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Archive for January, 2011

Voluntold

January 31st, 2011 5 comments

The US military went to an all volunteer force right after the Viet Nam draft ended. Depending on particular branch of service and the wants/desires/recruiter, various individuals received various deals and promises.

In reality, you volunteer for the military. After that, the oath that you swore means that you accept what comes next. You are serving the needs of the military. The military is not particularly obligated to you. After all, you are one little cog in a huge organization.

There is wisdom that says – don’t volunteer – if someone wants you to do something, you will be told or receive orders.

Now, we move on to the issue of deployments. A number of us were discussing the phenomena this afternoon. Of knowing that a deployment was on the horizon and just trying to position for the best job, good length of tour or locaion that was going to be tolerated.

One of the guys said he was “volunteered.” Ok, means that someone else made the decision and he just complied. Well, he replied, not really, I was told it would be much better if I just tossed my hat in the ring. It woud be a really positive thing and stand me in good stead when I was applying for long term civilian school.

Several heads nodded sagely – oh, you were voluntold……

Categories: deployment, military Tags:

Whose standard?

January 30th, 2011 5 comments

Medical care should be clear and easy, right? Person gets bitten by an animal that could potentially have rabies, follow the protocol.

Now the problem becomes – whose protocol? Centers for Disease Control? ACIP? WHO?

Getting the idea? There are difference between countries on medicines, vaccines and treatment. Most of the time, between Europe, UK, US and OZ, these differences are trivial; mostly a difference of packaging or cultural dosing. The principles are the same, the care is the same.

And then we come to Rabies prophylaxis. WHO (World Health Organization) has a five shot protocol which is based on several factors: approved and tested vaccines, rising in viral titers, and actual prevalence of rabies. The latest US protocol is a four shot series. Based on US vaccines and risks, this is more than reasonable.

Now think about Afghanistan. Some of the assumptions we make in the US are simply not true – none of the feral animals have ever been immunized. Nor have their dams. The incremental difference in anti-body titers between 4 and 5 doses is not much. In the US it is unlikely to make a difference, but what about in a location where the assumption is likely that the feral is infected. In a location where we have seen rabies in 10 week old puppies.

All militaries adhere to their national standard; the challenges come when treating someone from another country. ISAF uses the WHO standard, except, of course, where national interests over ride for own country patients.

The debate is raging fast and furious.

Meanwhile, I spent some time thinking. If I was stupid enough to get bit by a feral animal here, I would not turn down any added protection that might be offered by a more conservative protocol that offered an additional vaccine dose.

Categories: deployment, military Tags:

Did I leave?

January 29th, 2011 6 comments

What I discovered about KC-135s is small but significant. The plane was older (45) than most of the crew. We had two crews – the CCAT (Critical Care Augmentation Team) and the regular flight crew. The passenger section is the upper half of the fuesalage. The bottom half (this is a tanker) is fuel. That floor is ice cold. Trust me, you don’t want to laydown on the floor or even leave your boots in contact with the floor for any length of time.

I am not that tall, standing up was not an issue for me. If you are over 6′, I think it just might be! Besides the litter stands, there were a few comfortable patient seats, and a small row of jump seats. Small head, nothing like the fancy unit on the C-17.

Smaller plane, more fuel efficient, great crew. I read, talked and crawled into a comfortable chair for a while. Seven hours later, I climbed down the ladder, picked up my rucksack, signed in and went to my BHut to crash.

Spending the day cleaning out desk, parcels and emails. By this point, it is all starting to fade. Did I just dream it? Probably not, since I would never dream boxes in my bedroom or a computer that would not work in a billeting space.

Repeating the story a couple of times, it convinces me that I left. But it certainly feels like I have not.

Categories: deployment Tags:

Space-R

January 28th, 2011 4 comments

stands for Space-required. Unlike downrange (or when one retires) when one flys Space-A (Available).

In the former case, it means that the Air Force is obligated to find me a seat sooner or later. And the Army is probably going to have to pay for that seat.

In the later, it means that the burden of getting somewhere is on me, and it will take however many days it takes (and, in some cases, can you spell …. never?)

Ramstein PAX terminal has a DVQ lounge, so at least I have been able to hook up my netbook to a LAN line and download a few things.

Flight goes out in a while, KC135. Never have flown on one of those before. The bad thing is, I know it is headed down range because there is the need for a CCAT mission…

More tomorrow when I am back to what passes for normalacy in my deployed world.

Categories: deployment Tags:

Next

January 27th, 2011 7 comments

Between 1500 and 1600 this afternoon I was racing around collecting signatures like a kid on a scavenger hunt.

In military speak – it is called “clearing.” You have to check out at a number of locations for various reasons. For example, you have to clear finance to make sure that you have enough cash to last to your next stop. You have to clear the baggage room to make sure that they don’t wind up with stuff of yours staying here while you are on a flight off to some other country or another.

And, most obviously, you have to clear medical. It is why you were here in the first place!

Most individuals are on a flight to the US from here; headed to home station for further treatment. Some on commerical flights and some regulated through the evac system. A few of us got done what we came to do and head back to the deployment. The bad thing about people not returning is a stready drain in prepared manpower downrange. It is why we now have a number of medical specialists deployed who really don’t have much of a combat trauma role, but can make a difference on diagnosing disease and keeping the ok in theater. Cardiology and Dermatology are classic examples.

I hate to say it, but there are a fair number who just don’t want to go back. Usually it is those with medial problems rather than those with injuries or combat trauma. I think the fact of getting injured might just be a bit more acceptable than getting ill and it might just leave a number of soldiers feeling like they are still part of the unit. Attitude is everything.

So there I was, at almost every turn explaining to people that no – I was not headed to the US, I was headed back to Bagram. After collecting all those signatures, I received my orders. In the morning the very few of us headed back downrange will clear billeting, bus over to the PAX terminal and get manifested (I hope).

Unlike downrange – this is Space-R = Space-Required. I had been hopeful that rank might help. Maybe, maybe not, rumor has that there is some BG who has been stranded for a few days. Here is hoping that it is because of flight lack, not because of no space on flights that are going!

But anyway – I have orders. If I don’t get out, we will get bused to ROB and billeted there. Not for fun and games but because it is a lock down location where they will be able to find us and load us up on no notice should a plane suddenly express a desire for passengers.

Now, if the PX had not been closed today for inventory (I kid you not), my day would have been perfect.

Oh!!!! You need to see this! Real Ice Fishing for those of you who don’t have enough snow and ice. Some people actually (about 10,000) have a good time with a line, hook and hole in the ice!

Categories: deployment, military Tags:

a blur

January 26th, 2011 8 comments

This past week has been a blur. It wasn’t until answering an email from Carmen that I realized that my subtlety had been perhaps too much so. I suppose I can use as an excuse the fact that long distance flying from Bagram to Landstuhl took a number of hours longer than planned (that stop in Kandahar which I still don’t get) or the fact that I am sleep deprived. It meant that I got up on Thurs – the 20th and didn’t get to bed till quite late on the 21st (and then you have to add in the time zones as well. I should admit that I am just a bit past the point in my life where staying up for 36-48 hours has any appeal.

But honestly, it is more likely that I did not come clean early on through sheer embarrassment at needing to come out of theater for something as stupid as a retirement physical. Some parts of it just could not be accomplished downrange. While I was at it it, I took care of a few other bits and pieces. But still, there are all those who are ill or injured really need care. My guilt kicks in at the thought that I might be depriving someone else of a needed appointment.

