Monday, November 30, 2009

TIA

For all my readers who are medically astute: This is NOT a story about transient ischemic attacks. TIA is our abbreviation for “This Is Afghanistan”. It’s just another way for us to cope with the wackiness we encounter here, daily.

A recent example is my trip this week to Kabul. I have spent the last few weeks packing up offices and assisting with the minutia that accompanied our move from Bagram Air Field to our new home in the province. On the night we drove away from Bagram, I received a call from the commander that there was an issue a road project the team engineers are responsible for. He wanted one of the engineers and me to attend a meeting. The meeting would occur at a base down the road but we would need to “helo” there with the French contingent.

The next morning, following a quick meeting with the boss regarding the goals of the day, the lieutenant and I arrived at the helo pad, with scant time to spare, only to discover that the meeting was in Kabul. Being the good sports we try to be, we jumped on the bird and found ourselves at a French post in Kabul and, shortly thereafter, discussing contractor concerns in the office of an Afghan National Army general. We, with the help of the general and our French counterparts, managed to mitigate the concerns. If everything goes as planned, work will resume soon.

After completing our discussions, we were invited to lunch at the Afghan National Army chow hall as guests of the general. The meal was traditional, with rice, various meats and lots of naan (flat bread). Thankfully, neither of us fell ill the next day! We spent the remainder of the afternoon in talks with other American and French soldiers, planning future projects and cementing our working relationships. We ate in an amazing French chow hall for dinner. There were so many choices, I felt like a kid at a candy shop and, with everything my eyes told me I had to have, I likely looked like a piglet!. We returned “home” that evening, none the worse for wear and with adventure stories to share.

TIA, my friends. Some days are wackier than others!

Lori

For
Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International

Wednesday, November 11, 2009

Back to the front

It has been nearly two weeks since I returned to Afghanistan, and I am finally feeling back in the groove. I didn’t realize before leaving how hard it would be to return here. It isn’t the mission or the country itself that I struggle with; I miss having privacy. I spent two wonderful weeks in a fancy hotel room, enjoying all Bavaria had to offer. Now I am back in a dusty war zone, living in a little plywood shack with seven other women (whom I know only casually) and walking 100 yards to the bathroom and shower, a shower that doesn’t always have hot water.

When we first arrived, the novelty of being deployed and the “adventure” of it all made the transition easier. I had stars in my eyes, imagining all the great things we could accomplish. Now, I know how stressful the work is, how long the hours, and how hard it is to actually move a project to completion. I think the chaos of our current living situation doesn’t help, either. We are in the process of relocating our headquarters to another location. This involves packing everything—offices, personal belongings, even ammunition—and arranging for its movement to our new home. We have a plan to phase the process out but it still seems overwhelming some days as we struggle to move people, trucks and belongings a measly 40 km!

Knowing the deployment is already halfway done helps but, with the holidays rapidly approaching, I know the ache of missing my family will only become more acute. Knowing they will be able to see friends and family helps, but it will be a difficult time for them as well. Also, I have no idea how to make the holidays special for the soldiers and airmen who are here with me. The team has talked about decorating our tents and putting up a tree, and we anticipate a special meal from our French hosts. (Yes, we will be living in big tents for the remainder of our time here, with winter closing in!) But it just doesn’t seem like enough. If anyone has any ideas, please pass them along.

O, an update on the mouse situation—they continue to plague me! With all the moving and cleaning going on, we have found several and the spot outside my bedroom door is still the best place to put a trap. We have caught at least five there but, since my return, I have not seen any in my room, so that is a good sign. There are rumors of snakes being found in the living quarters. I think I prefer the mice! The girls in my hut are convinced that mothballs will keep the critters away, so now everything I own smells funny. But, if it works, I am game.

Lori

Monday, October 26, 2009

The adventure continues

Our picnic spread on our last killer hike

I have made it as far as Kuwait and am in a holding pattern to catch a military flight into Afghanistan. If all goes well, I will be back with the team in the next day or two.

Nate and I enjoyed a last adventure together getting to the airport. We took a train from Garmisch to Munich, and had fun just looking at the sights and reliving our vacation. After checking in, we tested out one last brewhaus, right there in the airport! And, according to the Beer Drinkers Guide to Munich, the place gets 3.5/5 rating, not bad for an airport pub! We shared a last wheat beer and some yummy Bavarian cheese spread with fresh pretzels, a perfect way to wrap up our trip.

So far, our respective travels have been anticlimactic. I have managed to get this far with only one mouse incident. The little pest managed to get in my backpack and nibbled my Twizzlers! What a pain! I caught a couple hours sleep here in Kuwait and am now waiting to see when I can hitch a ride for the last leg of my journey.

Nate is taking off from London as I type and looking forward to seeing the kids soon. He had a LONG layover (12 hours!) in London so stayed in this crazy space-pod “Yotel” place. It is a little cubicle with a bed, TV and private bathroom right in the airport and seems to have been a saving grace for him. He says it was crazy “futuristic” but served the purpose and added to the adventure!

As I head back to the team, it is with mixed emotions. I loved being in the real world—albeit the vacation world—for the last two weeks but am ready to get on with the mission. I know it will take a couple days to settle back in and get up to speed on what has happened while I was gone. With the election runoff pending, I am sure we will be busy, not directly with the election but providing mentoring and support to the process. I will post updates as I can, and thanks to Jim (the editor of Reflections on Nursing Leadership) I can do it via e-mail as well.

Friday, October 23, 2009

Germany, Day 13

I cannot believe our vacation is almost over. The thought of returning to the real world is tough for both of us. Nate will return to his life as a single parent, alone on the prairies of western Texas, and I will return to the demands of "herding cats" on the plains of Afghanistan. One thing in Nate's favor—he missed an episode of upset tummy with our youngest. Fortunately, Grammy was there to save the day. Unfortunately, the timing is just about right for our oldest to be stricken when he arrives home.

We highly recommend the hotel we have stayed in the last two weeks. Edelweiss Lodge and Resort caters to military families and is an incredible experience. The staff is knowledgeable and friendly, the food good and the rooms spacious. They had an amazing "R&R" rate that provided us a room and food for the entire 14 days, and that is what sealed the deal. We have enjoyed tours organized by the resort, rented bikes, set off on staff-recomended trails and have never been disappointed. How is that for an unsolicited recommendation?!

Of course, I expect to be asked: "What was your favorite part?" I honestly don't know that I could name a favorite. I really enjoyed the trip to Dachau. (Is it OK to admit enjoying a tour of a concentration camp?) It was really well done and I could have spent another two or three hours in the museum alone. In Germany, a visit to a concentration camp is a requirement for high school students, so it was interesting to see so many young people touring the grounds as well.

Then there was just being outside, hiking all over the mountains and breathing the fresh air provided a much-needed escape for both of us. With its detailed maps and signs and often a "hutte" as a destination, the trail system here is one of the best we have ever seen. Who doesn't mind hiking in the snow/rain when there is a cold beer awaiting you at the turn-around?

All in all, the trip has been a success, and we will treasure the memories forever. We couldn't have managed this without the support of my mom and dad, who toiled away at home with the little ones! THANK YOU!!! More to come as I make my way back to Afghanistan and the pending chaos as we gear up for a repeat of the Afghan elections. And, if the trip back to Kuwait is as bizarre as the trip out, it will definitely provide some blog fodder.

Wednesday, October 21, 2009

Just an observation

We have spent a great 10 days touring Bavaria and have made a few interesting observations. Although beer is served here like water and the food is hearty, you see very few overweight locals. And I haven't noticed any giant, open-24-hour gyms with flashy billboards, either. Is it the limitless options for physical activity? The ability to walk or bike wherever you want on well-maintained paths? Where have we gone "wrong" in the States? We have limitless fitness options but continue to be an overweight nation.

This is something I have pondered before but never has it been so obvious to me as during the last couple weeks. In our country, which thrives on the automobile and get-thin-quick schemes, how do you convince a population that the best way to better health is eating less and moving more? Back home, I am frequently asked by patients to prescribe weight-loss medications, something I nearly always refuse to do. My suggestions to find a local park and walk 30 minutes a day or climb the stairs at work insead of using the elevators are inevitably met with anger and frustration.

