First Day of the Blog

Just a reminder, this is the first blog entry which means that it is the oldest. I reversed the order so it could be read like a book. Think of it as Chapter 1.

Today is the first day of my blog from beautiful Kabul, Afghanistan. I decided to start this blog because I have had such an overwhelming response from all of the wonderful people that have written me through Soldier's Angels and Any Soldier. I have received so many letters and care packages from people back home that I thought that it would be a great way for everyone to keep in touch. I have received mail from class rooms, senior centers, and people young and old throughout the U.S.. I had no idea that there was so many wonderful people out there. I encourage you to post a comment. I would like to know what you think of my site.

I decided to title my blog 6 Months In Kabul for obvious reasons. I actually today I only have 19 weeks, or 137 days, or 3,197 hours or 191,823 minutes left, but who is counting. In case you were wondering what a shazdoc is, I am not sure either. I was told by one of the students that writes to me that being a doctor is the shaz. I thought that it was a really funny word and it gave me a good laugh when I heard it. She guarantees me that it is a good thing.

For those of you that do not already know, I am a Family Practice physician. I was told one fateful day in June, while I was busy with a full schedule of patients, that I needed to pack my bags because I was going to deploy to Kabul, Afghanistan for 6 months. Of course, my initial response was shock, then I have to admit, a small bit of grief, then later I decided that like any other challenge in life, you just have to make the best of it.

My favorite quote of all time was from Richard Nixon's final farewell speech from Aug 8th, 1974:
"It is only a beginning, always. The young must know it; the old must know it. It must always sustain us, because the greatness comes not when things go always good for you, but the greatness comes and you are really tested, when you take some knocks, some disappointments, when sadness comes, because only if you have been in the deepest valley can you ever know how magnificent it is to be on the highest mountain. "

Yes, I was in that deep valley for a short while because, after all, I was going to be away from my family for 6 months and, like everyone else, I had heard of all the really bad things that were going on over here.

I had a week to gather my stuff and fly off to Fort Riley, Kansas where I spent 2 months preparing for my deployment. At Fort Riley I did a lot of Army basic training. I got qualified on a lot of different weapons, I learned to drive a HUMVEE, operate radios, practiced convoy exercises, land navigation and many other combat related activities. I also had a number of Dari classes and "Leader Meets" where we practiced the art of communicating with Afghan nationals through the use of an interpreter. The Army tried to make the training as realistic as possible. We regularly heard Muslim prayer through a loud speakers and we even had a number of exercises where locals from the community were dressed as Afghans. There was also a "Heat Trainer" which is a real HUMVEE that is rigged to spin 360' to prepare us for a rollover.

I arrived in Kabul in Aug after a short stop at Manas Air Base in Kyrgyzstan. I am currently staying at Camp Phoenix. The best way I could describe this base is it is very flat with wall-to-wall concrete. It has a ton of small wooden houses staked in real close (we call them B-huts). It gets very dusty at times especially when helicopters fly in. Outside the base the landscape somewhat reminds me of Phoenix, AZ but with a lot more pollution. Camp Phoenix is actually one of the better bases. It has a lot of very nice amenities. I hesitate to mention all of them because I afraid that everyone will stop sending me care packages when they learn how nice it is over here. : )

I work with 3 other really nice people, one of them is also a doctor and the other 2 work in health care related jobs. Our mission is to open up a new clinic. We recently toured their old clinic. Their current clinic does not even have running water! The clinic will not only be available to the police but also to their family members as well. I know that when it opens it will have a big impact on their lives. I am really proud to be a part of this mission.

I hope you enjoy this blog. Please feel free to add a comment if you like.

Eid

Today was a pretty uneventful day. This morning I ate my typical breakfast of grits with a ton of kiwis. I do not know where I came up with this strange breakfast combination but I seem to have it every morning for the past month.

I spent a good part of the day working on a mass casualty plan for the new clinic. For those of you that do not know, a mass casualty is when a medical facility receives a large number of casualties that exceeds their normal ability to care for them. Patients are brought to a hospital or clinic and they are categorized based on their injury either Immediate, Delayed, Minimal or Expectant. Obviously, the Immediate patients require the most urgent care and so forth down the line. The idea is to focus your care on the people who need it most and are most likely to survive. I am curious how receptive my Afghan counterparts will be to my plan and whether or not it will be implemented. It will also be interesting lecturing with the use of a Dari interpreter. I will keep you posted on how it goes.

The highlight of my day was beating my office rivals in pool. We have a ongoing daily pool match where the winner gets to wear a 1st place medal. So far me and my partner have claimed the prize 2 days in a row. Tonight is poker night. I play twice a week. Last week I finished #1 out of 66. I won a casino PC game. It was pretty exciting. I doubt that I will be able to continue my winning streak. I am just hoping to place in the top 25 tonight. Poker is probably one of the activities that I enjoy the most at Camp Phoenix.

We are still awaiting the end of Ramadan, also called Eid ul-Fitr or just Eid. It typically ends with the next full moon. In case you did not already know, Ramadan is a Muslim holiday where the entire month is spent fasting. I copied a short summery of Eid from Wikapedia in case you are interested in learning more info.

Eid is an Arabic term meaning "festivity" or "celebration" while Fitr means "to break the fast" and can also mean "nature" from the word "fitrat" and therefore symbolizes the breaking of the fasting period. On the day of the celebration, a typical Muslim family is awake very early and then after praying the first normal everyday prayer, is required to eat in a small quantity, symbolizing the end of Ramadan. They then attend special congregational prayers held only for this occasion in mosquess, in large open areas, stadiums or arenas. The prayer is generally short, and is followed by a sermon. Worshippers greet and embrace each other in a spirit of peace and love after the congregational prayer. After the special prayers, festivities and merriment are commonly observed with visits to the homes of relatives and friends to thank God for all blessings.

For Muslims, Eid ul-Fitr is a joyous occasion with important religious significance, celebrating of the achievement of enhanced piety. It is a day of forgiveness, moral victory, peace of congregation, fellowship, brotherhood and unity. Muslims celebrate not only the end of fasting, but also thank God for the help and strength that they believe he gave them throughout the previous month to help them practice self-control. It is a time of giving and sharing, and many Muslims dress in holiday attire.

Happy 25.2% Day!

I read a funny joke this morning:

Radio Command: "I am an admiral with the U.S. Navy. You are in the direct path of a battle ship. Alter your course immediately."

Radio Reply: "No, sir. You must alter your course. I am a lighthouse."

I sometimes feel like that admiral. Aside from today being Eid, today is also 25.2% Day!!! We are 25.2% finished with our deployment.

Fridays are normally our "down day." It is our one day off during the week and we are all in our office working. It helps to pass the time. The locals normally host a bizarre on Fridays. A bizarre is similar to a flea market where you can buy local crafts, rugs, and various other local souvenirs. It was canceled today because it is a Muslim holiday. Next week I will try and post some pictures of the bizarre.

Yesterday, I received the nicest care package from the "Busy Bees" at a Senior Center in Thousand Oaks, California. They sent a very nice picture of all 11 of them. It still comes as a surprise whenever a new care package comes in the mail. I still cannot believe that there are so many nice people out there that are willing to sacrifice their time and effort for all of us over here. The seniors knitted us mittens, caps, and booties. One of our office mates runs very early every morning and he says that the mittens will come in very handy. They also sent us snacks, toiletries, and other goodies.

I also got sent a collection of poems from students from a Marin County Middle School in California. I thought I would post one of the poems that gave me a good laugh this morning:

When I Was Little

When I was little, I ran naked.
Now I play hockey.
When I was little, I crawled.
Now I walk and run.
When I was little, I slept in a crib.
Now I sleep in a bed.
When I was little, I ate baby food.
Now I eat pizza.
When I was little, I cried.
Now I whine.

Isn't that cute. That was written by a fourth grader from San Pedro Elementary in California. I didn't include his name in case he does not want it on the web.