People are nice, extremely helpful. Tomorrow is the last of what I need to do (and last stop with the blood sucking lab), then hopefully I will be cleared to get back to work till the end of March. Obviously, I am not holding my breath about it being easy to Space-R out of here, since they want new orders (visit the movement branch) and an incredibly early show time.

more as soon as I have a clue

(with a 0505 S1 to Landstuhl from Heidelberg)

Categories: deployment Tags:

The little stuff

January 25th, 2011 2 comments

It some ways it is not the big things that throw the deployed environment into sharp contrast with home, it is the little things.

  • Being able to brush one’s teeth with water from the tap
  • Passing people on the street who are not wearing weapon harnesses
  • Asphalt streets glittering like diamonds with ice coating rather than being coated with dust and sand
  • Paths paved with bone stone rather than just covered with ankle twisting size rocks.

But again there are things the same:

  • idiots on the S-Bahns who want four seats to themselves, just like everyone on the downrange buses, only without the excuse of wearing battlerattle.
  • Drivers who manage to speed even in areas where it should not be possible.
  • People working hard to get their jobs done and support others.

In the end, I think it comes down to how easy it is to get the job done and how much stress it creates on a daily basis. Changing environments, in and of itself is stressful.

On the other hand, Aviation DFAC can’t compare with a really good Thai dinner.

Categories: deployment, home Tags:

Change

January 25th, 2011 5 comments

or perhaps managing change or at least coming to grips with expections that don’t relate to the current situation. That was what I was thinking early this evening.

In some ways, working and dealing with Afghanistan is not all that hard for me. I know it is different from the other locations to which I have been deployed. It is certainly not the Balkans, Kuwait, Korea, Iraq. The weather is different, the bases are different. It almost is an island or time onto itself with its own peculiarities rules and expectations. I don’t make the assumption that I understand the place or know the rules without asking. Yes, I can get surprised by something, but I don’t walk in the door thinking that I have it all under control.

Dealing with Germany, whether it be one of the bases or the country itself is a different matter for me. We have made our home in Germany off and on since 1981 and I get caught in that challenging word – “assume.”

I assume that I know how to get around or get home (this one has bitten me more than once since construction patterns have forced me to backtrack or go around a different direction). I know what services are where, and what time things are open.

Wrong. The world is not stagnent. Opening times are not the same as they were 30 years ago. The stores lining the main street through downtown Landstuhl no longer has a yarn store (it closed sometime around 1993-95) and many of the family owned stores have given way to chains and franchises.  The train station no longer has a lobby or ticket window meaning that you are going to have to operate an electronic ticket machine while freezing outside in the cold.

You can’t drive up to the front of the hospital complex from town. In fact, that gate has been closed by years but, again, there is construction with the appearance that eventually the wall which now has a set of gates that look like river locks just might open for the right kind of traveling vessel.

On the grounds – two of the old Ramstein Inn buildings have been converted to house those registered with the WTU and a new USO, open from 1130-2300 has opened between.

As I look around me most days and realize just how young the medics, docs and nurses are, it gives me a fright. Sometime when I was not looking, the world changed around me. Since looking out my eyes I really don’t think I am any older, something else must have changed. Not me.

But that really is the point, isn’t it?

Categories: deployment, home, Prose Tags:

LRMC

January 24th, 2011 Comments off

From Ramstein Air Base, patients headed to Landstuhl Regional Medical Center are loaded onto Ambulance buses (yes, the ubiquitous Blue Birds which have been adapted with litter stanchions for the ten minute up the mountain drive. Taking the autobahn, the buses crawl up the hill and in the out gate before cutting through the campus to end at the Emergency Room entrance.

From there, it should be ordered chaos again. Perhaps a bit too much of a handover in public, especially when the weather is Germany winter (a bit colder than downrange), as a quick discussion ensues before each patient is rapidly moved toward ICU or hospital ward.

For outpatients, the process is even quicker: individuals are hooked to an LNO (liaison) who makes sure that they are fed, housed, organised and headed toward their appointments. The limit is two weeks. For those whose issues can not be solved within that time with a return to duty, they will face a trip back to CONUS. The rest will once again face the challenges of the Air Force Space A system as they attempt to get a ride back to theater.

Categories: deployment Tags:

Milk, bread and toilet paper

January 23rd, 2011 6 comments

It seems like a long time ago, but less than a couple of months – we were talking about emergency preparedness. As we roll into more winter, I can remember getting responses that included a number of stories about weather, bad weather….

And in the US, that means that risk of bad weather means everyone who possibly can, goes shopping. For milk, bread and toilet paper. In Germany the list is quite similar. Diane assures me that in the UK – one or two whispers of snow and the whole world seems to be buying out Tescos.

Deployed? Bad weather means power failure. Most important are flashlights, bottled water, long underwear and sleeping bags. The clothing and sleeping bag should be already on hand, the water is there by the case which leaves only the flashlight.

From not having any source of light (note, no candles or matches. Burning things in a wooden shack is a really bad idea. People who are dumb enough to do octupus with extension cords and overload circuits have been know to start fires. Yes, I know I just said that power could be out.) I now have two! I have this neat little velcro gizmo that attaches a tiny light on the end of my finger so that I can see what I am doing with cipher locks (thanks Steve!) and then there is this thumb long extremely powerful flashlight received from my SF buddy Mark. Both have been added to my pockets.

I can now find my way around at night and set off metal detectors. Check the people with a wand and ignore coats and jackets – right? I will never figure it out, but at least I am not in the dark…..

Categories: deployment Tags:

Quilts

January 21st, 2011 7 comments

Standing inside of a C-17 feels like being in the belly of a whale. Ribs arch overhead, the vent conduits could be a circulatory system while cables trace across the walls and roof provide the nervous system of the beast.

Dulls colors prevail, a dusty green-grey paint, silver metal decks with charcoal skid strips, uninspiring black seats line the outer walls. Even the crew uniforms are dull, sand colored flight suits with subdued patches.

The only built-in spots of brightness are the yellow warning and hazard signs plastered in the appropriate places. Otherwise, think olive drab.

On a stratevac flight there is also the occasional spot of red-orange medical equipment. Ambulatory patients sit in the seats mentioned above. The litters for the serious ill and injured are held in stanchions, four sets on each side – up to three high in each location (yes, that is 20-24 litter patients). Looking like pieces of an erector set, the metal assemblies provide both bracing and conduits for power hook-ups.

Otherwise, the only bright, cheerfulness comes from the quilts which wrap each litter patient in warmth and comfort. All the colors and patterns convey love from the volunteers who are making quilts; letting those who are injured know that people care. Care enough to send their love across in the form of a quilt; effectively a hug, to combat that long dark transport from theater to Landstuhl.

(for further information – www.landstuhlhospitalcareproject.org )

Categories: deployment Tags:

Stratevac

January 20th, 2011 5 comments

Terms can be specific. Stratevac = strategic evacuation. That is – out of theater to definitive care). In just about everyone’s military, Air Forces are the ones with this responsibility. Unless, of course, you are too small to have such abilities or find it is cheaper to buy the services from another military or civilian source.

No, I am not kidding about the civilian course – S.O.S. is contracted by smaller militaries as a great way to move the occasional patient.

The following information is nothing that you can’t find by perusing various Stars & Stripes, Washington Post, New York Times or other articles that have been written over the last several years.

For the ATO (Afghan theater of operations) the hub is located here at Bagram. That means that all patients leaving theater, whether litter or ambulatory have to come through here. Critically ill patients have their care transferred from the hospital to the CCAT at the ICU (ITU for you Brits) who effect the transfer to the aircraft. Ambulatory patients are rounded up at the CASF (Contingency Air Staging Facility) and are either hiked or bused out to the plane depending on how close it is. In the case of Bagram, just about everything is by bus/ambulance bus since there is a definite dislike of stray individuals on the flight line.

