Said Azim Hussaini, the deputy commander/executive officer of the hospital, giving a tour to the faculty. Also shown is some of the books for the presentation. The next photo is a shot of the faculty. The last one shows me presenting a book to the Dean, Dr. G. N. Aram. The Dean expressed great gratitude and hopes for continued support in the future. He hopes to create a collaboration with an American medical school, and I will solicit my alma mater, Wayne State University in Detroit.
About 300 additional pounds of literature arrived the day before the presentation, and these were distributed. In the two subsequent days, we received 3 boxes more boxes from UCLA weighing over 100 pounds total. These will be handed off to my replacement who arrives shortly. He is Dr. Frank Gutierrez and has graciously agreed to continue the program as point of contact. Thanks Valerie, thanks Dr. Azim and thanks Frank!

Holidays missed

Two of our corpsmen put up decorations for Halloween last October, the first "decorative" holiday since our arrival last September. They decided to leave them up and add new ones as the holidays rolled by. Shown are the results. We missed Halloween, Thanksgiving, Hanukkah,Winter Solstice, Christmas, Kwanzaa, New Year's, MLK, Valentine's, St. Patrick's Day, Spring, Easter, Memorial Day and 4th of July. We will be home by Labor Day. Booyah!

Hot, hot, hot

The hottest time of the summer. Highs 97 to 104 with 100+ most days. Light winds at sunrise then 30-40 MPH by midday and blowing grit. Gawd, I'll miss this place. We do 2 round trips to the hospital most days, about a klick each way, so about 2.5 total each day. Feels like you opened an oven. Can't wait to be back in balmy Pensacola where it's only 95 every day.
We continue on with the teaching and patient care. 3 patients were in the ICU yesterday and seemed to be getting the right kind of care. One of the midwives consulted me on a lady issue and was grateful for the info I shared.
We also had visits from an ANA General, a district commander for the police and an important village leader who brought his son (broke his leg in a motorcycle accident).
Despite the news from Afghanistan, our part of the country is quite peaceful, so don't worry y'all. I'll be home in a month or so.

Visitors & Compliments

We received visits from docs stationed in Kabul. One shows Air Force Col. Hall and Navy CAPT May, both physicians, who are senior mentors to the Afghan Surgeon General, MG Yaftali. They visited, met and toured for 2 days as part of their responsibilities with the Combined Security Transition Command-Afghanistan. Also shown is Navy CDR Huynh, a trauma/combat surgeon who mentors surgeons at the National Military Hospital. She is demonstrating a small portable diagnostic ultrasound that can quickly diagnose internal bleeding in the abdomen. She also gave a series of lectures on quickly managing injuries. All of our visitors complimented us on the progress the Herat Regional Military Hospital has made and unabashedly rated us the best of all the military hospitals, including the 400 bed National Military Hospital. The hard work and persistence pays off!

Mass Casualty drill

We received a 4 day visit from CDR Huynh, a trauma surgeon assigned to mentor at the National Military Hospital in Kabul. She and her colleague gave a series of superb lectures and demonstrations on handling combat injuries and setting up protocols to manage disasters. We also staged a mock mascas, or mass casualty drill with 10 mock patients ranging from a stable fracture to a heart attack. Shown are the arrival and care of the staff. Well handled although the event was not a surprise as we wanted.

Nice tribute from our Spanish colleagues

We share Camp Stone with Spanish, Italians and Slovenians. The following was sent to all of us from one of the Spanish officers:

It was between 1778 and 1783 when the Spanish Regimiento Fijo de Infantería de la Louisiana attacked and conquered Baton Rouge, Manchac, New Orleans, Mobile, the city and Bay of Pensacola and afterwards the whole Florida peninsula from British hands. Doing so, it opened the Caribbean Sea ports to the main flux of supplies for the new American Army. General Bernardo de Gálvez was the Commanding Officer of the Spanish forces supporting the American Revolution. The City of Galveston, Texas, was named after him.

This was part of the Spanish military contribution to the Independence of the United States of America. That is why on 8 November 1779 Thomas Jefferson wrote to General Gálvez, expressing his thanks for Spain's assistance to the revolutionary cause. George Washington toasted Spain for its support during the war and finally, in 1784 the U.S. Congress cited General Galvez and the Spanish government for their aid during the Revolution.

Today, as we did then, the Spanish military, who come from one of the eldest nations in the world want, once again, to congratulate our American friends on their Independence Day.

We wish you a lovely day. We also encourage you to follow the struggle for Justice and Freedom all around the world. In your effort Spain will never let the US walk alone.

Yours respectfully,
JAVIER DONESTEVE. CAPTAIN (OF-2)
PARACHUTE BRIGADE. SPANISH ARMY

Happy 4th of July

Even a week in Afghanistan would make me appreciate our freedom, people and prosperity, let alone a year. We celebrated our 232nd birthday with a camp wide festival. Lots of good stuff to eat and enjoy. We had 3 on 3 basketball, 3 point shots, timed weapon assembly (shown), voting and absentee ballot registration (shown), a visit by a camel and donkey, a raffle, excellent barbecue and the always-popular volleyball tournament. About a dozen teams this time and shown is a shot of Chief Kelley going for a low one (successfully). Great turnout and a good time despite 106 degrees.

Thank you CAPT Richerson and family

Our team lead, CAPT Richerson and family provided the t shirts shown for the entire team of 14. His family also sent Halloween treats, goodies at Christmas and has generally helped lighten our days here.
The T-shirt: Operation Enduring Freedom is the overall mission name here in Afghanistan. The caduceus represents our medical orientation and mission. Herat is the nearest city and provincial capital. We're an embedded training team serving as mentors at the local hospital. Great and unique souvenir for just our team.

Books Without Borders is now Operation Medical Libraries

Apparently the name Books Without Borders has been used elsewhere and merger did not fit the missions of both organizations. The UCLA Medical Alumni Association had provided support of the collection and shipping of donated medical texts up to now (actually, the untiring work of Valerie Walker) and establishment of a not-for-profit is the next logical step. So, Operation Medical Libraries will now be the organization collecting medical literature for the benefit of health care institutions and medical schools in Iraq and Afghanistan. No website yet but you can contact them at info@OperationMedicalLibraries.org.

Amusing sights

Some things I'll never see at home. The gunners in the Italian armored vehicles usually have a bunch of black feathers stuck to their helmets. Maybe my father in law can tell me why. It adds some panache.
Also shown is a "jingle jitney". This is a 3 wheeled motorcycle, apparently quite common in all Afghan cities. It's covered on the back and has two facing bench seats inside. This is used by a construction worker who comes on base for building projects. Others are used as cheap taxis or as the family vehicle. They can be heavily decorated with appliques, sequins, tassels and small bells all over the vehicle. Trucks for hauling anything are similarly decorated and even the insides of buses have tapestry, curtains, bells and tassels galore. The transport trucks are therefore called jingle trucks since all the decorations jingle as they bounce down the bad roads. A great youtube video on driving in Afghanistan is at http://www.youtube.com/watch?v=T7Ne8frFhSw. It's a video of driving from Kabul to Jalabad on J-Bad Highway.

Thanks to my siblings

Many thanks to sister Paula and brother Dave for their support of Books Without Borders via contribution. 20 boxes of literature weighing over 1000 pounds have arrived. We have sorted them by subject and will work with the executive director of the hospital to set the distribution to the local institutions. Thanks sis and bro!

San Diego Union Tribune article about Books Without Borders

One of the participants with Books Without Borders is the University of California at San Diego. This project was started at UCLA to send medical texts to Iraq schools but has expanded to include Afghanistan. I have received over 20 boxes of books and journals which will be distributed shortly to the 4 local hospitals and medical school. The San Diego Union Tribune wrote an article for the front page of the local section; I'm quoted. See http://www.signonsandiego.com/uniontrib/20080619/news_1cz19books.html

Wind of 120 Days

This annual event occurs during the hot season. Four months of winds with frequent days of 30-40 miles per hour. Kicks up a lot of dust. Recent high temps range from 95 to 111 (about 35-44 C). Shown is the black flag warning that no outdoor exercise should be attempted and only light work with frequent breaks. Hard to believe how cold it was 3 months ago.

Back in Herat

Had a great time in Qatar but the travel is always a challenge. We finally got back to Herat on Sunday the 15th (Happy Father's Day) via Kabul since flights from Bagram are unreliable. We opened the door to our room to hundreds of balloons; shown is my bunk. We spent the next 20 minutes popping and cleaning up. This was funny at 9 PM; it would suck at 3 AM. We got a great laugh out of it.
Also shown is a team picture. Now that WE ARE GETTING CLOSE TO GOING HOME, no one can be on leave or pass. So, we are all here and took a pose on a Humvee. Yes, we are smiling. About 2 months to go and our replacements arrive in about 6 weeks.

Last Day in Qatar

My friend Don and I signed up for the water sports day and had a blast. We rode the dhow as shown. 100 years ago they were sail powered and used for fishing and pearl diving. This had a diesel engine but had the old fashioned wooden rudder. We rode over to a low island across from the Doha skyline and anchored. We rode jetskis, swam and went tubing. They had a charcoal grill on the dhow and cooked up a great lunch as well. Great day yesterday.
Today, 5 hour plane ride and back in Afghanistan. Should be less than 2 months to go.

We went on the tour of Doha today, the capitol of Qatar. Doha has 1/2 million residents (out of 900K population for the whole country) but has the feel of a city the size of Chicago. About 1/3 of population are citizens and the rest are foreign workers hired to do actual work. Petroleum has given this 100x50 mile country the highest per capita income in the world; quite a contrast to Afghanistan which has the third lowest. Construction everywhere! 50 story high rises by the dozen rising within sight of each other. The City Center mall is near the growth area with 370 stores that include Pierre Cardin, McDonalds, Dunkin Donuts, Krispy Kreme, Starbucks, Radio Shack, etc. Everything is in English and Arabic. There's ice skating at the mall. We also visited the old town market area where you can buy all kinds of native hand-made stuff. That's a picture of me have local coffee, which is very strong and sweet. We went to the jewelry district where there are at least 50 jewelers crammed together. We visited the Corniche which is a waterfront park that stretches at least a mile alone the bay that goes into the Arabian (Persian) Gulf. The pearl picture is my buddy Don in front of the monument to the historical pearl diving here. I took pictures of dhows, 3 masted lateen rigged sailboats that they used for fishing and pearl diving before petroleum took over the economy. Saw lots of western families with small kids everywhere. It is so safe that many merchants leave their shops open and empty while they catch a smoke or a bite. We saw the palace of the monarch and the Al Koot Fort built in 1882 when the Ottoman Empire ruled the area. We also went to animal market where they sell camels, goats and donkeys. Camel milk and meat is a local staple, and they race camels. Falconing is also quite popular. We had a terrific lunch of local foods, mainly rice, chicken and lamb.