This morning I was working on the formulary for the new clinic. In case you do not know, a formulary is the list of medications that a pharmacy carries in a hospital or clinic. It is very interesting because they use different names for some of our more common medications. Did you know that Tylenol is called paracetamol over here? Also, when developing a new formulary you have to consider a whole different array of common ailments based on the country you are practicing medicine. Parasitic infections are a lot more common over here.

It will be interesting to see what it is like working with the Afghan doctors. One of the other physician mentors at a different base told me that the doctors that he works with treat all "inflammation" with antibiotics. He says that just about everyone that comes through the door receives antibiotics for just about everything. I was also told by a different physician mentor that they use methotrexate to treat asthma. For those of you that do not know, methotrexate is a chemotherapy drug that is also use to treat a lot of rheumatic conditions. It could be very toxic and needs to be monitored closely. Obviously, in the U.S. we have a lot safer medications for asthma. I am not sure if they use it because it is a cost issue or what. For instance, Advair is a common inhaler that we use for asthma and it can cost hundreds of dollars per prescription. Most Afghans do not even make that much in a month so you can see why they have to turn to nontraditional/alternative forms of medicine.

Later this month I plan on participating in 2 CMAs (Community Medical Assistance) programs. I have heard that upwards of 5,000 people come seeking medical care. It will be interesting to see how it goes. I will keep you posted.

The Macarena

Today I am very excited because I had a great idea. I was thinking about the large number of hits that my blog has been getting over the past few days (over 100 to date!!!) and I thought that it would be a great idea to start a children's clothing drive (emphasis on warm weather cloths since it will be getting very cold over here very soon). We could even expand it to include toiletries and toys. I have been told that families over here share a single tooth brush per household. I do not know about you, but if I had to share a tooth brush with my brothers growing up I might not have ever brushed my teeth.

There are a number of opportunities for me to distribute the contributions that I receive, although I have not yet worked out any of the details. As I previously mentioned, I will be participating in CMAs (Community Medical Assistance) projects. We also will have our clinic which has a peds department. There is also something called Operation Not Forgotten which is a collection drive for children done by Camp Phoenix. I believe they go out to rural towns to distribute their donations. Believe it or not, there is also the Pul-e-Charkhi prison that is just down the street. I learned from an article that I read that children have to stay with their mothers when they get imprisoned because they have no where else to go. It is really sad. I encourage you to read the article online. I posted some pics from the article.

The article is titled: AFGHANISTAN: Children share deprivations of imprisoned mothers. Cut and past this title into google. It should be the first or second result to pop up. For some reason I tried to include the link and it would not work. It is from irinnews.org

I do have to mention that the success of my site also brings with it somewhat of a bittersweet feeling. I am concerned that the more people that visit my site then more people that will send us care packages which is not my intention. As I mentioned in my 1st posting, I earn decent income and we are very well taken care of over here at Camp Phoenix. There are some soldiers in Afghanistan that are on a 15 month "camping trip." They eat MREs (meals ready to eat) for every meal, they basically live in small Afghan villages, literally "embedded" with their Afghan counterparts, without any access to internet or phones. I included a number of soldier support links where you can send care packages at the bottom of my blog. Here is my recommendation, find out which ones live on a small FOB (a FOB is a Forward Operating Base). Those are usually the ones with the fewest amenities. Also, bases in Afghanistan that are in the southern region are usually a more hazardous place to live. They get more rocket and motor attacks then in the northern regions. This is a generalization of course. We have our own share of dangers in Kabul such suicide bombers and VBIEDs (vehicle borne IEDs) .

For those of you that still want to send us stuff we would love to receive it. I just wanted to set the record straight so I could have a clear conscious.

Last night I did my boxing class. I dragged my friend along- we call him "Puffy." We call him that because his last name is Combs. Parents, ask your kids for further explanation. I did not warn him how rigorous the class was going to be. I got a good laugh watching him struggle to do some of the ab exercises. The best was watching him bob and weave. He made the instructor crack up. The instructor said that it looked like he was doing the Macarena.

We should be getting actual boxing equipment in soon, like punching bags and gloves. I still need to order tape and a mouth guard online. I am not sure how far I will go with this. I may need to stop once the sparing starts. I do not want to get hurt. After boxing they had salsa dancing. I usually go just to watch them dance. Tonight they have Karaoke over at the Coffee Bean (yes, we have a coffee shop on our FOB, you see what I mean about all of our amenities). I am trying to get my team to participate. Maybe in the future I can learn how to post short video clips. It should give everyone a good laugh watching us try to sing.

Today we worked on the clinic layout. We have a copy of the floor plan on the computer and we were mixing and matching who should go into which room. I have been calling the new clinic a clinic but that really is not accurate, it is more like a small hospital. It has just about every subspeciality, including neurosurgery. One of the first things we will need to do before the clinic opens is give the doctors training on all of the new equipment. Most of the equipment is state of the art, and therefore, very foreign to them. I have started to contact some U.S. doctors in the area in an attempt to get them to provide some teaching for things like the optometry equipment. So far everyone has been really nice and has enthusiastically agreed to help out.

I am posting our address in case you would like to participate in my drive. Don't forget, you can send children's cloths, toys, toiletries, and anything else you think would be helpful. Used clothing is encouraged. Don't go spending a lot of money. Just send me the old stuff that you already have and want to get rid of. You know all of that stuff that it is just collecting dust in your garage or attic.

Thanks again for visiting. Now don't just log off- post a comment!! I would love to hear what you think. : )

Pesky Flys

Good afternoon. Or for most of you I should say, good middle of the night. Everyone that reads this is probably fast asleep right now. That actually works to my advantage because usually the first and second drafts that I write have the most spelling and grammatical errors. By the time people are actually awake to read them they have been proof read a few times. By that time I have changed all of my macaranas to macarenas. I am sure plenty of errors still slip through the cracks.

I am beginning to learn a lot more about the world of blogging. My knowledge has been growing by leaps and bounds. My first accomplishment was to install a site counter. For those of you that do not know, it involves cutting and pasting HTML. I really know nothing about HTML but I do know how to cut and paste. Here is a good tip you can take with you- holding down the Ctrl and C key at the same time is a short cut to copy and holding down Ctrl and V key is a short cut to paste. The second slightly challenging thing I did is I created a photo album as you can see on the right column. I plan to add pictures daily so be sure to check it regularly. I plan on taking pictures of all of the major Phoenix events. For instance, there is a body building competition taking place in early Nov. That should be interesting. I also will try and showcase all of the various activities around Phoenix even though I do not participate in them, like Cigar Night which takes place 3 times a week (they actually give away free cigars!).

I anticipate that there will be many people logging on searching for info on Kabul and Camp Phoenix since they will be deploying here in the near future (like I did at Fort Riley). Hopefully, I can give them a taste of what it is like over here and somewhat put their mind at ease. I have a really funny thought, we could take it even further if we wanted to and we could really simulate what it is like over here. First, after blindfolding a person, you can burn a bunch of tires near them to recreate the smell. I have been told that tires are part of the ingredient that they use to make bricks and that is why they are always burning them. Next, you will need to add the occasional low flying airplane, a lot of dust and dirt in the air, and pesky flys buzzing in your face (but only when you are in your office typing on the computer). You also will need to add the sound of Muslim prayer in the distance 5 times a day along with Revele and Taps played over the loud speaker every morning at 06:00am and 21:00. If you recreate all of these sounds and smells then it will prepare you for Camp Phoenix. Maybe I should contact Fort Riley and let them know.

I think that the idea of a locations having unique scents and sounds is very interesting. If you can think of any other place that has an undeniable and distinctive ambiance then write them in the comment section. It would be fun to read them all.

Today I also came across a site called milblogs. It is a site that lists all of the military blogs listed on military.com. I registered mine. Here is a link, I hope it works:

http://www.milblogging.com/

It is fun but kind but overwhelming to see all of the different blogs that are out there. I think that I am going to favorite a few of them and read them on a regular basis. I should probably mention the blog that actually introduced me to and got me interested in blogging which was A*W*A*C. by Capt Traversa. He was also deployed to Camp Phoenix and he had a great way of describing his experience in a fun and entertaining way. Here is the web link:

http://traversa.typepad.com/

Surfing all of the blogs also inspired me to create a goal for myself. I would like to try and get 50,000 hits on my site and win the Air Force Milblogs Blog of the Year Award. Hey, if you are going to try for something you may as well go big. I think I can do it. After all, I have 6 months and plenty of time on my hands. Here is the award that I would like to win.
I hope you all got inspired by yesterdays blog. I expect to get a lot of children's cloth very soon in the mail. When I get a good amount I will deliver them and take plenty of pictures.