From here to Ramstein is about about 7-8 hours, give or take. The length of the flight means that there are limited choices of aircraft in the current inventory. The Nightengales are gone. Taken out of the inventory just a couple of years before they became critical, part of the decision was the fact that they were dedicated aircraft and pilots, not interchangeable with other missions. The advantage of built-ins and specialty air craft was billed as over come by the limited number of air frames and high expense.

So, now we have opportunity air craft – C-17s and KC-135s. Yes, you read that right – tankers being used for patient movement. They have some challenges: smaller, fewer patients, large tanks which limits the places the Air Force is willing to land (can you spell rocket attack?). The C-17s are huge and you can pack a lot of patients on them, both liter and ambulatory.

Most of the time there is a regularly scheduled C-17 run once a week where they try to move most of the ambulatory patients and all “stable” litter patients along with all on hand critical patients and CCAT. The rest of the time it is KC-135s because it is a critical patient move.

There is a limit to what we can do for patients here in theater. Additionally, we have a limited number of ICU beds. In order to support on-going operations, those beds have to be open. When they are filled with casualties, the casualties need to be moved to the next echelon of care.

So it seems that just about everyone got here on a C-17, and there are a few who leave via another aircraft.

(CCAT= Critical Care Team)

Categories: deployment Tags:

MEDEVAC

January 19th, 2011 5 comments

MEDEVAC= medical evacuation.

The US has three systems in theater, sometimes more depending on how you count.

Most of the time, if you are Army, MEDEVAC means helicopter = Dust-off. The Huey of Viet Nam fame has given way to the Blackhawk UH-60. Two pilots in the front, crew chief and a flight medic in the back. Rapid transport from point of injury (POI) to the next echelon of care or between echelons of care.  Because the altitude, the carousels are removed (saves weight) and litters are on the floor. The idea is to get the wounded to a surgeon as rapidly as possible.

If you are a Marine – you call PEDRO (which has been known to use opportunity aircraft but otherwise mostly operates on rotary wing).

If you are Air Force – well, you usually live on a larger  base (fixed wing aircraft need some kind of runway) and your mind turns to air movement within the theater – usually from Role 2 to Role 3 by C-130 (on board is either an Air Evac Team or a CCAT Team – Critical Care Air Transport Team).

If you are British – there is the MERT (transports on a Chinook) which brings critical care to point of injury, then back to the Role 3.  If you are German, a similar system exists.

And, if you are Special Forces, you are special – Fever is the name of the game.

What is common to all of these systems is the use of air frames. Which air frame varies by area, country and distance to be traveled.

What is not common is the level of provider on that air craft. Gone (about time in my opinion) is the system of depending on a junior medic to do “scoop and run.” Except, of course the US Army which is persisting in outmoded doctrine. Our Allies are all putting highly qualified emergency personnel on the aircraft so that a lot of resuscitation can be accomplished during the flight.

We are getting there – SF has paramedics. Army has started using en route critical care nurses for helicopter transports between “fixed” facilities – especially where the distance facility does not have a runway capable of handling a C-130. By doing so, we are starting to bring the standard of care up to level across the theater.  Especially when you consider that the patient getting moved might just be 22 and just parted with both of his legs, part of his arm and now has both IVs and Blood running and is unconscious on a respirator for stabilization and pain control during the flight.

Me? If I am going to be injured – this is the one spot in the world where I don’t worry about whether or not someone is going to get me out of there, back to the best trauma surgeons that exist and move by the most expeditious method possible.

Categories: deployment, military, Uncategorized Tags:

Wires

January 18th, 2011 2 comments

Walking along the streets here (gravel paths, routes between buildings, whatever) I have gotten used to overhead wires.  Just like in childhood, there are telephone poles with wires running between the poles and swapping back and forth across the street in a dance only understood by those who strung them up many months or years ago.

Living in the US and Western Europe, the concept of wires along the roads is old fashion and rarely seen. Instead, cables, wires and fiber optics are buried. Allegedly in an well thought out, marked on everyone’s city plan along with water and sewage hook ups. The idea of getting power to a building by jury-rigged stringing immediately conjures up the idea of someone living “off the grid.” The expression itself speaks volumes to usual practices and concepts.

Then you come to deployment areas.  Most of which are in third world countries where power lines and phone lines provided navigation hazards to helicopters from the beginning of the deployment, especially with the limited regulation and lack of same on most maps.

For [pick one - NATO, US, UK, OZ] arriving military forces, early in the deployment, power is local. Extremely local, as in your generator is outside your workspace or sleeping tent. Lack of regular fuel delivery means you have no comms, lights or heat. As deployments progress, we switch over to a grid with more centralized power generation. This might mean a generator farm, it might mean pulling from a host nation power supply. There is good and bad news – the good is that most of your S4 shop/motor pool is no longer tied up with insuring fuel truck deliveries and actually can work on other supplies and issues. The down side is that you are now at the mercy of others for power.

Wire overhead is subject to stupid and inconsiderate activities by large trucks, Hets, cherry pickers and crane operators who might well wind up saying – oops. Buried cable, which somehow is never located exactly where it is on the map is subject to being cut every single time some idiot digs a hole.

Either way, if you work in a windowless room, there is not much you can do without electricity. Certainly you have no lights or ventilation. Even more important, the UPS for the servers has an extremely limited battery life. The batteries on the laptops even less. Makes it rather hard to do anything but make phone calls in the dark.

Although in different sectors, my office and BHut are on the same grid.

Surprisingly – the USO is not.

Categories: deployment Tags:

Trauma

January 17th, 2011 13 comments

No news is good news – we have heard little from the “expert team” other than they are making progress around the theater. The weather has not been in their favor causing more than a few flight delays. It hasn’t been particularly warm either.

Rebecca – (daughter of two good friends) who is socially active and responsible, reads widely and  sees below the surface,  had the following thought:

Like many people over here, I have been watching and listening to the daily updates from Rep. Giffords’ doctors on her condition and her medical progress.  One question has occurred to me.  Does the average American realize that while we stand horror-struck at the tragedy in Tucson, Rep. Giffords is enduring what many of our wounded soldiers have and will endure during our military engagements?  It seems a little odd to, on the one hand, grasp at every new change in Rep. Giffords’ condition–she opened her eyes!  She can move both her hands!  It really is wonderful to hear.  But, the injured soldier is just that–injured, no details, no appreciation for the long recovery ahead.  I wonder if having the detailed public focus on the slow, unsteady, recovery of one prominent person can shed light on just what your medical staff deals with regularly.  The only glimpse I have heard is when the media refers to the surgeon attending to Rep. Giffords having experience from military service that aided him in dealing with this case.  What we have heard, however, is that her life was probably saved by a staffer who quickly applied pressure to the wound, and medical personnel who moved he quickly to a hospital, where they could, among other things,  remove part of the skull to alleviate pressure.  I don’t recall hearing anyone talk about the need for an MRI at the Safeway.

The truth is that we see at least one, if not more service members a week whose families would be delighted if the head injury their love one was faciing was as mild as Giffords’. Not the concussion group, but the soldiers getting shot in the head, crushed in vehicle roll-overs or blow up by IEDs.

Neurosurgery is making strides, but you have to have most of a brain in order to have a reasonable quality of life. No one yet has been able to re-grow pieces lost to explosions or bullets. Science may be making progress (like this in rehab) or the unit working  with traumatic brain injury at Walter Reed but there is a long, long road ahead for many. It is all too easy to forget about those who have returned home, especially those severly injured.

The signature injury from this war is not concussions, nor is it post combat stress disorder. The signature injury is the hundreds who have lost two limbs, the dozens who have lost three. Their numbers are increasing on a weekly basis.