A healthy weight is not always easy to obtain but the Germans seem to be onto something with their enthusiasm for the outdoors and activity. After too many hours spent sitting behind a desk in Afghanistan, I am thoroughly enjoying myself!

Monday, October 19, 2009

From snow to sunshine


Me, outside the Neuschnestein Castle Sunday.
It snowed and rained all day!


Nate, with the Waxenstein Mtn. range and SUNSHINE!

Today, the sun finally shined down on Bavaria! We have been enjoying ourselves, even with the ongoing rain and snow, but today's sunshine was very welcome.

On Friday, we picked up a rental car and, thanks to some helpful hints from our new friend "Jake," we headed off to see Mittenweld and Murneau. Our finely made Russian compact car didn't stand up to the test of relentless rain. In a mid-mountain pass, the wipers gave out. We had to return to Garmisch early and skipped the brewery in Murneau but, never fear, we made a side trip the next day!

On Saturday, we set out for Austria to check out Salzburg, which was very cool. It rained most of the day, but we hiked around and saw the sights. We took an amazing tour of Hohensalzburg, the impressive fortress that has guarded Salzburg since the mid-11th century. We could have spent all day wandering around and learning about the history.
The next day, Sunday, we took our little rental car on the senic route—over a couple small mountain passes and through Austria—to see King Ludwig II's castles. It was snowing and very beautiful. Nice to take the road less traveled. The two castles we toured—Hohenschwangau and Neuschwanstein—were impressive but very over-the-top. Neuschwanstein, the inspriation Walt Disney used for Sleeping Beauty, isn't even complete. Only 16 of the 65 rooms were finished before Ludwig died of mysterious circumstances.

Today, the sun was shining, so we set off on foot (we only kept the car for the weekend). We hiked all over the place, finally ending at a pristine mountain lake where we had a late lunch and enjoyed the view. We wimped out and took the bus home. I was ready to walk, but Nate claimed to be tired, or maybe it was happy hour calling him.

Needless to say, we are having a fantastic vacation, regardless of the weather. More to come in the next few days. We plan to tour Dachau, Munich and make another pass through Murneau.

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Wednesday, October 14, 2009

Our vacation in Germany, Day 3


The view from our room in Germany, Sunday


The view from our room in Germany, Wednesday

I am not afraid of a little snow. I like to ski, enjoy making snowmen and honestly like cozy warm sweaters and curling up by a crackling fire. What I don't really like is unplanned snow while on vacation. I am not here to ski and, without our kids, making a snowman just seems odd, but we are attempting to make the best of it by drinking our way across Bavaria.

For both of us, our travel here was essentially uneventful. My trip from the air base in Kuwait to the airport is a post in itself, which I will save for another day! And my fear of negotiating the Munich train system alone was unfounded, although it would have been much more daunting without two years of riding the DC Metro! I managed to find the right train, change trains mid-trip and even find a taxi to the hotel! Very impressive when you realize my only trip outside the U.S. (prior to the all-expenses-paid trip to Afghanistan) was to the British Virgin Islands!
Yesterday, we visited a really cool cheese factory where, after watching the obligatory video, we ate cheese and drank beer. We then toured an amazing monastery (built in the 1300s) that is now famous for its yummy liquor and beer. It is also a boarding school. Can you imagine sending your little ones off to school at a monastery/brewery?

Today, we awoke to the scene above and decided to press on with our original plan to hike to a "halfway house" that our guide from yesterday had told us about. It was a quaint little restaurant midway up the hill and across the valley from our hotel. We hiked—straight up—for a couple of hours and were rewarded by a beautiful view of the snowcapped peaks. After a couple of beers, we hiked on to some ruins and back to town.

We are currently resting up for dinner, watching the clouds play across the mountains (pictured above) with some intermittent snowflakes swirling down. Not a bad escape from the craziness that is Afghanistan.




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Saturday, October 10, 2009

Let the adventure begin!

Hello from Kuwait! I have started the process of R&R but, honestly, am more exhausted than I was prior to leaving Afghanistan. The whole process is a bit convoluted and confusing. Nate was teasing me about tracking his progress to Germany via Facebook, which gave me an idea for a post. Here are the updates I would have added to my Facebook page, if I had Internet on yesterday's journey:

9:15 a.m. (Friday)—Lori is on the way to check in for the flight to Kuwait (along with 150 of my newest friends); 30-minute wait for a 10-minute brief.

2:00 p.m.—Lori is back at the terminal for roll call. After relinquishing our ID cards, we are put in lockdown; can't leave the general area until our flight, which could take four to six hours.

3:30 p.m.—Lori is still waiting. I am sitting outside the USO (love these places), reading a book, all within a block of my office. I could still be working.

4:30 p.m.—Lori has finally turned in luggage for the trip. We are now sitting in the terminal, sequestered here until the flight, which is still three to four hours away.

6:00 p.m.—Lori is still waiting. We cannot leave for dinner, but are welcome to have Pizza Hut or Burger King delivered. No word on the flight.

8:00 p.m.—Lori is finally told to "form up" and "count off." We are initially missing 10 soldiers but, on recount, it appears to be human error. We are now told, "Hurry, you are late and the plane is waiting." HUH? We have been here all day and now we are late?

12:15 a.m. (Saturday)—Lori is finally in Kuwait. We are loading onto a bus to proceed to the R&R tent area. It is HOT here!

1:00 a.m.—Lori is waiting. I think I sense a developing theme. We are herded into one tent after another to fill out forms, review forms, turn in our body armor for storage—after filling out another form.

1:30 a.m.—Lori is waiting ... again. Most of the soldiers are going to the USA and they have separated them from those of us going elsewhere. Thankfully, one of the soldiers from my team is going to England, so I have company while I wait. We spend 30 minutes moving from office to office, frequently backtracking as someone prior didn't do something right. I am glad to have company as the fatigue and frustration start taking their toll.

2:30 a.m.—Lori is finally done waiting. I have a tent assignment, have found the bathroom and am settling down to sleep. Didn't occur to me to bring a sleeping bag. I end up with a fleece hat, sweatshirt, shorts, socks and my uniform blouse over me for a blanket. Still freezing.

5:30 a.m.—Lori is attempting to sleep. The lady in the bed next to me got up and took pity on me. Threw her sleeping bag over me as she has to go to a roll call for U.S. travelers. Finally, warm enough to sleep for a couple hours.

7:15 a.m.—Lori is up, looking for the gym and food.

How is that for a relaxing start to my leave? Actually, it is funny in hindsight. Lots of waiting, lots of frustration, but the end is near. I will be in Germany by tomorrow, beating Nate there by just a couple hours.

More to come, I am sure, as our European Adventure begins.

Wednesday, October 7, 2009

Mice

I am having a hard time finding something exciting to write about. Somehow, life here has become routine. My big news: In two days, I am scheduled to leave here to start my vacation. Technically, we have hit the halfway mark of our tour, if you count the training time. It is hard to believe we are that far along. I remember the day I received the news I was headed for Afghanistan and how sad and scared I was. My greatest fear has always been being away from my husband and children—strange fear for a girl who has made her career in the Air Force—but this has definitely broken me of that. I miss them terribly but I am adapting to this odd world and the quirks of my team.

Other than living in a war zone and experiencing the stressors that come with that, the issue currently bothering me most is the mice. We have mice in our office, and last night one ran into the room where I sleep. I know they really are not a threat, but every time one scurries by I yelp and sometimes even scream. Apparently, as new buildings go up on the base, the mice are being forced out of their “natural habitat” and coming to find homes with us. And the only option for extermination is sticky traps.

If you’ve never seen these, they are thick paper with lots of sticky glue. The theory is that the mouse will run through the trap, get stuck and you can dispose of it. Problem is, they are alive when they get stuck and someone has to put them out of their misery. Needless to say, my Army training has not instilled a killer instinct in me, and the whole concept makes me a little squeamish. But which is worse: living with mice in your room or calling someone to dispose of one stuck to the trap? I pick the trap! Too bad we are not allowed to keep pets or unit mascots. I would find a cat.