Thanks for reading.

Forgotten Heros

There is a marine phrase that is commonly used, "Semper gumby." It basically means that you need to remain flexible because plans change. I was told by many people prior to deploying to Afghanistan that I needed to "remain flexible." I did not know quite what they meant but I am quickly learning. My job over here may be changing soon. I will keep you posted.

For some reason the new information that I recently learned got me thinking of the day that I was first told that I was going to be deployed. You have to understand the context, normally the Air Force deploys its people for 4 month missions and they are usually sent to relatively safe locations, especially if you are a doctor. It was the middle of the day and I was in the thick of a busy patient schedule. Both of my bosses came to my office looking very solemn. You could tell that they had something significant to tell me. In those 5 seconds before they said anything I thought to myself, "OK, what can it be?...did someone die?..No that can't be it....Noooooo, they are going to deploy me!!" During the short conversation I was told that I was going to Kabul, Afghanistan for an yet to be determined time period. I later learned that I would be filling an army deployment spot and that the entire deployment was going to last 8.5 months. Talk about a surprise.

I was told on a Friday afternoon that I needed to be at Fort Riley, Kansas for training on Sunday!! Fortunately, I was able to get my report date extended by a week. I tell you what, I have never wanted time to slow down like I did that week before my deployment. It was truly a wonderful week. Every second I spent with my wife and kids was invaluable. I could remember being at the park with my family and just wanting time to stop. They always say you should live for the day and I really was. When I get back home I would definitely like to recreate that week indefinitely.

I have to say, I do have a bit of guilt about having left my family. My children were 4 month-old and 3 years-old when I left and I feel guilty about having my wife carry the load. Before I left I taught my wife all of the little jobs around the house that only I knew how to do. I showed her how to change the air filters in the AC, how to shut off the main gas and water, where the circuit breaker was, how to work the automatic sprinklers, and a bunch of other things. I was a little worried that now that she knew how to do everything that I would become irrelevant when I came back home. I even found someone to take care of our dog, good 'ole Huckleberry. My wife said that it would be too much for her to handle so I found an incredible coworker that was able to adopt Huck and she eventually found him a really good home. While I was at Fort Riley I even had a home alarm installed.

I am looking forward to tomorrow morning because I will be seeing my family via my web cam. I recommend bringing a web cam if any of you reading this are scheduled to deploy to Camp Phoenix. The internet costs $35.00 a month but it is worth every penny. I deployed with the Navy to Iraq in 2003 and it took 2 months just receive a letter. Now you can talk and see each other in real time. It is absolutely amazing.

I have to mention before I get off of the subject that wives are truly the forgotten heroes of this whole Iraq/Afghanistan campaign. We get all of the attention and concern and wives are left to carry on a very hard and lonely job back home with very little appreciation. The next time you see a spouse of a deployed soldier be sure to thank her for her sacrifice as well.

Thanks for reading.

Power Point

We had a very interesting time today giving the power point presentation that was both in English and Dari to our Afghan physician counterparts. LtCol Johnson did a very good job with the help of our interpreter. Maybe I could enlighten you on some of the interesting challenges we face in opening up a medical clinic in Afghanistan. Men and women can not wait in the same waiting room so we have to create different waiting areas (I do not endorse the customs I just follow them). It is important to take into consideration the religious customs when creating a clinic, for instance, the urinals should not face towards mecca. It is also very important that the Afghans have a way to wash a body right after someone dies, I am not sure why. Never the less, we need to construct a body washing area in the new clinic. There needs to be a place to pray in the new clinic so a prayer room needs to be constructed. It is traditional to sacrifice a goat at the opening ceremony to bless the facility (we are still working out those details). Some other interesting Afghan customs is that it is common for a man to kiss another man on the cheek as a form of greeting and hold hands. It is also customary to enjoy a nice cup of chai and talk about each others family prior to discussing business.

We had a lot of cultural awareness training at Fort Riley, they called it "Leader Meets." We actually had actors that dressed and acted as if they did not know any English and it took place in a traditional Afghan surrounding. We were presented with challenging scenarios that we had to work through all with the help of an interpreter. Let me share just a few cultural taboos with you. You should never sit with your legs crossed where the bottom of your feet are showing, this is considered rude. You should never place your hat on the ground (I am not sure why) but it is common for Afghans to kiss their hat after it falls on the ground. You should not give the A-OK sign because it is considered offensive.

Everyone seemed to be pleased with our layout of the floor plan so we do not need to make any major changes. Our next step is to start training the staff of how to use the new equipment. We also will be giving lectures on mass casualty and emergency procedures, and infection control. I am looking forward to it.

I learned yesterday the origin of the word blog. I believe that it comes from the combination of the words web and log. I found that to be interesting.

Thanks for reading.

Just Looking

Good evening. Last night I watched a band play in the DFAC (that is another name for the chow hall which is another name for the place where we eat). You just have to smile at how the military likes to rename everything. For instance, the Navy calls a bathroom the head and the army calls it a latrine. Anyways, the band that played was really good. I would upload a picture but my camera's battery just died on me. It always amazes me the number of activities Camp Phoenix has to offer- weight lifting competitions, salsa lessons, women's basket ball, dominoes tournaments, guitar lessons, etc. I do not think I have ever mentioned but they even have a mini college on the base. They offer $1,000 to anyone that is intereted in teaching a class. You can fight in a war during the day and attend college classes at night. Talk about multi-tasking.

Angela and LtCol Johnson went to the National Military Hospital (NMH) today. The NMH is a newly refurbished old soviet built hospital. They said that the hospital is a very modern facility with state of the art equipment (courtesy of Uncle Sam, of course). Apparently, they say that you are allowed to smoke in the rooms. LtCol Johnson relayed a funny story about a patient that was complaining about his care to them while he was talking on a phone and smoking a cigarette.

LtCol Peters and I just worked on our power points that we will be giving the doctors at the new clinic. Believe it or not, one of our talks is just on the importance of hand washing.

Tomorrow is our one day off. It is nice because we get to wear our PT (our exercise) uniforms all day long. Of course we still have to have our 9mm and ammo on us at all times. It is funny how you can get used to always carrying a weapon around. There should also be a Bizarre tomorrow (in case you do not remember, that is where the locals sell a bunch of local souvenirs). I will be sure to take some pictures and upload them onto my site. They sell just about any recent movie for $1-2 dollars. The only problem is the movie is a CD of some guy sitting in a movie theater with his video camera filming the movie. You sometimes see the heads of people in the front of the theater. The box and the cover look very official but when you play the movie it just is unwatchable. They also sell just about any kind of watch and sun glasses you kind find. Of course there are plenty of Afghan rugs. The rugs can run pretty expensive.

As you walk down the isle of shops on either side of you have fairly aggressive vendors all vying to get you to buy their stuff. They all say, "Come here...just looking.....just looking." They think that they are outsmarting you by doing a preemptive strike on what you are about to say because you sound pretty silly when you respond "just looking" to their "just looking." Children with a bunch of bracelets, postcards, and stacks of Afghani currency come up to you. I bought some money and I have been sending it to some people that have sent me letters. Let me know if you want me to send you something from over here.