I am old enough to remember the aftermath of the Viet Nam war. No matter how much everyone “supports the troops,” we have no idea yet of the long term challenges and burdens.

Categories: deployment, military Tags:

Air Quality

January 16th, 2011 Comments off

This discussion has been on my mind for a few days. I didn’t post sooner because I decided the discussion really needed some comparision pictures (Seoul and Beijing). Then, after realizing that I did not have them with me (my Seoul pix are from 2005 and the Beijing from 2007), I figured that all of you could easily look on the web. There is some on-line information – Seoul with a great photo here. It was not hard to find a whole raft of pix relating to Beijing – it was obvious that something had to be done prior to the Olympics. 

All of this is distant. What upsets a number of US service members, civilians and Allies is having to live in Kabul. Kabul, because it is a large city, has cars, trucks, wood/dung/tire/trash providing fuel for heating fires. This winter has not been pleasant.  We are starting to see an number of articles in various papers, like here (but regular masks might filter out particles, not going to do anything for gases).

These – 

http://www.rawa.org/temp/runews/2011/01/06/afghanistan-kabul-air-pollution-prompts-advice-on-use-of-masks.html

http://www.npr.org/templates/story/story.php?storyId=99127084

http://www.rawa.org/temp/runews/2010/12/01/kabul-a-breath-of-fresh-air-cannot-be-purchased-for-any-price-in-most-days-of-the-year.html

pretty much speak for themselves.

From a military point of view – it can be a challenge.  It is not feasible to move the camps.  Much of the rest of the country is simply not this bad. (Leaving aside the Poo Pond). And it is considered radical to propose that people stop smoking, drink fluids and (gasp) forgo outside PT.

Categories: deployment, Uncategorized Tags:

What a difference

January 15th, 2011 5 comments

a day makes!

We didn’t see rain or snow yesterday, but when the sun came out in the evening – our ring of mountains emerged crowned with white.

Categories: deployment, Uncategorized Tags:

Seven

January 14th, 2011 3 comments

0700 in the morning hangs on the cusp of night and day. It is light, pearly grey from the dense overhead clouds and the security lights have dimmed. The birds are screeching overhead as they wheel between the trees, their lives disrupted by the soldiers leaving the clamshell after early work outs.

I pass almost no one as I walk from my BHut to Four Corners. There is no snow; the temperature having stayed at that lovely level where we are all chilled to the bone. Just before I get to Disney, the front door of the ADTs Company HQ opens. Filing out is a line of men, full gear, heavily weaponed on their way to their MRAPs. They spend mission after mission outside the wire.

The mud and water splash from joggers, runners and the occasional vehicle on Disney for it is still PT time and exercise has priority. Heading toward the USO and the PAX terminal, the ground shakes as two fighters scream along the runway heading up and out on their patrols. I can hear the announcements for the flights – or lack there of as a quiet voice telling those Kandahar bound that their flight has been cancelled. “Check the board to the left of the counter” she advises “there maybe flights later today.”

All around me are soldiers with IBA, kevlar, weapons ranging from 9mm to heavy assault rifles and machine guns. Marines, sailors, airman without weapons hopeful that their flight to Kuwait, R&R in the near future, is not cancelled or delayed for weather.

I wonder at the arrogance of the visiting team of experts from the Pentagon. They have their agenda, thoroughly convinced that they know better than those of us hear in theater. So sure that this is a mature theater; that there are no restrictions on health care. Completely convinced that we can do anything and support anything.

Meanwhile, I am thinking of the cases we reviewed in last night’s VTC. Not all the trauma in theater, just the most critical cases. Doctors, nurses, techs, medics, support staff from the US across the theater  discussing each case from point of injury to receiving hospital in the US. The US based participations letting us know how each of them is now doing. All of us looking to make the care better; understanding the limitations of transportation, distance, and the acuteness of the need. Cases that represent gunshot wounds, IED blasts mounted and dismounted; young men who came intact and are leaving theater paralysed or missing three limbs.

The USO is full of able bodied service members looking for internet access, a cup of coffee, a phone to call home. All of them know the risks they are taking just flying from Bagram to another locations. Our team of experts gets rapidly passed along; easier on hosts to deal and move along rather than have to take their eyes off the war to entertain and explain.  The downside for all of us is that it leaves an unreal expectation of how the theater operates.

I don’t wish them a mortar attack or any danger. At the same time – they need to understand that there is a war going on. Each and every day service members are at risk both on patrols and on each one of the bases. We do medical care that is needed. We don’t do procedures, surgical or diagnostic, that don’t benefit that particular troop. The attention is on combat casualty care, to do the best possible to mitigate horrendous injuries. Research diagnostics?

An MRI? I don’t think so.

Categories: deployment Tags:

Rain

January 13th, 2011 6 comments

There may be snow in 49 states but not here. There is snow on top of the volcano in Hawaii, but we are matching Florida. In a country where it normally starts snowing in Oct and lasts through to March or later, we do not have snow.

What we did get, starting this afternoon was rain. Sheets and sheets of rain, enough to settle all the dust and more. There are standing puddles, there just might be a bit of mud. Now, it is right at freezing with predictions of snow. That is what they have been telling us for days.

What I do know is that if it drops to -7C (19F) all that water is going to freeze leaving roads, sidewalks and pathways to resemble skating rinks. Reality is also that it will severely affect flight operations – at least for the fixed wings. Sliding down the runway is no one’s idea of a good time and I am not sure what we have (if anything) for de-icing. Certainly there will be issues for those heading north to Manas on their way home.

Unlike our camps in Kuwait, roofs here are pitched and should shed water and snow. Few buildings have flat roofs, for as we know, all flat roofs leak. I haven’t noticed anything looking like storm gutters so that might just explain the water puddles extending the length of the ruts between the BHuts.

Rain on fuzzy jackets = bedraggled troops. Most of us broke out our marshmallow appearing jackets this afternoon. They might not shed water as well as gortex, but they are a lot warmer. Just think of us hiking from one end of the post to the other humming, Puff the Magic Jacket out from my trunk….

Categories: deployment Tags:

Breakfast with the VEEP

January 12th, 2011 14 comments
across the room

across the room

Yes, that is right. Breakfast and photo op, me and hundreds of my new very best friends.

Standing in line waiting for security screening it was well below freezing at 0615 in the morning. Most of us, haven been given an 0630 show time new better. Early is much better than the end of the line. Even so, I wound up around the corner along the Disney fence from the Dragon DFAC. Right behind me in line were some no so happy young soldiers and airmen. You would think that they would have thought to wear jackets…..

Anyway, these type of situations are always great for meeting new people. The kind of service members who spend their lives behind the scenes, doing a job on a daily basis for which they rarely get credit. In fact, I don’t think that most of us even realize that these jobs even exist.

For example, I wound up talking to this very interesting pilot. Married with three children, he and his crew have been doing 3 months home in AZ, 3 months in theater for a significant length of time. They fly aircraft that are restricted from the rest of us. After having first spent 10 years in the Navy, he is not sure that he wouldn’t rather do 6-9 months, then get a solid 12 months home. Since he doesn’t get a vote, he drops in and out of the family. His job is critical to the safety of ground manoeuvre troops, most of whom don’t even realize that they have this level of protection.

Pilot

Pilot

Then there is the guy who just returned this morning from R&R to stumble into the DFAC not realizing that we had an event in progress. On a daily basis? He is one of the iron majors who just happens to deal with news, information services and media. Also married with three kids, we discussed the great and not so great things about being stationed in Germany. He would like Heidelberg as his next duty assignment prior to retirement. Failing this dream? It would be nice to get his protective gear checked out of hold so he can catch a flight back to his job in Kabul.