Qatar

Pronounced variously KOTter, kuhTAR, or even GHATter. Shown is my buddy Don Sylvester and me at Mullarkey's Irish Pub at the Qatar base that is HQ for Central Command covering the Middle East and southwest Asia. We are here for our allowed 4 day pass. We headed to the main airbase in Afghanistan 3 days ahead of time as instructed since flights from Herat are irregular. We got there fine but we then bumped by a general from our scheduled flight to Qatar. Over the next 3 days, we were bumped from another flight and 6 others were cancelled. On very short notice (actually no notice, I happened to check the air terminal and got lucky), we caught a cargo flight that left at 3 AM and landed at sunrise in Qatar.
We get to wear civilian clothes, sleep in comfy berths, eat at restaurants and hoist some brewskis. Tours and fun things like desert safari, boating, fishing and diving are available. It is a great break from the routines of deployment.
Since we are almost to the start of summer, daily highs are ~110 and it "cools off" at night to about 90. Very humid too since Qatar is a 100 mile peninsula off Saudia Arabia sticking north into the Persian Gulf, oops, Arabian Gulf. It has the highest per capita income in the world and gives all citizens free health care and education through college. It gave women the vote 12 years ago, women hold important posts and some degree of western dress is allowed. Only 1/3 of the population are citizens; the rest are foreigners brought in to do the actual work.
When I get back to Camp Stone, we will have less than 2 months to go!

MRAP

For Mine Resistent Ambush Protected vehicle. These have been heavily used in Iraq and now I have seen a bunch of them. Can't say where or even show a picture but these have been a vast improvement for protecting the troops. Only serious injuries so far have been due to failure to wear seatbelts. Great technology.

One year done

June 3 2007 marked our arrival at Norfolk Naval Station to begin the Navy Mobilization Processing System. Glad it's behind us and only a couple months to go!

Pass/June

We are allowed a single 4 day out of country pass so I and another on the team are heading to Qatar. We're at the major airbase in Afghanistan and hope to get the flight out in 2 days. The installation in Qatar is very nice and modern. No more plywood B huts and squatty potties.
We are now in June and looking forward to August when we come home!

Hot, hot, hot.

Officially 100 for the first time this year. Not the last time, it is only May 29. Humidity 6%. So far our heat pumps keep the huts comfortable. No rain since mid April, and none expected until October at the earliest. Makes Pensacola seem chilly.

Grazie Alberto!

I have had the pleasure of free Italian classes by Captain Valent of Tuscany, a paracadutisti (parachutist) of the Esercito d'Italia (Italian army). Italy is in charge of Afghanistan Regional Security Integration Command West (ARSIC West) based in Herat, and Alberto is a mentor to the Afghan Army garrison here. He is heading home on rotation but will be back next year. That's me ("Biaggio") to the left and another Italian student, Giuseppe to the right, with Alberto in the middle. Ciao!

Memorial Day

Memorial Day certainly has more meaning today. The entire camp (including our Italian, Spanish and Slovenian colleagues) gathered as planned for observance, dedication and ceremony. Yesterday, a soldier assigned to a FOB in southern Herat Province 60 miles to the south lost his life in a fire fight with Taliban. So, we especially remember him and his family today. We planned to dedicate and name four buildings on the camp already to others who died in service in Herat Province. We will add one more. Names were read, the CO laid a wreath, our flag lowered to half mast and taps played. And we rededicate to the defense of freedom and our country.
Today is also the second anniversary of my taking the oath to defend the Constitution of the United States. Thank you all for the support, and especially my best friend and wife, Linda

Distinguished Visitor, III

Today, I consulted on a brigadier general of the Afghan National Police for western Afghanistan. He was very gracious and appreciative. We also almost met with the head of the regional civilian hospital, Dr. Rashid, but it was postponed.

Distinguished Visitors, II

Wow, what a day. Shown is the Surgeon General of the Afghan National Army, Major General Yaftali with our team leader CAPT Richerson (same rank as colonel in other services). MG Yaftali spent the last two days meeting the hospital staff and mentors and touring the facilities. He is in charge of health care delivery for the soldiers and their families and is the top of the Chain of Command for the hospital. He spoke to a large meeting of the staff and mentors for over an hour in Dari. He concluded in English for the several mentors there. He observed the wonderful improvements in the hospital, thanked us and said "You came to Afghanistan, not to read a story, not to write a story, but to make a story". Wow.
After the meeting with the General, I was then asked to by the deputy commander of the hospital to meet another distinguished visitor, Haji Abdul Khaleq Mir, the Deputy Governor of Herat Province. They wanted me to review his test results and advise him on his health. What a privilege. Fortunately, he is hale and hearty, so a pleasant visit.

Command Coin

Just arrived, our official command coins. We on the Morale, Welfare and Recreation committee (MWR) put together the design, got bids and used raffle funds to purchase 300 which we are selling like proverbial hotcakes. The border on both sides states "Combined Task Force Phoenix" for the coalition command in Kabul collaborating on the rebuilding of the country; and "Operation Enduring Freedom" for the ongoing peace-keeping since November 2002.

The obverse shows a rising Phoenix (the mythical bird that dies in flames and rises anew from the ashes, read Harry Potter) with the Afghan flag above it. On either side are "Herat Afghanistan" in English and Dari. Below the Phoenix are the flags of the countries participating in the Herat area: US, Slovenia, Italy and Spain.

The reverse shows the country with the flag superimposed and a star marking the location of Herat. Camp Stone is our FOB (forward operation base). ARSIC West is the Afghan Regional Security Integration Command for the western country.

Command coins are mementos of duty stations and most military bases, even ships, have unique coins. The commander will also have special ones made to give in recognition for special accomplishments. It is also used as a challenge when buying drinks: if you ask to see someones command coin and he doesn't have it, he buys. If he does, you buy. Being a bit of a Navy rookie, I am sure others will chime in with other uses of command coins. Some collect them and display them. They can be traded with other commands, services, even foreign military. Just don't get caught in a bar without one.

Oopsie

Yup, an accidently self-inflicted wound. As he set the butt of his rifle on the ground, it discharged a round up into his armpit and out the top of his shoulder. Fortunately, no artery or nerve damage; only broke a piece of shoulder blade. He is extremely lucky and should have near full use of his arm in a couple of months. We had safety (duh, yeah!) pounded into us about our weapons, and so-called "negligent discharges" are extremely rare in US military. This will definitely send the message to the Afghan recruits. At least he correctly made sure his weapon was never pointed at anyone else, the first rule of weapon safetly. It reassures me that this is the first one we have seen in the nine months here, and we are on a basic-training base. Repeat after me: safety on, magazine out, chamber clear, safety on.

Parker of Arabia

We have been warned of the "120 days of wind" that come every summer. Today we reached 93 degrees, no rain in a month (none expected for about the next 6 months) and wind gusting to 40 MPH. Just talking allows a very fine grit to get in your mouth. Shown is HM1 Parker's solution to the problem with an inexpensive scarf bought at the bazaar.

Spring Festival

Great turnout today. We had a fun day of activities in the fall and planned this one for two months. Lots of competitions like 3-point shooting (won by a female Air Force medic), football toss (the Italians could not quite get the hang of an American football), horse shoes, water balloon toss (the final toss was almost 40 feet) and the perennial favorite, volley ball tournament. Shown are the Italians discovering the fun of trying to play catch with a water balloon. Also, a picture of our admin officer and me raffling a Wii and iPod to raise $$ for future fun. Eight 6-person teams competed in volley ball, including 3 Italian/Spanish teams, one team of Afghan interpreters and 4 mixed-service teams of Americans. Only disappointment was not being able to rent camels for photo ops. See the post for November 23.

Education

Shown are a couple of the 2 dozen posters on medical anatomy in Dari and English. These are posted around the conference room where lectures are given. This helps the daily seminars being given by LCDR Charlie Barnes, our ER nurse mentor. He's training small groups in CPR and ICU care. Our team arranged covering the cost of the framing so these will be permanent and durable.

Not Smart Part II; Air Force Band

Yes, those are unrestrained, unhelmetted soldiers riding on top of the truck cab. I guess they figure a skull fracture is a badge of honor.
Shown is the roving Air Force Band, doing a 3 day stint at gorgeous Camp Stone. They played pop tunes from the 60's to the 80's. Very entertaining and the first live show here ever.

Desert climate

The photo shows a black flag, indicating curtailment of all outdoor exercise due to a wet globe bulb temperature of 90 or higher. It was 97 today, May 10th. More to come. Flags go from white or no flag (no limits) through green, yellow, red and black. Add 10 degrees if wearing body armor. At Fort Riley last summer, we were in body armor when it was over 100 with high humidity. And lived to tell about it.
The hot arid climate also causes dehydration. Coupled with the high mineral content of the well water, the 4 year old boy shown has kidney stones. We will try to get him to a hospital with the capability of treating him properly.

Books Without Borders appeal

Books Without Borders is ready to send 75 boxes of medical books to multiple locations in Afghanistan but still needs about $4000 to cover shipping. We tried working with Operations Independence with only a bit of success. Please consider supporting. The books will go to all the area hospitals and the medical school in Herat, thus helping now and in the future. Thanks!

All checks need to be payable to Postmaster. The address to send the check is:
UCLA Medical Alumni Association
c/o Valerie Walker, Director
James West Alumni Center
Box 951397
Los Angeles, California 90095-1397

Here is the BWB link: http://www.medalumni.ucla.edu/bookswithoutborders/bookswithoutborders.shtml Anyone who makes a gift of $100 or more will be added to the Website as a Program Donor.

Pinpoint of light at the end of the tunnel

We have been Boots On Ground for 250 days. We landed in the Combat Zone officially last 29 August when we reached Manas AFB in Bishkek Kyrgyzstan very early in the morning. We are supposed to be out of the CZ No Later Than this coming 29 August, probably sooner. We have also learned the names of our replacements who have just started training for deployment. My Afghan counterpart, Col. Azim, is deputy commander of the hospital and expressed his wish that I stay another year. Nice compliment, but...

Distinguished Visitor

On Saturday May 3, we received a visit by Dr. Mujadade, shown in the picture. He was the first president of Afghanistan after the Soviets left over fifteen years ago and represented the true return to democracy. He now is the head of the national senate. I had the privilege to shake his hand; his English is excellent.

Another celebrity look-alike

I think he looks like Chuck Norris.

Progress; Safety first

Afghanistan sharply divides the sexes through culture, and under the Taliban girls and women were forbidden employment, education and the vote. There are now women in senior government and military positions although the numbers are still small. Shown is the newly appointed assistant chief of nursing, the woman on the left. She previously taught nursing and is well respected by her colleagues here. She will oversee the day-to-day duties and work of the nursing staff. Herat has many schools for girls now and the universities admit most who apply. The country has a national women's day as well.
Also shown is me in the "Gator" we use for hauling stuff around the FOB. Even though it's very slow and low to the ground, we wear hard hats and high visibility belts. The ANA soldiers however never wear goggles, helmets or seat belts. We currently have several badly injured soldiers in the hospital due to vehicle accidents. Maybe in 20 years...

Revolution Day

Today is a holiday in Afghanistan that celebrates the departure of the Soviet army in 1989. Lots of speechs and parades around the country.

Books for Soldiers, Thank you Library Jane!

We just received a shipment of paperbacks from Library Jane and the Blount County (TN) Friends of the Library. They worked with Books for Soldiers and sent us some good reading. So I'm a sailor, not a soldier; we DO know how to read. Many, many thanks.