I am very much looking forward to a two-week break from Afghanistan. Nate is meeting me in Germany, and we plan to relax, tour around and sample beer. The kids get the benefit of two uninterrupted weeks with their grandparents and are looking forward to being spoiled. Yes, I am still feeling a bit guilty about not coming home to see them but, as I have said before, I just can’t bear the thought of saying goodbye to them again. The next time I see them, I want to be home to stay! I will try to write while we are traveling and update you on our adventures. I have never been to Europe and am looking forward to the rest.
Added 10 October from Kuwait - guess what!! I came into my transient tent while heading to Germany to find a - guess what - MOUSE on my bed!!! He had been in my backpack and eaten at my granola bars!! GROSS! They seem to be following me. Hope the hotel is safe!

Monday, September 28, 2009

All in a day's work


As you look at these photos, I’m sure you wonder what an Air Force nurse practitioner is doing flying around Afghanistan in a Blackhawk helicopter. This is one of the best, yet little known, benefits of my current position. In addition to providing medical support to our driving missions throughout the province, we occasionally put together air-assault missions. When we do, one of us medics generally goes along, “just in case.” Our soldiers are well trained in combat lifesaver skills (see prior post) but when things go wrong, the first thing they usually yell is “Medic!” and they like to know we are there to help.

Our mission last Thursday was to the western region of a province we are in the process of handing off to a new PRT (Provincial Reconstruction Team). To do the handoff appropriately, we needed to perform quality assurance checks on these projects, but driving would take several days, and there was no guarantee we could reach all the destinations. Because of safety concerns, we have started using only MRAP (Mine Resistant Ambush Protected) trucks and there is some belief that they are too large to navigate the terrain.

I have to admit flying is much better than driving. In addition to the adrenalin rush, we were able to see the three projects in just a few hours. As the mission medic, I carried enough supplies to treat the soldiers, if needed, including intubation equipment and pain medications. I also went fully armed and was responsible for additional security at each objective (not your typical day as an NP!).

Thankfully, the mission ended up being routine and, other than a couple hard landings, we had no incidents. I managed to jump in and out of the helicopter every time, without seriously hurting myself. I did wound my pride—and bruised my ribs—when I jumped out of the Helo, threw myself forward a few steps and landed in a “defensive fighting position.” Apparently, I was supposed to land on my knees, elbows and the butt stock of my rifle rather than my abdomen/chest. Oh, well, lesson learned!

I have a few days to recover while the rest of the team conducts a series of missions. Then, it will be back to work for a few days prior to the start of my leave (two weeks alone with my spouse in Germany!!!). More to come as the adventures continue.

Lori

Tuesday, September 22, 2009

Another week down

The last few days have been slow-going, and I can’t really say why. Maybe it’s because I have been chained to my desk rather than going on missions or because, in just 18 days, I will be meeting my husband for a holiday in Germany! You know how time seems to slow just before a vacation, and then flies by while you are on the vacation? That may be what I am experiencing now.

As a nearly exclusively Muslim nation, Afghanistan has been observing Ramadan for the last month. Ramadan is a time of fasting and praying for the purpose of cleansing your spirit and growing closer to Allah. Because of this, work slows down and there are fewer planned meetings. The frustrating part is, we have difficulty completing our mission without interacting with our Afghan partners. Well, yesterday was the beginning of Eid ul-Fitr, or Eid, the three-day holiday marking the end of the fast. We have been lucky enough to receive invitations to participate in several Iftar dinners (a special gathering to break the fast) as a way to celebrate, and we have enjoyed socializing with our Afghan friends.

Today’s Eid celebration was in one of the large tents on the base and all the provincial leadership from Regional Command East was invited to participate. There was yummy Afghan food, traditional music and time to simply relax and learn more about our governor. He is more than 60 years old, has two wives and 20 children. His oldest son accompanied him to the event, and the governor considers this son to be his counterpart and best friend. This is something I could understand, as I consider my mother to be my best friend, as well. We talked of the wedding celebration he hosted for a prior team when one of the sons married, and we asked if any more were planned during our tenure. (It was a shameless hint at an invitation!) This man and his son were commanders in the Mujahedeen fight against the Soviets 30 years ago and are now doing the best they can to rebuild their country.

Do Afghans do things the way we would in America? Definitely not. One of the things we have come to accept is that there are different customs in Afghanistan than in America. A baksheesh (similar to a bribe) is not unusual for getting someone a job or even to pick up your paycheck. Sometimes, the quality of work is not what we would tolerate, either, but with the influence and tutelage of our engineer staff, this is showing considerable improvement. But, we have discovered our Afghan counterparts to be friendly, generally happy people who dislike the violence here as much as we do. Many of them have been affected directly by the violence and look forward to a day when war is once again in the past. For me, even with missing my family terribly, the experience continues to be one of discovering new things about myself and the world and making memories that will last a lifetime.

Lori

Saturday, September 12, 2009

Strong food, strong babies

A month ago, we initiated a children's malnourishment program at one of the hospitals in our province. I did a long story on it, but was never able to post due to connectivity issues. The program is called "Strong Food" and is intended to bring severely malnourished children to a point where they regain their appetite and are able to eat regular food again. The food is a paste-like mixture of ground almonds, dried milk, sugar, oil and vitamins. It has a very stable shelf life and actually does taste pretty good.

A month ago, we spent two days training medical staff at one of the two hospitals in the province. It was a great time. We felt a connection with the staff and it appeared that they were really taking in the information and developing a plan to administer the program. We spent the first day teaching about malnourishment, how to mix the food and how to select the children for the program. The second day was spent screening more than 50 children by taking height/weight measurements. Seventeen children were selected. We then left the staff with a month's worth of raw materials, mixing directions and my phone number.

I was pleasantly surprised when we rolled back in there yesterday. In the preceding month, a total of 75 children had been given the supplement, and I had asked if a few could come so I could see them. Ten children were present who had benefited from the program. What's more, there was raw material left over. Corruption is rampant in this nation and I fully expected to find all the supplies gone and no children to evaluate.

I am sure this program is benefiting someone besides the children but it wasn't obvious to us, which was good. Staff members were quite proud of the room they had designated for mixing and storing the food. It was very clean, and all the mixing tools we had brought a month earlier were still present. We left an additional month's worth of raw material and promised to return soon to further evaluate progress. I consider the staff's ability to manage this program so well during the last month a success and look forward to returning.

I head back to home base today—compliments of a helicopter! My postings will again become sporadic, but I will continue to be creative in submitting posts and hope to soon share the experience of my first helicopter ride.

Friday, September 11, 2009

September 11

Yes, I am still here, still struggling with an Internet connection. I am back at our "frontier post" and, even though I didn't get any dinner, I can at least get a great Internet connection. The lack of dinner is because the military cooks get Fridays off, which shocks me. I have yet to get a full day off since arriving more than two months ago! Oh, well, there will be food tomorrow, right?!

Today is September 11th, and it is strange to experience this day here where it all started and where the fighting still continues. To be honest, the day would have passed with little fanfare except our intel sergeant, a Vietnam veteran, really focused on the significance of the day when we got a last minute briefing prior to hitting the road. He is in his 50s, experiencing his second war, and as sentimental as they come. His favorite task is stopping traffic on the main drag on base to allow all of our trucks to pull out in order. To see him standing there, cigar hanging out of his mouth, directing traffic and saluting each truck as it passes, brings tears to my eyes every time.

Many of us have a superstition, that thing we must do prior to departing on a mission. One soldier stands to watch us leave, believing it is bad luck to turn your back on friends as they drive away. Another carries a little toy troll and wants everyone to touch it prior to rolling out. Yet another tucks a toy lizard into the band around the outside of his helmet. And our intel sargeant? Sending us off with a salute is his way of recognizing the mission, the soldiers and the sacrifice we all give just by being here. I support all of it, anything that supplies that feeling of "fairy dust" or protection as we depart can't hurt!

So, on this day, please spend a few minutes to consider those who continue to sacrifice for us all. And know we thank you for the support.

Friday, August 28, 2009

Life on the frontier

I have said all along that, here in Afghanistan, we are living in the days of the Old West, hence the nickname of our team—High Plains Drifters—and the name of my blog. The last few days, here in the province, prove that fact.