Iron Major

Iron Major

Vice President Biden worked his way around the DFAC, shaking everyone’s hand, stopping for every picture that anyone wanted (yes, cell phones and cameras were allowed, no pointy objects or weapons, no surprise). I had not planned on being in the picture queue – I was the only one of us three at the end of our table with a camera. Didn’t stop VP Biden – so here is my picture as well.

Biden is older than I

Biden is older than I

Unlike the President, smart dudes with me cleared it with the security detail and gave the VP unit patches, receiving Coins in return. Not a bad souvenir of an otherwise long deployment.

Categories: deployment Tags:

Water

January 11th, 2011 7 comments

H2O. Liquid of life. Something that all of us Westerners take for granted, especially those of us who don’t live in a water restricted area. Even there – SW US, areas of Australia – water restriction is usually related to agriculture, lawn watering, car washing. It does not have much to do with drinking water.

At home if I want water it is easy; I can turn on the tap. I automatically expect it to be clear, clean, and safe. City supplied water to the house. Water treatment is part of normal public health oversight so that I don’t have to worry about potability*. It is safe to drink and use, directly from the tap. And by home I mean Germany/UK/US. It doesn’t matter. The water standards may vary a small amount by country but there are standards and there is oversight. If I want something fancy, I can buy bottled water with or with out carbonation.

(*Potability implies that the water is free of infectious disease elements such as bacteria and parasites as well as free of excessive levels of any harmfull chemicals, elements, or substances).

Back to Afghanistan. Remember this is a landlocked country. No shores – no easy access to large bodies of water (for desalinisation). Also, no near source of water which can rise to be precipitated out by the mountain ranges. There are limited springs which means all the water comes from snow melt. During a winter like this one where there has been little snow at high elevations and almost no rain there will be significant consequences for both city and agriculture come spring. Add to that all the Allies with money and the ability to sink wells for water – just one more thing affecting the water table.

Back to the troops. Given there is no local, easily available safe water supply, we have to create our own.

Water is used for multiple purposes – drinking, washing, laundry, cooking just to name a few. The quality of water needed for each of these purposes varies. It is just about standard that we restrict military to drinking bottled water. There is continuous surveillance of the water bottling plants and constant testing of the water to insure that it meets home country standards. Movement of water is a major logistical challenge. Pallets and pallets and pallets of 500cc bottles. We have gotten out of the habit of bottling in 1.5 liters – there was just too much wastage

Washing water (people and laundry) must be disinfected, i.e. not containing infectious agents. It can have levels of mineral content unacceptable for consumption.

Cooking requires potable water – the water will be consumed as part of the food (think soup, sauces, coffee and everything else in between), otherwise it is used for washing all those industrial size pots and pans. Again, clean implies nothing left on or in those pots to make people ill at a later time.

Similarly, hospitals require potable water.

There are various logistical planning factors; Westerns expect about 20 liters per person/per day. We could get by on a lot less but we expect freshly cooked food, clean clothes, and the ability to take showers. Now, think of the number of military in the country plus Allied contractors.

Traditionally, everyone thinks of beans and bullets as the critical military support needs. In reality, everyone who has dealt with refugee situations knows a few basic facts: safe water comes first, then comes sanitation.

Categories: deployment Tags:

Field Latrines

January 10th, 2011 9 comments

Yesterday I just described some of the mild issues that occur on even most of the most civilized posts and deployments. If you are not at one of those well established locations in time – you may well have dealt with what Ron describes (edited only to remove some personal IDs). Shared with his permission -some memories into words. A little gross for some, but this is the reality of soldiering most never deal with.

I got in the mood of topic and put some memories into print.  Share if you like.  A little gross for some, but this is the reality of soldiering most never deal with.

 Anyone who has ever deployed to an initial phase of a combat theater of operation knows how base the first few weeks of a conflict can make the simple tasks a challenge.  This becomes most clear the first time one feels the need for a toilet.

 The US/NATO operation in Bosnia in 1996, as part of the Implementation Force (IFOR) mission was my first introduction to the joins of the e-tool (entrenching tool aka tactical shovel).  We entered northern Bosnia early January.  In case you did not know, the word “Balkan” means mountains in Serbo-Croatian.  Yes we were in the mountains in January.  The high temp was just above freezing, nights well below freezing.

You also have to factor in our diet, MRE’s or nothing.  Stated another way, an extremely low fiber diet.  Water was difficult to come by on the best of days.  We were buying from local sources and then throwing it away when it failed inspection on delivery.  Everyone was living on about 1.5 liters per day for all functions.  Most troops in the field need 4 times that amount of water to function.  All combined lead to 1800 cavalry troopers who were chronically dehydrated and very constipated. 

I digress:  On the medical side of things, social issues aside, some interesting problems began to occur due to our living conditions.  Of my 1800 troopers, 12 had acute appendicitis from January to mid March.  I made some calls to the experts and this was not a problem the leadership wanted to explore.  Talking to my peers from prior conflicts this is also as old as war.  Chronic constipation is a causative factor in the etiology of the acutely inflamed appendix.  

The unfortunate females that had been “pushed out” to my battalion from our supporting service units, signal, mechanics, supply and medics, all had at least one urinary tract infection per month.  I put a couple of them on chronic macrobid as a prophylactic measure.  I also become far more familiar with their menstrual cycles than I ever wanted.  Without exchange facilities, the medical team becomes the supplier of female sanitary products.  Factor in no bathing facilities from January to March late and you have an interesting challenge.  The scouts found a secondary school with showers, we paid them for regular episodes of 2 hours of hot water and private use… and the UTI’s went away.  This was a “ladies” only contract, so they then had to return and deal with several hundred unwashed men. 

Back to the lack of toilets.  When you felt nature’s call, you had to endure the hunt for a private location, clear the snow, break a hole into the frozen ground with your trusty e-tool, drop and squat, do your business, cover said product and recover garments.  This all to be completed while wearing your “full battle rattle” of weapon, web gear, ammunition, flack jacket and helmet.  Factor in a nice cross wind with drifting light fresh snow and it’s a really good time.  So you can imagine that if you are constipated, as we all were, you really wait until you are sure the mission will be a complete success.  I recall being so focused on what I was trying to do that I did not see the wild life near my selected location.  I looked up after hearing heavy breathing that was not my own and saw a huge 12 point stag eating frozen apples off a tree about 2m away.  He calmly chewed and snorted clouds of steam while looking my way.  This was just the motivation I needed to finish quickly moving slowly so as not to get charged.  He casually turned and walked past as if I was not there. 

After opening a couple of field manuals I got with an old CW4 mechanic and we built some 55gallon drum burnouts.  This is a military version of the hole in the ground outhouse.  In a permanent position with many people making regular deposits the hole in the ground will not remain unfilled for long.  Therefore a more sustainable system that can be emptied must be created.  The burnout latrine is a temporary solution to a long-term problem.  I will spare you all the details, but in summary one must pour a liter of diesel/JP8 into a half drum that has been 3/4 filled with waste, then provide some source of fire ignition such as a thrown burning match and then stir the flaming contents until it has been reduced to ashes.  For political reasons, the boss decided that everyone, including himself, would take a shift once a week and pull burn out duty.  It took about 4 months before I could get that smell out of my nose.  On the technical side, should you find yourself stirring a burn out… stand up wind. 

After about 6 weeks of living with a constant column of smoke marking our positions we finally got the first few port-o-potties.  They were beautiful blue and white fiberglass monuments to civilization.   They were fresh out of the shipping container with some assembly required, and they actually came with instructions for use with illustrations and text in 4 languages.  They had a door that closed with a little plastic latch for uninterrupted use.  The inner wall was imprinted with the manufacturer’s location, South Carolina.    Though unheated it did not matter.  It was a few moments of privacy, out of the elements to clear your system.  They were a little 1x1m slice of heaven.

