Medical Mentoring in Kabul

Week 7 (May 18-May 25): COIN training

2009-11-06T04:29:00.000-08:00

Week 7 (May 18-May 25): COIN training

This is the week we learned about the theory behind Counter Insurgence. Basically, the idea is in order to win a counter insurgency war we need to win the hearts and minds of the people. In this war there are 10% of the people who are hard core insurgents, 10% who are pro-government and the last 80% who are undecided. It is this 80% that we need to work on winning over, so they do not actively or passively help the insurgents.

The rest of the time, I spent taking people flying in the afternoons and evenings. I’ve always enjoyed taking people flying in the hope of sparking interest and creating new pilots. One of the nicer trips I took was to Abilene, Kansas, birthplace of Dwight D. Eisenhower. We landed at this tiny little airport and borrowed a beat-up rental car which we took into town to grab some burgers. Dennis Glover, JC Christenson, and his daughter Kate had a great time.

This is a team picture of our Ft. Riley crew. From left to right. Top: LTJG Holly Johnson, LCDR Mike Feightner. Middle: SSGT Jourusik, HM1 Travis Gann, CDR Beth Harbison, CDR Neil Heimer, LCDR Steve Shadley, LT Josh Meador, LCDR Andrew Lin, SFC Pleniak, HM1 Jerry Cantorna, CDR Dennis Glover, LCDR DJ Becker, and CDR Tim Foster.

With the four-day weekend, I started flying back to San Diego on Thursday afternoon. This is a picture of Camp Funston on the Ft. Riley Post. Boy, was I glad to be heading back home to see Thuy again. We actually had been very good about keeping in touch nightly by phone or Skype.

As I was flying back there was a significant amount of weather over Arizona, which required me to deviate and stop a couple of times in Arizona. As you can see here, my Doritos did not like the altitude at 6,900 feet.

My adorable niece at a model home in Scripps Ranch. These homes are in a development called Santuary. Thuy and I have been looking at these homes for a couple of years now. Maybe one day…

Attie in the model home bedroom.

Attie as the queen.

Attie as the drummer.

Week 6 (May 11-17): Personal Weapons Qualification, MK-19, BFS, ROE, Detainee OPS, and airplane rides.

2009-08-28T08:53:00.000-07:00

This week was a good mix of range time and classroom time. We spend Monday qualifying on our personal weapons the M4 and M9. Tuesday we spent at the range becoming familiar with the MK-19, automatic grenade launcher. Wednesday through Friday we spent in the classroom learning about BFS (Basic Fire Support), ROE (Rules of Engagement), Media Awareness, and Detainee Operations.

This is picture of me driving the HMMWV to the range on Monday. Excited to start the new week. Can’t believe I’m getting paid to do this.

NEED PICTURES FROM DJs photos.

Our Basic Fire Support (BFS) class was a lecture followed by a computer simulator where we practiced the 9-line commands. We practiced fire support on the following targets on the left side of the screen. They taught us how to bracket the target and estimate ranges and directions. I felt this was a useful course which I hope to never need to use.

On Thursday and Friday we had multiple lectures on Rules of Engagement, General Orders, Fraternization, Ethics, Code of Conduct, Graduated Response, and Media Awareness. Detainee Operations on Friday taught us how to handle captured enemies. We had a half day practical where we practiced securing a building and used our skills to search out the homes and document the captured prisoners.

The rest of the classes were enjoyed by all... As you can see LT Josh Meador (right), a family physician from Naval Hospital Lemoore, was smiling in the back of the classroom during our ROE class. CDR Lach Noyes, the general surgeon from NH Pensacola, appears to be enjoying some shut-eye. Lach was actually my surgery staff when I was an intern in NH Pensacola. The Navy is a small place were a past teacher can become a peer in only a couple of years. I’m looking forward to work with Lach in improving the ANA hospital in Kabul.

Here’s a great picture of myself and CDR Tim Foster an HCA from NH Pensacola. This is just before we flew to Hermann, MO. I went to visit an old friend Mike Rothermich and Tim Foster met up with his wife and five children in St. Louis. Tim flew the entire way and I got to catch up on my sleep.

Mike and his son Aaron flying the airplane.

Over seven years, since we last saw each other. Mike was an intern with me in NH Pensacola. He eventually became Chief of Residents, went to NH Guam, and was promoted two years below zone. We played rugby together at Pensacola and you can see I wore the warm-ups from the Pensacola rugby team.

I spent a great weekend in Hermann, MO. Got a personal tour of Mike’s family practice office, the hospital where he’s the medical director at and took in some of the local sights and beers.