One of my "Angles" sent me a really good CD that I am listening to right now. It is not one that I would normally buy because it is country/blues but I am really liking it. The artist is Grey De Lisle and the album is titled Iron Flowers. Here is a link to her web site:

http://www.greydelisle.com/albumFlowers.html

OK, before I sign off I have to describe my room's pet peeves. Now, don't mistaken this for complaining because, like I have said before, I probably have just about as nice of accommodations as you can have in Afghanistan. There are some people who have to sleep under a tent under the stars in their sleeping bags. I only mention them because they have become so annoying that they have become comical. My mattress is just a little larger then a normal twin mattress so my fitted sheet is always half way down my mattress when I wake up. The walls of my room are deceivingly thin. I am not kidding when I say that I live in a shed- it is exactly like a backyard shed. I literally hear every detail of the person next to me from the velcro of his uniform to the creeks in his bed. Talk about bed creaking, if you just think about moving the bed frame sends out a long and loud creek that continues after you stopped moving. The AC/heater only works through the use of a remote controller that chirps really loud. The battery on the remote is low so it will chirp loud when you press the button but not change the temperature. Throughout the night I am constantly pressing the temperature change button trying to change the temperature without any success. So every night my neighbors get to enjoy their own personal remote control chirp and bed squeak symphony.

Thanks for reading.

The Gordian Knot

“There are two kinds of people, those who finish what they start and so on.” --Robert Byrne

I discovered a great new website today called Quotationspage.com. I provided a link. They have a word of the day and a quote of the day section. I included today's word of the day because I thought it was so interesting: http://www.quotationspage.com/

Gordian knot (noun) [GOR-dee-ahn not]
1. an exceptionally complicated problem: "It took him years to solve the architectural Gordian knot, but finally, plans for an unprecedented high-rise stretched out before him."
2. the intricate knot tied by King Gordius of Phrygia to a pole near the temple of Zeus in Gordium and cut by Alexander the Great with his sword after hearing an oracle promise that whoever could undo it would be the next ruler of Asia; the knot cut by Alexander the Great at the temple of Zeus.

Some would say that the task of rebuilding of Afghanistan is a gordian knot. Go ahead and use the word with your friends. Be sure to act suprised when they do not now what it means.

Today we had a Bazaar (yes, I am actually spelling it correctly today). I took a ton of pics and created a photo book. I was not just looking today, I actually bought a dress for my daughter. Take a look.

The asking price was $60.00 and I got him down to $25.00. It is all hand made. I do not feel guilty negotiating because they actually expect it. The dress has bells and other metallic trinkets that make noise when it moves. I know my daughter will love it. I would say that she could wear it for Halloween but I think that my wife already has a costume picked out. I believe that she will be a cat this year.

I also uploaded some pics of the National Military Hospital (NMH) and my birthday in case you were interested.

I received a package today with 4 discs filled with PC games. I shared it with my office mates. I also received a very nice supportive email from a spouse whose husband who just deployed to Afghanistan. Keep them coming.

Thanks for reading.

FOB Snobs

"Doubt 'til thou canst doubt no more...doubt is thought and thought is life. Systems which end doubt are devices for drugging thought."

-Albert Guerardd

Today we attempted to go to the old clinic to discuss some issues with the staff but we were unexpectedly sidetracked by security issues. We ended up spending the day over at Camp Eggers. Camp Eggers is another base in downtown Kabul. I was able to catch up with the people that I trained with at Fort Riley. When we first flew into Kabul the entire team stayed at Camp Phoenix for about 3 weeks and then the majority of the group broke off and went to Eggers because they were ready to start working and our clinic was not going to open for a few months.

There is a very interesting phenomenon in Afghanistan. People that visit from other FOBs (forward operating bases) always seem to point out only the good things about their FOBs and they always like to pick out things that they do not like about your FOB. They are like FOB snobs. Someone will visit and say, "Oh, my FOB has trees. I don't like Camp Phoenix because it is too dusty and there are no trees." Never mind the fact that they get rocketed on a regular basis and that you sleep in a tent, you still prefer your FOB because it has trees? I am exaggerating but you get the point. I think when people are forced into a bad situation you tend to point out all of the positives things to make yourself feel better about your situation. The weird thing is that you find yourself getting defensive over your FOB and you find yourself competing over who has the better FOB. It is all kind of silly. So the point of all of this is that the people over at Eggers do not want to leave Eggers and the people over at Phoenix do not want to leave Phoenix. We both think that our places are better then the other. Unfortunately, there is always talk of moving us to be with the rest of the team but we fortunatley have been able to stay put.

Another form of FOB snobbery is the whole going outside of the wire thing. Going outside of the wire is leaving the base. Some people do not have to leave the base because they have a job does not require it. Even so, there is still a subtle snobbery about this. There is even a name for people who do not leave the base, they are called Fobbits. The majority of the time you do not have a choice whether or not you go outside of the wire since it is dictated by your job. One last form of snobbery that I noticed recently is poker playing snobbery. It is starting to get so bad that I decided not to play last week. Here is an example, if you beat someone that has a strait on the flop when you get your straight on the river, they get mad at you because you got lucky with your river card and they deserve to win becasue they were dealt their good hand. Sorry for those of you that did not understand that. Start paying attention to the different forms of snobbery that is out there. It is really funny when you discover it.

It was nice to catch up with my friend Puffy. We became pretty good friends over at Fort Riley. He is a really good guy. In the morning we hung out in the Eggers coffee shop. Puffy told us about all of the new things that he bought from the bazaar. He bought 2 metal giraffes, a wooden box, marble tea set, and a burka. He told me that he ran out of money when he was trying to buy the marble tea set so he had to resort to bartering. He ended up trading a pair of tennis shoes for the tea set. He still does not know how he plans to get everything back home.

Here is Puffy with some of his proud purchases.

By the way, did you realize that I have had over 500 hits to this site? I heard somewhere that the average blog was read by only one other person. Not bad.

Thanks for reading.

Warehouse

"I'm going to memorize your name and throw my head away."
-Oscar Levant(1906 - 1972)

This is just a random quote that made me laugh a lot. I didn't get it at first. I figure it has to probably be just about the worst insult that you could tell a person.

Today we went back to the new clinic. We have 3 weeks until it opens and we are still rearranging the room locations. Today, believe it or not, one of the issues was that women and men cannot share the same exam rooms. We knew that there had to be separate waiting areas but we did not know about exam rooms. That is an easy fix. A lot still needs to happen from a construction standpoint but I think that it should all come together on time. I am curious how receptive the Afghans will be to the committees I plan on starting. I could potentially start about 10 but I think I am going to limit it to credentialing, infection control, and emergency management.

After we left the clinic we headed over to the French compound called Warehouse. We went with the Wolf Pack which is a group of Army folks that have been nice enough to work us into their convoys. They have big guns on their vehicle and we don't. They were having a going away for one of their guys. I am not sure why the French call their compound Warehouse. Here is the sign when you first enter the compound.

The sign says, "Switch Off Your Jams." No, they are not talking about music. Jammers are electronic devices that jam IEDs (improvised explosive devices). They interfere with radio signals and that is why you have to turn them off.

I was impressed with the French base. They really know how to go to war. They have a number of nice restaurants. Take a look at this one. It looks like a regular restaurant that you would find in the states. War fighting by day, fine dinning by night.

Before we started to eat we had to exchange our money into Euros. I somewhat confused the guy at the exchange counter because I wanted to convert $18.00 and he was only used to $10.00 and $20.00 bills. He said that $10.00 should be enough for lunch. I went to the counter to order my meal and they had a bunch of photos where you could point to what you wanted to eat. I pointed to a sub sandwich and he said that they only serve this for breakfast. I then started pointing to just about every picture on the wall, even the weird long hot dog looking think that was split at each end in three different directions. every time I pointed to a picture he shook his head indicating that I did not have enough money for the meal. Meanwhile, the line was getting longer and the people were growing more impatient. I ended up borrowing 2 Euros and eventually got the pork medallions with mushroom and onions . It was qui a bon gout (delicious).

A few other observations from the French compound. They had a mini Eiffel Tower about the size of a light post. They have a club/bar and they are allowed to drink alcohol. They also wear really big, floppy, berets. I do have to mention, just about every French soldier that I have met has been really friendly. I have even made a couple friends over here at Camp Phoenix.

Lastly, my wife wrote to me earlier and told me that they had to evacuate our home over in southern California. She and the kids are staying with my brother's house in L.A.. She said that the flames are very near my daughters preschool. Hopefully they can get the fire under control. I am going to try and call them tonight.