For those unfamiliar with the actual workings of such devices, there are a few steps of maintenance and service required on a regular basis.  The US Army in its infinite wisdom felt it had closed the loop by delivering the units.  I am sure someone in Tuzla Main had a matrix on a power point slide for MG Nash’s briefing that evening, checking off the delivery and deployment of “field sanitation units”.  Unfortunately, the process of empting the closed system had not been considered. 

This is where the political skills of my boss, then LTC C (now MG).  To empty a port-o-potty requires a high power vacuum system that evacuates semi solid waste materials into a portable reservoir.  In the states you would open the phone book and makes some calls.  A couple of hours later a contract would be signed and your storage vessels would be routinely emptied, seats wiped down and paper replenished.  Not so in the northeastern corner of Bosnia, in February, when the martial to be removed had been produced by American peacekeepers. 

After the third day I open the doors of each unit and they were crowning over.  The fact that it was cold was a blessing, freezing the mound and preventing it from flowing under gravity’s influence.  One unit’s little mountain of stool actually had boot prints from some desperate trooper trying to make room for his deposit.  I pulled out the public health/preventive medicine hat and locked to doors.  Until the holding tanks were emptied the toilets were off limits.  That which had been a huge morale boost, was now a health threat.  We were back to the long walk into the woods searching farther and farther out for unsoiled ground or stirring burnouts.  Some genius had destroyed the burnout drums, so it was back to the e-tool nature walk or hold it in and hope for a solution soon. 

LTC C, Black Knight 6, made the acquisition of waste disposal contracts our mission one for the next week.  Patrolling the Zone of Separation turned to negotiating with the locals, seeking a business agreement for the services needed.  It turns out the only SST’s (not supersonic transports, but shit sucking trucks) in Bosnia were located on the far side of Tuzla, about 70km away on bad unmaintained roads.  The contractor was willing to come, but only for an outrageous fee, and only if armed escort to and from our position was provided.  Brown and Root would eventually assume the management of such functions, but at that time we were on our own. 

So twice a week a mounted patrol of 4 vehicles, 4 crew served weapons, and 12 troopers, would make the long predawn trek to the contractor’s yard, meet his driver and escort the SST on its rounds through our AO.  The SST frequently got stuck in the snow and mud, so the escorts became very good at process of extracting and towing.  More than once the driver was still drunk from the night prior, so I am told he slept while one of our guys would do the actual driving.  The Driver, Drago, had all the classic signs of end stage liver disease.  He had a nice light yellow tint to his eyes, big swollen belly and a tremor.  Probably from the occupational hazard of the combination of decades of chronic hepatitis and slivovitz (plum brandy).  Drago also had to be paid in cash each morning before the contractor would allow the truck to depart.  So the convoy leader would have to meet a finance officer and sign for 200 marks for that day’s service rounds. 

Once we built McGovern Base, Brown and Root delivered a set of prefabricated multi-toilet trailer units.  Heated.  Running water.  Flushing.  Private one seat stalls.  Real American style toilet paper.  Clean.  Shower trailers went the next row over.  It was like we were no longer in the field.  Lines did occasionally form (queue for those from the UK).  After the prior winter I did not care.  The only problem with base camp living was the insane rules.  Otherwise it was like being in summer camp with weapons.  But that is a whole different story. 

So was the lesson learned? No.  Scroll forward to 2003, far Eastern Turkey, Operation Iraqi Freedom, in an old grain storage facility we rented and named Camp Idaho.  The same dumb sequence of events played out.  I was not in a leadership position, just one more surgeon in an FST.  I tried to offer my advice to the guy in command over breakfast on the process of port-o-potty contracting and it was not well received.  The difference was this time it was not freezing and gravity did cause the mountain that formed to flow… into our living area.  Can you imagine a situation where the toilets did not come with a service contract?  Due to inflation and less skill negotiations, the Turkish SST cost 400 Euro per cycle.  Their SST got high jacked by bandits after leaving our camp more than once.  I have to believe the bad guys were after the 400 Euro and not the contents of his tank.  The doc’s in the FST all put in 10 Euro a week and we paid a local to maintain our private facility in spotless condition at all times.   It was the cleanest port-o-potty you have ever seen.  The average local wages was about .75 per day, so he was getting rich off our toilets as well.

Categories: deployment Tags:

five minutes

January 9th, 2011 4 comments

A short essay on life, sanitary facilities and the deployed environment.

With rare exception, the chances are very good that you are sitting somewhere rather comfortable while reading this post. You have access to a toilet that flushes, toilet paper is there if you remember and the biggest concerns are working out a cleaning schedule with those others with whom you share home or workspace. Skip the rest of this post if a discussion of sanitary facilities is not to your liking.

Being deployed is a different world. In fact, it is almost like having a toddler: that time of life where you are almost done with potty training but when ever you are out of the house, you have to have the location and accessibility of bathroom facilities firmly fixed in your mind.

Prior to being here and having to cope with strange cleaning schedules, I never worried. I have always been one of those people who could travel just about anywhere and not have an issue. On a cruise ship while everyone around me is suffering from Norwalk Virus, I am just shaking my head. Perhaps it is being Prev Med or female (with hand washing ingrained from an early age) or having a  immune competent GI system. I also spend a lot of time counselling everyone around me that a vegetarian diet and a lot of non-caffeine containing fluids could improve their outlook.

So, here we are on Bagram at a nice normal time in the morning. Wandering out of the BHut – there is a pickup truck blocking the doors of the two nearest port-a-lettes. Ok, I wanted running water and flush toilets anyway. Hiking down to the San Trailer – the doors are blocked open and there is a cleaning crew inside. Looking at my watch, this time does not coincide with the posted cleaning schedule. Hiking down another block, there is a set of portables near the chapel. Two are occupied and the door is broken on the third.

Huh, life is not supposed to be this challenging. Most days the only self support time concern that I have is getting to the laundry for pick up or drop off during duty hours.

My choices are now – stop at the USO for flush toilets or hike toward the office and try one set or another of portables along the way. If I want fancy, there is always the hospital three blocks down the street. The weather is nice, sun shining and not all that cold. Much different than sub-zero temperatures some nights when the thought of leaving the warmth of my room is a real deterrent. Not being one of the guys, a pee bottle or chamber pot doesn’t really appeal.

But then, if I was one of the guys that extra five minutes of sleep wouldn’t have turned into a 20 minute hunt for a functioning sanitary facility.

Categories: deployment Tags:

emails, meetings and

January 8th, 2011 7 comments

a migraine the size of Texas.

No really, I don’t have a headache at all, but am probably at risk tomorrow for caffeine withdrawal.

It has been just one of those days where email has flowed in faster than my ability to answer, delete or deal; there have been too many meetings and phone calls leaving little time to think.

The end result is that I have work in progress on all three systems sitting on my desk (plus need to log onto the NATO system on another desk), multiple piles of paper cluttering up the desk and a sense that things are spiraling out of control.

I could come up with several excuses (doing two jobs in addition to my own, staff officers who are trying hard but just don’t get it right the first couple of times, staff in other sections burning out at the 10 month mark) but it isn’t worth it. (Making excuses or complaining too much.) There is nothing any of us can do about self-invited “expert teams” that want to tell us how to manage certain aspects of care in theater (reference previous rants about MRIs) or scheduled VIP senior leadership except make sure that they hear what we have to say.

If you have not seen this site – iCasualties tracks all the fatalities by year, province, country of service member origin. Our (Allies) deaths certainly  don’t match those of the local country, but there is such a high cost.

