Day 310: 1000 Patients

Back at my clinic in Fallon it would take all of our providers about a month to collectively see a thousand patients. Well, today a group of doctors, nurses, and medics from the US, Afghanistan, Italy and Slovenia accomplished in just a few hours what would take weeks of effort back home--we saw and treated 1000 patients.

Today kicked off a new era in our mentoring mission here in western Afghanistan as we performed our first ever US led medical humanitarian assistance mission in the region. Our goal was simple...go to a remote village in outer Herat and see as many patients as we possibly could in a single afternoon. After driving down bumpy, dusty, dirt roads for nearly 2 hours we arrived at our venue. It was a school on the outskirts of a large village where hundreds of people had gathered in anticipation of our arrival.

After setting up some security, we got busy doing what we were there to do--see patients. On one side of the school we gathered the women and on the other side we lined up the men. Children were mostly with the women, but some made it over to the male side where I had set up shop. One by one the patients came up to be seen (okay, who are we kidding, it wasn’t that orderly...imagine Walmart on the day after Thanksgiving). At times it was pretty crazy. We had only about 8 or 9 medical providers and even fewer interpreters. The Afghan army with the aid of some of the coalition guarded the perimeter and helped with crowd control.

As I saw patients, I was struck by how lucky we are to have good medical care back home. Most of these people had common complaints...headaches, arthritis, stomach ache, and sore throats. For these people it was pretty easy to give them a few medicines and send them on their way knowing that what we had given them would be very helpful for them. Other patients were more complicated. We saw patients with epilepsy, developmental problems, birth defects, amputations, suspected heart disease, etc. Unfortunately, there was little we could do with these patients. We referred them to their public health hospital (knowing that they probably couldn’t do much for them either), gave them some vitamins or tylenol and sent them back home. It was frustrating to know that many of the patient’s conditions would be easily treated back home, but here nothing could be done for them. I saw several people, including both children and adults, who probably will not live long due to their conditions. Again, it was frustrating to feel so helpless, but the reality is that there is really nothing you can do given the lack of resources in the country.

My favorite patient of the day was a five year old boy with skeletal dysplasia (I’m not sure of the politically correct non-medical term these days, but essentially he was a midget). This kid was tiny. My little Eden back home was twice as big as this little guy...which says a lot if you know Eden. He was very cute. You would never guess that this kid could talk. But he could understand and respond even to my broken Dari. The cutest thing about this kid was that every 20-30 seconds he would smile, stick out his hand to shake mine, and then in his little “munchkin” voice say “hi”. Hard to really convey the experience in words, but honestly it was a heart warming encounter.

After 4 or 5 hours we had finished seeing all of the patients we had come to treat. So we jumped back in our vehicles and headed back home to Camp Stone. It was a good day. Hopefully some of the people we saw benefited from the care we provided. Hopefully it helped convince the people in the village that the Americans, Slovenians, and Italians were there to help them and their country. Hopefully it helped make the Afghan army a little stronger and a little more legitimate in the eyes of the Afghan people.

1000 patients...wow, I don’t think I can ever complain about a “full schedule” back home again.

Day 307: All Around the World

One of the most rewarding parts of this deployment is the interaction I have with people from many different countries and many different backgrounds. Daily at Camp Stone, I work with, eat with, and play basketball with people from Italy, Spain, Afghanistan, New Zealand, and Slovenia (well maybe I don’t play ball every single day). Luckily most of them speak a little English which facilitates our ability to communicate. It is interesting to see the differences between us but also neat to see how similar people from all over the world really are.

