Qalat

19th Century British Fortress at Qalat (taken from helo)

Qalat is the city (if that is the right word) adjacent to the base.  It sits in a valley at 5000 ft elevation, and lies along the road from Kandahar to Kabul.  It has a population of 10,000 and serves as the capital of Zabul province.  From a distance it appears to consist of mostly mud structures and tents.  What it might have as a core industry, I have no idea, except for the livestock that I can see from the base perimeter road.

Zabul province is within the Pashtun tribal region that extends into both Afghanistan and Pakistan.  The tribal region was split over a century ago in treaty forced on Afghanistan by the British.  The Durand Line was drawn to provide a buffer between the British and Russian sphere's of influence in Central Asia during the period of wrestling empires.  This line now serves as the frontier between Pakistan and Afghanistan.  Of course, little regard was apparently payed to the historic lands of the Pashtuns.  That fact along with the history of semi-autonomy explains why the weak Pakistani central government and nearly non-existent Afghani central government can't seem to control the area.  This helps explain the America's conundrum in meeting its objectives.

Most of the Taliban are Pashtuns but Pashtuns are not necessarily Taliban.  Still it is hard to know what they think about our presence.  Certainly the locals who work on base are friendly enough but I hardly assume that they are representative.  An army captain from one of the units here recounted an incident that occurred outside the wire.  He noticed some sheep straying from their herd so he tried to shoo them back.  His act resulted in a stone-pelting at the hands of some nearby teenagers.  I suspect that we have a ways to go to win their "hearts and minds."

Qalat 'burbs

First Casualties

It has been three days since the team officially relieved the in-place team of clinical responsibility.  They are on their way home now to well-deserved reunions, homecomings, and leave. 

August has been a slower month for casualties which most attributed to Ramadan.  However, things seemed to have changed.

Our first casualty had had a gunshot wound to the jaw.  He was still walking and relatively stable.  Unfortunately we were not able to get him a MEDEVAC to higher level of care for several days due to weather.  Then we treated an Afghan National Army (ANA) soldier who suffered an IED blast to the face.  His right eye had a penetrating wound and left eye globe was gone.

Yesterday there was another ANA soldier who was shot in the thigh.  The round pierced his femoral artery and vein and fractured his femur.  The tourniquet saved him in the field but when we loosened the tourniquet for surgical repair the bleeding started.  He went through 30 units of blood plus plasma.  The surgeons successfully placed a shunt between viable parts of the artery and sutured the bleeding veins.  The orthopedist was able to place the leg in traction.  The good news is that he survived to make the MEDEVAC to Kandahar.  The bad news is that our efforts could not save his leg.  He will face life as a high amputee in Afghanistan.

Any sense that there might be a period to settle in is gone.  It was a sobering reality. 

Flight Over Afghanistan

We flew a Dutch Chinook helo from KAF to FOB Lagman.  Convoying by road is dangerous, so I am told.  It is unfortunate that I didn't get a chance to lend my warrior training to the fight.  Oh well.

This trip will probably be my only view of the "real" Afghanistan.  Impressions:  rugged country, desert with scattered green areas, livestock being tended on foot, mountains without snow caps, sparse population.  We did get a view of a fortess reputed to be left by Alexander The Great about 2500 years ago.  Hopefully I will at least get more of a flavor of the country by interacting with the locals.

The team that we are relieving was quite happy to see us.

By the way, if you want to come visit us via a Dutch Chinook, contact your travel agent.

The Spectacle of Kandahar

It would be actually incorrect to say that I have seen Kandahar.  What I saw was the air field at Kandahar, or "KAF" as it is known, which is really a sprawling military installation.

It is hard to describe all of the sites and sounds of the place.  The air terminal was old, decaying and vaguely colonial.  It seemed like something out of a movie.  Whereas Kuwait was sandy, Kandahar was dusty and that dust covered everything.  The stench from the sewage "pond" could be overwhelming at times.  There was a maze of the tents, cargo boxes, plywood structures, trailers, and concrete barriers.  Large areas were fenced off as construction zones.  We were warned about procedures in case of the apparently frequent rocket attacks but none occurred during our brief stay.