Thanks for reading.

Live Life Like a Dog

Yesterday we had a “Coms Blackout” so I was not able to post a blog. A Coms Blackout is when they shut down all of the phones and the internet. They do this whenever a service member dies in Afghanistan. The purpose is so the military can personally inform the family instead if the family receiving the news in an email or a phone call. So for future references, if I do not write a post for a day it is probably because of the blackout. If I go two days without a post then we may have a problem. Please pray for the service member’s family who soon be receiving some very sad news.

I have a good friend from medical school that just so happens to be an excellent General Surgeon in the Air Force. He sent me a great email today. I distilled it down to its key message. It is about a boy and his dying dog and why dogs live such short lives.

"People are born so that they can learn how to live a good life -- like loving everybody all the time and being nice, right?" The six-year-old continued, "Well, dogs already know how to do that, so they don't have to stay as long."

Live simply.
Love generously.
Care deeply.
Speak kindly.

What a great message.

My wife and children are staying at my brother’s house. I believe the fires are under control in the immediate area where I live. I will keep you posted.

Today was not a very exciting day. We did a little vehicle maintenance. As you may know, our team is composed of relatively high ranking members so we unfortunately are left to do all of the less-then-glamorous tasks. I am posting a picture of the highest paid and best trained car washer in all of Afghanistan. A Lieutenant Colonel in the Air Force with 20 years of practicing medicine under his belt and he is power washing a HUMVEE in Kabul, Afghanistan. It just goes to show what a great team I have.

Another good friend of mine sent me a care package today. Her name is Dani and her husband’s name is Mark they both live in California but they are currently in New York on vacation. She sent me a ton of candy, poker chips, a statue of liberty hat, and silly string. I hopefully will not be disarming any trip wires any time soon so the silly string should only be for fun.

I actually met Dani when I was in Iraq in 2003. She was an embedded reporter and she did a number of articles on our unit. I had a front page article in the Ventura County Times. My wife told me great story about when she was bought 10 copies of the paper as a souvenir. A young boy that was selling the paper asked her inquisitively why she was buying so many. She proudly pointed to the picture on the front page and replied, “Becasue this is my husband!” Ahhh, my 15 minutes of fame was so sweet.

Dani ended up coming home from Iraq early and she was able to contact my wife. They struck up a great friendship that continues today. Not only is Dani a great writer but she is also an accomplished painter and just an all around great person.

I provided a link to her an article she wrote summarizing her experience during the deployment.

http://www.danidodge.com/journalism/vc/iraq/firstperson1.html

Thanks for reading.

Day At The Museum

"Cabbage: A familiar kitchen-garden vegetable about as large and wise as a man's head."

-Ambrose Bierce, The Devil's Dictionary US author & satirist (1842 - 1914)

Today we actually had a very full day. In the morning we visited our new clinic and had a long but productive meeting with key staff. We asked a ton of basic logistical questions and got some very interesting answers. For instance, when we asked about how they did their medical records they said that that used to keep a "family book." The book served two purposes, one was to show who was eligible for care at the clinic through a photo that is displayed on the cover and the other was to document their care. They would bring the book in with them whenever they were seen for an appointment. The other interesting thing we learned is the way they pay out disability (remember this is primarily a police clinic). In the military when someone performs 20 years of active duty service the VA reviews their medical record and determines the percentage of disability that the service member should receive. The way the ANP physicians do it is they basically pay them cash on the spot when the injury occurs. They have a really big book that lists all of the different disabilities and how much the patient should be compensated.

We brought along an Army dentist with us and he spent some time with his Afghan counterpart. I also helped unload some of the new equipment like exercise bikes and exam tables.

After the clinic visit we hooked back up with the Wolf Pack (our Army friends who we hitch a ride with whenever we go out because they have really big guns on their turrets). They invited us to another one of their going away lunches. It took place a restaurant called "The Turkish House." It is located within the compound of the Ministry of Defense (MOD). The MOD is the Afghan equivalent of the Pentagon. The Wolf Pack mentors the senior leadership of the Afghan National Army (ANA) over there.

We had an incredible lunch. The Turkish House was really nice. There was a well known Afghan drummer and guitarist playing music. We sat around a huge table and ate kabobs, flat bread, rice, soup and eggplant. It was delicious. The occasion we were celebrating was the end of a deployment for one of the Army guys. He is a National Guard member who works as a music teacher in his civilian job. He was deployed to Kabul to help "mentor" the MOD's music band. I tell you what, there used to be a time when certain jobs were unofficially nondeployable but when they start deploying music teachers to war zones then all bets are officially off.

The person having the going away was also a liaison for the interpreters. I wanted to mention an interesting interpreter observation. A good number of the interpreters out here are actually doctors. The reason they are doctors is because doctors earn only $50.00 per month seeing patients verses $700.00 as interpreters. You really cannot blame them for what they do. I would probably be doing the same thing. The sad thing is that just about every one of them that you talk to is also trying to get a visa to go to the U.S.. The reason why it is sad is because these people are the brains of Afghanistan and we need them to stay and help rebuild their country.

I had a very poignant conversation with our interpreter when I was driving our HUMVEE back home from the clinic. We all communicate within the HUMVEE through the use of headsets that make you feel like you are in a cockpit of an airplane. During our long drive home I asked our interpreter what it was like when the Taliban took over their country and I got wonderful 20 minute first hand account of those terrible 2 years as we drove through the heart of Kabul. I felt like he was a narrator guiding me through a real life museum. Just imagine a mob of crazy fanatical people taking over your community and no one there to help out. People were scared to drive around town because the Taliban would take their cars away. They would cut off people's hands and hang them from light posts all for minor infractions. Women could not work, could not go to school, could not be in public without a man. I could not imagine what it was like. I asked him a question of whether life had improved since the Americans arrived (knowing the obvious answer, but I was curious as to how he would respond). He answered, almost yelling, a resounding, "Yes! It is much better!!" That simple affirmation was all I needed to reassure me that this crazy 6 month adventure was worthwhile. I know that I am participating in a worthy cause and I am proud to be a part of it. We are making important and lasting impacts on these people's lives and it is definitely worth my sacrifice.

Thanks for reading.

Sleeping With The Fishes

"To be positive: To be mistaken at the top of one's voice."
-Ambrose Bierce, The Devil's Dictionary US author & satrist (1842-1914)

Good afternoon. LtCol Peters and a few of my office mates returned from the new clinic this afternoon. LtCol Peters took what I think is my favorite picture of this entire trip. They were leaving from the clinic when this child on this donkey passed them by. Look closely and you can see that he is saluting the convoy.

I got a really great package and a ton of letters from an 8th grade class in Gaffney, South Carolina. I thought I would share of few snippets from some of the letters. I found them to be funny.

Hey. what have you been doing? Me, nothing much. I wish I could be home sleeping. This morning my teacher fell out of her chair. She said it was gracefully. I am bored. Life is crazy I can only imagine what it is like over there.

I have got horrible grades in Ms. Ivy's class. I am trying to get better grades. I do not know what my parents will do if I make an F.

Hello, I am going to church camp this weekend with my church. Also, my friend Josh has this piece of smarties paper and there is gum on it. He was sticking it on other people and it was really funny. Have you heard of the game Halo? I can play one of the theme songs on guitar.

Hi you long distance pal. I have a beef with you. You see this is the second letter and I still have not gotten a reply. That is something I do not understand. I am writing to know how it is in Kabul because nothing special is going on over here in Gaffney.

I better write to her before her beef with me gets any worse.

Yesterday while I was at the MOD a high ranking ANA General approached me and asked if I could help with a medical problem that one of his family members was having. I gladly agreed and asked him to meet me at the Camp Phoenix medical clinic. It was kind of funny because I had this sureal Sopranos moment while I was gathering her history. I thought to myself, I better not make an mistakes or else I will be sleeping with the fishes. I am obviously just kidding but it is true Tony Soprano was running through my mind.