Meanwhile, there are commands here in theater doing a fantastic job of delivering care, that have more expertise than any civilian facility in the US. No one is particularly happy that our surgeon’s know more about traumatic blast amputations than any trauma center in the US; it is just a fact of war. It is very difficult, but not impossible, to conduct research here. In no case should it compromise care or put additional burdens on an already short system.

I think I am going to take my two cans of Triple Mocha Energy Blend (Shock Ice Coffee) scored from Aviation DFAC home. Probably not for tonight, but one just might be what I need in the morning since their FAQ page reports one can is about = two cups of coffee. Now was that US or European Coffee?

Categories: deployment Tags:

Downloading Disgust

January 7th, 2011 3 comments

More than once I have mentioned the fact that I am an audiobook junkie. Some audiobooks come out as Podcasts (www.Podiobooks.com ) or iTunes are great ways to get those. Then there are downloads from various commercial enterprises which includes, again, iTunes but also Audible, Amazon, AudiobooksDL and a host of other sites.

What all of these sites require is either enough bandwidth allocation to download said file in something less than a lifetime and sometimes specialized software. The government does not allow us to download MP3 files on gov computers, so that particular option is a non-starter.

Even those people here paying the $100 a month for the high connect satellite feed say that moving large files often requires multiple restarts and a lot of frustration. Without it, the only other option is the WiFi at the USO. The connect speeds there are set so that no one gets a large share at the expense of others. The result is an average of 4 minutes per MEG downloaded. Obviously, they are successful in encouraging people to use the network for basic browsing and email while discouraging the rest of us from hanging out for hours in a vain attempt to get much desired book content.

I am fussing today more than others because one of my favorite Podiobook Authors – Nathan Lowell - has started the release of the last book in his Share series. It took more time than I want to admit over the last week, but I managed to secure Episodes 1-9. 10 will not download. Not from iTunes, and not from Podiobooks; keeps telling me that I don’t have permission. The same thing happens with Episode 12. I did grab Episode 11.

Listen to me whine. Sheesh, you would think that I don’t have enough books here. Of course, this is not including the fact that I can buy on Audible but not download at all (bandwidth at the USO and the software issue on gov computers).

I think tonight after services I am just going to curl up with a real book for a change! 

Categories: computers, deployment Tags:

Viral Videos

January 6th, 2011 7 comments

I had not planned on stirring up a controversy, but there are multiple sides (maybe) to the current Navy firing of CAPT Honors. Probably the most coherent and even handed discussion is that which I found in USA Today.

Several points – made by Mark (Special Forces), Ron (spent way too much time with Armor and FSTs) is that anyone who is offended at the time needs to say so. PC can be taken too far. I fully agree with them on speaking up, but it assumes that making a complaint at the time implies that the command is going to listen, evaluate and modify inappropriate behaviors.

Honors’ dismissive treatment of the objections says as much as the videos do about his leadership qualities. At the start of one video, he talks about complaints sent “gutlessly through other channels,” and tells the “bleeding hearts” that they’re likely to be offended again. Then the show goes on.

Honestly? In the Army I see a command response more often that not. Senior leadership cares mostly and makes an effort. But a ground force is inherently different than a seagoing force. On land normally there is greater access to communications and different expectations. Walking the plank is neither option or reality. Commanders are always immediately responsible to their chain of command. (Recent change of command in Afghanistan is a case in point).

Army is not perfect.

Back to the Navy – what is clear now is that the Navy, in the form of CNO and others, would like to use Honors as a scapegoat and absolve themselves of all responsibility. Is it worse that they are sacrificing him? Or that they knew about all of this and did not act until forced by the public?

“Contrary to assurances that standards of conduct will remain high, and that ‘leadership’ and sensitivity training can ‘mitigate’ the consequences of human failings, this embarrassing episode demonstrates how discipline can be incrementally redefined downward, lowering standards for all,” Donnelly said. “Adm. Mullen and like-minded allies in the White House, Pentagon and Congress are inviting trouble that cannot be ‘mitigated’ by wishful thinking alone.”

And when Fox news is negative, well. the Navy has lost a lot of support.

There is more at stake here than the career of one officer.

As a country, we are trying to move forward on all fronts. Yes, there are times when PC is used as an excuse. But what is really wrong with treating all your colleagues with dignity and respect? That means not making fun of people, not using offensive language, keeping ones hands and opinions to oneself so that they do not make the workplace an extremely negative experience.

It would be nice if we all had a sense of humor and a bit thicker a skin, but deliberately targeting groups and individuals; demeaning them is not conductive to good morale and discipline.

Frankly, the military culture has changed over the years. There may be too much sensitivity at times, but I will take it any day over the overt discrimination and hostility I lived with my first tour on AD (1981-1984).  I don’t have to put up with being cursed at, sworn at, and told that “you #$%^&* have no business in the Army.

I am concerned that the person next to me does their job. Not their religion, skin color, ethnic background, marriage status, sexual orientation. I want them to do their job. I should not be making fun of them, nor they of me.

We have enough enemies out there, why would we want to create enemies of members of our own forces?

(I took a quick look at the controversial videos. Didn’t find them funny or particularly appropriate. And that is after the worst of the language has been edited out)

Categories: military Tags:

it is a wonder

January 5th, 2011 8 comments

what people will post on You Tube.

We all have heard stories of those less than brilliant people who have recorded themselves doing extremely stupid things while driving and then posted same on the Internet. This is almost always followed, no surprise, with a visit from the local law.

Then there are those videos which are internal to an organization and get loose.

I can give you three examples from the military-

let’s start with the most recent courtesy of the US Navy. I was made aware of this by my friend Barbara followed by a front page article in the Stars and Stripes. The controversy is over video made and shown in 2007 aboard a Navy Ship.

– This whole controversy generated some stirring discussion around the office. Much of it was related to “was it offensive or not.” Just about everyone wanted to see the videos to decide. My point was simple – the Navy is the service that brought us Tail Hook. Senior leaders have been trying hard for a cultural change. The fact that 16 years later some rather senior officer on an aircraft carrier chooses to make/have made videos with sexual references/overtones of any kind to me shows a lack of judgment. Commanders and their staff are not Saturday Night Live. They set the mood and the tone for what is acceptable behavior. Yes, those clips might have been funny, but if people were offended, they had little to no options for recourse. Captain underway is Captain underway.

-Second. While assigned in Baghdad in the 2003-2004 time frame, a particular Military Intelligence Unit put a number of homemade videos on their internal server. Obviously, because I know about them, they did not stay secure all that long. These particular videos caused a lot of problems and resulted in significant number of disciplinary actions. My thought is that if you are stupid enough to video yourselves having sex, you deserve what you get when you post it for others to see. (there is also this small fact that the military actually cares about adultery but is rarely able to prosecute due to evidentiary lack). And no, it is not hard to make an ID given the uniqueness of some tattoos.

Finally, there were those Evangelical Air Force Generals who make tapes/announcements/religious propaganda for the far right. They did it in uniform with their offices in the Pentagon in the background. Surprised they were when accused of misusing their positions. I hope they are enjoying their retirement.

Anyway, we have had some interesting discussions here today, making a nice break from complaining about the cold.

Categories: military Tags:

Complexity of Cousins

January 4th, 2011 7 comments

Perhaps there are some people (Southerners by stereotype) who are good at figuring out familial relationships between individuals. So that, when introduced, someone might even be able to say “oh, your mother’s sister’s cousin on the “jones” side, isn’t she married to…..? and even understand the relationship.

Me, I understand first degree relatives (parents, sibs, and children) and the rest of the world. That is probably helped by the fact that I have few relatives and my children have even fewer.

