VMO

So, sometime in my recent past I was able to go on another village medical outreach about an hour from my new location. Turned out that it was a village surrounded by a refuge camp with approximately 12000 families. If you know anything about families in Afghanistan, that's like 10 dudes with 10 wives a piece and a few thousand kids running about the mine fields like no big deal! Anyway, two other PAs and I went out with SECFOR (security forces) with humanitarian goods and medical supplies for about 300-400 people. The three of us saw about 300 people in about 4 hours. This seems impossible but when you have a limited diversity of meds to treat acute illness and minimal else, you can really crank it out especially when you have 1 interpreter per provider. That really helps. We had people being carried in on backs, on wheel barrows and in sacks. There were illnesses reminiscent of biblical times. I found myself thinking of the stories in the bible about people bringing their sick to Jesus to be healed and there I was, watching this old haggard woman being carried in on the back of her dilapidated husband just to see me. How humbling! Unfortunately, there was little to do for her but give directions on how to seek further care either in the large public hospitals or in Pakistan. Right, like there's money for the trip! On my last VMO, I noticed a significant amount of arthritis in "older" meaning 40s and 50s around here. So, this time I came prepped. Alright!!! Something in my lane......injections! Thank God, get me away from this primary care crap and give me something I can fix! So, I came armed with multi vial cortisone for injection in did probably 10 injections, about 30 less than I thought I would. It's a way to really get some effect longer term, up to 6 months or a year if your lucky. Much better than giving a few tablet to last a few days. Among the other issues we saw: blindness, traumatic amputees looking for prosthetics, dry skin....go figure....thank God vaseline is cheap over here. I can't seem to get them to understand dry skin. Imagine that! Others...club feet and other disfiguring deformities like severe scoliosis and kyphosis, worms, TB (please step back), malaria, and of course every form of Ear, Nose and Throat problem. Back to the TB. You do your best to be polite when someone walks in and tells you that they have fever and bloody cough. Out of the "man-jammies" comes the xray with infiltrations all over. You take your step back to get yourself some breathing room and tell the terp to step in and let them know they need to be seen at the public hospital for TB screening and full treatment. It's the same look, every time. I'll be on one side of the room and the other PA with be on the other. Haji walks in and whips out the xray. You look over your shoulder and see your comrade step back and get some space. It's kind of funny. Meanwhile, the terp's like "But sir, why the hell do I have to stand next to him!?" For all you on your way over....Always take hand gel with you and hand wipes. You never can get enough gloves and dear God! The stuff you'll put your hands on just to treat the needy. It's enough to break a nail biting habit! We had to turn away what was approximated to be 1000-1500 people for treatment. We didn't have time or supplies. Women were literally fighting in line to get ahead of the other. We had to get terps outside to try to calm the situation because we aren't allowed to touch them (women) and shooting a few to make a point doesn't exactly fall in line with Army values!
I didn't get many pictures of the VMO because I was too busy. There were two medics that were a big help and they took a few shots. Nothing amazing but here are a few pics. The sunrise pic is one of the FOBs we stayed at on the way to the VMO. Nice place. Gets mortared about 3 times a week. Usually Tali is pretty wide though!

GO DAWGS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
42-30!!!!

RUFF!

Thanks

Hi everyone. Just wanted to drop a line of thanks for the mail I received today. Bill, thanks for the box of candy, toys etc. Bev Freeman, thanks so much for the junk food. Not sure about how much of the homemade checks mix that'll be shared but if the Lord leads me, I'll give up a pretzel or two and maybe some of the crumbs, maybe. Thanks for the books as well. They'll be eaten up over the next month or so. Atlanta Computer Sales, thanks for bringing my Toshiba back to life and getting it back so rapidly.
OK people, I'm back and hopefully will have some missions coming up soon to be able to feed your minds with good propaganda and photos.