I just read this from a fellow blogger at http://docinthebox.blogspot.com/ The History channel is doing a special on military blogging. You might want to check it out.

BAND OF BLOGGERS on the History Channel on Friday, 11/9, at 8 PM ET/5 PM PT; with an encore presentation on Monday, 11/12 at 6 PM ET/3 PM PT. Check out this very special hour and support our troops! You won't be sorry.

"Explore the impact of blogging as a new medium for immediate and raw information. In the midst of modern day combat examine the unfiltered and raw evolution of military blogs and bloggers. Listen as soldiers who during their recent Iraq deployments reflect on the important connection they had with their blogging and how the band of military bloggers has revolutionized the way we understand combat. Experience firsthand, unfiltered accounts of the pain, the hardship, and even the simple beauty found in Iraq; stories that often go unseen in the media's coverage of the war."

Climbing The Ghar

"Today is your day! Your mountain is waiting. So. . . get on your way. "

-Dr. Seuss US author & illustrator (1904 - 1991)

I went to the post office last night after dinner and, I am not kidding, I had about 30 different care packages waiting for me. It was very overwhelming. The people over at the post office usually want you to open your packages before you leave to make sure that no contraband is being shipped to you. This time when I asked if I should open them up the person jokingly said, "No, just take them... just go!" I smiled and laughed. The last thing he wanted was to wait for me while I opened up all 30 of my boxes. I had to make 2 trips back to the office with the help of a dolly. Boxes were falling everywhere because the cement is full of pot holes. Random people were grabbing boxes as they fell helping me out. It was a funny site. Here is a pic. You really cannot appreciate the number because there is a whole back row that you are not seeing.

The majority of the boxes were toys and medicine that was sent for children from the Zonta Club of Marathon. I need to google them to find out who they are and them send them a really big thank you note. I also got a few care packages from very wonderful soldier support people back home. We got sent a a ton of games- scrabble, chess, dominoes, different magazines (about 30), and way too much candy and snacks. If we were to eat all of the candy that people sent us we would not be able to fit into our uniforms. Everyone, thank you all very much for everything. I have a Community Medical Assistance (CMA) coming up and I plan to distribute all of the toys, medicine, and some of the candy to the local underprivileged children. I will be sure to take plenty of pictures.

I also received another package of letters from the Middle School in South Carolina. I tried to load a web cam thank you video with a bunch of Q&As but the file was too big and it took too long to upload. Let me work out the kinks. I promise to have the video technology perfected sometime in the near future. Stay tuned. I also bought all of the students nice presents at the bazaar today. I will not say what I got them since I know some of them read this blog. It should take about 2 weeks for the gifts to arrive so be on the look out.

Today we climbed "The Ghar." The Ghar is a 1,500-foot rocky mountain that sits on the compound of the Kabul Military Training Center. It was really fun. The last 20 feet are the scariest. There is a very narrow part that you have to climb to reach the top. I just tried to not look down while I did it. The view at the top was spectacular. I took a ton of photos and loaded them onto a picture book on the right column. I encourage you to take a look. After we finished with the Ghar we visited an old Soviet military junk yard. We saw a bunch of old tanks and other vehicles. It was very interesting.

Thanks for reading. Take care.

Visit To Orphanage

"If my hands are fully occupied in holding on to something, I can neither give nor receive."
-Dorothee Solle

This morning we convoyed over to the new clinic. Things are starting to kick into high gear. We are getting close to the big grand opening. Half of the the morning was spent moving stuff into exam rooms and the other half was spent meeting with the key staff. I have a new found appreciation for the weight of an autoclave. We are trying hard to encourage the new staff to take ownership of their clinic. We want them to start moving into their offices and to start rearranging the stuff the way they want it.

After we got back to Phoenix I went out again and went on a Humanitarian Assistance (HA) mission. We visited the Allahoddin orphanage. Before I describe the orphanage experience I have to mention the trip there. We road with a bunch of Army guys from Alpha Company. I was in the vehicle that they affectionately named, "The Beast." The entire way there they blared a loud and annoying siren. Normally when we convoy somewhere we somewhat blend into the traffic and, for the most, pass by unnoticed. This time everyone made a point of starring at us. There was this weird moment when we were stopped in a crowded market place. There I was wearing my big ski goggles and kevlar helmet peering out of this small, thick, bullet proof window from this heavily armored HUMVEE with a loud and annoying siren blaring. You could just tell that the people that were looking back at me had this strange expression like I was something very foreign to them. I felt like I was a space alien flying in in my little space craft looking out of my window starring at all of the humans. The humans were looking back at me with a strange expression because they had never seen a green alien with a third eye in the middle of his forehead. This was really the first time I felt this way mainly because we were drawing so much attention to our convoy. I am not criticizing the siren, it was actually very effective in moving traffic away, I just have not had that particular experience yet.

The first thing I saw when I pulled into the orphanage was the well that the U.S. installed during one of their previous HA visits. We actually have done a lot for this particular orphanage on previous missions such as painting the exterior of the building and rewiring the building for electricity. When we got there we unloaded all of our supplies. We brought with us a 5-ton truck full of toys, cloths, and blankets. All of the children came out of their dorms and lined up patently in 5 rows. I opened up a bag of jolly ranchers and handed one out to each of the children one by one. We were both studying each others face. We couldn't communicate very well but we were able to exchange smiles and laughs.

I was fascinated because they all had similar skin lesions. A lot of them had very large scars over their faces and really chapped cheeks. I brought over the interpreter who is, of course, also a physician. I asked him about the skin lesions and he said that it was the after effects of having once had Leishmaniasis a disease that is transmitted by sand fleas. Leishmaniasis is something that is extremely rare in the U.S.. As a matter of fact, I have only read about it in books and here 25% of the children at this orphanage have been afflicted with it. The interpreter also said that the abrasions over their cheeks were due to dry skin. I asked him if it was eczema and he said, no, just dry skin. We need to work on getting them some moisturizers.

Take a look at this little girl. No matter how hard I tried I could not get her to smile.

Doesn't it just break your heart. I posted a bunch of pics. There were so many incredible cute kids. I wanted to bring them all home with me. It is so much harder when you have kids yourself. I saw so many little girls that are my daughter's age. The cutest thing was watching them carry the blankets, jackets, and toys back to their rooms. They were so overloaded that they could hardly carry it all.

Today was probably one of my best days in Afghanistan. The quote up top is so true. I am going to try and do more community service when I get home. It truly brings a fulfillment that is unmatched by anything money can buy.

Thanks for reading.

Rambo

"Speak the truth, but leave immediately after."
-Slovenian Proverb

I have been working on my blog a lot lately. I have decided I need an editor. It is so funny because I will write something that, at the time I am writing it sounds funny and clever, then when I read the same thing one week later I will say to myself, what was I thinking that sounds really stupid. Anyways, I think my new tag line should now read- New from Shazdoc Inc., 6 Months In Kabul Version 2.0- now with 50% less misspellings and grammatical errors. You see, I am going to read that line one week from now and think that it is really stupid. Oh well.

I also would like to thank the creator of the blog A*W*A*C*, Capt Traverso, for mentioning my blog on his site. He is responsible for a lot of the traffic on my site. If you are ever cruising the blogasphere pull over check out his site, here it is:

http://traversa.typepad.com/

Today I thought that it would be a great to get a picture with Rambo. For those of you that do not know, Rambo is somewhat of a legend in these parts. I really can not do him justice in explaining his contributions to Camp Phoenix. I will refer you to the USA Today Article that I have linked. I first heard about him over at Fort Riley. It was during my anxious phase of the predeployment period. When I was inquiring about the security over at Camp Phoenix someone told me, don't worry there is a local Afghan named Rambo. He stands at the gate and makes sure that no one bad gets it. At the time I thought to myself, are they kidding? How is one guy going to protect the whole camp. We even had an ongoing joke whenever I mentioned any security concerns, Maj Martinez would say in a loud tone, "Don't worry, Rambo will protect us."

http://www.usatoday.com/news/world/2007-03-08-rambo_N.htm

Rambo's wife and one of his children were killed when a rocket that was shot by a Taliban member hit his home. He was a truck driver and security guard for a transportation company that existed on the land that the U.S. bought to build Camp Phoenix in 2003. He has been here ever since. The incident that made him famous was back on 1/16/07. A suicide bomber driving a Vehicle Borne Improvised Explosive Device (VBIED) had entered the gate of Camp Phoenix and he opened the driver's side door and pulled him out of the car before he could detonate his explosives. Rambo was even mentioned by President Bush in a national speech.