I continue to live at our forward base, where it is quieter than at headquarters, but still somewhat difficult to get much accomplished. We have one computer for business, that those of us up here share, and one phone. We attend meetings where everything is spoken in French but, thankfully, the PowerPoint slides are in English. And we attempt to do laundry in little machines that take two hours for a complete wash-dry cycle.

The worst thing? Communication home. I can e-mail but I had gotten very used to talking to my family daily and, sometimes, even twice a day. Now, I can only use Skype or buy phone credits, but I didn't bring my credit card, so that's impossible right now. Technology is conspiring against me. I can't get Skype to send my password—it seems I asked twice in 24 hours and thus violated some security system. How? I don't know. I never got a password reset, so have no clue.

The benefit? There is clean air, although it's still very dusty, and a very accommodating French medical team. While I walked around yesterday looking at our future accommodations, my medic had the chance to help with their daily Afghan sick call. And tomorrow, if all goes well, we will work together on some additional projects.

That is all from here. I return soon to headquarters where there will be decent facilities and a reliable way to phone home, but my ability to post will again decline. Such is the odd juxtaposition between these two places.

Wednesday, August 26, 2009

I am still here

Hello, friends! I am still here, still in Afghanistan, still fighting the dust, wind, poor Internet connection and dysfunction of my deployed "family." I have written several posts but have been unable to upload from my personal computer, because of the non-existent connection from my room. I am online today at a MWR (Morale, Welfare and Recreation) facility at our forward base within the province. I snuck up here for a "break" from the craziness that is our headquarters at the big base where we usually live.

"Break" is a little tongue-in-cheek, as it is pretty austere up here: tent living, water rationing (for showers, not for drinking) and a very limited meal menu. You eat what they serve! But, there is a great coffee and pizza shop, the French are great hosts and the night sky is beautiful. We are allowed lunch in the French chow hall and I was shocked at the big rounds of cheese just there for the cutting. I had Gorgonzola brie and Havarti, spread on local naan bread! I could get used to this life!

While the team runs missions into some of the districts near here, I am continuing to network with our French counterparts, and will try to do clinic with the French docs tomorrow morning. Do you remember the local national who was injured in the thrasher machine in July? The American surgeons were unable to save his hand but he did survive the incident. (Infection was a very real possibility.) The hand was amputated and a skin graft done. I hear that the site looks good. I hope to see it tomorrow when he returns for a dressing change.

That is all from here. I see Nate is up so I am going to try to Skype with him before I max my 30-minute time limit.

Sunday, August 9, 2009

A man's world

Have I written yet that I am living in a man's world? Some days I don't notice and, on other days, it smacks me right across the face. Those of you who have spent any time in or around the Army are rolling your eyes. Of course, it's a man's world and we women are outnumbered. The Army still has career fields that are exclusively male and all of our security force here on the PRT [Provincial Reconstruction Team] are members of one such career field. I guess it just still catches me off guard, since the U.S. Air Force and the medical field, specifically, seem to have a better balance of men and women.

Here on our team, fewer than 10 percent of the organization are women, and I am the only female officer. We ladies stick together; none of us are too “girly” and we manage to fill the “little sister” role pretty well. We climb in and out of our big trucks without help, lug our 30 pounds-plus medic bags around and clean our own weapons. I even helped unload ammo from the trucks the other night after a long mission. These things do not bother any of us and they actually make us feel like valued members of the team. We can carry our own weight and pull duties with the men, thank you very much!

So how does it hit me in the face? There are portable toilets here where the seats are on a spring to stay in the “up” position.They're still easier to deal with than the ones that are just a hole to stand over. I won't even get started on that. Then, I was told the other day that there is a “discussion going around” that I shouldn't engage in talks or carry out what we call key leader engagements with senior Afghan leaders in our province, most of whom are men. Why? Because I am a woman and they don't respect women like westerners do. My response? “Reeeally? Huh. Well, let's go see the governor!” So we went to see him and the meeting was fine. Now, mind you, I will never meet alone with any male Afghan officials; my security and interpreters would never let that happen. They are pretty protective, which, to be honest, is where the being-a-woman-in-a-man's world thing is sometimes nice.

With the pending elections, it will be interesting to see what changes happen in our province. For example, here the governor is appointed by the president, not elected by the people. There are representatives in the province who are elected, and this is part of the pending process, as well. Two of these positions are held by women and they are true heroes; they must walk a very fine line between being a respectable Afghan women and promoting themselves as serving the people. I look forward to meeting them soon and telling them how much I respect them for their desire to serve their people under such scrutiny. They are truly finding their way in a man's world, so how can I complain about my own battles?

Friday, August 7, 2009

Deployment blues

I am singing the blues tonight so, rather than complain to my teammates, I will send it into cyberspace! First of all, I miss my kids and husband. They are having the vacation of a lifetime, seeing national parks and family all over the West Coast. They are visiting places Nate and I enjoyed when we first met, places we visited as we got to know each other.

They spent a day in San Francisco, where we got engaged. We only lived an hour from the city but, back then, Treasure Island was still a Navy base and we could stay there for a steal! We would take friends and families on tours all over the city when they came to visit. I remember taking my grandparents on one such day trip. We all had a great time! So, as I sit here in my dusty little room, I know my family is happy, but they are also storing up memories that don’t include me, and that hurts.

Next on my list of complaints? I miss good food!!! They do try here. The food is plentiful and likely as well as can be done when you are cooking for several thousand people every day, but I just miss the flavors from home: the meatloaf with provolone and fresh basil, the curry of every style, and a good steak with fresh green beans on the side. I miss skim milk. Here, milk comes in a box. It might be 2 percent, but I can’t read the writing. I miss real creamer; the powdered stuff just doesn't cut it on a daily basis.

What else, you ask? I miss technology. I can't just pick up the phone and call my parents, something I do several times a week at home. I struggle to post. The Internet connection in my room goes down every two minutes, and I pay for that luxury! I miss curling up on the couch to watch HGTV or falling asleep to Leno, although I hear now it is Conan? How is that working out?

I could come up with more: the wind, dust and dirt; the very small room and long walk to the bathroom; the smells that come from the bathroom and the fact that, for several days, I didn't get a hot shower.

But, for most of my complaints, I can also see the flip side. If I was at home, Nate and the kids never would have gone on the trip, and think how good that first home-cooked meal will taste next spring. Without technology, there’s more time for reading. At least we have a bathroom and a shower; it could be pit toilets and a bucket.

Enough with the blues. I am off to bed with the good book Rachael brought me—thanks, Rach!—and looking forward to a hot shower tomorrow. (There is hope!) And, did I mention that some days I manage to find Lucky Charms for breakfast? That, and knowing how much love and how many prayers are sent to us every day, will keep me going forward.

Thank you, everyone!!

Friday, July 31, 2009

One month down

We've been here a month, one MONTH! Four weeks ago, it seemed like the time here would crawl. Now I know how fast it really will fly, and how hard it will be to develop, source and complete projects while we are here.

One goal we all have is to see at least one project through to fruition. I realize that sounds odd, but many of the projects that are being undertaken in the region are complicated engineering projects that take months to complete and often span the deployment of two or even three PRTs (provincial reconstruction teams). What can we complete prior to heading home? We really do not know.

The process for vetting and developing projects really rests in the hands of the local populace. They—with questions and prompting from our team of specialists—nominate projects to their elected officials, who then set priorities. We take it from there and work to develop what the people want. But change will be slow, as it should be. It took the United Staters many years to become the nation it is today, and Afghanistan should not be rushed.

On another note, we had our first “medical emergency” last night. We had just finished a quick mission to coordinate some election information when one of our soldiers closed his finger in a hatch on a truck. The hatch weighed a couple hundred pounds. We were unloading the trucks when the solder's buddies, staring at his smashed finger, began calling “Medic!, Medic!” Mind you, all the soldiers are trained in minor medical assistance but the first instinct is always to yell “Medic!” His fingernail was barely hanging on, so we numbed his finger and took the nail the rest of the way off. A quick X-ray showed a small fracture at the end of the digit but this, too, will heal.