Another Web Article

We are periodically visited by the Combined Security Transition Command Afghanistan, CSTC-A (see-stikka) who coordinates the efforts to improve security and rebuild the country for the coalition. A recent visit by their public affairs folks generated the article about the hospital at www.cstc-a.com/News/2008%20news/0804012-Navy%20and%20ANA%20hospital%20staff%20team%20up.html. I am reviewing a patient in the ICU with the chief of surgery, an excellent orthopedic surgeon. This is my fifth appearance in web articles since coming here.

Food illness/poppies

The Afghan army base here had its third episode of intestinal problems affecting over 200 recruits all at once. Same pattern and cause as the prior 2 episodes: the meat was undercooked, transported to a remote dining facility and then sat for a few hours before mealtime. Some of our team, the hospital leaders, the officer in charge of food, the corps surgeon and colonel in charge of logistics spent the morning touring the facilities. Shown is the butcher shop; not pleasant but I will spare the details here. We visited the kitchen and saw that they considered "well cooked" to be the raw side of rare. We drafted up (again) over a dozen recommendations. Maybe the corps commander will implement more than the 2 he agreed to last time.
Shown also are some wild poppies. Afghanistan's southern provinces supply the majority of the world's raw opium from poppies, and the Taliban sell it to raise money for their insurgency. Narcotic use is against their faith, but it seems okay if they can make money from it... The poppies pictured are not the opium variety but seemed symbolic.

Words of Wisdom

Posted in the hospital: it translates as "Use your wealth for your health; not your health for your wealth".
The hospital is really hitting its stride as an acute care hospital. The ICU is usually full now. The ER was flooded with 5 injuries from a roll-over pickup truck accident. The ANA soldiers aren't good drivers, don't wear seat belts or helmets and the roads are poor. That said, the staff rose to the task and managed everyone quickly. The usually-quiet radiology room cranked out at least 20 x rays in 2 hours. Well done! We're so proud!

Greening of Afghanistan

Shown is "Camel Thorn", or kharn in the Dari language. It grows wild and is green only in the spring. The local sheep and goats can survive on it, even when it appears brown and withered in the hot summer. The other picture is a thriving rose bush planted near the ANA clinic. There is a great deal of planting and gardening going on, including by the new recruits. We've even seen small plots of grass. These are watered by well water and seem to be doing well. I was also shown some low-growing vines and was told it is the national flower of Afghanistan; it's honeysuckel! Nice smell and sight that reminds me of home.

Old fashioned building methods

Shown is a mud brick wall and the bricks being made on site. Straw is mixed in mud, the mud is dumped and trowelled into a form, the form removed and the bricks sun dried. The wall will surround the expansion of the interpreters' camp.

Appeal

See my Feb 26 post about Books Without Borders. Books Without Borders is ready to send 75 boxes of medical books to multiple locations in Afghanistan but still needs about $4000 to cover shipping. We tried working with Operations Independence with only a bit of success. Please consider supporting. The books will go to all the area hospitals and the medical school in Herat, thus helping now and in the future. Thanks!

All checks need to be payable to Postmaster. The address to send the check is:
UCLA Medical Alumni Association
c/o Valerie Walker, Director
James West Alumni Center
Box 951397
Los Angeles, California 90095-1397

Here is the BWB link: http://www.medalumni.ucla.edu/bookswithoutborders/bookswithoutborders.shtml Anyone who makes a gift of $100 or more will be added to the Website as a Program Donor.

ICU is open!

Incredibly, the ER and ICU were unopened and used as storage when we arrived 7 months ago. If not for our efforts, they would remain closed. The ER opened 4 months ago and is gradually looking more like an ER. The ICU took its first patient yesterday, and the second, shown, today. To open it in grand style, the patient today had a cardiac arrest, which we were able to recover. I paid a visit this evening and the patient is hanging on, albeit on a ventilator and potent drugs.
Also shown is me with the chiefs of medicine and surgery, who are the key practitioners for the ICU. Progress!

Back in Herat

8 cities, 5 days. I left DC early on the 1st and joined hundreds of other military at Atlanta. We took off on a jumbo jet that evening and made a stop in Ireland for refueling before landing at Kuwait International the following evening. 1 and a half hour bus ride to the US base where we slept overnight. Those for Afghanistan then saddled up late in the afternoon; we were told we would get to Bagram (central A-stan) via Kandahar (southern Astan, Manas Kyrgyzstan (several hundred miles north of Astan), then back to Bagram in central Astan. Instead, they deplaned us in Kandahar where we stayed overnight, then flew to Bagram. Landed at Bagram late at night in pouring rain, and settled down to sleep. Now to get to Herat... Not too many flight to Herat so we finagled a ride to Kabul which has daily flights to Herat. Stayed overnight yet again, and finally got to Herat Saturday. I'm not sure what time zone my bod thinks it's in. So, DC to Atlanta to Shannon Ireland, to Kuwait to Kandahar to Bagram to Kabul to Herat. Not fun.
Pictures shown: Iraq from 35000 feet, best way to see it. We passed over it on our flight from Ireland to Kuwait. The other shows a Tim Horton doughnut shop, part of the chain and national icon in Canada. Lots of Canadians at Kandahar so they had to have a Tim Hortons. About 30 people were waiting in line each time I went by. And yes, they have a hockey rink there too.

On the road again

Hard to tear myself away, but I'm heading back. Great two weeks of leave with some boating, canoeing, long walks, wildlife, cherry blossoms, the National Kite Festival, lots of good food and time with family. Just over 4 months to go to start the return home.

Nat'l Cherry Blossom/Kite Fests

Today starts the annual cherry blossom festival in DC. Japan gave several cherry trees to the US early in the last century. They have proliferated along the Potomac River and Tidal Basin. Each year sees a 2 week festival to herald the blooming and start of spring. Today is also the national kite festival with hundreds of kites around the Washington Monument. Shown is a pirate ship kite floating in front of the Monument. Gorgeous day for a walk.

Florida wildlife

The most common critter on base in Afghanistan is the common fly, but we saw plenty of goats, sheep, camels and donkeys. It's a bit different in Florida. Shown are animals seen on our various outings like an anole (small ubiquitous lizard}, a snake and a couple of small hermit crabs.

Leave is a wonderful thing

Great being home and with my honey. We've done some boating, cooked good food, ate at the officer's club, lots of hiking and exploring and even saw many hermit crabs. Also one blue crab. Too small to eat. I paid a visit to my home command and enjoyed visiting. I will head back to the mountains and desert soon but it feels great now.

Blue Angels

Pensacola is the home to the Blue Angels aerial demonstration team of the Navy for 60 years. They start their season in March and have practices at their home field. So, we headed over to the air station along with a few thousand others to see the show. Very loud and very cool.

Leave

Well, just had to stop at the McDonald's in Kuwait first. Anyway, about 2 days of travelling that included 22 hours of air time in C17s and a DC10, I am back in the US. Many thanks to Pam Duncan for the pickup and loan of vehicle. We have had great family time with lots to eat, beach walking, visiting the Naval Aviation Museum, and canoeing on the Blackwater River. Afghanistan seems and is 7000 miles away.

If it's 3 AM and Sunday, we must be in Ireland

7 hour flight from Kuwait and on the ground in Shannon, on St. Patrick's eve! 2 hour refueling and crew change. Then over the pond being chased by the sunrise to Atlanta. Almost there! The Duty Free shop is open but I decided Guinness flavored chocolate doesn't appeal.

Travelling sucks, but...

Day seven of going home for leave. First we took a little 12 seater plane to the main airbase in Afghanistan. Spent several days there getting briefed on what to do in the leave process, but mostly doing nothing. Then rode a giant old C17 to one Gulf country and switched to another C17 to another Gulf country. Arrived after dark and then had another leave briefing from 1:30 to 2:30 AM. The sun has now risen (2 hours of sleep) and one more brief. We will have our bags inspected then wait several more hours to..... GO HOME! Hoorah!

In Memory of Pat Tillman

Pat Tillman was a professional football player. After 9/11, he left football and joined the the elite Army Rangers. He died of friendly fire in Afghanistan and is remembered here with the naming of the USO center in his honor

"Fashions"

There are several local merchants with shops on base, open every day. Back at Camp Stone, we only have a weekly bazaar. Shown are a couple of their concepts of men's fashion. So, there's the red shirt, lightly patterned jacket and paisley-oid tie. Then there's the velveteen jacket with a nice, shiny nap. Watch out Paris! The new fashion capital is here!

Mountains

I must have 30 pictures already of the mountains surrounding Bagram Air Force Base. The base is at 4800 feet above sea level and on an large flat valley. The surrounding mountain ranges go over 15,000 feet and it takes your breath away; well, maybe the altitude adds to that. To the east, the Hindu Cush range starts and is part of the Himalayas. Cool. The weather on base is very dry and daily temp ranges from about 40 at night to 65 in the daytime.

Warning! Bagram foot bridge

Cute. EOD means explosive ordinance desposal. That's what we used to call the bomb disposal teams. 20 year old Russian tuna sounds pretty dangerous.

Leave!

Why is this man smiling? I am going home for a couple of weeks. It will take about a week to get there, 2 weeks at home, and then about a week to get back. Any deployment of 9 months or more gets the 2 week break. By the time I get back, we will be down to 4 months and change for "redeployment" aka going home.

MasCas exercise

We've been here for 6 months now and have not had a practice "Mass Casualty" drill. The new nurse practitioner, an Air Force major, decided it would be a good idea and had several meetings with everyone medical, including medics and corpsmen. So, one evening at about 2300 (11 PM) we heard a couple of loud BOOMS and all headed to the bunkers. After the all-clear, we headed to the clinic and received the mock patients. Everyone did their jobs well. The only need for improvement was better communication. This was especially hard since our Spanish and Italian colleagues were all trying to communicate with the operations center on the single channel. We'll work it out. The photo shows one of the Spanish nurses, an Italian doc and yours truly.

Wayne State Doc/Interview

The textbook is one of the most popular texts on Emergency Medicine. It is sitting on the shelf of one of the Afghan Army docs here and is first-authored by Judith Tintinelli, MD, who spent much of her career at Wayne State University. I graduated from WSU in Detroit and taught at the med school for 15 years. Our reach is long.
The other picture is preliminary to a television interview with the Deputy Director of the hospital. The interview occured due to a visit of one of the major Ministers of the country. We provided a medical consultation with him and so the interview occurred at the hospital.

Bilingual Mass/Not Smart

We finally had a mass in English, thanks to the visit by Fr. John (Lt. Col. in the Air Force). The usual Italian mass was cancelled and combined with Fr. John's so Padre Mariano joined us and added a few words in Italiano. About 30 attended in our tiny chapel and was a great service.
The local soldiers refuse to wear seat belts or helmets, and hang on to the Ford Rangers any way they feel like it. I've even seen one sitting on top of the cab. They drive fast and there are speed bumps. No wonder our number-one cause of injury is vehicle related.

Operation Care Package/Half-way!