Here is the familiar salute that everyone receives when they return from a convoy and reenter the base. Thanks for reading.

Happiness

"Money never made a man happy yet, nor will it. There is nothing in its nature to produce happiness. The more a man has, the more he wants. Instead of its filling a vacuum, it makes one. If it satisfies one want, it doubles and trebles that want another way. That was a true proverb of the wise man, rely upon it; 'Better is little with the fear of the Lord, than great treasure, and trouble therewith.'"

-Benjamin FranklinUS author, diplomat, inventor, physicist, politician, & printer (1706 - 1790)

"Happiness is as a butterfly which, when pursued, is always beyond our grasp, but which if you will sit down quietly, may alight upon you."
-Nathaniel HawthorneUS author (1804 - 1864)

Today we took a different route to get to the clinic and I drove the lead vehicle. This past week I have really had a chance to see a lot more of Kabul and I am sort of feeling guilty because I had developed my impression of Kabul based solely on the not-so-nice parts that I have been seeing. Just like any city it has it's good and its bad, unfortunately, it has just taken longer for me to see the nicer parts. There was actually a moment today when I was driving home and I said to myself, "I could live here, this place is not so bad."

Driving around the streets of Kabul you get this sense that the city is so full of life. There is always a ton of people walking around. There are little makeshift shops everywhere. People are on the sides of the streets pushing carts selling bananas, pomegranates, french fries, etc. Children are everywhere. Where I grew up in Southern California you needed a car to get anywhere because everything was so far and spread out. People went about their lives in their own little world. I am not exaggerating when I say this, where I grew up in Woodland Hills, California, I could not have even been able to identify my neighbors if I passed them in the supermarket and I lived there for 8 years!

Over over here in Kabul people are out and about. There is a real sense of a community. I have spoken with a number of interpreters and they have all told me the same thing that their families are not spread out all over town. They all live together in large compounds with all of their extended families around them. In Kabul they may not have a Starbucks on ever corner and they may not all live in a big homes with a green lawns but they have something more important, such as close knit families, friends, religion, and community. These are all things that money and prosperity can not bring.

I found this great article on the topic. I highly recommend reading it. It also allowed me to figure out why I liked blogging so much- it is because of the "flow" it creates. Read it and you will understand.

http://www.yesmagazine.org/article.asp?id=866

When we arrived at the new clinic there was this awkward but funny moment when I said hello to the person in charge. I knew that he always likes to kiss on both cheeks whenever we meet and I was prepared for this greeting. This time I made him laugh because I think made to loud of a kiss sound. I think I got it down now. You just have to touch cheeks and not really kiss. They don't teach you this stuff over at Fort Riley. Today he also called me the "quick doctor." He said that he can always understand what LtCol Johnson is saying when he speaks but he can never understand anything that I say because I talk too fast. I just assumed that the interpreter would translate everything that I said and that why I have been talking so fast.

About 15 of the key staff showed up and it was a very interesting experience. Talk about herding cats. I basically went from room to room with the blueprint of the clinic in hand telling, or I should say recommending, which office was going to be theirs. It was a funny kind of experience that only someone that has grown up in an Italian household can appreciate. When Italians communicate they do so in a somewhat loud and animated manner, hand gestures and all. To the casual observer it would appear that a normal conversation is a heated argument. When I was growing up I can recall having to warn my friends that would come over for dinner so that they wouldn't think that we were arguing at the dinner table because it was our normal way of speaking. Afghans are very similar. I would stop in front of a room and say something like, "this is where Anaesthesia is going to be." The Anaesthesiologist would pause, look at the room, then look at the clinic commander and the interpreter, and then they would proceed to discuss it's size and location back and forth for 4-5 minutes. I am sure that it would be no different opening a new clinic in the states. As a matter of fact, I'm sure that it would have been much worse.

After about 10 minutes of discussing the room the Anaesthesiologist turned to me and asked, through the use of the interpreter, the location of the mechanical ventilator. I kindly reminded him that it is supposed to be an outpatient clinic. He somewhat persisted so I asked him what he is using now at his current clinic. He told me that he is using a small ventilator. I told him that he should bring it over to the new clinic and continue to use it. He thought about it for a second and then he shook his head and smiled with satisfaction. LtCol Johnson patted me on the back for that one and told me I did a good job.

After the clinic visit we visited our friends at Camp Eggers and had a productive meeting. Tonight I will need to go to bed early because we will be doing CMAs for the next 2 days. It should be an interesting experience. I will be sure to take plenty of pictures.

Thanks for reading.

CMA

"Your manuscript is both good and original, but the part that is good is not original and the part that is original is not good."
-Samuel Johnson, (attributed)English author, critic, & lexicographer (1709 - 1784)




Today we did a CMA (Community Medical Assistance) project in a remote village in southern Kabul. It was a great opportunity to give out a bunch of the donations that we received. A ton of 6 M.I.K. 2.0 readers have sent me medical supplies, toys, candies, and school supplies. I loaded a picture book on the right hand column where you can view a lot more of the pics from today. I encourage everyone to continue sending me stuff. I will personally hand deliver them and always include pics. These 2 children below were some of the ones that benefited from your kindness.

Seeing patients today was definitely a challenge. I heard an appropriate analogy yesterday that is very applicable to today's situation, it was like drinking water from a fire hose. It felt like the entire village came out to see us. I believe we saw about 3,000 patients. We expect to see the same number tomorrow. The CMA was actually suppose to be an Afghan National Army CMA. They were supposed to be running the show and we were suppose to just help out where ever we were needed.

There were 4 tents, 2 for women and children and 2 for men. I worked in one of the women and children tents. There is a real delicate balance that you have to strike when seeing patients in these kind of conditions. We were seeing patients in a dirt floor tent, with no labs, no x-ray, and a limited supply of meds. There is not much that you can accomplish unfortunately. There is a mantra in medicine which is first do no harm. You really need to understand your limitations and not try and overstep your bounds. For instance, just about every older adult had blood pressure that was through the roof (yes this is an official medical term). You will not be helping them if you just give them just 3 days worth of blood pressure medicine because hypertension is a disease that needs to be managed over time. It would be harmful to give someone medicine to abruptly lower their blood pressure just to have it rise again 3 days later when they run out.

Unfortunately, a lot of what we saw today were chronic medical conditions that really needed to be managed in a clinic with regular close follow-up care over many months. My goal was to alert them of the problem and to encourage them to seek proper medical care.The only problem is when I suggested this their answer was always that they had no money and therefore did not have access to care.

I saw some children that I would have referred to an ER right away if I were in the states, but instead, they were left to walk back to their home barefoot. For instance, there were a couple of children with serious heart problems, probably ventral septal defects, this boy pictured below was one of them. He was as cute as could be. He had the classic "machinery mumur" on exam. I am going to try and make an effort to see if I can get in contact with a charitable organization to see what we can do to help him. He really needs to be seen by a peds cardiolothoracic surgeon. If anyone out there can help, ie., if you have any contacts, please let me know. You would be saving a life.

I saw a number of cases that I have never seen before. I saw a bad case of spina bifida. I also saw a young child that had the after effects of infantile polio. Obviously, there was not a lot we could do for them but we still tried our best to show our care and compassion. When we could we referred them to a local hospital out in town.