I was happy to see that our first injury was somewhat self inflicted, and the girls and I were able to improvise some supplies and make do with what we had. One of my favorite sayings here is “Dance with the girl you brought,” meaning, learn to deal with what you have. It may not be perfect but you can make it work. To clarify, we soldiers are NOT short on supplies or equipment but, sometimes, what you use at home just isn't available and you learn to adapt and overcome. Having to improvise isn't mission failure but a chance to lean on your ability to think out of the box, and it only serves to make us better medics when we return home.

Enough, I am off to bed and looking forward to another day. You never know what it will bring.

Tuesday, July 28, 2009

A culturally broadening experience

I just ate my first official Afghan meal here in Afghanistan. (Technically, I had my first Afghan meal when we were fed a delicious traditional meal while in training, thanks to our language instructor and family.) Tonight, some of "those guys" (the ones who wear civilian clothes) came by and invited our team to a traditional meal as a thank you for taking them along on a mission a few days ago. I have to admit I was a bit skeptical initially. While I love strong flavors—we eat a lot of curry at home—I was worried about the preparation and potential aftereffects. I can't attest to the aftereffects yet, but the meal was wonderful! We had beef and lamb, yummy warm naan bread and even some yogurt sauce. After some hesitation, I tried it and then couldn't stop dipping the naan. It was fantastic!

We enjoyed some interesting conversation as well. One of “those guys” happens to be a cultural anthropologist who has lived in this area for years. Rumor has it he fought alongside the Afghans against the Russians. This gentleman has some interesting stories to tell and a wealth of cultural knowledge to share with our team. I learned so much tonight about the pending month of Ramadan and how this can potentially affect our mission planning. Imagine waking before dawn to consume a meal and then fasting from both food and water for the rest of the day, this during the hottest month of the year. In addition to the fasting, there are also frequent religious services that can affect the ability of our team to interact with the local population.

As an Air Force nurse, I am meeting people I only envisioned previously in my imagination: people who live among the locals, not to exploit them or extract intelligence, but to learn more about their culture and ultimately help us understand the best ways to interact and effect positive, necessary change. One of the things our team is doing really well is seeking out all the resources available to us and finding ways to work together. The duplication of effort that can occur is frustrating and, as a smaller team, we need to find ways to “work smarter, not harder.” I can't tell you much about “those guys,” but I have a feeling we will continue to combine missions and share knowledge, which can only be a win-win situation, especially when the thank you comes in the form of food!

Friday, July 24, 2009

War-zone living

As I write this, I am pondering the realities of living in a war zone. It is surreal, knowing I am in the most heavily mined country in the world and planning missions that include preparing what to do in the event the trucks are attacked, yet I just finished off my "surf-n-turf" dinner with name-brand ice cream. Please do not take the foregoing statement to mean that I have developed an attitude of complacency. The reverse is true: We are faced daily with the fact that this is a war zone and fellow soldiers are giving their lives to make things different here. It is just a strange way to live.

I know many of you may wonder how we do live, and I struggle to tell you as I am always fearful of giving out information that is considered "secret." So, in broad strokes, I will try.

We sleep in wooden buildings that are divided into "private" rooms, but the walls only go three-f0urths of the way to the ceiling. Sound does travel, and if your neighbor sets her alarm for 5 a.m., you might as well get up, too. We have electrical power and can pay for Internet and cable TV that comes right into the room. The Internet is slow and unreliable, but at least I am managing to post. (So far, so good.) I didn't even splurge for the cable. Aside from the fact that I don't have a TV, I spend so little time in my room it seemed like a waste. There are several dining facilities (DFAC) on base, but all serve basically the same food. I have heard a rumor that one is better than the others, but my expectations are low. All in all, the food is fine—not spectacular, but palatable. I am thrilled with the amount of fresh fruit, and the chocolate-chip cookies are yummy!

I spend my day at the office doing any number of tasks. I do clinic work for a couple hours daily, but that is pretty flexible, depending on need or mission requirements. I spend the rest of my day doing whatever needs to get done—anything from planning a mission to sorting medical supplies to diffusing some confusion with the provincial governor. I have visited the Egyptian hospital here on base several times and am excited about the warm welcome I received and their desire to assist the people of Afghanistan.

A lot of what we are doing right now is trying to build relationships needed to complete our work over the next several months. I am constantly amazed at how many organizations—military and others—are operating in the area but how little project-related communication there is between them. We really want to build our network so we can reduce duplication of effort.

So, when do I find time for fun? At some point in the day, I usually manage a trip to the gym and, most evenings, I watch a movie or read before falling asleep so I can do it all again. My day is spent with members of my team, so I enjoy the peace and quiet that my room brings. I try to talk to Nate and the kids daily but, with their current travels, that has been hard. I find the times we do talk difficult. It makes me miss them more and the reality of the situation hits home. I guess that is the surreal part: The days become routine but then you are hit over the head with the realization that this IS a war zone and I am going to spend the next 8.5 months a long way from home! Heavy for a Friday night, but that is where my mind is today.

Sunday, July 19, 2009

New sheriff in town


Friday, we had our official transfer of authority ceremony here in Afghanistan and took over full responsibility for the reconstruction of the province. It was a traditional military ceremony presided over by a colonel, with at least one general in attendance. We stood at attention while our unit flag was unfurled (that's me above, commanding our band of warriors), saluted for the national anthem, and sang the Air Force and Army songs.

Since then, we have been busy moving offices (trying to make the most efficient use of our small space), cleaning and sorting through all the supplies left behind. The medics who work with me—known around here as "the Girls"—spent the day sorting medical supplies and stocking our medical kits. It is difficult to decide what is necessary to carry versus what is just nice to have. So far, we are finding ways to strike a good balance. Ninety-nine percent of the time, we will simply need ice packs and ibuprofen, but it's that 1 percent of the time when we need to save a life that we don't want to find our supplies lacking.

When we are not working, we are enjoying what amenities we have here. There are two gyms within a block of our living quarters, two dining halls and even a USO with big comfy chairs to relax in. There is a post exchange store with all the comforts of home and a coffee shop. (I find the coffee bitter and am thrilled to have my own coffee maker in my office and lots of good coffee left behind for me to use.) If only my family was here, I would have all the comforts of home!!

[Editor's note: Lori's Internet connection failed just as she was completing this posting, which probably explains why the photo she refers to is missing. She will add the photo when her schedule permits.]

Wednesday, July 15, 2009

First mission

Finally, all the stars align and I can blog about my Afghanistan adventures. I have been plagued by Internet connection issues, computer problems and just all-around business since arriving two weeks ago. I have so much to write about. I struggle with where to start!

I went on my first mission this week, and it was thrilling! I am happy to say we experienced no adverse events and considered the two days a complete success. We spent much of our time looking at our current engineering projects (several sections of road and some school projects) but my favorite part was playing with the children. The photo is of several children at one of our stops.

They were initially very shy but, once the camera came out, they all rushed to have a photo taken. The girls are all a little hesitant and tend to keep their distance but will creep closer as the boys become more engaged. I found getting them busy doing something with me helps break the ice. Counting was easy. I would try to remember the numbers in Dari, often getting them wrong. The children would laugh and try to teach me. I would also point at various objects and ask the word, then try to teach them the English equivalent.

The countryside is beautiful but barren. It reminds me a lot of southern Arizona, with beautiful blue sky and hidden canyons with flowing streams and trees. The living conditions are simple; often mud walls, few cars and true manual labor. We saw several wheat fields being harvested by hand and one area where the cows were being walked in a circle to separate the wheat.

I had the opportunity to meet with several doctors at the only hospital in our province, and they are very excited to work with our team. We hope to introduce a nutrition supplement for malnourished children at some point in our tenure here. It is a project that is having impressive results in other areas and the people of Kapisa would benefit greatly. There is also a physician training program here at the main base that incorporates didactic lessons with hands-on experience at all three international hospitals (American, Egyptian and Korean) and the providers were anxious to be recommended to the program.