The nice people at Operation Care Package sent us all packages of lots of good stuff before Christmas and have done it again! Thank you to Jane, Trisha, JoAnn, Fern, Debbie S., Rose Mary, DJ, Abigail and Molly. Socks, a cap, toiletries, snacks, etc. Thanks for the nice surprise.
As of 28 February, we have been Boots On Ground for 183 days with no more than 183 to go. So, halfway home.
Also pictured is a $25 "Omega" watch bought at the local bazaar. Such a deal.

Books Without Borders

Please see the link www.medalumni.ucla.edu/bookswithoutborders/bookswithoutborders.shtml.

Books Without Borders was started April 2007 by the Medical Alumni Association of UCLA and is growing rapidly. This program provides medical education literature to the hospitals and medical schools of Middle Eastern countries that are recovering from the recent wars. I volunteered to be point-of-contact for the Herat area in Afghanistan. Great project! Check it out.

Boungiorno/Buenas Dias

Or, good day in Italian and Spanish. Italy's army (esercito) is in charge of the west region of Afghanistan for the coalition. They help run the local airport, mentor the Afghans and provide humanitarian aid. They set up a pizzeria here at Camp Stone where you can have interesting combos of toppings for around $6. One has started an Italian class twice weekly and I attended the first session on the 20th. He is teaching for free. Grazie! Shown is their logo for this mission.
Also shown is lunch with the Spanish contingent. Spain's army (eserjito) also provides mentoring and humanitarian help. They get Fridays off like we do (Muslim sabbath) and have a convivial lunch every week. We were invited and enjoyed the paella and turron (like Italian torrone, made with eggs, sugar and almonds). Gracias!

Navy missile strikes faltering spy satellite

One shot, one kill, 133 nautical miles (153 statute miles), from a cruiser shooting at a satellite traveling 17,000 MPH. Proud to be a sailor, the Force is with us.

Close Reefed Tops'l Breeze

Navy talk for a windy day. Today and yesterday were unusually warm, in the 70's which is 20 degrees above normal. Quite a change from the 20's of 2 weeks ago. The morning was quite pleasant with a nice breeze at 7 AM went I got breakfast. I walked out 20 minutes later and a gale was blowing, a Force 7 to 8. OK landlubbers, about 40 miles per hour. Shown are the flags blowing straight out and a piece of roofing blown off of one of the ANA buildings. This is a preview of the "120 Days of Wind" experienced every summer. The barometer is dropping and dark clouds forming, so rain tomorrow. That's a good thing.

Busy work

While we had the several inches of snow, earth movers shoved them into piles. Now we've had several days of 40's and 50's, but the depth of snow and weeks of intense cold prevented a complete melt. So, to provide gainful employment at a few dollars a day (per capita imcome is only $500 per year), these gentlemen are spreading out one of the surviving piles. While there was still a lot of ice around, they used pickaxes and shovels to clear paths between huts. Whatever it takes, and they are grateful.

Thank You Oak Leaf Club!

Pictured are soft warm neck gaiters paid and made by the Oak Leaf Club of Pensacola. This club includes the spouses of Navy officers in the health professions (medical service corps, dentists, nurses, doctors). They had sent generous care packages for Christmas and wanted a nice warm-up for us during the winter. They held "Wraps for Wraps" sales at the hospital, selling pita wraps to raise funds for the gaiters. Wow! They are great and much appreciated! Thanks to the club and president Teresa Beer.

Italian lecture/military bearing

Shown is Lt.Col. Dr. Nunziata, an Italian dermatologist on our base who helps mentor the garrison docs. He and his colleague who is a plastic surgeon have provided a number of reconstructive and cosmetic surgeries at the ANA hospital. This helps the patients and instructs the docs. He wanted to lecture as part of our Sunday lecture series, so gave lectures today on leischmaniasis (disfiguring skin infection) and skin cancer. The plastic surgeon will lecture next Sunday on skin grafting. Their help in every way is much appreciated. Grazie! Too bad they "rip out" soon.
Also shown are recruits in formation. We saw none of this when we arrived almost 6 months ago. Now they are out in the cold, in formation and doing "shout-outs" by 8:30 each morning. Not only that, I saw them policing the area for the first time and rumor has it that the slackers have to do KP! Credit goes to the Italians and Spanish who are mentoring the troops. We had a marked increase in their number of mentors 2 months ago and it shows in a more disciplined group of recruits. Now, suppose we had Marines...

ANA Barracks

The dining facility for the Afghan National Army base seems to have served some questionable stewed beef yesterday since 270 soldiers started making frequent trips to the latrine late at night. I hopped on the bus to go with several of the hospital staff to the barracks about a half mile away on the same base. All the soldiers had vital signs (blood pressure and pulse) taken and treatment given. All received a shotgun of 3 antibiotics against bacteria and parasites; antidiarrheal med; antacids; and packets of electrolytes to add to boiled water. 9 of the recruits were given IVs in the barracks. Shown are the barracks, very similar to the layout I lived in at Fort Riley last summer: double rows of double bunks with lockers for personal belongings. Also shown is their heating system. That's one of 3 wood stoves used to heat barracks for 80 soldiers. Also shown is their makeshift pill holders, basically a rolled-up cone of paper. Add the pills and fold over the top. All soldiers were screened and managed within 2 hours. We returned to the hospital to find one of the docs getting an IV; same problem. Nothing contagious, just garden variety food poisoning. It did give me a rare glimpse of the garrison.
Weather: I got up at 4 this morning to a starry sky. I called home and came out of the phone area to rain. I then worked out and came out of the gym to snow. Later, nicely sunny. If you don't like the weather, sometimes you can just wait a few.
Happy Valentine's Day to my honey. Love you and miss you a whole lot.

Finally!

47 degrees today! A bit of rain, then partly sunny. Major runoff with one intersection several inches deep in water. Felt good to not have multiple layers, double gloves and a knit cap on. I promised my roomie that the snow would be gone when he's back from leave; we are well on the way. Rain for the next few days, then a promise of 50 degrees. We are in the "monsoon" season until April. Average annual rainfall is 9 inches with nearly all of it from November through March.
As of 2/11, we have 200 days left on the deployment.

Plaster Velpo/lunch at the hospital

The patient shown dislocated his left shoulder for the 5th time. Standard US treatment would be an elastic restraint (called a Velpo) that holds the upper arm tightly to the side of the chest and the wrist to the front of the chest for a few weeks. This allows the damaged ligaments and joint capsule to tighten up. Afte the 3rd dislocation, surgery is used to prevent further episodes. The Velpo technique frequently fails since this injury occurs in teenage boys, and they are notoriously non-compliant with the treatment. So, I hope this Afghan version works. It's a plaster cast and will truly immobilize the shoulder involved until removed. I bet it will get quite uncomfortable in a hurry.
The docs invited me to lunch with them today; we had them over to our side for American cuisine a few days ago (they loved the Baskin Robbins ice cream). Shown is a typical lunch of stewed beef, a potato dish, a milk pudding, naan (bread), fresh fruit and half a pound of rice. I did not eat it all so they were concerned I didn't like it; I can't eat that much!
BTW, Happy Birthday to Sanjoy and my "baby" brother Dave. Sanjoy, thank you, thank you for the unexpected wonderful treats from the famous Mike's Pastry Shop of Boston. Also, it finally got above freezing yesterday. Should be 40's soon.

Family issues

Pictured is a box of fifty one-month foil packs of "birth spacing pills" in the hospital pharmacy. We see very few women in the clinic and the men culturally won't buy these for them. They can be purchased in town.
No families live on base and even the local ones have no good way of traveling the 10 miles from the city to the base. Families of soldiers may receive care at the hospital: wife, children (even as adults), parents, parents-in-law and siblings. There are plans for base housing in a few years.
Their law allows a man to have up to 4 wives; I only met a few with 2, all the others have one. Each wife must get the same consideration, even to equal living space. Men with multiple wives sometimes even have separate but equal houses for each wife.
Fertility rates are quite high for many reasons. Over 1/3 of children die before age 5. There is no social security, so family support is paramount. Up to 20% of women die of childbirth complications. The hospital in town does 50-60 deliveries a day, and the moms are discharged 2 hours after delivery if no problems.
One soldier patient was with us for a few months, and we kept seeing new brothers who cared for him. We found out he had 10 brothers and 5 sisters of two mothers and one father. And they provided excellent, around-the-clock care for him.

DV/Slippery

The gentleman (DV-distinguished visitor) shown with me is General Mujaddidi (sp?) who paid a surprise visit 2 days ago and wanted a tour of the hospital. A US Army officer was with him and recognized me and so asked for me to give the tour. The General is a hero in Afghanistan as a fighter against the Soviets 20 years ago. He has the challenging job of Inspector General in a country where corruption and nepotism is the norm. He was warmly greeted by several in the hospital who knew him and was interested in my discussion of the challenges facing the hospital.
Sorry to go on about the weather, but this is the coldest winter in 100 years according to a news headline. Snow is uncommon, but we have a layer that is almost 6weeks old. Crikey, I could have stayed in Michigan for this. Anyway, you drive 10,000 pound Humvees and trucks over this, voila, ice. Not just any ice; lumpy, uneven, unpredictable ice. I have avoided slipping and falling for the most part, but managed to "pancake" on my back this morning when it was a toasty 1 degree. We have had a few broken ankles due to slips. I hope we don't get the hottest summer in 100 years after this.

Technology

Some more baby steps in modernizing the delivery of health care: Look carefully at the keyboard and you will see the usual QWERTY but also the Dari alphabet (alef-bey in Dari for the first 2 letters of their alphabet). We obtained the dual keyboard for their new computer lab and the computers have the software to easily switch between the latin and Dari alphabets. Dari has 33 letters but there is no case, so English is actually more complicated with 52 upper and lower case letters. Dari spelling is also phonetic, so easy to pronounce if you know the sounds of the letters. I have been entertaining the 'terps lately with English homophones like u-you-yew-ewe.
Also shown is an Italian cardiologist teaching the Afghan internist how to do echocardiograms, vessel ultrasounds and ultrasonic thyroid exams. The USA supplied a state of the art ultrasound machine when the hospital opened and this doc is getting quite proficient at its use.

Cookies!/Hands-on medicine

Shown is CDR David Lemme, a fellow family physician who spends some time with us at the hospital when not doing his mentoring at the Afghan army clinic. The patient was in a roll-over (very common here)and complained of some upper back pain. CDR Lemme is an osteopathy grad and is experienced in musculoskeletal manipulation. He put the patient into a position akin to a full nelson and yanked back; we were all amazed to hear a loud "pop". The Afghan docs were nonplussed and not ready to try this themselves.
Many thanks to sister Paula (and grandnephew Aiden Murphy) for the yummy Cowboy Cookies, that arrived today, 10 days after mailing. Also lots of other goodies and books. Paula endured many separations from her Navy pilot husband Roy and having number 1 son spend a year in the green zone (aka Iraq). Thanks for your cards, goodies and empathy. Who said big sisters are the crabgrass in the lawn of life?