Today was again one of these culturally diverse days as I met with three other people for church services who come from completely different backgrounds. First, was my regular church companion Roberto. Roberto was born in Nicaragua but has lived in the US for most of his life and became a citizen around 2001. He speaks perfect English and is obviously also fluent in Spanish. He is an engineer working with an international aid agency here in Herat. Second, was Radek, a member of Eupol (European Police) from the Czech Republic. He was baptized into my faith in 2003 while back in his home country. He and I were introduced earlier this week and luckily he was able to make arrangements to come to Camp Stone today for Church. Finally, we had Alfonso, who is a Spanish citizen and who works closely with Radek in the police mission. Although Alfonso isn’t a member of our Church, he was willing to come join with us for a quick Sacrament meeting this afternoon.

It was fun to have different conversations bouncing back and forth with English being mixed in with some Spanish. I even learned a little Czech (Ajot...pronounced Ahoy...it means hello...or goodbye).

One thing I am reminded of frequently here in Afghanistan is the goodness of people throughout all the world. Sometimes we get so America-centric that we forget just how many amazing people and cultures are found on this Earth. Despite the differences in our languages, cultures, religions, and appearances, we are all brothers and sisters, children of the same Maker, and consequently our similarities bind us together in ways that our differences, no matter how great they appear, can ever overcome. I am grateful for moments like today that remind me of this important fact.

Ajot! Adios! Ciao! Later dudes!

Day 304: Happy Birthday Ammon Boy!

Today is Ammon’s second birthday. If all goes as I hope, this will be the last family member’s birthday I will miss due to this deployment. If the stars align just right, I should make it home for Abbie’s birthday in April, when I take my mid-tour leave, and then for Ellie’s in August when this deployment finally comes to an end.

So today, I will unfortunately have to miss the celebration back home as my big guy transitions from the one year-old stage to the wild and crazy two year-old stage. Ammon, probably more than anyone else in my family, has changed during this past year. I look at the pictures of when I left and compare them to what I see over the webcam now and I am amazed at how much he has grown up. I love to hear the new words he has discovered. I love to watch him play with his big sisters. I love that he is a mama’s boy and wants to always climb up on Sue’s lap. I can’t wait to get home to start his basketball training--although, maybe football would better suit the big guy.

Ammon--happy birthday, pal. I can’t wait to see you next month. I love you and I miss you!

Day 301: Happy New Year...Again?

So I know you are thinking it is a few months late to be writing about the New Year. Trust me, I am not trying to start 2009 over again. I am the last person who would purposely rewind the clock 3 months and add more time to this 452 day odyssey. However, today really was New Year’s Day...at least for the Afghans.

The Muslim World uses a calendar based on the migration of the prophet Mohammad from Mecca to Medina in 622 AD. Consequently, today started the year 1388 in Afghanistan. Because it was an Afghan holiday and everyone was out partying, we spent the day getting some admin. work done in the office. Honestly, for me, it was just another typical day. Here are three of the highlights:

First, I arranged for $3000 to be spent to build the first Afghan National Police “hospital” in Western Afghanistan. $3K for a hospital...talk about a bargain. Maybe I ought to go into real estate. Actually, the “$3K hospital” is a long story. I will explain it in more detail on another day.

Secondly, I transferred 100-plus first aid bags from one part of Camp Stone to another. This actually has become one of my most common past-times--moving supplies around the camp. If the real estate agent thing mentioned above doesn’t work out, maybe I could look into becoming a professional mover.

Finally, this evening while I was talking to Sue, I was called by my boss to help find some emergency medical supplies to be sent to one of our downrange locations. When I arrived on the scene and started gathering the needed supplies, I found that one of the “emergency medications” was ear wax removal drops. Emergency ear wax removal--yet another first here in Afghanistan.

So as you can tell the year 1388 started off with a bang for me. It is always promising when the first day of the year is filled with so many successes and accomplishments. If I can get this much done on the first day of the year, just imagine what I am going to be able to accomplish in the 150 some odd days of the year 1388 that I have left in this journey! Happy New Years everyone.

By the way, the picture posted here was taken today with a group of the medical folk who work with me here at Camp Stone. As I’m sure you can imagine, it was tough to break away from my busy schedule to find the time to pose for this picture.