Prior to us departing, Tim brought his family out to the airplane and I had the opportunity to give them all rides.

Sarah, the eldest daughter, I heard was now planning on taking glider lessons.

On our way back, Tim and I stopped to refuel at Gardner Municipal Airport, the “Best Little Airport in Kansas”. It is located just west of Kansas City. We took off from their grass strip. I hadn’t had the opportunity to fly off a grass strip in over five years. I noticed while I was out here that Kansas and Missouri were quite found of their grass strips.

Week 5 (May 4-May 11): Weapons

2009-07-12T18:08:00.000-07:00

Weapons, weapons, weapons… This was the theme of the week. After the three-day weekend, this was a great way to get back into training. On Tuesday, we loaded into our HMMWVs drove to the armory and picked up our crew-served weapons to include our 50-caliber machine gun, M240 machine gun, and M249 machine gun. Later during the day we received primary military instruction on the weapons. This was in a clamshell tent located a couple blocks away from where we were staying. The instruction also included familiarization with foreign weapons.

This is picture is of me sitting in the HMMWV truck commander position. The person in this position is responsible for the radios and communicating with the overall convoy commander. They are responsible for the truck.

HM1 Gann is sitting in the right rear dismount position. Both rear positions are the dismounted positions. They are responsible for exiting the vehicle when required. Travis Gann is a pharmacy technologist going to Mazar-i-Sharif. He is carrying the M249 machine gun.

HM1 Cantorna is our driver. He is a MRI technologist from National Naval Medical Center (NNMC). Jerry is also carrying a M249 machine gun, which fires the 7.62mm round.

LCDR Becker is a anesthesiologist from Naval Medical Center San Diego. He is sitting in the left rear dismount position. He also doubled as our medic for our entire convoy.

The mandatory ‘Soldier of Fortune’ photo op. From left to right, HM1 Webber, HM1 Wolfe, and HM1 Cantorna. These were some of the sharpest HM1s I’ve had an opportunity to work with. All three of them are up for HMC this year and I would not be surprised to see them all get picked up. HM1 Webb was actually the sailor of the year at Jacksonville Naval Hospital this year.

The team picture of our HMMWV. Left to right: myself, HM1 Travis Gann, HM1 Jerry Cantorna, and LT DJ Becker. We actually didn’t have an uparmored HMMWV to drive. The uparmored M1151s were limited and each team only have one available to them.

This is a picture of the M249 machine gun. It shoots the 7.62mm NATO round. It’s larger than the 5.56mm US M4/M16 round. We had to learn how to disassemble, assemble, and perform a function check on this weapon.

The were multiple AK47s that we became familiar with during our familiarization to foreign weapons course.

These are examples of 7.62mm sniper rifles.

This is the 50 caliber machine gun used by NATO forces. Large machine gun. Had to learn how to assemble, disassemble, time and space, and perform function checks on this weapon.

The next day we received PMI (primary military instruction) on our personal weapons: the M9 handgun and the M4 rifle. This was the electronic range were we used laser to practice basic marksmanship skills.

This is me attempting to demonstrating basic marksman ship skills.

Later that afternoon, we went to the electronic simulator range to practice shooting the 50 caliber machine gun and the M240 machine gun.

I put in the above screen shot from my iPhone to show where the range was located. You can see the wedge shape that the range carves out in the Kansas countryside.

DJ and me looking tough as we carry our ammo from the depot to the 50 caliber machine guns. We ended up loading this ammo into a metal case where it is fed into the machine gun.

VIDEO OF THE 50 CALIBER SHOOTING.

Because there were over 100 people trying to qualify on the M240, M249, and 50-cal for both day and night. We were shooting from 0800 through 0400 the next morning. Over 20 hours of shooting in one day. However, a lot of it was spent waiting for our turn on the range. ‘Hurry up and wait’ is the army term for this. See the above photo and you’ll understand.

After spending all day on Thursday shooting the machine guns, we spend all day on Friday cleaning the weapons. It was a tedious process, which included using everything from brushes, cloths, and dental appliances to remove every last speck of carbon on the weapons. Above CDR Beth Harbison demonstrates how how to clean the 50 cal. Beth is actually an ED doctor from Jacksonville, Florida.

One of the benefits of flying my Cessna 182 out to Ft. Riley was the ability to visit my cousin Schenley in St. Louis, Missouri. I was also able to spend some time with my cute nephew Nathan and Schenley’s beautiful wife Susan. We played hockey and baseball. Nathan by the end of my stay became quite good at swinging the bat. I see a future in him…

Schenley and me in historic downtown St Charles.