Best of luck/continuing education

I have been fortunate to have "Doc" as an interpreter for the last several months. He is a graduate of an Afghan medical school but knew enough English and Dari to serve as a interpreter. 'Terps are paid better than docs for the most part so it was a good match and obviously very helpful in my conversations with the local doctors. He had the best facility with translating medical terms and served as my go-to guy when giving lectures. He translated the PowerPoints, handouts and our presentations during the lectures. We now have a small library of Dari presentations that are shared with other hospitals across the country. His mom is having health problems, so he has resigned to stay with her. He hopes to stay in touch. Good luck! The picture is Doc with my roomie, Don, and me.
The US docs have been giving lectures regularly and we have encouraged the ANA staff to respond in kind. So, they have given good lectures on the endemic problems like TB, typhoid and malaria. Shown is a lecture given by their nurse leadership on basic issues in injury management. They enthusiastically embrace the training since their backgrounds range from 1 month to 7 years of medical training. Whenever we must delay a lecture, they insist it be the next available day, rather than wait a week and have 1 less lecture. Yesterday, I even observed a basic literacy class that was just started for the housekeepers! No doubt in my mind that education is critcal to success (all that college tuition....), so I exulted to see the hospital doing these on their own initiative. Zowie!

Afghan celeb look alikes/Gran Formaggio

One picture is of a nurse at the hospital that looks like Omar Sharif. The other is a brother of a paraplegic patient who basically stayed at his side and helped care for him for 2 months. I think he looks like an Afghan Russel Crowe.

The hospital had a short visit from a "big cheese" (gran formaggio)from Italy, the surgeon general of the Italian Esercito, or army. Italy is in charge of the training of Afghan troops in western Afghanistan and has overall administrative responsibility for the International Security Assistance Force (ISAF). Our hospital is used as an example of a project that is succeeding.

MAIL! MAIL! MAIL!/Ornament/Yellow Ribbon

After 17 days of no mail, we received LITERALLY 5 tons of mail yesterday. Fortunately, the post office crew was about to change over so the outgoing and incoming workers were here to deal with the distribution. So, I received lots of mail as shown by the stack. The oldest took 3 weeks to get here. Nothing broken or frozen despite the huge load and subzero temperatures. Many thanks to: Louis, my father-in-law who sent a nice note and wonderful Italian goodies; Teddi and Bill, good friends (football "relatives") who sent Vernors Ginger Ale (Michigan product) and yummy stuff; my bro Mark who sent a souvenir flag from his visit to Portugal (Deschere is derived from a Portugese name); and the chaplain corps in Afghanistan who sent a Tupperware with toiletries and snacks.

I have mentioned my terrific roommate, Don. We bunked together during training and room together here in Herat. He is a "mustang", a former enlisted who then commisioned as an officer. He started out as a Navy medical corpsman, deployed with Marines, made Chief Petty Officer (senior enlisted and elite) before getting a nursing degree. He is a lieutenant commander like me, but has been in the Navy 26 years longer than me. A wealth of help and info. Anyway, he and his wife Kathy gave the the ornament shown as a souvenir of deployment. It has 2007 and "Operation Enduring Freedom" on it as a momento of this year in Afghanistan.

Don and I are both from Naval Hospital Pensacola. NHP is a small hospital but has deployed 100 sailors. They placed large yellow ribbons on the compound for each deployed sailor and Don's wife Kathy took pictures. Shown is mine with my name and the deployment dates. Only military can access this area but she managed to get photos. Thanks Kathy! I enjoy their pictures of their first grandchild, Kaelyn.

100th post/ free ad for Transitions

This is my 100th post since starting the blog last spring. We are almost 5 months in country now, with 7 to go. Hope y'all have enjoyed the eclectic nature of the posts.
I joined the Navy in May of 2006 and in anticipation of boot camp, I purchased durable photo-sensitive glasses. I normally wear contacts but did not think that would work well at Officer Indoctrination School. Since they did not allow anyone to wear sunglasses (What!? No Tom Cruise/Top Gun look???), I was the only one with dark eye protection since mine were considered glasses. The glasses darken with UV light; at 3500 feet above sea level and the brilliant white snow all around, they get really dark as shown. They take about 4 minutes to clear when that dark so I grope around like a blind man when I arrive at the hospital. Again, glad to have them since a windy and (usually) dusty environment mitigates against contacts. Since I can get Lasik from the Navy for free, maybe it's time....

Local Flavors

They generally don't drink plain milk here. The locals prefer a yogurt-like concoction with sugar and salt added. Shown are locally produced milk. The blue one is "half-cream" milk, which is actually reduced fat. The pink one is strawberry flavored milk, and the yellow one is..... banana milk! The milk actually is tasty but I haven't tried the yogurt. We are warned about consuming any dairy products that don't come in individual containers, and the yogurt is usually spooned out onto individual plates.
The bottle is the Afghan version of fiber supplement, like Metamucil. My prior education noted the lack of constipation and related "problems" in countries like this due to the high proportion of fruits, grains and vegetables; and also the squat-style loos are supposedly better for the back end. However, hemorrhoids is a common complaint here. Maybe it's due to the lack of facilities.
BTW, it finally got into the 20's today and felt balmy. The sun is strong at this altitude and latitude (34 degrees north) so the snow melted a bit. Still very slippery.

Subzero

Record setting cold. Not only have we received an unusual amount of snow, no locals can remember it ever being this cold. Normal High/Low is 48/26. Today, 16/-6. Even with the "heat" pumps (pictured) going full blast, the hut was a toasty 51 this morning. Most of us are using double-nested sleeping bags, which keeps us very cozy. Now, if we could just stay there.... When the sun is reasonably high in the sky, it can be fairly comfortable. That lasts for the middle 6 hours of daylight. With all the trucks and Humvees driving on the snow, it is terribly slippery. So far one soldier and one interpreter have broken their ankles.
Also shown is a witch one of our hut mates received for Halloween and left it out by our MASH pole. It has yarn hair which frosted over with the ice fog we've had for the last few days. Hard to believe it will be 110 in 6 months.

No break in cold/Pacool

We continue with the 9th day of temps below freezing instead of the normal highs of 48. We've had snow for the last 3 days and expect more tomorrow. In a place that rarely sees even a coating of snow, we have received over a foot. The news reports over 40 hypothermias in town; they just are not used to this. Their houses are not well insulated and the roofs are not designed for the frozen variety of precipitation. We have constant overcast. Just like back in Michigan. At least the power is on here and the water runs. We had a 1 hour outage in the chow hall and some huts this morning, but all is back to function. That's an 8 foot mound of snow piled up in our main open area.
I am wearing one of the ethnic hats of Afghanistan, a pacool. My assigned interpreter brought it back as a gift to me on his trip home for the December holidays. Pure wool. Thanks!

Oh yeah?

Military is full of oxymorons. The sign tells us to conserve our non-potable water, which is used for personal hygiene but is chlorinated. No episodes of water-borne illness so far. Well, for a desert climate, we have had lots of rain and snow in the last 2 months, with the rainiest part of the year yet to come. The picture shows 2 of our 'terps and HM1 Parker and LCDR Sylvester on the 8th when the temp struggled to 18 degrees, after a 4 inch snowfall the day before.

Back to "normal"

With the sunshine today, room temps are back to our preferred upper 60's. The weather is still below normal but it's funny how 35 feels warm after single digits. The contractors were able to re-establish running water so we are A-OK, Hunky-Dory, Lima-Charlie, five by five.

Frostbite Falls, Afghanistan

Normal high/low for Herat on January 8: 48/26. Actual: 18/5. We are about 400 feet higher in altitude and away from the city, so we were doubtless colder. To make it more "pleasant" we lost power and water as well. We started to have brief outages the evening of the 7th and the entire camp went dark about 3:30 AM on the 8th. Apparently the camp ordered winterized diesel, which was sent from Kabul. What was delivered was not winterized, so it gelled due to cold temps and all the generators failed. Hut temps dropped to 44 by morning. The KBR folks (no longer a subsidiary of Halliburton) who contract for general maintenance of the camp had to wheel out little gasoline generators to charge up the big generators for start-up. Spotty returns of power occurred all day. Finally, the dining facility was back in business about 5 PM. All the cooking that day was done on wood fired grills. Actually, the food was quite good. Light in the DFAC was via windows until the power finally returned. Our berthing power returned about 7 PM and has stayed on since (now about 20 hours). Hut temps have crept up to 61, in part due to some sunshine. However, the senior officer huts on the east side of camp went another night without power and had indoor temps at freezing.
The water in many of the latrines (Armyspeak)/heads (Navyspeak)/powder rooms (Air Force speak) froze so the return of heat brought leaks. Ergo, the water is shut down for the time being. Shaving and brushing teeth are with bottled water and flushing uses water from jerry cans. Fortunately, I managed to get a warm shave and a shower at 4 AM this morning before they shut off the water.
We had blizzard conditions on the 7th. Very unusual here; the locals said they have never seen so much snow, 4 inches in December and another 4 now. The Afghan docs come by a tourist-style bus and were much delayed so we US docs and nurses went ahead and rounded on the dozen patients. I enjoyed being "back in the saddle" and taught the duty staff about my approach to the patient and method of documentation. On the 8th, the buses would not run at all, so the docs never came. My roomie and I headed over to the toasty-warm hospital and had tea (chai) and bread (non) with the staff, rather than eat in our cold, dark DFAC. Today was a semblance of normal, although still colder than normal. Today's high, 32.
Pictures: Interesting curved icicles, aka "Afghan icicles". A picture of a snowman by our HM1 Parker. Me enjoying chai at the nurse's station of the hospital. A patient enjoying the snow, the 18 degree temp, in his jammies and sandals. The text message declaring a snow day due to the docs not coming.

Family Medicine

As in, your family takes care of you. It is not unusual for family members or coworkers to spend a lot of time with hospitalized patients and provide much of the care. Indeed, one of the challenges of getting the nurses to assume more responsibilities is the willingness of relatives to do the work while nurses loaf.
"Relative care" is especially true for women. A young lady was admitted for post operative swelling from an ankle injury. She gave birth to the adorable baby girl shown and brought her along so she could continue to care for her. Her mother-in-law also stayed with her to provide care and chaperoning.

Happy New Year

Now that it is 2008, I can say that I will head home THIS year, instead of NEXT year. We've been "in country" 125 days; it is 212 days since we started with the training in Norfolk. On January 15, we will be at the half-way point between the start of training and the return home (15 months, 453 days). We have been here long enough to become the veterans. Replacements are arriving by the droves now, mostly Army. We get to show them the ropes and make their life more pleasant. We are grateful to those who helped us settle in with a special thanks to Air Force Captain Paul MacDonald who helped drag our gear to our huts when we arrived 4 months ago.

One-third/Brrr!

It is now exactly 4 months or 122 days since we entered the CZ, combat zone, by landing in Kyrgyzstan on August 29. So, 1/3 of the way through a 1 year deployment. It is also 209 days (out of 454) since we started mobilization and training in Norfolk. But who's counting.... About 70 days until I leave for leave.
Unusually cold. Per weather.com, normally we have highs of upper forties and lows of upper twenties. It was 12 this morning and only 25 this afternoon. Brisk north wind and very clear skies. Great for star gazing but bitter when you walk over a half mile to the hospital just after sunrise.