Another interesting thing I encountered was attempting to interview and examine a patient in a burka. There is a strict custom that dictates that all women wear a burka or atleast cover their head when they reach puberty. How strict this is followed depends on where you live. Usually the further you get from the city the more strict they are. It was strange peering outside the gate and just seeing the sea of burkas. I can specifically recall this one patient that the Afghan interpreter saw. She was being seen for arm pain, knee pain, and stomach pain. The interpreter said to me, you see, this is osteoarthritis, it is because she weighs too much. I looked at the patient who was completely covered with only her eyes showing and I thought to myself, "how can you tell?" But again, we were not there to cure any diseases we were mainly handing out over-the-counter medications along with antibiotics and it was not meant to be a comprehensive exam.

I expect more of the same tomorrow. Again, I wanted to thank everyone that has sent in meds, candy, and supplies especially the Zonta Club of Marathon (Marathon is a city in Florida). They must have sent about 20 boxes full of stuff. Some of the boxes cost $30.00 just for shipping.

Take care and thanks for reading.

Day 2 of the CMA and Happy Halloween!

"One of the first duties of the physician is to educate the masses not to take medicine."

-Sir William Osler, Aphorisms from his Bedside Teachings (1961) p. 105British (Canadian-born) physician (1849 - 1919)

If yesterday was like drinking water from a fire hose then today was like drinking water from a fire hose that was connected to the Hoover Dam. I think everyone we saw yesterday told all of their family and friends to come today to be seen. It was like nothing I had ever seen. Around noon, after a very tiresome morning, I turned to the interpreter and asked how many more patients needed to be seen. The interpreter replied causally, "About 500." I smiled and shook my head. The people that we were seeing were the poorest of the poor. It did not matter if they were sick or not, they were going to be seen by a doctor because this was their one and only chance.

I actually treated some sick people today. One child was having a respiratory illness along with an asthma attack so we treated her with an inhaler, antibiotics, and prednisone. Another child had an abscess that needed to be lanced and drained. An older lady came in crying saying that she was very weak because she had not eaten for 5 days. I gave her IV fluids and one of our MREs. I saw more cases of Leishmaniasis. This one girl had it over a large portion of her cheek. I provided her with a referral to be seen at a specialty Leishmaniasis clinic. Usually if you give them a U.S. referral slip they are able to be seen because if they don't then we will stop donating supplies to the hospital.

I am going to reiterate the challenge of examining someone in a burka again. A very common complaint among middle aged women was pain- back pain, leg pain, neck pain. Initially, I would respectfully ask if I could interview them with the burka over their head. They would occasionally decline or act very uncomfortable at which point I would insist that they keep it on (they are always fully clothed underneath). I then would ask if I could examine the area that hurt. They would of course decline. So I literally had no idea what they looked like and, more importantly, what their area of pain looked like. Also, most people did not know their age either so I did not even know how old they were. For the most part, I gave them Motrin then recommended that they be seen at a local clinic for further care. What else could I do?

It was heart breaking examining some of the children. The huts that that they live in do not even have running water and they rarely bathe. I can recall this one child that was having leg pain. When I examined the leg he was bare feet and his legs were caked in dirt. It was very sad. I started to see a number of the children with similar problems- back and leg pain. I asked the interpreter, "Are these children pulling my leg? Why do they all have the same problem." He said, "Yes, they all just want some medicine."

A mother brought in her 7 year-old child who she said wet his bed every night. I asked if he had stomach pains, fever, pain with urination, etc. I did an exam and it was normal. I then proceeded to counsel her on limiting fluid intake and along with other conservative treatment measures. After I was done her story changed, the boy was having fever, pain with urination, and abdominal pain. Again, I just smiled and shook my head. I did not have any labs to help me out. I treated him as if he had a urinary tract infection and then I referred them to a local clinic for follow-up care.

Another problem I had was I wanted to hand out out a bunch of the toys and candy that was donated from people back home. It was very tricky because there were literally thousands of people waiting in line so, for one thing, I did not have enough for everyone and, second, if I were to start handing them out it would have created a riot. I waited until the very end right before we left to hand them out. It still created a mini riot but it quickly abated after all of the children with toys ran away. I learned a lesson that day, I will only give away donations to much smaller groups next time.

I almost forgot that it was Halloween. There is a comedian performing in the gym. It has been a long 2 days and I am feeling under the weather so I am going to go to bed early.

Happy Halloween and thanks for reading.

Zonta

"I believe in getting into hot water; it keeps you clean."

-G. K. ChestertonEnglish author & mystery novelist (1874 - 1936)

Tonight I thought that I would highlight an organization that has sent me so many toys and supplies, the Zonta Club of Marathon Florida. I did a little research and I learned a little bit about them. I copied this from Wikipedia.

"Zonta International is a global organization of executives and professionals working together to advance the status of women worldwide through service and advocacy. The first Zonta Club was founded in Buffalo, New York in 1919. Currently, Zonta International is headquartered in Chicago, Illinois. The organization has over 30,000 members in 67 countries.

Zonta is well-known for its Amelia Earhart fellowship program, founded in 1938 in honor of Amelia Earhart, who was a member of Zonta Clubs in Boston and New York. The fellowship provides funds for women to study aerospace science or engineering at the post-graduate level. The organization also awards the Jane M. Klausman Women in Business scholarships to students entering the third or fourth year of a business-related undergraduate degree program, and the Young Women in Public Affairs Awards, which recognize pre-college women aged 16 to 20 and encourages their public service."

I have to mention something a little funny and I hope that they do not get offended. I have to post a picture of one of the stuffed animals that was sent by them.

Let's just say that this little guy will be coming home with me. There will be no international incidents started on my watch. My daughter will be very happy to get this new stuffed animal.

We will be doing a Humanitarian Assistance mission for a local school later this week and it will be a great opportunity for me to deliver a lot of the school supplies that I have received. Someone from Waynesboro Virginia sent me $50.00 worth of school supplies.

Tonight I received pictures of my children in their Halloween costumes. They looked adorable. As I mentioned previously, my daughter was dressed up like a a cat. My son and my wife had a shared costume which was themed after one of the episodes of The Office. I will spare you the details.

Lastly, I wanted to reiterate the purpose and goal of my blog. I have been getting a lot of mixed feedback lately. I think because it is starting to grow a little too big. Originally, it was intended to document my experience during this deployment and it was meant mainly for my family and friends at home to read. It has since evolved from being mainly about me to more about the good that is happening in Afghanistan and also about our supporters back in the U.S.. I want to be able to highlight all of the positive things that are taking place over here. My pool playing and the kiwis that I ate for breakfast just did not seem as intersting and as important as compared to the things that the military is doing over here and what the people back in the states are doing for us over here.

Before this deployment I had no idea that there were so many wonderful and caring people that have done so much for our troops. A group of ladies knitted over 500 hats, socks, and scarfs for the Afghan orphans. When I saw that huge box full of hand made winter cloths, I just shook my head with disbelief and amazement. The amount of work that must have gone into producing all of that cloths was just amazing. Similarly, there is a Soldier's Angle that I have been in contact with for a couple of weeks through email that started asking schools in her state to write letters to deployed soldiers. Through her effort she has received something like 50,000 letters. Just today she wrote me to tell me that there was another big box full of letters on her door step.

Similarly, there are thousands upon thousands of servicemen and women that are over here making a huge sacrifice by being away from their families and loved ones for upwards of 15 months, risking their lives on a daily basis, sometimes just to deliver toys and blankets to children in orphanages. This is important stuff and I want both of their stories to be heard.

I will not hesitate to edit and/or remove anything from my site that does not does not fit this mission. I want people back home and the soldiers deployed overseas to be proud of my site. No one should be allowed to complain that the media focuses only negative news from Iraq and Afghanistan if they themselves have not made an effort to be part of the solution. If I ever stop being part of the solution then you have my guarantee that this site will be discontinued. So please continue to give me feedback.

So thanks for putting up with my amateur writing and my corny jokes. Hopefully I can continue this blog and we can continue to spread the positive message. Thanks for reading.

Right after I wrote that last sentence taps came on on the loud speaker as it does ever night at 22:00 (10:00pm). It is obviously a very sad melody because it is played at every military funeral. Although, for me it is very soothing and comforting whenever I hear it every night before I go to bed.

I posted a link to a site with a .wav recording. Take a listen.

http://home.att.net/~HonorAmerica/taps.htm