Day 300: The Refugee Camp

It is easy in life to forget how blessed we really our. Despite recession and financial hardships in our current economy, as Americans, we generally have enough money to feed our families, live in nice homes, drive around in cars, and go on an occasional vacation. Being here in Afghanistan has reminded me that many of the things I consider essentials (electricity, plumbing, health care, a roof over my head, etc.) are luxuries to a large percentage of the people of the world. It is so easy to get focused on ourselves and our financial concerns that we forget how little some of our brothers and sisters across the world have.

Yesterday, I was reminded again of this as I went out on humanitarian assistance mission to an outlying Herati village. These poor people were living in a “refugee camp” after being displaced from their homes in the north due to conflict and war. Our mission was to deliver some flour, rice, clothes, coal and stoves to these poor people. My job on this mission was to scout out the site for a potential medical assistance project in the future.

As we pulled up to this mud-hut village and watched the people flock towards us, I was humbled by seeing them and the conditions in which they live. They were obviously poor. Some had shoes...some didn’t. Many of their clothes seemed worn. Most were thin. Some of the older people were hunched over and seemed to be just barely limping along--I can only imagine the years of hardship they have endured. I didn’t see even one person walk out listening to their new iPod or talking on their Blackberry. None of them were driving BMW’s, or any car for that that matter. I did see a few bicycles.

Despite their obvious poverty, I was touched by their seeming happiness. I watched kids running around playing...oblivious to the fact that they didn’t have a Wii waiting for them back home. People smiled. They seemed grateful for the assistance they were being given.

Now don’t get me wrong, I don’t think there is anything wrong with having a few of the “luxuries” of life--I have more than my fair share of them. However, I think it is important to remember and help those who haven’t been blessed to the same extent that we have. I am grateful to so many of you for the donations and support you gave this past winter for our “Afghanistan service project.” Your donations will help people like this enjoy a little more dignity, will help them stay warm, and will help their children to gain an education.

Life is much more than the possessions we acquire in this life. It is about learning, growing, and loving others. Some will be rich in this life...some will be poor. It matters less what we have, then what we do with what we have been blessed with--whether that be a little or a lot. I am grateful for days like yesterday that remind me of these important truths.

Day 298: Happy Birthday Eden

In the afternoon of March 18, 2005 our little Eden was born. I remember the day well. I was on call. Sue had gone in that morning for her regular prenatal appointment. Her doctor, Dr. Roman, decided to send her up to labor and delivery “to have a baby” rather than send her home--much to Sue’s delight. A few hours later, with the aid of a little medication and a few pushes, Eden became a part of our family.

Four years later, this precious little baby has grown up (a little at least) to become our little “Eedie Beedie” (not sure how to spell that one). I have never seen such a cute, fun, happy, and helpful four year old girl packaged up into such a little body. I love looking at these four pictures. Each one shows her on each of the previous March 18th’s in her life. She is a great sister, mommy’s little buddy, an always excited preschooler, and a reverent little Sunbeam. How blessed we are to have her in our family. How grateful I am to be her father.

Eden, happy birthday! I love you! I miss you!

P.S. Have an extra piece of cake for your daddy.

Day 296: The Mysterious Meatball

Last night I had an interpreter I occasionally work with call me with a concern about his brother. He told me that he had “a meatball growing under his tongue.” Now I have seen a few interesting things during my short medical career. However, I have yet to see a meatball growing in someone’s mouth. So I told him to bring him on base so that I could take a look at it.

Today when he arrived, sure enough, he had something growing in his mouth. The picture above shows the specimen right beneath his tongue. It was a pretty large cyst that was growing rapidly and pushing his tongue out of its normal position. Although large, it looked very benign. So what did I do with it? Well, like all meatballs, it required that I investigate to find out what it was made of. So I took a knife and cut it open. It oozed and oozed and then oozed some more. Honestly, it was a fun little procedure and rewarding to watch it slowly disappear. It is the kind of sick thing that only a doctor can enjoy.