Incentive spirometry/Thanks Pat & Jan

We have had a couple of chest injuries in the last month; one was a bullet through the chest and out the back; the other a tension hemopneumothorax from breaking 3 ribs in a roll-over accident. Did I mention they don't wear seat belts around here? The lungs get damaged and restricted in movement. It also hurts to breathe so the patients breath shallowly. This puts them at risk for pneumonia because periodic deep breaths open up and help cleanse the lungs. Back home we use cute devices with colored ping-pong balls that patients try to keep floating. Here, we suggested a straw and a bottle of water. Blow bubbles and the back-pressure keeps the lungs open. It made a dramatic difference in 1 day with the roll-over guy. The staff actually cut some IV tubing for the straw. The long length and narrow diameter is better than a typical straw.
I received nice cards and a box of sugar and chocolate chip cookies from two wonderful nurses who worked with me 20 years ago. Thanks to Jan and Pat. They were wonderful coworkers and introduced me to the wonders of pirogies and the Polka. Thank you!
And a happy birthday to my honey. Love you and miss you.

CHRISTMAS!!!

I actually worked a half day at the hospital on Christmas Eve; one of the docs there wanted help with a lecture on TB. We discovered a Farsi version of Wikipedia at fa.wikipedia.org! We held our own medical team party back of our main berthing hut (b-hut) in the afternoon. Everyone brought out the abundant goodies from family and friends like homemade breads and panatones.

The Catholic mass was held at 8 PM, presided over by the Italian priest shown above. Imagine 75 people in a 15x30 foot space, standing room only. Most attending were Italian but there was a fair representation of Spanish and Americans. The Old Testament lesson was read in English by one of our Navy commanders; the Epistle by a Spanish officer in Espanol; and the Gospel naturally by the priest in Italian. The service was printed in a flyer so we could muddle along and enjoy passing the "pace", pronounced pa-chay.

The dining facility was quite festive with the life size sleigh shown. An army major general arrived late Christmas afternoon and gave an inspiring speech. He also gave end-of-tour medals to about 30 soldiers and airmen getting ready to "rip out" and go home. The general's plane also brought a 5-ton-truck full of mail, so we had the proverbial mail call as shown. 3 workers yelling out names and tossing packages. One surprise was a package mailed from Virginia only 5 days ago by a good friend of the family, Teddi. She has a special bond with us since our sons played football together in high school. Nice treats and some needed toiletry items and a multi-game electronic kakuro. Thanks Teddi!

The dinner today was amazing: carved whole turkey and prime roast beef; boiled shrimp; ham; 3 different kinds of cakes; lots of cookies. Shown is most of our team sharing the evening meal. We invited some of our interpreters as well.

I was able to speak with the family a couple of times. I am so blessed that they are together; that the young adults are near my wife during my deployment; that our mission is bearing fruit; that we are safe; and that my family is healthy and doing exciting things. God bless us every one. Almost 1/3 through the deployment.

Really should wear seatbelts

These pictures show a fracture of a thigh bone (with a wire mesh splint) and a tension pneumothorax. A "pneumo" like this was caused by 3 broken right ribs puncturing a lung. Air leaks around the lung, and the lung partially collapses. Pressure built up and pushed the heart against the left lung. These two unfortunates came in with 3 others (one other died at the scene) due to a truck accident. None had seatbelts on since they get teased if they wear one. They usually don't wear helmets either, so we see skull fractures as well. They commonly sit in the open bed of a pickup. Occasionally I will see a soldier riding on top of the cab of the truck. They don't have any formal training in driving either. We will keep working on all these issues. We see more vehicle-accident injuries at the hospital than any other cause.

Christmas Greetings

Digital Video and Imagery Distribution System has provided the news stories seen on earlier postings. This is the holiday greeting they recorded 2 months ago. You can also find it at http://www.dvidshub.net/?script=media/holiday_greetings.php&view=VA and scroll down to my last name. Thanks to everyone for their support and good messages.

Monsoon Season/Does this make sense?

November through March sees almost all the annual rainfall here. When we arrived in early September, we went 2 weeks without a cloud in the sky. Since late November, we have received 4 downpours and one day of snow. We have had thunderstorms the last two days. One picture shows some late day rainfall to the west.

The Army issued 3 sets of rain gear. So, as I put on the Gore-tex one today, I wondered why rain gear is issued in desert camouflage. Gotta love the military.

Base tour with NATO

NATO docs who work near the Herat airport came to visit the ANA hospital we mentor. We had visitors from Italy, France, Germany and the Czech Republic. With the hospital commander, we toured the hospital inside and out, including the (empty) morgue.

On the spur of the moment, we decided to walk around the rest of the base. We swung by the dining facility which feed over 1000 soldiers three times daily. Shown is the butcher area where they chop up meat for stewing. Also shown is one of several vast tubs of rice. We also saw tubs of stew and beans. These are all cooked over wood fires. Also shown is the fire fighting equipment composed of shovels, buckets, barrels of sandy dirt and various tools. A smoke alarm is not used since they cook inside over the wood fires.

We also visited the new mosque and were invited in for tea by one of the mullahs. The Afghans pride themselves on hospitality. The NATO docs (and a visiting US Navy pharmacist from Kabul) were quite impressed by the facilities and the progress we are making.

Eid

Muslims are celebrating one of the Eids, or holidys, on their calendar. This one observes the time of the annual Hajj, the once-in-a-lifetime pilgrimage to their holiest city of Mecca in Saudi Arabia. This Eid has a focus on charity, one of the 5 pillars of Islam. Any who can afford it will purchase a farm animal (anything from a kid up to a camel) which is sacrificed, butchered and some of the meat distributed to the poor. Our medical team collected enough for the hospital to purchase a sheep, and the resulting food will be distributed to the housekeepers of the hospital. We also brought over some of the abundant donations from support organizations in the US. We gathered to share chai (tea) with them, enjoy some goodies, and present the donation for the sheep purchase to the director of the hospital. We also provided an Afghan-flag-logo backpack with treats and school supplies to each person on staff at the hospital. All Afghans have extended families who can put the supplies to good use. Shown is my roomie Don presenting a backpack to one of the soldiers assigned to the hospital. We are now off for 4 days during the holiday.

Interesting stories

The hospitals here are somewhat loose about utilization. Many patients are admitted for reasons we would not admit in the US. Many stay far longer than needed. Some patients just come and go. One soldier decided to leave against medical advice one day. The next day, we saw he was back; he was in his fatigues; he was lying on top of the sheets but shrouded in a blanket. Reason? He was tired of being in the hospital and left, but his barracks was too cold so he came back in the middle of the night and crawled onto an available bed!

A visiting Navy pharmacist related his first visit to the national military hospital in Kabul. The doors to the operating rooms were propped open and he could see a surgeon stitching up a hernia repair with a cigarette dangling from his lip.

Most of our admissions here are injuries so I dutifully asked about tetanus vaccine. One doc chuckled and talked about how tough Afghans are and immune to tetanus naturally. Apparently, the standard treatment for scrapes and cuts in children is rubbing a handful of the dry dirt into the wound to stop the bleeding. That's where the tetanus spores are so that's how they become immune. The old saying is literally true: "If it doesn't kill you, it makes you stronger".

Hmmmm

This is a clock in the hospital. It was free. There are others of the same clocks. The clock advertises a brand of cigarettes. Most of the doctors smoke and can be frequently found outside of the hospital puffing away. One of them recently got back from Turkey after heart bypass; he complained to me of occasional cough and shortness of breath; he admits that he has decreased heart function and his lungs are somewhat damaged. What can I say. This is the one vice allowed Muslims but I can't condone it.

M*A*S*H Pole

One of our Chief Petty Officers designed and put a direction pole for everyone's home. I contributed with my Google Earth program that can provide distances. So, here's our sign with mileage and a closeup of the Pensacola indicator. These are great circle distances. The shortest route to P'cola from here would be northwest over Norway, then due west over the tip of Greenland and finally south over Canada to the Florida panhandle. Going straight west would be about 10,000 miles. The great circle distance is less than 8000. Looooong way from home. Also 10.5 time zones.

Clear day

Clearest day so far. Tends to be hazy all summer due to the "Wind of 120 Days" and the dust. We've had rain three times and a snowfall so the dust is down and the wind is less. This looks northeast towards the more mountainous parts of Afghanistan. The snow-capped area is about 40 miles distant. The average altitude in the country is 6000 feet above sea level. The extreme eastern end of the country includes the Hindu Kush range of the Himalayas. There the altitude rises to over 24000 feet. Kabul is at 6000 feet. We're at 3500.

Internet video of MedCAP/CMA

The Afghan National Army base provided a "Super MedCap/CMA" back in September (MedCAP=medical civil affairs program; CMA=civil medical affairs) wherein 2800 villagers were brought on base to receive medical care and humanitarian aid. The Armed Forces Network did some videos and I stumbled across one today. It shows me working with one of the hospital doctors. Also seen is my roommate and good friend LCDR Don Sylvester. You need Windows Media Player to view this; just go to the link and the Player will open and play the video.

www.dvidshub.net/vjump.php?vid=29455

Kaboom!

Nice of them to give us a heads-up. On Saturday, the Afghan Army on just the other side of our Hesco wall did a controlled detonation of a piece of UXO, unexploded ordinance. It was close enough I could feel it. We all ran for shelters but got the all-clear within 5 minutes. Nice drill.

The following day, I just happened to check my local Army email and saw an advisory that the ANA was doing artillery practice Sunday afternoon and to ignore any explosions. It went on all afternoon and some guys could see the smoke about 2 klicks away from our watchtower. Sometimes 3 in rapid succession. Some were powerful enough to cause the walls to shake a bit. Should scare away the bad guys (and small animals) for a while.

This is why I went to medical school

Our base, Camp Stone, is growing and taking on more permanence. In light of this, local contractors are now building cinderblock huts instead of plywood for berthing. Everyday, 30+ Afghans are screened and come on base to do the building. They cannot just wander around so typically a dozen US military escort them on, around and off the base. Today was my second turn of doing this. I met a crew at the gate about 8:30, escorted them off for lunch, back again after lunch, then off again at the end of the workday. BORING. I did find the work methods "interesting". The pictures show 2 guys working on a corrugated tin roof, in bare feet (about 50 degrees), using 220 volt electric tools, with a rainstorm about to start. Eek. The other picture shows a homemade ladder which seems to bear up just fine.

100 DAYS!/ugottabekidding-2/Oak Leaf Club

It is 100 days of the 1 year "in country" for us as of December 7. Triple digits! We celebrate every 50 days with a "cigar party" on a watch tower in the middle of camp.

Follow up to the request for volunteers to make their missions 9 months longer. That's only for certain job types. The rest of us can spend a full year extra if we want. Give me a New York second to think it over: fuggedaboutit!

A very nice surprise arrived from the Oak Leaf Club of Pensacola. The Oak Leaf Clubs of the Navy are volunteer support organizations of spouses of military health care workers: docs, nurses, dentists, pharmacists, administrators, etc. These officers have an oak leaf insignia designating their profession, hence the Oak Leaf Club. The three of us from Naval Hospital Pensacola just received stockings and gifts from the Oak Leaf Club; the stockings were made and filled by a senior group in Milton, FL. We are touched and thrilled to be remembered at this time of year, 7000 miles from home. THANKS from Don, Todd and myself.