Our carriage ride in St. Charles. Schenley’s parents came down to celebrate Mother’s Day with Susan.

Schenly, Susan, Nathan and me right before I took off to go back to Ft. Riley. Unfortunately, the weekend had to end.

This is LCDR Tim Thompson who is our pharmacist from Naval Hospital Camp Pendleton. Tim is heading to Afghanistan with us as the pharmacy mentor. His grandmother and girlfriend both live in St. Louis, so it was a perfect opportunity for us to get some flying in. Tim was a quick learner and a natural at the stick.

Week 4 (Apr 27-May 3): Blue Force Tracker, Biometrics, and Easter Long Weekend

2009-07-11T07:52:00.000-07:00

This was a short week with our team on Monday and Tuesday being split into two groups. Half of us took a biometrics and blue force tracker course. And the other half of us took an advance medical course. Being that all of us were docs, nurses, and corpsman. They originally set us up to all take the course. Some of us felt this would not be safe since we will be leading our own convoys and would need to learn how the blue force tracker worked. I volunteered to help take the biometrics and blue force tracker course.

The camera above is what we use to ID potential suspects. Basically, it’s a fancy camera that is capable of facial recognition and finger printing. One model has a satellite link to the FBI database and the other one has a data card with over 10,000 profiles downloaded into it.

In the communications class we learned how to setup the radio frequencies and download all the encryptions that we’ll need to use.

The blue force tracker (BFT) is a device that is great for situational awareness (SA) on the battlefield. Every unit that has the BFT will be displayed in real time on the screen, to include vehicles, aircraft, artillery, and tanks. It’s been documented to have significantly decreased the number of fratricide events. See the above poster for a couple of case reports. Enemy units are displayed by manually entering them on the screen. These manual updates will also display on all the other BFTs in the local area. This device can be used to e-mail each other with urgent messages and also be used to call a medevac with one click of the mouse. It’s a great piece of equipment that significantly increases SA.

The 1^st Division command during the Easter three day weekend had no DUIs and authorized the command another three day weekend on the 1^st of May. Most of us, flew back home on that three day weekend. Mike, DJ and I, (the three from San Diego) chose to fly out late on Thursday and return Sunday night for three days and three nights back at home. Not to bad. However, because the two hour drive from Ft. Riley to Kansas City it took almost 9 hours each way to get home.

On Thursday night, Thuy and I stayed downtown at our Wyndham timeshare in San Diego. And the rest of the weekend, the focuse was on food. Especially, anything that I couldn’t get in Ft. Riley, Kansas. Friday, my parents, Anselm, Joy were able to come down and bring down some of my favorite foods from a restaurant near Irvine called Taiwan Little Restaurant. My favorites from this restaurant include the steamed dumplings and fatty pork. Saturday night we had to make a stop at Onami, all you can eat seafood restaurant in Mission Valley. On Sunday, because Thuy had to spend most of the day at work, I decided to fly back a little bit early in my Cessna 182 Skylane. Although a bit reluctant at first, Thuy convinced me by saying, “This will be your last opportunity to fly in the next seven months and this will also allow you an opportunity to fly out to St. Louis to visit Schenly and Mike.” I ended up flying over 40 hours in the next three weeks.

The picture above is the Grand Canyon, you can see the battleship in the center of the picture. Beautiful even at 11,500 feet! I actually made it back over eights hours earlier than Mike and DJ, because their flights ended up being delayed out of San Diego. But most importantly, I had my airplane.

Week 3 (Apr 19-25): IEDs, HMMWVs, and CLS

2009-07-10T17:33:00.000-07:00

Week 3 (Apr 19-25): After an uneventful Sunday of eating, running, and lifting, we began week 3 with the improvised explosive devices (IED) course. This was a sobering one day course where they showed all the latest technologies that the enemy are currently using against us. They also demonstrated some of the electronic, mechanical, and thermal countermeasures that NATO forces were employing to defeat these threats. Thank goodness many of these countermeasures are very effective against most of these IEDs. God bless the EOD units who continue to risk their lives to keep us safe.

The first picture above is an example of one of the countermeasure devices that are currently employed by NATO forces. It’s called the crusader and is built into the new HMMWVs. It includes the antenna on the far right, the actual box on the left which is located in the trunk and remote which is located within the cabin. The actual device is not classified only the frequencies that it jams.