So there you have it. The case of the mysterious “meatball” is now solved. Anyone hungry?

Day 293: Friday the 13th

I’m not really superstitious. Black cats, walking under ladders, opening umbrellas indoors, standing under mistletoe...these things don’t really cause me much anxiety. As far as Friday the 13th is concerned, I associate this more with some scary dude with a mask terrorizing the neighborhood than I do with a day that might bring me bad luck (is it the guy with the mask or is it a guy with knives for fingers...obviously I have never seen the movie). The bottom line is when it comes to days like today, I don’t believe that it is more or less lucky than any other day of the year.

However, since I am deployed to a war zone, I figured now would be a good opportunity to do a little scientific experiment. If anything bad were going to happen around here, today would be a good day for it. So I decided to make a mental note of everything that happened today and look for signs that the curse of Friday the 13th was upon us. Here is a summary of what happened and my impression of whether the event represented good luck or bad luck.

1) I woke up at 6:30 this morning not having woken even one time to get up and go to the bathroom...GOOD LUCK.
2) I had a nice phone call with my parents and then with Sue to start the day off. In fact I even talked to Sue twice before 8AM...GREAT LUCK.
3) I ran four miles in 29 minutes and 15 seconds--my second fastest time this year...tiring but GOOD LUCK.
4) My Afghan counterpart who is the regional medical director called me and wanted to meet with me today. When he arrived he listed four or five projects he was starting, on his own initiative, and explained how he planned to carry them out...AMAZING, UNHEARD OF, IT MUST HAVE BEEN A DREAM.
5) It was Mexican food day at the dining facility...always GOOD LUCK when this happens.
6) I had a nice Sacrament meeting with my fellow LDS colleague Roberto...GOOD LUCK.
7) I played a good hour of basketball leading my team to victory with several key shots and plays...Some would call this GOOD LUCK but I prefer to call it SKILL.
8) I was asked to go see the intubated, head trauma, ICU patient that is over at the ANA hospital while the usual physician mentor is away. The patient is still alive...GOOD LUCK.
9) The ice cream available at dinner was only vanilla and strawberry instead of mint chocolate chip or Oreo. This made it easy to resist and allowed my “No Treat Tracker” to go up to 25...painful, but still GOOD LUCK.
10) The only time I spent in the bunker today was to take a quick picture to show you all what it looks like...GOOD LUCK.


So there you have it, this scientific data can now be added to the growing evidence that Friday the 13th is no different than any other day.

**Ironic addendum--just as I was finishing up this post, 4-5 incredibly loud blasts rocked the Camp. I thought for sure that we were under attack...something I have never experienced before. We ran to the bunkers really fast while smoke filled the air. My heart was pumping pretty good. I have to admit it was scary. When I finally made it to the bunker all I could think was, “wow I guess Friday the 13th really is a cursed day...I never should have written that post”. It turned out however, that the explosions were only a part of a carefully orchestrated drill. So I will stick to my original observation that Friday the 13th truly isn’t a lucky day!

Day 288: My House in Shouz

I've been spending the last few days near a small village called Shouz (rhymes with house if you are wondering how to pronounce it). We are in the midst of yet another ANP medical inprocessing event. It actually has been a very nice event--for a number of different reasons. First, it has given me the opportunity to escape Camp Stone for a few days. Second, I have had my own private room, wireless internet, and lots of quiet. Third, I don't get any work email access down here and my cell phone doesn't work...meaning no one back at Stone or in Kabul can get a hold of me and ask me to do any busy work for them. Fourth, I am able to work with some good Afghan doctors and meet some interesting students. Fifth, I am able to play an occasional game of combat basketball.