Humanitarian aid/ugottabekidding

Shown is the Navy medical embedded training team (plus one airman) loading brand-new backpacks with school supplies and toys for local students. The kids are on their long break now; they take the winter off so they don't have to heat the schools. They resume in February. So, assembly-line fashion, we loaded them with notebooks, pens, pencils, crayons, scissors, erasers and toys. The backpacks bear the Afghanistan flag. A very conservative guess would be at least 4000 backpacks.

On a humorous(?) note, our team received an email soliciting interest in extending one's deployment for and extra 9 months. Back home, the Bureau of Medicine for the Navy is firming up plans for our replacements. They would have to be selected within the next 4 months to allow lead time for training and the deployment. We've been here only 3 months and would normally head home August '08. They want volunteers to stay through May '09. I am unaware of anyone interested: Normal Navy deployments, even ones of our kind, usually last 6 months or so. We are here for a year and total time will be 15 months when you include mobilization in Norfolk, training in Kansas and the redeployment procedures home. 9 more months would mean a total of two years with the Army. I look forward to getting back to Pensacola and seeing my family.

On a clear day

With the snow and the wet ground, the dust has settled for the first time. I marvelled at the glorious views this morning and took about 20 pictures. Shown is a mountain to the west of our compound (you can see the tops of the B huts) and a range to the east looking from the front of the hospital. Yes, people live out there, herding sheep and goats, and growing a few vegetables with well water.

It was low 20's this morning and warmed up to about 60 in midafternoon.

Operation Care Package

A great surprise! The nice people at Operation Care Package (operationcarepackage.org) sent me a wonderful, ummmmm, care package! Greeting cards, a pocket electronic sudoku, a Christmas jazz CD, batteries, socks, and goodies, goodies, goodies. Thanks! A special thanks to the Dewalds in Virginia, and Tiffany of Girl Scout Troop 1073 in Illinois. I am here 7000 miles away from home and you made my holidays so much better. Shown are some of the included greetings. Merry Christmas, God bless your efforts and thanks!

Snow!

It does happen every once in a while here. Wet snow coming down today just a few days after an honest-to-goodness rainstorm. No thunder or lightning. That's snow on our small holiday tree. Gets us all in the holiday spirit as we look forward to Santa in his up-armored Humvee and his 8 flying camels Ahmed, Ibrahim, Ashmed, Ismail, Aziz, Dilbar, Miraj and Reza (the red-nosed camel). Locals tell us that this is the heaviest snow they have ever seen, about 4 inches.

3 months

Yesterday marked 92 days "BOG"-boots on ground. We arrived at Manas Air Force Base in Bishkek, Kyrgyzstan on 29 August, officially entering the CZ, combat zone, and started the clock for one year here. Since we are coming up on a leap year, we could be here 366 days although most get out before the full year is up. Anywho, we are at least 25% of the way through. We do have a small observance of each 50 days here, so we will hold a cigar party on an observation point next Friday, 7 December to mark 100 days in country. It's Pearl Harbor Day as well, but that is not something the Navy celebrates.

Rain!

I have been "in country" for 13 weeks as of tomorrow. No rain that entire time. Indeed, sometimes several days without a cloud in the sky. We've had a few broken overcasts over the last few weeks, but today looked dark. Finally, just after sunset we got a light rain. Not enough to grow crops but at least the dust will settle.

The picture shows the moonset over the mountains with clouds a few days ago.

OPERATION GRATITUDE-THANKS!!!

Just about all of us received a "care package" from Operation Gratitude out of Encino, CA. Thank you so much!!! There are several sailors/soldiers/airmen here who get very little from home, so this is so generous. Lots of goodies, like lotions, candy, Girl Scout Cookies, greeting cards, magazines, lip balm, a Marine Corps Mr. Potato Head, popcorn, energy bars, a microphone/headset and playing cards. Wow! The best to you all and thanks for remembering a small corner of Afghanistan.

Return of the Mongolians

A contingent from Mongolia has arrived to help out. More irony. Genghis Khan and the Mongolians invaded about 800 years ago (along with about everyone else in history). However, this time no pillaging and burning; rather, building and helping. Welcome!

Fall Festival

To preserve our sanity, we have a volunteer MWR, Morale-Welfare-Recreation, committee. Today is the big event of the fall, the Fall Festival. Individual events like horseshoes, free throw shooting, football toss, and bob for the most apples in 1 minute. That's Army Specialist Dollinger showing her excellent technique. Team event: volley ball, won by a group of our interpreters (they have way too much free time). Also, as shown, get your picture with a camel! We will end the day with a raffle for a Play Station Personal and a 4 GB iPod.

Happy Thanksgiving

Deployed American forces all over the world generally get a great dinner today. We're no exception: ham, turkey, prime rib, boiled shrimp, 3 kinds of hand-dipped ice cream, 3 kinds of cake, and "red" and "white" sparkling grape juice. No wine in deference to our Muslim hosts.

Being 9.5 hours ahead of EST, it's tough watching football. Noon games don't start until 9:30 PM here. Best of luck to the Lions and Happy Thanksgiving to all.

Feeding Frenzy

One of our medical corpsman has contacted various websites that support the military. As a result, we get boxes of goodies at least weekly. He brings these to our team meetings so we can pick out treats and useful toiletries. We recently received surplus Halloween candy and Girl Scout cookies, more than would be healthy. I brought a bunch to morning report at the hospital since they love getting anything from the US, even cheap pens provided by the pharmaceutical representatives. I gave it to the Deputy Director of the hospital who was leading the meeting and he "distributed" it after the meeting. Cookies were put out on dishes and grabbed 4 at a time. Candies were picked over quickly. Shown is several staff members, docs and nurses alike, going after the remains. They are very appreciative and thank us and those at home for brightening their day.

Irony

We learned much about the history of Afghanistan during our training. This country has seen the likes of Alexander the Great and Genghis Khan. The British fought 3 wars with Afghanistan and created the modern boundaries: it was a buffer between British India and Russia. Most of you are familiar with the Soviet Union's invasion of the country from 1979 to 1989. The US supported the insurgent mujaheddin and the Soviets left after a 10 year struggle. The Soviet Union disintegrated soon after. The people we have met still speak unkindly of the Russians. Lo and behold, we saw the truck in the attached picture; a gift from the Russian people to help the Afghans. 2 ambulances on the Afghan Army base are also Russian. It makes sense to send equipment rather than people, since Russian mentors might become targets of natives with long memories. Strange bedfellows.

Associate Professor!

When I retired from Wayne State University to join the Navy in May of 2006, I requested to remain on the volunteer faculty. As a result, we have had a medical student from WSU spend a rotation at our training program at the Naval Hospital, Pensacola. The Department of Family Medicine and Public Health Sciences just notified me of promotion from Assistant to Associate Professor. Thanks so much!

Greetings from the kids

One of our hutmates is an Army JAG (insert Army lawyer joke here). The grade school attended by his older daughter sent hand made posters for all of us. Thanks guys for your support!

I also intercepted an email from my home command, the Naval Hospital at Pensacola. NHP is a small hospital with a typical daily census of 25 inpatients. Despite the small size, there are 100 deployed from the command like me. The intercepted email concerned the organizing care packages for all of us, all 100! The support is wonderful and appreciated.

Needs help

This young man is about 40 inches tall and weighs 36 pounds. A typical 4 year old except he is eight. He began with stomach problems 4 years ago and a scope showed varicose veins in the esophagus. This is typically seen with end-stage liver disease, so that was evaluated. He does have a bad liver but has only had one type of hepatitis test. I recommended other tests and to check his blood count. It was quite low so we gave him a transfusion before he went.

He needs testing beyond what he can get here, including a liver biopsy. I believe he will benefit from a liver transplant, but that is not available either. God bless this brave boy.

Dust storm

It looked alot like fog and it was a cool morning. However, it did not dissipate with the day and outdoor objects got a very fine layer of grit.
We are taking care of a 24 year old soldier who passed out in his barracks. He arrived conscious but a very slow heart rate. I suggested thyroid tests; the hospital is out of reagents to do this. I asked for cardiac enzymes; no dice. We did serial EKG's, just like the old days. Looks like he had a small heart attack. Did I mention he's 24? So now we are going through a laborious process of getting him 500 miles to Kabul where they can evaluate him and give him a pacemaker if needed.

Haircut/Internet

We seem to have functioning private Internet now. We have better speeds from the dish and managed to get the wireless up and running after a couple of days. Thanks especially to IT1 Lee! Shown is one of our docs, Larry, up on a Hesco wall with the satellite dish.
One of the Army Chief Warrant Officers offers free haircuts in our barber shop. I was due. I asked just for a side trim, but I got an Army haircut. It will grow back.

Internet up but slow/ Happy Birthday Marine Corps

The satellite dish and Internet connection were established after several hours of physical labor and phone calls. I am posting this sitting in our B-hut. We are getting download speeds of 10-60 Kbps; fine if I'm the only one using it, but we plan to have a wireless network of at least 14 subscribers to keep the cost down. The ISP promises to make it better or take it away if they can't. The speeds at the free MWR were much worse than even these speeds (<1 Kbps frequently) but we are trying to keep the cost below $100/month per person.

Today is the 232nd birthday of the Marine Corps. Their original purpose was close-quarters combat in naval battles. They were reinvented between the world wars for coastal assaults, which were critical in the Pacific during WWII. They were also the first Americans to land on foreign soil, the "Shores of Tripoli", when subduing the Barbary Pirates of the northern Africa coast. A good read on this first war with Muslim terrorists in the early 19th century is Mr. Jefferson's War.

Pictured is what happens when you work out with the Marines. That's a joke! It's actually the Halloween witch sent by the mom of one of our docs. She has a motion sensor so her eyes light up and she cackles when someone walks close. Note she is wearing the regulation brown undershirt, which is FORBIDDEN by the base Army commander for working out. Our gentle jibe at an annoying edict.

Retry on internet

We attempted to bring in a private satellite Internet provider in September since the computers were always crowded at the Morale, Welfare and Recreation center (MWR) and the connects were as slow as 500 bps (not 500 K but 500 bits). One company had us up and running but the speeds were horrible. When we raised the issue, they said "Didn't you know that the 1 Mbps you are paying $1260 a month for is also shared with 19 other satellite dishes?". We had them remove it and give us a refund.
We had a UK based company come today and try the same setup. We are connected but the speeds aren't what we expect. They said it should improve within a few days. We hope so since MWR is going to be shut down starting 11/11 for about a week for reconstruction. In other words, if the private provider doesn't work, we will all be offline for about a week. Here's hoping!

New construction

While in training over the summer, I read a list of recommendations by T. E. Lawrence, Lawrence of Arabia. He recommended that in the long run, it was better that the Arabs do a job passably than the English do it for them perfectly. This has been one of our guiding principles. After 35 years of coups, Soviets, civil war, al Qaeda and Taliban, there are few occupational traditions here other than herding and opium poppies. At the same time, we, the mentors, are temporary. So, as a spur to the economy and some OJT (on the job training), most of our contruction is done by the locals. Their methods are "creative" as you can see. My father in law will shake his head when he sees these; he was in construction for many years and set very high standards. The geology and weather here are pretty stable, so I don't think anything will fall down.