The practical exercise from the IED course included locating the IEDs in the simulated Afghan town. Can you locate where the IED is in the picture above? Find it? It’s actually the flat rock on the bottom right of the picture. There was a small pressure plate that the instructors placed there to get us when we stepped on that rock. Fortunately none of us stepped on it, but sadly, none of us were able to locate it either. The said the best way to find these IEDs is to notice what doesn’t belong there. They said if it had rained and it was muddy, someone for sure would have stepped on it, to keep their boots from getting muddy. Sometimes I guess it’s better to be lucky than good…

On Tuesday and Wednesday, we took the HMMWV driver’s course. With this course we all became qualified to drive the HMMWVs day and night (with and without NVGs. The driver’s training also included how to tow the trucks using the hasty and the regular method. The hasty tow is used under fire where you just run out there and quickly attach a thick rope to the disabled vehicle to get it out of the kill zone, see the yellow rope on the hood in front of the driver’s side hood? The regular tow is when you have more time and can attach a stiff metal towbar from one vehicle to the disabled vehicle.

One of the trainers we had to pass was the HMMWV rollover egress machine. It’s similar to the helodunk from flight school., we were completely flipped over 180 degrees and told to egress with our complete body armor on and our M4 rifle. It’s really quite tricky. Apparently, with all of the new armor that these HMMWVs got it made them very top heavy and susceptible to rollovers. The Army found that by using this trainer that they noticed a decrease in the number of deaths from these rollover accidents.

This video is an example of the rollover egress machine in action. The critical angle for the trainer is 28 degrees. At this angle, we were taught to yell ‘roll over’ so that the other passengers and especially the gunner will know to get down into the cabin and brace themselves.

Here’s a picture of me in the gunner’s turret in the brand new uparmored HMMWVs, the M1151 model. These vehicles were brand new even with the new car smell. At of these vehicles were over 6,000 pounds, 6.0L turbocharged engines. Because of the weight these ‘trucks’ they accelerated very slowly but had tons of torque and once you got them moving they could really move.

For the course and anytime we drove the HMMWVs we had to have our complete body armor on for safety. As you see, this armor is very bulky and difficult to move around in. There are four ceramic plates (front, back, and two sides) that are designed to stop the larger 7.62mm round. This armor with everything attached weighs over 40 pounds. One of the things we found out throughout our time in Ft. Riley was that we had to continue to adjust the body armor to make it more and more comfortable. In this picture here, you can see my arms to not come down completely and I ended up adjusting my side plates down an inch allow my arms to rest more comfortably.

The other two guys in the picture are DJ Becker and Mike Feightner. All of us are from San Diego. DJ is an anesthesiologist and Mike is a radiologist at NMCSD. DJ grew up in Montana. Mike is from Chicago and played some pretty high level rugby at Penn State and for the Super League team Chicago Lions.

The last three days we completed the Combat Lifesavers Course. This is a course that the army has all their soldiers take. Its goal is to reduce number of preventable deaths. They found that if the common soldier is able to treat the four main preventable injuries it would reduce the number of deaths. These four skills are applying pressure to stop bleeding, treating a tension pneumothorax, using an occlusive dressing to stop a sucking chest wound, and applying a tourniquet. In the above photo they demonstrate how to transport a patient with just a blanket and two poles.

Week 2 (Apr 13-20): Camp Funston

2009-06-29T14:15:00.000-07:00

The second week at Ft. Riley we moved from Custer Hill to Camp Funston where we will complete remainder of our training. Camp Funston is another training area within Ft. Riley that is setup like a forward operating base (FOB). When we arrived we found out that we would be staying in 40-man open bay barracks. I was slightly disappointed, as most of my other 39 roommates were junior enlisted 20-year-olds who enjoyed loud music, staying up late, and drinking. So much for some quiet reflection time. :) The accommodations were sparse, basically a twin size bed and small closet to lock our clothes. Here I am with LCDR DJ Becker, he's one of the anesthesiologists from Naval Medical Center San Diego. He's also got a very nice blog, that's got a great number of pictures and movies. http://danieljmt.blogspot.com/2009_04_12_archive.html

Once we got settled in, the rest of the week they attempted to teach us Dari, one of the two main languages in Afghanistan. The other language is Pashtun which is mostly spoken in the south. However, most medical and official business is conducted in Dari. They started the first hour of each day this week with Dari lessons. Some of the key phrases we learned were hello (salaam), how are you (chetor asti), and thank you (tashakor). The language is very difficult with many sounds we don't us in the English language. Fortunately, each of us will have an interpreter assigned to us during our deployment.