Well, that is not completely true; there are also grandparents, cousins, nieces, and nephews. It is that cousin category where all of this gets me completely confused and that is before I even consider the generational issues. (Actually, the linked Wikipedia article is extremely clear.)

What has this to do with deployment? Very little, except that I am in Afghanistan trying to figure out what I want to send Andrew for his birthday. It is scary when I realized that figuring out a present for a teenage young man was easier than describing the relationship.

Background: my mother (84) was an only child. Ends pretty much all discussions of relatives on that side. My father (84) has one sister (younger than 84) and she had two children. You with me so far? I have two first cousins, one of whom has two children. Technically those two children, essentially contemporaries of Ms Maus (my youngest), are first cousins, once removed. I think. In reality, I think of them in the niece and nephew category because of their ages.

Back to the thought of presents. I finally worked out what I wanted to send him and headed for the door. Just in time to feel the building rattle from a nearby impact. Since there was no prior warning of a planned detonation, we all voted for target practice from the hills. The second impact was barely over when the Apaches launched (since they are just over the back fence it caused more window rattling). Watching the chat might just be interesting, but “donning IBA and sheltering in place” leaves me less than thrilled. It might just wind up forcing me to change choices from iTunes to Amazon!

Categories: deployment, family Tags:

Bringing back memories

January 3rd, 2011 4 comments

Writing about the stars the other night prompted this response from Ron. I am including it in its entirety with his permission. We worked together at Heidelberg MEDDAC; he and his wife provided just about our only local support network while I was in Kuwait. He has since left the service, and is now in Orthopaedic practice in Nevada. Their gain, unfortunately – our loss. He spent a year as an Armor BDE surgeon at the start of IFOR.

I can relate to the night sky while deployed. When we crossed the Sava River on Jan 1996 it was bitterly cold and overcast. Light rain falling and freezing on contact with everything. Our convoy was a tactical movement with a high degree of vigilance maintained by all. We were anticipating land mines, IED’s and snipers that did not materialize until the weather got much warmer. The elements were our biggest enemy that day.

The Serb forces had been celebrating New Year’s Day with random automatic weapon’s fire into the air. They were mostly drunk and appeared not to understand how tense their presence made our people. At about dark someone decided to open up with a 20 mm antiaircraft system about 200 m away from our position. They were wildly firing tracers into the night sky. It sounded like they were firing directly at us. It took a lot of self control for the 18 and 19 years manning 50 cals on top of our vehicles not to return fire. They were on their side of the zone of separation and there was nothing we could do about their stupidity. The decision was made to put a lot of distance between us and them. We started moving and kept moving, pushing for a position on a map. The quality of the maps is a whole other story.

We had be moving all day, 0330 to 2300… just looking for a secure position to lager. We stopped on what was eventually designated “Desolation Blvd”. It was a cluster of villages in the Posavina that had been ethnically cleansed. A house or two would have a main gun round wound in an outer wall, roof collapsed with the windows blown out. The product of using tanks to motivate the locals to leave and be ethnically cleansed. All the homes abandoned and stripped. No power. No people. Ghost towns. Random livestock wondering through mine fields. Unharvested orchards covered in snow. About a foot a packed snow and ice on the ground. It was an apocalyptic scene.

I dismounted my vehicle for the first time in hours. Looked up and the sky had cleared. It was about zero F. I had never seen so many stars. You could see individual stars, planets, constellations, even satellites moving across from horizon to horizon. It was amazing. When I finally looked away everyone was still looking up at the sky. Mouths open with a look of wonder and fascination, as if seeing it for the first time.

With no background light pollution and no clouds, the atmosphere was perfectly crystal clear. I have never see as beautiful a sky as that night. I was not warm or happy. I was grateful to be alive.

I am not complaining. Just relating events that are burned into my memory. The comment on crystal clear sky tripped my recollection. If you have not been in that environment and trying to stay alive, you would not understand.

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In Afghanistan – (Russian Viet Nam?)

January 2nd, 2011 3 comments

Let’s go back and think about where I am for the moment: the wonderful landlocked country of Afghanistan.  Take a look at the map ; note especially all those spectacular mountains and extensive coast line (not).  If you are looking for fun and cheeriness – just skip the rest of this post.

I am going to leave aside the discussion of how the US got involved. If you want to go there – I suggest checking out the following links some which are extremely funny. The US State Department page speaks the commitment of rebuilding after years of way. As if those years just happened without any involvement of anyone – certainly not anyone related to the US… Then there is the Afghani Government page which is pretty blunt about things not being rosy after 20 years of conflict. For a positive spin on those things which are really important – sports competitions and medals… go here. And, of course, if you want your facts, at least as understood by spooks, you can always go to the CIA.

For a slightly westernized version of history – the Wikipedia article is good, especially with reference to the history since 1917. Looking for typical British bluntness? Go to the BBC country background page. If you want to play economics – here is the World Bank’s Fairy tale.

Why am I mentioning all this? I found this site  which provides both running totals and breakdowns of casualties and fatalities in OEF and OIF. It doesn’t speak to the personal cost – of broken families, of children with problems, of suicides.  It brought home to me that spending my days dealing with issues (not patients) does have a significant impact: experienced clinical input to med planning, medical services, behavioral health services means that second and third order negative effects can be minimized or avoided.  Others are doing one on one care; I am looking at the distribution and availability of services. I am doing my best to make sure the proper care is where it is needed.

It does mean that I am justified in trying to kill off the MRI Fairy and her cousin who wants the ability to perform fancy cardiac diagnostic services in theater!

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Stars

January 1st, 2011 8 comments

Last night was mild, the air was still and the sky crystal clear. Just after midnight, cheers and music was streaming from a concert given at the Clamshell next to the Rock Gym. Celebrating surviving another year, people just happy to be alive, warm, fed and with friends.

Orion glittering as he strode across the sky with his bright belt and glittering sword. The Pleiades gleam blue as I wonder about their stories. There is a smell of charred wood in the air perhaps drifting in from the country side although wood here is so limited.

It is easy to be distracted as I look for other constellations in the night sky, reminding me of a conversation long ago with with a couple members of the Heidelberg congregation. Ben (Romer) was speaking of when he was deployed during DS/DS and telling his children to look up at the night sky and know that they were sharing something so magnificent with their father. They could be connected.

I thought about that again this morning as I sat outside the USO hoping to stay online long enough to finally get “Wait Wait” downloaded before the old episodes fall off their website and iTunes. I heard a SGT talk with her family in New York as they watched the ball drop at Time Square. Outside, the city lights were overwhelming the heavens but she had her peace for sharing with them. Her calls to Atlanta went just as well.

A transportation specialist, she just relocated here from a distant FOB. She loves her new job. Instead of just her children and family at home – she now has four units of soldiers to care for as the LNO. I think they are lucky, these soldiers arriving and leaving at the main base to have such a mom, a good NCO who is meeting the planes, rounding up her people, making sure that they have places to stay, know where to eat, how to call home and ensuring that they are where they need to be for onward movement. Her personnel will never be in the situation as those two young soldiers arriving from Kandahar on Wed morning with no idea where to go and who to see.

We talked about the old days in the Army, of barracks, CQs and always knowing where to find responsible and supportive people. Finishing up quickly, she headed over to the terminal after hearing a flight announcement. It wasn’t one of hers, but she was checking anyway, just to make sure that all the soldiers had assistance.

Thinking back to the sky last night, know that my family can see Orion, the Pleiades, the other stars from our terrace in Heidelberg. Perhaps from a different angle, but then we all look at the world from a differently. I think as long as we look at the same stars, can see our small place in the cosmos and do our share, we can make this a better world in the coming year.

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