We did have one medical emergency while staying overnight at a French base in the area. My counterpart who I am replacing (a physician assistant from California) and I were going to meet the French doctor for dinner. When we entered his clinic, we found him working on a local young man who had suffered a traumatic amputation of most of his hand. Somehow, he had put his hand into a thresher machine. The French team had stabilized him so, while my counterpart dressed the wound, the doctor and I called for help from the U.S. hospital. The goal is for the local providers to learn to care for their population, but this injury was so significant that we were able to send him to the American facility for surgery. We were thrilled to see this young man get appropriate care. It goes a long way to show the people of his village that we are there to help them.

This continues to be an amazing opportunity, and I look forward to the next nine months. I admit I miss my family terribly, but the time is flying by and, if the next 34 weeks go as fast as the first two did, I will be home before I know it. Nate and the kids are doing great and enjoying their summer travels—a much needed adventure to help their time pass quickly as well.
I promise to write more often, as long as the computer and connection cooperate!
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Saturday, July 4, 2009

I've arrived!

Hello everyone, and Happy 4th of July from Afghanistan! We left Indiana early afternoon on Monday and arrived in Germany to refuel in the early morning hours of Tuesday. After a short stop, we were again airborne and arrived in Kyrgyzstan that evening. Needless to say, the jet lag was horrible. We endured several required briefings, received our assigned follow-on flight for the next day and finally found the dining facility.

We ladies slept in a huge tent—the same size used for our dining facility in Indiana!—that held several hundred bunk beds. We were lucky! Fewer than 50 women shared the space with us and we all managed to get some sleep, but the jet lag kicked in and most of us were up within a few hours. Fortunately, there was wireless Internet and a 24-hour coffee shop, so we were set.

We left Kyrgyzstan the following evening (Wednesday) and arrived in a dusty, windy Afghanistan at dinner time. After enduring more briefings and collecting our baggage, we found our advance team waiting for us. We were so happy to see them and know our travels were over. After making a quick stop to drop baggage in our assigned “huts,” we went on a walking tour of our surroundings and found dinner.

It was interesting to observe our nation's birthday in a war zone. We celebrated by raising the American flag over our building and listening to a reading of the Declaration of Independence. We followed this up with a great barbecue hosted by the current unit. Now. it is time to get down to business as we continue to find our way around and talk to our counterparts on the current team. They have done an amazing job of managing their responsibilities in this diverse province, and we hope to do them proud as we continue their efforts.

Wednesday, July 1, 2009

A way to support the troops


Remember those old WWII movies with the soldiers dancing at the USO with the lovely local ladies? Did you know the USO still exists?

They are an amazing organization and an incredible support to U.S. soldiers, sailors and airmen stationed here and all over the world. The United Service Organizations (USO) has been around since before WWII and continues to bring a touch of home to service members everywhere. They currently boast more than 130 locations throughout the world, and we have an incredible example right here at Camp Atterbury. The local USO is staffed by volunteers who provide hot coffee, cold drinks, snacks and always a smile. The building also houses two big screen TVs, pool tables, ping-pong tables, foosball, video games, board games, reading material, etc. The service is provided free of charge and is much enjoyed by all.

Another neat opportunity the USO provides: They will video-record you reading a book to your child, then give you the tape and the book to send home. I did this the first week I was here and my kids were thrilled. I hope to do it again before we head out of here.

Want to know more? Check out their website: http://uso.org/. Got a few extra pennies and wonder about a deserving organization? Send them to the USO. I can promise you the troops who benefit will appreciate it.

Sunday, June 28, 2009

Back in the heartland

So after a week of this:



And this:


And lots of this:


We had to do this:
The week was a blast and lots of memories were made to last us the next long nine months. I hated to leave, but Nate and the kids are doing great, are healthy and happy, so there's not much more I can ask for. They are off on a summer of adventure with an opportunity to see family and friends, which never would have been possible if I wasn't leaving for so long. After meeting up with the rest of my team here in Indiana, I am off soon for Afghanistan. It is an odd feeling: a small amount of fear of the unknown mixed with a lot of excitement and a readiness to get this mission started, so the clock can start for our return home. I promise more to come as we get settled and I learn more about our mission, roles and responsibilities.
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Wednesday, June 24, 2009

Shameless plugs

Believe it or not, I have managed to find some free time while at home this last week, and I am finally getting to some blog work I had wanted to do from the beginning. Since starting this journey, I have been meaning to explain the blogs I follow (see right side of page).

My good friend, Meg, started my whole interest in blogs with her site, "Soup is Not a Finger Food." She is an amazing writer and has a hysterical outlook on raising three boys in the DC suburbs. Her posts are usually humorous and, if they aren't, they leave you thinking. Thank you, Megster, for all the blog support and your friendship!

Next in the line-up is "Drifter Sends," a newly created blog by one of the soldiers I will be deploying with. This career Army officer has spent two tours in Iraq and will be our operations officer in Afghanistan. He lends a ton of experience to our group but admits this deployment is different, because of our unique mission, and he will be leaving his young son for the first time.

The "Accidental Soldier" is a member of the team that is currently in Afghanistan, which we will be replacing next month. Felipe's posts are a great way to see what that team has accomplished, and they provide a window into what we will be doing for the next nine months.

The final blog in my list is "Waariya"—actually a Web page and blog started by the public affairs officer in our group. Darrick is an accomplished writer and former Marine who will be very busy helping to get the message out to the public about our mission. He does great daily posts and will provide another perspective on our mission in Afghanistan.

Finally, I can't say enough about the Honor Society of Nursing, Sigma Theta Tau International, http://www.nursingsociety.org/default.aspx. This is the organization that started this whole blog ball rolling (Thanks, Rach!). They provide an editor for my posts (Thanks, Jim!) and even helped with the banner artwork. I never would have embarked on this journey without all the support Sigma provides.

There, enough of the shameless plugs. I am off to be the mommy for a few more days, relishing this world before returning to my life as a soldier.


Saturday, June 20, 2009

Home sweet home!!


Finally, the nearly three months of training in Indiana are over, and I am home for a much needed break from reality. The kids are stuck like glue—that's them above—and I am loving it! We have so far spent time at the pool, enjoyed catching up with each other and with friends, and eaten a wonderful curry dinner. Nate planned a spa day for me on my first day home: hot rock massage, nails, hair; quite the pampering for an amateur soldier! It gets better! Tomorrow, we head for San Antonio for a few days of seeing more friends, SeaWorld and the chance to make more memories to carry us through the next nine months. Forgive me if the posts are few and far between this next week. I plan to spend it stuck to my family and dread the pain when they peel me off for the flight back to Indiana next week.
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Monday, June 15, 2009

Reconciliation

Have you ever had to reconcile two parts of your life? I am currently working to reconcile the need to become proficient in firing at least two different weapons with my calling as an NP. Not only will I be trained to use these weapons, they will become my constant companions for the next year, and I am expected to use them, if necessary.

I did not grow up in a hunting family, nor does my husband own a firearm. We never felt the need to protect ourselves that way. With our lack of experience with firearms and two inquisitive children in the house, we figured the risk far outweighed the benefits. I am not an anti-gun activist—and I do agree that people kill, not guns. I don't care if you own your own arsenal (although I question the need) but I just do not aspire to gun ownership.

As an NP, my job is to help and heal people, not inflict mortal wounds. We have already had the ethics lecture with the vignette depicting the need for triage between a minimally injured American soldier and a significantly injured insurgent. My answer, based on my responsibility to heal and the triage concept, was met with heated discussion from the commanders (all non-medical) about how they would argue to have their troop cared for first. Now, imagine getting back to base after a skirmish only to be presented with an injured enemy troop and discovering you were the one who had fired the offending bullet.

My analytical mind enjoys the challenge of target shooting and the puzzle of disassembling and reassembling a weapon. My desire to keep my fellow PRT members (and myself) safe from the “bad man” will motivate me to become as proficient as possible on all our weapon systems. But, the healer in me will continue to struggle and pray that I never have to pull the trigger on another human being.

Friday, June 12, 2009

Constantly under the microscope

As a medical provider, I have spent many hours in a clinical training environment, with any variety of preceptors looking over my shoulder. It becomes routine to adjust to another's opinions of "the right way," sometimes incorporating their suggestions, sometimes just smiling and moving on.