Yuck.

I have seen a couple of cases of vitamin deficiencies here, rickets and pellagra (vitamin D and niacin respectively). So, getting vitamins here is important. A common one for kids is a liver extract (the "cod liver oil" of infamy in the old US). The picture shows one meant for strengthening the blood with protein and iron. It is literally "hemoglobin syrup" and lists hemoglobin as the key component. That is 90% of the content of red blood cells, so this is a blood extract. I was informed that it tastes as bad as you might imagine.

Media Star

We had a "super med cap" back in September when 2800 villagers were brought to the ANA base and received health care and humanitarian aid. The Armed Forces Network did some video taping and a brief clip of "moi" showed up on the Armed Forces TV channels here. We haven't been able to track it down, but our public affairs guy thought it looked good. Photos of the same event also showed up in The Phoenix Patriot, a monthly glossy publication out of Camp Phoenix, our HQ in Kabul. I'm shown checking the throat of a child. You can look it up at www.taskforcephoenix.com/phnxpat.htm in edition 11. You may have to wait a month or two for it to actually get online.

I am also in edition 9 of the Patriot; it hasn't been published yet either but you can check back.

Today (Monday, 11/5), many of us made videotaped greetings for the folks and TV stations back home. This is a service provided by DVIDS, the digital video imagery distribution system. The link is below and the clip of me should be online within a few days or so. If you see it, please download/save it and send it on to me. Thanks!

www.dvidshub.net/?script=video/video_list.php&base=Greetings

More Army Humor/hyperthyroid

Army calls them latrines; Navy calls them heads. We jokingly claim that the cushy Air Force types use "powder rooms". Mainly, we are using conex boxes, aka shipping containers converted to restrooms and showers. Shown is one used by the clinic here. Since it is a bit away from the rest of the camp, they decided to make it coed. As shown, space aliens are welcome too.

The boy shown was described by his soldier father yesterday as "eating all the time" but remaining quite skinny. We asked the dad to bring him in and his photo is attached. Note the wide open, almost popeyed appearance; medical term is exophthalmus. Clearly, he has an overactive thyroid. We will get him tested and it is quite treatable. Here we must also consider parasites and tuberculosis, but my money is on the thyroid. We don't normally see this obvious presentation in the US since patients come in long before they get this far. He has likely been symptomatic for a year.

Mmmmm, Non!

Also known as Afghani bread. The bakery is out back of the hospital in a shack. The ovens are shaped like 4 foot high hollow beehives. Wood fires are built in the base to heat the "hive". Meanwhile, the bakers pound out what looks like small pizza doughs of about 10 inches. They then pound the dough with a studded stone to make regular indentations. The flattened dough is put on a special pillow. The baker sticks his hand holding the pillow very quickly into the oven and slaps the dough against the vertical inside of the oven where the dough cooks quickly. Another baker snatches the baked bread with a long tool and stacks them for use. Most are eaten within an hour of baking. Quite tasty and would be an entertaining enterprise in the US.

Panj Aban 1386

Today's date in the Persian calendar, or the fifth day of the eighth month in the year 1386. This is based on calculations by Islamic scholars. The year starts on the midnight closest to the vernal equinox and is 365 days with 8 leap years every 33 years. This is more accurate than the more prevalent Gregorian calendar we all use. The origin of the year numbering is the year that Mohammad made the Hegira, or journey, from Mecca to Medina. The religion of Islam did not grow until he arrived in Medina and within 100 years after that Islam dominated most of north Africa and the Middle East into southwest Asia.

Today's Dari words are days of the week. The week starts on Friday, their day of worship and is Jumaa. The rest of the week includes the name Shanbah. Saturday is Shanbah, Sunday is Yakshanbah (literally one-shanbah), dushanbah (du=2), sayshanbah (say=3), chardshanbah and panjshanbah. Thursday or panjshanbah is the start of their "weekend" and time off, so TGIP!

MasCas

As in "mass casualty". We staged a sudden influx of patients to the ER at the Army hospital and monitored their response. They have done this in the past and today's performance was impressive!

We brought in a combination of injured and ill patients like a penetrating chest wound and a heart attack. Generally quite well handled. This is similar to disaster drills at US hospitals where a mock disaster like a plane crash is staged. In the US, this will also involve police, EMS and local government; ours was focused on the hospital. One notable difference in procedures: each patient was checked for weapons and explosives by soldiers before we touched them. This is a peaceful part of Afghanistan but we always take precautions. A couple of mock patients hid rocks in their clothes as fake grenades.

The drill was in the morning and the critique ("after action report" in armyspeak) was in the afternoon. All agreed it was quite useful.

Kute Kids

As I mentioned in earlier posts, life expectancy is only about 45 in Afghanistan. This is mainly due to high infant and child mortality. 1/3 of children do not make it to age 5. Part of our mission is to help turn this around. We expect a massive amount of vaccines soon and will help set up vaccine programs. Case in point: one of our patients is just recovering from polio. He is recovering fully but could have ended up paraplegic for want of 4 shots.
So, every family plans on lots of kids. Shown are a couple of the soldiers kids. The boy is just visiting his daddy for the day. The heart-melting girl has a small swelling in her neck and has been losing weight despite a good appetite. Docs reading this are sagely nodding their heads thinking "thyroglossal duct cyst". We will get some labs and then one of the surgeons will remove the cyst. She should be cured. What a doll!
I tend to underestimate the age of children (the boy looks 8 and is 12, the girl looks 3 and is 5) since they are smaller than US kids and mature later. On the other hand, the desert climate makes adults look older than they are. I frequently overestimate their ages by 10 years.

Skull fractures

With the end of Ramadan last week came the 3 days of Eid al Fitr. This celebrates the end of the month of fasting. Quite festive with lots of eating, visiting and showing off new clothes. Many of the soldiers were given leave to see family. Many returned in ambulances due to rollover accidents. Typically, not wearing seat belts. Also riding in the open beds of pickups. Also not wearing helmets when appropriate. Also, not the best roads. The rollovers are attributed more to hurrying to get back rather than recklessness. Also, alcohol is forbidden so the only possible drugs used would be illegal ones. Hashish and opium are rampant in Afghanistan.
The photo shows a skull fracture, the dark line down the middle. This fellow is actually doing quite well. Awake, oriented, moving everything. Others: one has a paralyzed left arm; one needs his face surgically realigned; one almost died but we stabilized him and got him off to a neurosurgeon but with a very poor prognosis (fixed pupils and abnormal reflexes indicating brain damage).
The next Eid holiday is for the annual Hajj pilgrimage in mid December. The Hajj is a once in a lifetime event but everyone enjoys the holiday. We've been warned that we should expect more motor vehicle accidents.
We also saw assorted broken bones. I will recommend a surgeon mentor for next year. Oddly, the only double fracture we saw was a soccer player. Another player fell on him and broke his thigh and shin! He will recover just fine.

Care Package from Pensacola

Many thanks to CDR Mark Duncan and CAPT Cary Ostergaard for their thoughtful surprise package to help make my deployment pleasant. They sent all kinds of goodies including some items I had requested from home. I now have a camp stool for my hootch, a couple of lab coats for hospital rounds (helps hide the Beretta), a Michigan mug to irritate the Ohio State fans around here, Jelly Bellies, bubble gum, a few cigars, a bag of pistachios, "etc". I had a cigar last night to celebrate passing the 50-day mark in country. All my thanks and best wishes to the Department of Family Medicine at the Naval Hospital Pensacola. A special thanks to CDR Duncan for checking on my "stuff" and CAPT Ostergaard and LT Murray for giving my wife calls to see if there is anything she needs. What a great family the Navy is.

'Terp lunch

We work with several interpreters who translate back and forth between English and Dari (a version of Farsi or Persian). They are relatively well paid for their skills and can apply for visas to the US after 3 years of work. They enjoy the work and like learning about the US.

They live in a "terp" village tucked between the Afghan army base and the coalition compound. Now that Ramadan is over, they can have lunch (they must fast during daylight during Ramadan) in the village, which is provided as a benefit. We get invited to join them on a regular basis, so I took advantage of this the other day. The lunch is rice with raisins and a bit of oil on it for flavor (very good); a meat stew, usually beef or lamb; their version of fries, which are bean sized; fruit, a bit of salad; a soda; and their delicious bread. The bread is flattened dough thrown against the vertical side of a wood-burning oven. Looks like a giant flatbread and tastes like a soft matzoh. Really tasty when it's hot out of the oven.

Happy 232nd Birthday Navy!

The Continental Congress approved the construction of the first frigate and formation of the US Navy on October 13, 1775. Having recently observed the Air Force 60th anniversary, we wanted appropriate celebration. We formed up in the parade area for a picture (I'm in the second row between the two middle flags) and singing Anchors Aweigh. One line is "Roll out the TNT"; we like to shout BOOM after TNT, but one of our commanders was able to generate a firecracker boom at just the right moment. We also had a reading of the birthday message from the new CNO. You can read the message at www.navy.mil/search/display.asp?story_id=32488.

The cake cutting is traditionally done by the youngest and oldest sailor at the command; yes, that's me next to a 21 year old enlisted.

Posted by LCDR Bruce at 5:59 AM



2 comments:
Roy & Paula said...
OK, two comments.

First, did you end the singing of Anchors Aweigh properly? Namely, BEAT ARMY!!!!?

Secondly, you should send the Navy Birthday picture to Navy Times or Stars and Stripes, or both.

-- Roy



October 14, 2007 1:04 PM
LCDR Bruce said...
We were told to NOT antagonize our Army colleagues. We did the general version, not the USNA version.

Our public affairs officer will submit to the publications, but I think I might submit to Headline News since they show pictures from the troops.

October 15, 2007 8:18 AM

Mmmmm, coffee!

Afghanistan is a Muslim country with the full proper name of The Islamic Republic of Afghanistan. As such, they avoid alcohol. The US command has banned alcohol consumption by any US military. Caffeine is OK so we like our coffee, tea and colas. The coffee provided by the dining facility is barely passable, so we have invested in better technologies.

The building shown is a pizzeria put up by our Italian contingent before we got here. It's actually one of our plywood B-huts, but they put a nice brick veneer on it to give it a more European look. It also has a nice flat screen TV for music videos or sports. The Navy people have made Friday night pizza night. I had prosciutto e funghi last night (basically ham and mushrooms).

Well! One recent addition to the pizzeria has been the espresso bar shown here. We can have an espresso or cappuccino for about 75 cents. I am having a cappuccino as I write this and am munching on a chocolate cornetto (croissant). Grazie a Dio per Italia!

The last picture is our hut's informal coffee bar. A few of our guys purchased coffee makers that can run on the 220 volts supplied here and others of us purchased good quality ground and bean coffee and biscotti. So yesterday morning we held our kick-off of Friday morning coffee club (Friday is our day off).

So, you can see how we are roughing it here. Nice way to start the day.

Px/Ship Store