Training Afghan Medics: The Language of Healing Pt7

Lisa’s Diary 2014

Captain Lisa Irwin

Captain Lisa Irwin

Captain Lisa Irwin is a REME Reserve Officer currently on a three-year Full Time Reserve Service commitment with the Defence Cultural Specialist Unit.  She has spent 15 months learning Pashto and Dari before deploying to Camp Bastion to be the 2 IC of a team of medical personnel set up to mentor Afghan medical personnel. This is her third tour of Afghanistan and her second blog, as she blogged during her last tour in 2010/2011, when she was deployed as a Female Engagement Team Commander.

 

29 Apr

left behind

As I sit in my tent typing this it feels very odd as everyone else in the tent is packed up and ready to go back home. The Med Group personnel are changing over so it is out with the old and in with the new, apart from a small number of people that will endure like me. Many of the people going have become my friends and I shall miss them, and most of the Med Dev team have changed over so there will be a period of adjustment for all of us. My new OC (Officer Commanding) is a good bloke so I think we will work together well and the new CO (Commanding Officer) of the hospital seems to be good too, and he understands the importance of what the ANSF Med Dev Team does and will support us in our endeavours.

The new team are bedding in to their roles at the moment so the atmosphere at Shorabak is very different when we go over; the guys are finding their feet and our Afghan colleagues are assessing them and seeing how they work. It takes a bit of time to develop a good relationship- and the previous team had an excellent relationship with the Afghan medics and doctors- so I am sure in time the atmosphere will be as it used to be. There is some continuity with me still being here as 2 IC (Second-in-command) and our 3 British clinicians will not change over for a few more weeks. It does feel as though I am being ‘left behind’! I will go through this again in July too as most medical personnel only do 3 months at a time out here so later in the year I shall witness another changeover.

Hi, I’m Lisa

 

I got to meet Al Murray, who was performing a show.

I got to meet Al Murray, who was performing a show.

I was lucky enough to see Al Murray perform when he came out here recently. More than that I also got to meet him in his dressing room before the show. I stumbled somewhat over introducing myself as I thought ‘Hi I’m Lisa’ was perhaps a little too informal, but ‘Hi I’m Captain Irwin’ was too formal. So, instead I looked a bit of an idiot when shaking his hand as I said ‘Hi, …….I’m………Lisa’! The show was excellent though, including the 2 support acts. I haven’t seen many shows whilst deployed, as I haven’t been in the right place at the right time, but they are always excellent for morale so well done to the artists that volunteer to come out.

7 May

There has still been little kinetic activity (fighting) out here, as the Afghans and insurgents have been focussed on harvesting the poppy, so that has meant few casualties. The harvest finished recently and there still hasn’t been much of an increase. It is a difficult one as we are glad that less people are being hurt but it also means less opportunity for the team to mentor the Afghans in difficult medical situations. There have been instances of casualties arriving at Shorabak whilst we are there and that happened again recently with one of the medics telling me ‘casualties are coming’ as the ambulance pulled up at the Emergency Department door. The casualties were 2 ANA that had been burned when a cooking pot exploded. We watched how they dealt with the casualties, who mainly had burns to the arms and face, and interjected with advice on occasion, and the casualties were dealt with promptly and efficiently. It perhaps was not how we would do things but their way worked for them and the casualties received appropriate treatment and are now recovering well.

With our time left out here rapidly reducing we need to make the most of every opportunity that we have to mentor so that we can leave the ANSF trauma care in as good a state as possible. To enable that we sought permission to mentor at night too and that permission was recently granted and was enacted tonight. An ANSF casualty came in to Bastion via helicopter and his injuries were such that the ANA doctors in Shorabak would not quite be able to manage him on their own but would be able to with some of our team mentoring them. After several phone calls made by my OC and I the casualty was transferred over to Shorabak, a small team of mentors was sent over ( with Force Protection) and I am happy to say that the case went well and the casualty is now recovering. It was the first reactive mentoring case carried out at night and the team, plus everyone else involved with ANSF Med Dev, felt it was a step forward in the mentoring process.

14 May

The past week has been a bit of a blur as I have been very busy. Not only have I been busy with the usual tasks of my job but I also volunteered to teach basic Dari to anyone interested in the Medical Group (though primarily the ANSF Med Dev team). Dari is not my best language (Pashto is much easier for me) and I am not a qualified language teacher, but the classes seem to be well received and the small things that I teach enable the team members to communicate better with their Afghan colleagues and thus help to develop their relationship.

An Afghan Warrior is treated by Afghan medics.

An Afghan Warrior is treated by Afghan medics.

We had a day last week when there was an influx of ANSF casualties presenting both to Bastion Hospital (having been evacuated by ISAF helicopter) and to Shorabak Hospital. The first I was aware of the casualties coming in was via a phone call at approximately one in the morning which necessitated me dressing quickly and heading in to work. There I met the OC and our clinicians waiting for the casualties to arrive. The next few hours passed in a blur of phone calls, discussions about treatment and where the casualties needed to be treated (ie did they need to stay in Bastion or did Shorabak have the capability to manage them) and a host of other things. Suffice to say I had 2 hours sleep that night (my OC had less!) and still worked a full day the next day. I think I was running on adrenaline!