Well, we "soldiers"—my generic term for all of us here in training, really made up of Air Force, Army and Navy team members—at Camp Atterbury are currently undergoing a mission readiness exercise, otherwise known as "living under the giant microscope." We are conducting missions, throughout the acreage of the base, meant to replicate those we will likely experience once deployed to Afghanistan. We plan as we will in-country, conduct mission rehearsals and travel by convoy as a means of ironing out processes prior to leaving the training environment. So far, it has been the best training yet—a true time to put it all together and synchronize the information we have gained in the last two months. The drawback? Everywhere we turn, we are being observed, critiqued and assessed on our ability to do all of the above tasks.

We really appreciate all the work these dedicated trainers are doing, but some days it seems like we can't win. When that happens, we just smile, take the advice as intended and move on. We know we will soon be on our own in Afghanistan and the decisions will be ours. If, out of 20 suggestions, we utilize one, we have gained another tool to help us in our missions. And the additional time spent working together can only strengthen our bonds and improve our effectiveness once our boots "hit the ground."

When will that be? For security reasons, I can't say for certain and, to be honest, it changes every day. What I can tell you is, I anticipate celebrating my 39th birthday far from the safe shores of the United States!

Tuesday, June 9, 2009

Hey Doc, could you look at this...

As previously discussed, my role here is, first and foremost, senior medical provider. The senior part is just to make it sound important. In reality, I am the ONLY medical provider to members of PRT Parwan. I am lucky to have two very experienced and motivated medical technicians, but the buck stops here—with me.

The military is its own animal when it comes to using “mid-level practitioners” (a term I really dislike but it does clarify where we fit into the medical provider picture). In addition to nurse practitioners (NPs), there are also lots of physician assistants (PAs) to be found. And don't get me started on general medical officers (GMOs), medical school graduates with a single year of internship who, for whatever reason, do not enter a residency. They are sent to various assignments in physician billets but are not really qualified for that level.

We NPs continue to be licensed in our state of choice and we carry the required certification, depending on specialty but, within the walls of our military treatment facility, we practice fairly independently. We have full prescribing authority, are empaneled, have our own patients and conduct our own peer review. Some days, I equate it to hanging out a shingle and starting your own practice. I'm lucky. At home, I work with two great physicians who are ready and willing to answer my questions, or help me find answers when none of us have them.

On deployment, the independent practice concept can be taken a step even further. We NPs and PAs are often deployed forward of a hardened medical facility, where the physicians and surgeons stay, awaiting arrival of the really sick and injured. They are a phone call or Internet connection away, but there are no hallway consults. And, with luggage weight at a premium, our reference materials dwindle to what we can load into a PDA or find on a somewhat unreliable Internet connection. You quickly realize that explaining to every last troop what an NP does and what our unique role is is just more than they want to know. They want to know someone is there to take care of them when they are sick or injured, and “Doc” quickly becomes your accepted call sign.

Here at training, I am already getting the request to “take a look at this.” Thankfully, it is usually a sprained ankle, bug bite or, for many, the cold virus that has quickly spread among units (can't be helped when living in such close proximity). My goal now is to build confidence for when we are downrange and the concerns get different. Stress can reveal itself in many forms, including physical and mental fatigue, illness and even thoughts of suicide. As an NP, my strength for that “gut feeling,” when it comes to my fellow PRT members, will be critical, as mission preparedness can often equate to mission success. So, NPs of the world, never fear. I will continue to laud our strengths even while answering to “Doc” for the next year.

Thursday, June 4, 2009

Why Afghanistan?


This is a question I ask myself most days. What is it all about? Why are we going? I have learned a TON in the last several weeks about the region, in general, and the long, tumultuous struggle the people have endured. They have been at war for the last 30 years—first the Soviets, then the Taliban and ensuing civil war, and now “occupation” by international forces. I use “occupation” in quotes as we are not there to fight the people of Afghanistan; we are there to liberate them from the Taliban. But some, here and abroad, see it as something else.

Who remembers that many of those involved in the attacks of 9/11 were from Afghanistan? Did you know Afghanistan has the highest infant mortality rates in the world? That nearly 80 percent of the population is illiterate? That just a few years ago, more than than 80 percent of the population lacked access to any medical care? That is why we are there. The long-term goal is to leave the people better off than the day we arrived (opposite the goal of those who came before us, when you consider the destruction caused by the Soviets and the Taliban).

So, why is a family nurse practitioner going? And what will I be doing to make the above happen? We—the members of my team and 11 other teams training here with us—are part of something called a Provincial Reconstruction Team (PRT). There are 25 PRT teams spread across Afghanistan, 12 manned by U.S. forces, 13 by other international teams. Our goal is to connect the Afghan people with their government and promote growth throughout each individual province.

In general, it is believed that the insurgents have an easier time manipulating people who are isolated from their govenment and countrymen, so our main responsibility is building roads. We don't actually do the manual labor; we have engineers on our team who help the Afghan locals bid and hire the necessary labor required to complete the job. Throughout the project, we return frequently to ensure adequate quality standards are enforced. We also partner with local leaders, physicians and educators to help meet the basic needs of the villages.

Prior teams have built schools, clinics and government offices. As a whole, the work done by American military and coalition members has enabled more than 50 percent of the population to have access to health care. Now, many more children—boys AND girls—have access to basic education.

I didn't really answer what I am doing, did I? I will wear several hats on this LONG trip. When you include training, it will be at least a year away from home! I am the senior medical advisor to the commander. As a senior ranking member, I also have some responsibility to ensure that everything, in general, runs smoothly. I will provide daily opportunities for our team to receive medical care, organize the necessary medical support for any missions off the relative safety of our home base and develop various medical outreaches to the local communities. In addition, I am constantly preparing for the worst-case scenario by training the entire team on how to respond to battle injuries and save their buddy, if injured. We want to leave in a year knowing we helped the Afghan people of Kapisa province, but our primary goal is to come home with everyone we leave here with.

As the coming year develops, I am sure there will be many more “hats” I will wear. Some days, I am the motivator, the one keeping the group moving forward on a five-mile march. Some days, I'll be the listener as lives back home compete for our attention. Some days, it will be my turn to struggle with the daily stress. Our team has a great sense of humor and lots of variety in skill sets, which will definitely come in handy.

So, readers, what else do you want to know about our upcoming job? About my role? Think I am crazy?

Monday, June 1, 2009

Where's the Mommy?




I knew the hardest thing about deploying would be being away from my family and, so far, it has proven true. Prior to leaving, I was asked several times how I could be leaving my family for so long. How do you answer that? If you say, "It's just part of the job," you seem pretty cold and uncaring. If you break down in tears, people question your commitment to your chosen career.

I joined the Air Force nearly 16 years ago knowing a deployment was a constant possibility but, after all these years without being tasked, it became something that happend to other people. Now, here I sit in southern Indiana, learning all kinds of skills that one doesn't usually associate with a nurse practitioner. I have learned to shoot two weapons (M4 and 9MM), I have called firing comands to a HMMWV gunner, and have a basic understanding of greetings in Dari.

The best thing about the training? It keeps us busy and helps the time pass so I don't miss my family so much. My husband is doing a great job "holding down the fort," but somethings just cry out for the Mommy. My daughter turned eight a few weeks ago and Nate baked the cupcakes for her class. He also planned a great evening out at her favorite restaurant and fun was had by all, but I just hate not being there to celebrate with them. My boy "graduated" from kindergarten last week. (I know, a silly idea but tradition where we live. It is considered second only to the actual event 12 years later.) His teacher was so kind and forwarded some photos she took of him but, again, it isn't nearly as good as being there.

It is an odd feeling, knowing life is going on without you. Your children will continue to grow, events will happen in your loved ones' lives that you will never be a part of. That is a hard thing to accept and, some days, the "mommy guilt" is overwhelming. But even on the worst days, I soldier on, knowing each day brings me one day closer to home and believing that what we are going to do will make a difference in other's lives. While my family will have memories of this year that won't include me, I will be helping to change lives in Afghanistan and will forever be part of someone's memories there.





