Frontierland

I have just returned to Bagram after spending 8 days at a small fire base in eastern Afghanistan. The fire base is called Lilley, although the inhabitants also call it Shkin after a soldier who was killed here several years ago. I was attached for the week to a group of Special Forces medics (known as 18 deltas, or just 'deltas') and medical providers. The SF dentist was also there, and he and I were the only two doctors in the bunch. The mission for the week was to provide medical care to the local populations through two village medical outreach programs (VMOPs); the secondary mission was to help provide medical care to the Afghan soldiers and local Afghans at the clinic located at Shkin.

I spent days and days preparing for the mission. It required that I draw a bunch of Army gear, participate in MRAP familiarization training (which I blogged about here), draw medical supplies and pack medic bags for the mission, get a second weapon (since I refused to go outside the wire without an M16 or equivalent ... the 9 mm just isn't good enough) plus ammo, and pack everything up as compactly as possible. It was a long few days, especially since I was working full-time as well.

We departed Bagram via chinook helicopter, and it was a pleasant and beautiful ride to Goode Army Airfield, where we refueled, then on to FB Lilley. Our arrival day was mostly full of unpacking, repacking, and meetings to learn about the next day's VMOP. I shared a room with a female interpreter, Julie, on the second story of the mud-brick building known as "The Alamo". The base had never been occupied by females before, so the guys had to get used to sharing their bathrooms and showers with us. Luckily, they were very accomodating and made us feel totally welcome.

On VMOP day, we moved out in our MRAPs for a 2-hour convoy to the site, and along the way we encountered casualties of a vehicle-borne IED blast. (The attack was on an Afghan security force about 3 minutes ahead of our convoy.) There were 3 casualties, one of which I was involved in treating, monitoring, packaging for transport, and loading onto the medevac chopper. There was an incredible amount of coordination among members of the team to both treat the patient and keep us safe. The non-medical elements formed a 360-degree perimeter with their vehicles to provide security, while the medical elements called in the medevac and popped smoke onto the landing zone. For me, it was the most incredible experience to see the "other" side of a medevac - the point-of-injury side. I have seen hundreds of patients unloaded from medevacs at the hospital, but had never loaded one myself at the point of injury. I learned more from this experience that I ever could have learned sitting around Bagram.

The VMOP was a success. I saw exclusively children, and the majority were fairly well medically. We left around 2 pm after seeing about a hundred patients, and convoyed back to Lilley without incident. I was totally exhausted by the end of the day ... the adrenaline surge of the IED blast combined with carrying around so much equipment was bound to exhaust me.

The remainder of the week was spent with Sumaira (a nurse practitioner) and Doc Abdul, the Afghan-trained physician at the Lilley clinic. Samaira is a Pakistan-trained community health nurse who has worked at the clinic on base for 3 years. Her training consisted of one year of midwifery and one year of community health; however, most of her knowledge has been acquired on the job. She taught me a whole lot about third-world medicine, and I was able to contribute to her education in small ways, too. She and I worked well together, and in fact became friends. She made me some local food while I was there, and I will send her some personal goodies this week.

The clinic days were punctuated by two interesting training opportunities: the range and medic training. I went to the range with the SF folks and shot my 'comfortable' weapons (the M16 rifle and M9 pistol) plus learned to shoot a few others (50cal, grenade launcher, different kinds of 9 mm, and AK47). My favorite was the grenade launcher - what a fun little weapon! I was a little bruised in the armpit afterwards, but it was worth it for this type of training. The medic training was an opportunity to teach the first-line medics about bleeding control, suturing, emergency airways, and the like. It's something that rarely occurs in the states, and thus I jumped at the chance to both learn and teach.

Our flight to Bagram was cancelled the first time around, so - darn! - we spent an extra day at Lilley. We enjoyed "surf and turf" dinner (which is Sundays at Lilley, Fridays at Bagram) and played some Rock Band to pass the time. I even have blisters to show for it!

Life at Lilley was so different than life in Bagram. Although it's an SF compound, the ambiance is far more laid-back and relaxed. Most soldiers run around in civilian clothes, baseball caps, beards, and flip-flops without being weighed down by a weapon of any sort. (I personally did not bring civvies, but I wore crocs as footwear and neglected to put up my hair when it was reasonable to do so.) The typical Army rules and regulations are not at all enforced - in fact, they are not even discussed. It's accepted that iPod ear buds act as ear protection, and that helmet use in the MRAPs is optional. As long as the mission gets done, little else matters.

I returned to Bagram with a sinking feeling in my stomach. I didn't want to come back. There's an appeal to fire base life which is difficult to express - it's a smaller, more intimate base, which is less formal and less bureaucratic. As an example, I got off my twin-engine fixed-wing aircraft at Bagram and went straight to the hospital to check in with my command. I was wearing one of my army combat shirts (like you see in the range pictures), a uniform only authorized during missions. Quite a few people made comments about the uniform I was wearing as I signed in. I thought to myself, "Come on, people! I've been downrange for 8 days and just got off my flight, and you're bothering me ALREADY about my uniform??!" Give me a break.

Bagram is a comfortable, safe place, and I have learned so much from my 3 months on the intensive care unit and on the ward. Given the safety of Bagram, most people can't understand why I would volunteer for this mission, why I would take the risk of not coming back to my husband and my son. But the things I learned at Lilley simply could not have been learned in Bagram. Yes, there was inherent danger in going downrange and outside the wire, but the benefits of seeing patients in local villages, living like a real soldier for once, and initiating the medevac chain first-hand cannot be overstated. There are hundreds of thousands of soldiers, sailors, airmen, and marines deployed to the middle east in harm's way every single day, and they don't cry or whine about the risks inherent in their deployments. They just quietly and valiently do their job defending our freedom on the front lines. It was my pleasure to be one of them for a week, and for this I am truly grateful.

I would do it again in a heartbeat if given the opportunity.

Read more about Shkin:
Wikipedia
Global Security