Back to the Basics

One of the several reasons I started this page was the hope to be informative to my fellow practitioners that might be in my shoes one day. I've been fortunate to meet a couple of you and have received some emails on the side about questions concerning the mission. Hooah! (It's an Army thing and frankly, I'm not sure I get it quite yet). Still don't get the Hoorah! from back in the Navy days either. I always preferred aye aye. Said more to me. Anyway, moving on.....So, I thought I'd drop a global refresher for those of you not bold enough to drop me an email. I don't bite you know.....well.......my wife may beg to differ. And at that she blushes and can't wait for me to call and tell me how embarrassing that statement was! Alright, back to the task at hand. If you are mobilized to Camp Phoenix for support of Operation Enduring Freedom it is true that you may not be doing what you currently expect. Case in point, me! I'm a PA, mobed to be a PA and I'm a, well, Infantry PA with the emphasis on infantry. If you happen to be Navy or Air Force, you are of the lucky that may get to do your job. You are not combat arms and will probably cover down on a TMC or the like. You may, if you are in the Army, get to cover down on a ANA mentor position. You may support a TMC or hospital. You may be an infantry PA and cover down on the PMT (police mission) and sundry other not so normal jobs for PAs. You could find yourself the sanitation expert on your little world. You may be slightly more advanced in entomology by the time you leave here. You name it, you may be it. I'm not saying that's a bad thing, I'm just saying be prepared. So, number two. Logistics (class 8/medical supplies)coming out of Phoenix is as effective as getting an upper GI endoscopy to remove hemorrhoids, eventually you may see some of it but its gonna hurt. Point here. Bring as much medicine as you can from your mobe station. An extra tuff box may be sufficient with basic primary care type meds. Most of what I see around here are common HEENT complaints, dyspepsia, occasional inflammatory diarrhea but mostly transient that's treated without abx. Now, some other areas around the country go through tons of Cipro so I'd be prepared. Also, think National Guard, think over thirty and weekend warrior. Think Tylenol, Motrin and Aleve. You'll use it, I promise. Don't feel like you need to load up on IVF, tourniquets and stuff like that. Get some extra but don't load down on that. It's harder to get normal supplies. Don't worry about narcs, you can get them at Phoenix. DO BRING a copy of your license as well as credentialing packet from whatever branch you're in. I carry it on a thumb drive and have had the opportunity to work in some coalition ORs. Most of them will be glad to let you help but will want some proof of training and credentialing. Come on, wouldn't you! Hell, I don't even want some credentialed people working on me! Don't him haw about that statement. All you providers can name a few of them!
Alright, I'll stop the babble. I do want to hear from you if you have questions. I'm here to help and I do speak my mind. Mind you, the opinions expressed in this blog are those of a professional that usually practices in the real world and these are not necessarily the opinions of the US Army. I cannot be held responsible for the truth and reality that pass my lips and I'll deny the truth if questioned under a white light!
PS .At Riley, pay attention to soldier skills. The rest is fairly useless. Reality is here and as long as you have common sense, the ability to use your weapon and a decent capacity to adapt to environments, you'll be fine. That is unless you are at a flag pole. Then all you need to know is.....Is your unit patch correct or are you wearing your reflective PT belt in the day time. Another is the wearing a helmet in the Humvee while driving a max of 10mph on KAF. You get my drift. We call them FOBbits. They still get to worry about nothing while the rest of us go outside the wire and do the job that needs to be done.
Peace, love and 7 months.

Uh.

Uh. Hmm. Uh. Well, the weather is getting pretty nice. Very cool mornings, about 40-45 degrees, and then BAM smokin' hot in the afternoon, about 100 degrees today. Just like the rest of the country, it leaves you bewildered. Last week was quite balanced. This week, not so much.
Other than that. Got the chicken plates of the Humvees painted all black with Super Gs in the middle. They look great. I'll get pics up soon.
Monkey, cat and birds all hanging in there.
Hmmm. I'm tapped out.

I'm no genius but hey, I got this one

My little clinic is quite meager to tell the truth. I'm a high priced addition to any team that doesn't have a full up medical team. That being a TMC (troupe medical clinic) or higher. I was beckoned to come see one of the high ranking individuals on the FOB and found him to be lying in bed, weak and rather confused. Well, as I began talking with him, via my interpreter, I found his responses to be rather confusing and inappropriate. I asked how long he'd been sick and if he'd been seen by a doctor downtown. Well, of course, only the "best doctor" and this is what he gave him......Tylenol, a muscle relaxer and some vitamins as well as some antibiotics. Nice, anything else. Yes, a negative malaria test and a normal white blood cell count. Good. Well, have the (person) stand up. HMM..rather weak. I do a little strength testing and other neuro tests and tell the other high ranking individuals that it may be good to get him to the hospital because the least of his worries requires antibiotics and pain relievers, the ..... has had a stroke and needs further treatment. They were blown away. No way, a stroke. What's that? Oh boy, here we go, just get him downtown to that "best doctor" in the hospital to get him evaluated for a stroke, not an infection.
Bottom line. If you are a civilian, don't get sick here. Very scary!!!! Can you imagine the size of the lawsuit that'd bring in the US. Whew! Gave me heartburn just thinking about it. At any rate, said individual has connections and power and got treated at a coalition facility and is being transferred to another facility for appropriate rehab.
I'm know I'm just an ortho guy and I'm no genius, but I got this one!