Thursday, May 28, 2009

Another skill to save your buddy




I mentioned previously that the medics and I were (finally!) going to treat some simulated patients during a base defense exercise. Well, it went fair. In the course of the day, we touched four or five casualties and, since the proctors had no medical knowledge, we really weren't being critiqued. The lack of supplies may have made a difference as well. Everyone knows how hard it is to care for simulated patients (really your peers describing their wounds to you) while using simulated supplies.

That all changed in the last three days while our group completed the Combat Lifesaver course. This is an Army-developed curriculum designed to give typical soldiers some skills to save themselves or their buddies in the event of a traumatic injury. The soldiers are taught the four leading causes of death on the battlefield (hemorrhage, pneumothorax, airway compromise and hypothermia) and how to correct them. They learn to stop serious bleeding of an extremity using a combat tourniquet. They are taught how to recognize a chest wound, apply a chest seal dressing and even how to decompress a collapsed lung by inserting a needle through the chest wall.

The soldiers are also instructed in the use of a nasopharyngeal airway and how to insert an intravenous catheter (IV) into their partner's arm. The course culminates with seven-man teams entering a darkened simulation room that has fog machines and sound effects. The team must assess four casualties (utilizing some of the best simulation technology available), perform the necessary interventions and prepare their patients for air evacuation. The photo shows two airmen treating their simulated casualty.

The two medics assigned to the team and I have had a great three days instructing portions of the course, providing oversight during practical segments and observing during the final exercise. We have also had an opportunity to gain some incredible knowledge from the medics who instruct the course. These dedicated individuals have all spent time in combat zones around the globe and are enthusiastic to teach the average troop these necessary skills.

The simulation exercise was an eye-opener for many. I had a discussion with an instructor about how these men are trained to “shoot to kill” and have no qualms doing it to save themselves or their buddies. Yet, I was amazed how the cocky infantry soldier can freeze when faced with medical casualties whose lives hang in their hands. As a nurse and health-care provider, the opposite is so true—the idea of firing a weapon to harm another individual causes me some hesitation!

The idea for this course is to provide a foundation of knowledge that we now get to build on. We will definitely spend some time assessing a casualty and proper placement of tourniquets. The military works from a theory of muscle memory, and I plan to apply this approach to these lifesaving skills.

The skill the soldiers were most apprehensive about was starting an IV. They talked a big game, trying to sound tough to their buddies, but when the needle hit the arm, many became a bit squeamish and a few even passed out. I continue to reassure the troops that an IV is not an immediate intervention in battlefield medicine, as the military uses the latest in interosseous technology, making an IV nearly obsolete on the battlefield. But, it is another fear conquered, another skill learned, something else to add to their virtual “battlefield toolbox” and take along for reassurance.

Is the training of a non-medical individual to perform these procedures a concept we medical people have a hard time with? YES! I do worry they will believe they are now “medics” and “experts” in combat care. But, if we don't teach them how to save their buddy, we are doing them a disservice. Most combat fatalities would be lost, whether medical personal administered care or not, but the individuals who survive often do so because of the care their buddies rendered in the field. There are only three of us medics on this mission and we can't be everywhere at once. I will rest easier knowing we gave these soldiers one more skill set to help them and their buddies return home safely. Ensuring we all come home together is the ultimate goal of our year in Afghanistan.

Sunday, May 24, 2009

Memorial Day


I am often overcome by thoughts of those who gave the ultimate sacrifice, those lives lost to fight tyranny, overcome strife or stand up for what they know is right. For those of us preparing to enter a combat zone, Memorial Day takes on increased significance.

Before I go too far, I should point out that the day would likely slide by unnoticed as the training goes on. We were not given the typical three-day weekend to celebrate or even the day off. And, really, what would we have done if we had the time off? None of us have a car here. We are restricted to post (with a few exceptions) and, when we do leave, it is in uniform. We were invited to a local Memorial Day concert Friday evening, but between a long day of training and fighting off a virus, I chose to fall into bed shortly after dinner. A few friends did attend and said it was fun; the support of the local community was evident, something many soldiers don't experience often.

The true meaning of this American holiday hit tonight while I was in church. We managed to wrap up training ahead of schedule and the medics and I slipped into a crowded chapel for the contemporary service. Church here is always a time of reconciling mission with faith; I celebrate Jesus while wearing a pistol on my hip and a rifle at my feet. But to worship with 50 other soldiers, sailors and airmen, all training to enter a combat zone, and give thanks to those who went before, really drives the message home. We are so lucky to live in a country where you can choose your destiny, where freedom is celebrated and where a stranger is willing to lay down his or her life to allow us these opportunities.

So, today, fellow Americans, while you bask in the sun at the pool or grill with friends, spend a few minutes to remember those who paid the ultimate sacrifice for our freedom and know there are many, many more men and women taking up the cause so we can all live free.

Sunday, May 17, 2009

Not in Kansas Anymore...

Most days here, I feel like Dorothy in the Wizard of Oz. Can you just imagine the headline: "16 yr Air Force NP whisked away by tornado to the Dark Side"? I haven't touched a real patient in three months. I have managed to "simulate" some impressive traumatic-wound care, usually overseen by cadre with no medical background. One of my fellow providers laughed that she could have said just about anything and, as long as it was said with confidence, the observers would laud her performance!

What have I been doing? I have learned how to shoot a long rifle and a pistol (and done a pretty good job at it!). I have called fire commands to a gunner while riding in a HMMWV (and out-performed several Army teams). I have endured foot marches, daily physical training and radio courses. We have even undergone HMMWV rollover training in an impressively designed simulator. And, right now, I am currently living in a drafty tent, sleeping on a cot while manning a simulated FOB (forward operating base).

Tomorrow, my medics and I finally get to do our jobs. Tomorrow we are in charge of "base defense" and, as part of our responsibilities, we will be standing up an aid station to care for the simulated injuries we expect to sustain. We have reconned our assigned building, prepositioned some supplies, planned for some staff training on our responsibilities and gathered some supplies to simulate treatment. We are giddy with excitement! After a month and a half of "playing Army," we get our chance to show our stuff.

Yes, we are definitely NOT in Kansas anymore, but tomorrow we just might get a chance for a day trip back to visit. I'll let you know how it goes!

Wednesday, May 13, 2009

About Me!


Hi! I am Lori, aka the High Plains Practitioner. What does that mean? Well, I am an active duty Air Force Major, family nurse practitioner who is currently training to deploy to Afghanistan. I am also a wife, mother, daughter, sister, friend and lots more. I was asked by the publishing folk at the Honor Society of Nursing, Sigma Theta Tau International, to document my experience in Afghanistan over this next year, so this blog came to be.

Many people ask: Why the Air Force? My typical response – the Air Force choose me. I was attending Saline High School (in Saline, Michigan, a small town about 5 miles outside Ann Arbor) and interviewed extensively for an AF Academy slot. At one interview (my last), I was asked if I was ready to make the AF my career. As a typical teenager, my response went something like: “I don't even know what I am doing Friday night; how can I answer that question?” I then went on to attend Indiana University where, at my parents suggestion, I enrolled in the AF ROTC (Reserve Officer Training Corps) and discovered I really enjoyed the people and the structure the detachment provided me. Next thing I knew, I was awarded a four-year nursing scholarship and the rest is history!

Since entering active service in the fall of 1993, I have experienced an amazing career. I met my husband within months of arriving at Travis Air Force Base in beautiful northern California and we were married two years later. We have since lived in Ohio, Nevada, Washington, DC and are currently stationed in the southwest United States. Each assignment has been interesting – some more than others! Ohio is where we got our first “boy” - a golden retriever puppy named Tahoe. Nevada is where our human children arrived (Goose, our girl, in 2001 and Ham, our boy, in 2003). We had fantastic neighbors in DC who we continue to count as friends today. Our current assignment is one we went to hesitantly but have learned to love. We experience great schools, a true family-focused community and play as much golf as possible. Who could complain?!

For those of you who stuck with this to the end–thank you! I am excited to develop this blog to showcase the mission we are doing in Afghanistan and the role of NPs in rebuilding this war-torn country. For the rest of you, there will be plenty about my first deployment, my experience being away from my family and silly things that happen over the next 12 months. I am looking forward to this experience. Thank you for sharing it with me!