After our first hour of Dari language class and the remaining seven hours each day we had counter-insurgency class (COIN). COIN was actually a great class to give us a better appreciation of what the NATO mission is in Afghanistan. Essentially COIN taught us that our job is to train the Afghan soldiers, policemen, medics, and doctors. We did a lot of case studies on how in the past we had not been effective in winning the 'hearts and minds' of the civilians (i.e. Honduras, Vietnam, etc...). If I could sum it up, essentially, don't kill civilians and make sure we put a 'Afghan face' on anything we do over there. Giving them things or doing things for them does not necessarily do them any good. They need to learn to make mistakes and learn how to fix things themselves. From what I understand the Afghan National Army (ANA) is already progressing well, but the Afghan National Police (ANP) still has some work to do, since we didn't start mentoring and embedding with them until the last couple of years.

On Wednesday evening of this week the training included a leader engagement meeting. During our eight weeks here, we will have eight of these leader engagements, where we will learn the cultural dos and don'ts when interacting with the Afghans. For example, dos include: always ask about the family, drink lots of chai (Afghan word for tea), make sure you socialize with them. Don'ts include: don't shake or eat with the left hand, never show the soles of your feet at them, don't ask about their daughters or wives, and don't rush conversations into business. However, the most important thing these leader engagements do is allow us to practice using interpreters.

On Thursday the Afghan instructors made a delicious cultural dinner for us, so that we'd have an opportunity to try the tastes and flavors once before we head over there. The food was rice and chicken seasoned with many spices. I thought it tasted like a mix of Indian and Ethiopian food. The food was eaten with our hands (the right hand of course). This is one of our cultural advisers. Many of these cultural advisers we have training us also work as interpreters in Afghanistan.

This was a very nice week, but the 8+ hours of classes each day really became tedious and we were looking forward to getting out into the field next week.

Week 1 (Apr 4-12): Welcome to Fort Riley

2009-05-31T19:06:00.000-07:00

On Saturday, April 4th we departed on buses from NB San Diego to NAS Coronado, where we boarded a Marine DC-9 for Manhattan, Kansas (Ft. Riley, Kansas). As you can see Thuy was there to see me off. This is picture of me right before I stepped onto the flight from NAS Coronado.

Although, I've had almost five months notice for this deployment, I think it finally hit me the moment I stepped into the tail of the DC-9 that I was deploying. It was both a moment of excitment and nervousness at the same time.

Once we arrived in Ft. Riley, we were bused to our temporary barracks on Custer Hill. We'd only be staying for one week here. Basically long enough for the Army to issue us the rest of our gear. We arrived from NMPS with one seabag of uniforms and boots. After this week was completed we'd have another three seabags of gear to include: more boots, more ACUs (Army Combat Uniform) both flame retardant and regular, IBA (individual body armor), cold weather gear, M4 rifle, and M9 handgun.

The big red one is also known as the 1st Infantry Division. This is the unit that has been assigned to train us at Ft. Riley and get us ready for deployment. Our team SGA (small group advisor) is SSGT Walters. We'll be working with us as our liasion. The Navy liasion officers are CDR Troup and HMCS Osoroz.

Week 0 (Mar 30-Apr 4): NMPS

2009-05-29T05:17:00.000-07:00

I'm going to call checking in at NMPS (Navy Mobilization and Processing Site) week zero. While most people had to fly from other commands and stay in the BOQ, I was fortunate to live only 2 miles away and be able to continue to stay at home with Thuy the entire week. We were able to visit some of our favorites restaurants like O-Nami and 99 a couple more times.

NMPS is a command originally designed to process reservist as they become activated for active duty, but this mission evolved to processing active duty too as more IAs (individual augmentee) were asked to join the fight. At NMPS, they mostly made sure our medical records were up to date, shots complete, our pay was setup, and all of our computerized training done. The days were mostly half days, with time to be spent at home with Thuy.

Here's a picture of me being fitted for a gas mask during this week.

This other picture is of Thuy and me hiking up to Cowles Mountain the highest point in San Diego City. We love this place and visit often as this was the place where I proposed.

Memorial Day

2009-05-26T20:34:00.000-07:00

I think it's fitting that the first blog entry should be posted the day after Memorial Day. It is important to remember all of those who have given the ultimate sacrifice so that we may live the 'American dream' and enjoy our daily freedoms.

What I hope to accomplish with this blog is to create a place to share my journey to Afghanistan with my family and close personal friends. Unfortunately, I'll be starting this about 6 weeks into my training at Fort Riley, Kansas, so what I'll do in the next couple of days is to give weekly summaries from the very beginning. I hope you will enjoy this blog as much as I will have writing it. Thanks again to my family and friends for supporting me.