There was activity everywhere.   It was a remarkable hodgepodge of American military units, NATO units, three-letter government agencies, and civilian contractors.  There are also many third country nationals from places like Bangladesh and the Philippines who perform much of the menial labor such as construction, food service, and cleaning.  There were compounds within the compound (Here's the Canadians, there are the Brits, down the road are the Dutch, etc) The roads were jammed with military vehicles, trucks, and some of the fleet of white SUV's.  The air field buzzed with all variety of military aircraft.    It all made one wonder how any one person or entity could have their thumb on all of these parts.

The hospital was brand new and, dare I say, nicer than the hospital that I came from back home.  It gave new credence to the saying that real estate is location, location, location.   I was glad to see it's fantastic trauma capability.

Everyone who passes through KAF hates the place.  Places you need to go are far away.  Accomodations are sparse.  Lines are terrible.  We spent the night in a 250 bed open-bay barracks for transient personnel.  It was as luxurious as you might imagine.  Just what was that smell?  Which leads to another truism.  Don't ask questions that you don't want to know the answer to....

Kuwait: 120 F. Nothing More To Say

The team arrived in Kuwait after a long night on a charter flight.  The breeze hit us as we stepped off the plane.  Kuwait is quite lovely in August, you never have to take a cold shower.  No sirree.  Hot showers for all.

I do have a suggestion for modifying the combat uniform in Kuwait:

Our stay was mercifully short. 

Ft. Dix: "Warrior" Training

The team spent one month at Ft. Dix, NJ undergoing basic combat training.  Ft. Dix is one of the locations where navy and air force units tasked with supplementing army missions are trained. 

Since we are 1. navy and 2. medical there is no doubt that some type of training is in order.  That said, given the "one size fits all" approach to training, I now get the movie MASH like never before.  The army told us repeatedly that the goal was to make us not sailors, airmen, or soldiers, but warriors...without the eagle feathers.

It was two weeks of useful training crammed into one month.  On one hand, we received some excellent briefs on Afghan culture, learned to shoot straight, talked on the radio, and generally acclimated to the army's method of doing business.

On the other hand, the army seemed bent on turning us into infantry.   So we conducted foot patrol tactics, shot machine guns, threw hand grenades, kicked in doors to take down a room, learned some hand-to-hand combat (God help me if I ever am reduced to relying on that!), and had a hard time taking a lot of it seriously.  At one point I found myself on a fire team with a transplant surgeon, a colorectal surgeon, and a critical care nurse which probably set the record for most over-trained, under-performing fire team in the history of grunts.

The Geneva convention actually bans medical personnel from conducting offensive operations.  Plus the army only issues us a 9mm pistol for personal protection.   One of our surgeons who has deployed several times put it all into perspective.  On his last deployment, he was told by the gunnery sergeant on a convoy "Unless the Taliban is physically dragging you out by your feet, you are not to shoot, load your weapon, or get out of the vehicle.  If you are the last man standing, then you can take charge.  Got it Doc?"

The army even scheduled us for their basic combat lifesaver course where grunts are taught how to put on a tourniquet, etc.  We threw a bit of a stink and managed to get out of this, but it begged the question "why".  However, if I have learned one thing in the military over 20 years, it is that asking such questions is akin to teaching a pig to sing.  It wastes your time and annoys the pig.

In any event, we made it through, are "certified" for theater operations, and headed down range.

The Mission of a Forward Surgical Team (FST)

We are a US Navy trauma surgery team brought together from naval hospitals world-wide to provide care for casualties, military and civilian, in the Afghanistan war.   We are supplementing Army Medicine in this mission.

Here is a decent summary of FST capabilities from Wikipedia:

http://en.wikipedia.org/wiki/Forward_Surgical_Teams

Our team members:

Officer-in-charge/colorectal surgeon, San Diego
Transplant surgeon, San Diego
Orthopedic surgeon, Bethesda, MD
Anesthesiologist, Camp LeJeune, NC
Nurse anesthetist, Portsmouth, VA
OR nurse, Pensacola FL
ER nurse, Yokoska, Japan
Critical care nurse, Rota Spain
Physician assistant, San Diego

Our  hospital corpsman come from Jacksonville, FL, Beaufort, SC, Bremerton, WA, Naples, Italy, San Diego, CA, Camp Pendleton, CA, Bethesda, MD.

FST Building at FOB Lagman