The students we are inprocessing now are actually not from our region. Instead they are from the southern provinces of Kandahar and Helmand. These are pretty dangerous areas (lots of Taliban) and it has been interesting, and sobering, to hear of some of their experiences. The recruits have told me stories of friends and family members who have been tortured, burned, and even killed. I can't count how many of these guys have showed me scars from when they were shot or hit by shrapnel. It is sad to think that for every one of these students I am interacting with today, there are undoubtedly many who didn't survive their run in with the enemy. These are very simple people. Most are uneducated. Most are poor and have no worldly possessions. Many are addicted to drugs. Hopefully this training and their subsequent police careers will provide them new opportunities to learn and progress. Hopefully their lives will be better because of it.

I also am seeing an occasional interesting patient...like the one pictured below with a large axillary (armpit) mass. These are the kinds of things you just don't see every day in the States.

Day 286: Combat Basketball

Sometimes you have to be creative to promote progress here in Afghanistan...sometimes you have to think "outside the box". Well today I was introduced to the creative vision and ingenuity of a group of soldiers in an isolated base several hours south of Herat. These guys didn't have access to a basketball court. So rather than accept the fact that they couldn't play ball for a year, they decided to take matters into their own hands. They took an old bedframe, some welding equipment, and before you knew it they had a basketball hoop. One of my fellow Navy guys and I were the first ones to give it a try this afternoon. Overall it wasn't bad. The nice thing about playing on a hoop made out of a bedframe is that you always have an excuse for that occasional "brick". It is harder to excuse away the air balls...not that I shot any of course. The other thing that makes "combat basketball", as we called it, interesting, is the razor wire that surrounds the court. It makes you think twice before diving for that loose ball.

Day 284: Springtime in Herat

The other day as we left Camp Stone and drove into downtown Herat, it was surprising to see how green things are getting. We have had quite a bit of rain recently and now with some warmer weather, some vegetation is starting to spring up. Honestly, it is strange to see...as I have never seen anything but brown out here. I couldn’t take any pictures that day because I was driving. So today I decided to look around Camp Stone to find evidence that spring truly has arrived. It was a little difficult given that every square inch of ground is covered in rocks. However, finally, I found something green in a place I wouldn’t have suspected. On the tops of the sandbags that cover the bunkers there were just a few little green plants growing out. It is amazing how nature finds a way to survive even in the harshest of environments.

So today I am grateful for spring...for the warmth...for a little green...and for being one more season closer to going back home.

Day 281: "If You Didn't Find the Hair..."

My brother Jeff and I both served our Church missions in South America. I was in Argentina and he was across the river from me in Uruguay. Many times we would eat with members of our Church or other acquaintances in their homes. Generally the food was pretty good. However, sometimes the conditions in which it was prepared were just a little unsanitary. One phrase that was often heard on our mission was, “if you didn’t find the hair, you ate the hair.” Now don’t get me wrong, I am very grateful that these people, many of whom went day to day not knowing if they would have food to eat, shared their valuable resources with me. They were some of the most kind and generous people I have ever met. However, it doesn’t change the fact that sometimes eating in their homes was a little scary!

Well Afghanistan reminds me a lot of Argentina. These people, who have so little, are willing to share what little they do have with their guests. Afghans are the ultimate hosts and go out of their way to make you as comfortable as their circumstances allow. So today while I was visiting with our regional medical director at the provincial police headquarters, I wasn’t surprised when he insisted that we eat lunch with him. I have eaten in quite a few Afghan dining facilities before. However, never have I eaten in one that made me quite so worried about the trouble it would likely cause to my GI tract. Despite not always wanting to eat with the Afghans when they offer, it is hard to really say no to them...trust me I’ve tried. They really want to serve the Americans and share what they have with us. So we ate. Honestly, the food wasn’t that bad. We had some rice with raisins (I picked out the raisins), some flat bread (called naan), a meatball (I didn’t eat it but smashed it up so it looked like I tried it) and an orange for dessert. Five hours later I am still feeling pretty good...I’ll let you know how things go overnight.

Oh and by the way if you are wondering, I did find the hair...hopefully that means that I didn’t eat it!