The "raining of lead" has ceased

Here we are at the end of another Ramadan season and I don't feel like I've celebrated enough but I'll try my best to make up for it when I'm at home on leave. It only took 2 days of nightly spraying of ammo to get it out of the system. I remember back in the old days we could go for 3 days no problem! The new generation just isn't made of the same fiber, you know. Or maybe, just maybe, its the fiscal responsibility that the newer fighters feel to their country and cause, realizing that the bottomless pit of money can't come in from the US and NATO forever. The epiphany, the blinding light of wisdom, is spreading throughout the culture at a blistering speed and the knowledge of unity and selfless service to the helpless and needy is no longer cowering to blatant ignorance and lack of education. Wooooo, careful where you go Nathan.
OK, so I went a little over the top. However, I didn't hear any weapons last night and there isn't any crapola in the concrete water runoff ditch this morning.
One step at a time. One step at a time.

It's Over!!!!

Nope, not the war. We'll be here just like we are in Germany, Japan and Korea, for the long hall. No. I'm referring to the season of Ramadan, a season of fasting from 0400 to total darkness in the wee hours of the night, about 1930. This is supposed to be a season of reflection and preparation for Edes, Christmas on steroids if you will (in a 4th world country). The season really reminds me of Lent because its supposed to bring them closer to Muhammad and Allah. Tis also the season Muslims make their journey to Mecca. I saw part of the selection process in Lashkar Gah. Only a certain number of people can go from each area of Afghanistan. It looked kind of like a lottery, frankly but I'm betting there was a highest bidder to the Mullah (religious teacher) in there somewhere! Whatcha think?
Moving on......there was weapons fire galore last night. You name it, AKs, crew serve, tracer rounds, probably some IEDs for fun! This morning there were kids with little "fire crackers" across the road "exploding" them. Sounded more like an IED or mortar round to SGM and me. So be it. "Like father, like son." "Boys will be boys." "Raise them in the ways they should go...." and the like. Future insurgents....remind me to give a few more toys to those kids! "Here kid. Stay away from the Humvees with the super G on it! Look for the G, got it!"
So, the medical complaints of fatigue, headache and abdominal pain should go down. It amazes me during sick call how many of these guys come in at 1700, before dinner, complaining of headache and abdominal pain or just "not feeling well or better yet flu." "Well, when was the last time you ate, 0330? HMMM. No diarrhea or change in bowel movements? No nausea, vomiting? Just a tummy ache? Tired and weak? Just don't feel like you have any energy? Ya, no magic pills for that....Go eat and drink something and see if you feel better!" Next!
So, today is the start and the feasting continues for 3 days. Yeah! Let the waste of ammunition continue!

Some Pics

Above.....home, for now. Right.....a doll that my daughter sent over to give away. Below......SGM Allman with Georgia, our monkey.

My New Little World

I guess by now most of you know that I've moved to another FOB further east of Lash. I won't give specifics but I'm still in southern Afghanistan. The new address that Amanda sent out speaks for itself. If you haven't received it, please get in touch with her if you want it or email me direct and I'll get it to you. All has been well thus far. We hear a lot of small arms fire around here, especially in the evening but most of it is off in the distance a few km away. Not much more than that. The FOB is small and I must admit, despite missing my friends in Lash, its nice to be away from a "flag pole" and it much more relaxing. I do a sick call for the ANP about 4 days a week and enjoyed the VMO we did last week. It's no magical transition into real medicine but its been a nice change of pace anyway plus I'm back with Sergeant Major Allman whose become a good friend. Don't be jealous Dan and Jeff, I still love and miss you guys as well, especially on Thursdays!
Let's see here. The Dawgs lost to Tennessee. That's pretty depressing so I won't go there. USC and the gamecocks lost.....that's a balancing upper. Sorry Ward, it had to happen eventually. The Buckeyes pulled through another one, whew! We'll carry on until next Saturday and hope UGA picks up the pace and Ohio continues its run.
I tried to throw up some pics tonight but the blogger host won't let me. Sorry, I'll try again tomorrow.

Hold on

Hold on people. I've had little time over the last week to keep up with emails and the blog. My computer should be back in a week or two and that'll help out.
The new FOB is small but great. I miss the guys at Lashkar Gah but it has been refreshing to get a different view of the country.
The internet is a little faster here and I should be back in the blog and email groove soon.
We went out on a village medical outreach the other day and I think I'll get my hands on a few pics to load up.
Thanks to all of you on your comments etc. I love you see them. Lets me know you're acutally reading.
Anyway, more to come soon