This week my OC and I were introduced to an Afghan Major General who commands the ANA 215 Corps (the ANA we work with belong to his Corps). As usual I was wearing my headscarf, which he commented on as good because it showed my respect for their culture, and I had a conversation with him and then gave him a brief on the Shorabak hospital and its capabilities- all in Pashto. At times I was uncertain if I had the correct word but I looked to the interpreter who nodded at me to carry on and the General listened intently and thanked me for my brief. The interpreter reassured me it was good Pashto and I felt really pleased. My language ability has definitely improved during my tour- although I am far from fluent I can definitely get by.

I shall be moving to a new job next week to cover someone’s R&R and I think it will be another varied and interesting job- even if I am only doing it for 2 weeks. It involves working as an advisor with some of the Afghan Doctors who are responsible for training frontline medics, to ensure ANA casualties receive the correct care when they are first injured. It will enable me to develop a deeper understanding of the whole casualty care piece, from point of wounding to receiving treatment at Shorabak (or in some cases at the moment in Bastion) and so I am looking forward to it very much. Particularly as the doctors appear to know of me and are looking forward to working with ‘Touran Leila’, as I am known in Shorabak (Touran is Dari for Captain, Leila is my ‘Afghan’ name).

 

Pt1: Lisa’s Diary 2014

Pt2: Lisa’s Diary 2014

Pt3: Lisa’s Diary 2014

Pt4: Lisa’s Diary 2014

Pt5: Lisa’s Diary 2014

Pt6: Lisa’s Diary 2014

Read Lisa’s previous blogs from 2010/2011:

Lisa’s Diary 1: October-December 2010

Lisa’s Diary 2: January-March 2011

Training Afghan Medics: The Language of Healing Pt6

Lisa’s Diary 2014

Captain Lisa Irwin

Captain Lisa Irwin

Captain Lisa Irwin is a REME Reserve Officer currently on a three-year Full Time Reserve Service commitment with the Defence Cultural Specialist Unit.  She has spent 15 months learning Pashto and Dari before deploying to Camp Bastion to be the 2 IC of a team of medical personnel set up to mentor Afghan medical personnel. This is her third tour of Afghanistan and her second blog, as she blogged during her last tour in 2010/2011, when she was deployed as a Female Engagement Team Commander.

 

13 Apr

Hard to say goodbye

Today was a momentous day for me, my eldest son turned 21! Being in the military can be really hard at times as you want to be able to share special occasions with family and friends and the separation can be tough. However, the wider military family are very supportive of each other and we all know how difficult it can be so there is a lot of understanding and support. We are actually quite lucky now as the military has become pretty good at welfare provision. We have internet and telephone access, and even when I was working at small remote check points on my last tour I was able to make calls via a satellite phone and not feel completely cut off from home.

There has been a definite reduction in insurgent activity over the last few weeks, despite the Afghans holding their elections. The Afghan Government increased operations conducted by their security forces and it seemed to work, with relatively few casualties coming in. However a few days ago one of our interpreters phoned to say they were expecting a number of casualties injured by an IED.

Initially it was difficult to get a clear picture of what had happened and when the casualties were expected but after a couple of minutes of speaking to my interpreter he handed the phone over so I could speak to the ANA Colonel in charge of the incident myself. Well, my Pashto isn’t bad but trying to conduct a conversation over the phone, without the cues of body language and gestures, is quite difficult! However, to my relief (and, I think, the Colonel’s) I understood what he was telling me and realised that the casualties were several miles away, coming by road. I relayed the message to the Bastion hospital command team and asked the interpreter to call me when the casualties arrived.

Several hours later in the early hours of the morning, he rang back to tell me the casualties had made it to Shorabak and there were two that the ANA doctors were concerned about. I quickly got dressed and hot-footed it to the hospital (thankfully only a few minutes from my accommodation) and informed the night staff that the ANA were requesting to transfer two casualties to us for examination. A couple of phone calls later we had the go-ahead to receive them. One was not too sick and was returned to Shorabak after being examined but the other had multiple injuries and needed an urgent operation. Thanks to the expertise of our medical staff, and to all those involved in moving the casualty to Bastion, he is now recovering.

17 Apr

The lull in kinetic activity has continued so we have seen few casualties either at Bastion hospital or at Shorabak. Those that have presented to Shorabak have been managed competently by the Afghan clinicians and medics and moved as soon as possible to Kabul to receive further treatment if required, or to recuperate. In terms of mentoring, the best teaching opportunity is when a case comes in that is suitable for reactive mentoring but that also enables us to conduct other teaching sessions with the clinicians and medics simultaneously, though it can sometimes be difficult to hold their interest!

We are now coming up to the handover/changeover of the Bastion hospital personnel, which also means most of the personnel in the mentoring team. It will be hard to say goodbye to people that have become my friends but I know they are all hugely looking forward to going home. I shall be the continuity (although the new doctors have been here for almost a month already) so it will be very important for me to keep communication flowing in the team and for me to look out for them. They will be working in a strange environment and most of them will never have worked with ANA before, so they are facing quite a challenge. However, I am sure that they are looking forward to it as much as I was, and I will be able to reassure them that it is an interesting and challenging, if at times a little frustrating, role.

Pt1: Lisa’s Diary 2014

Pt2: Lisa’s Diary 2014

Pt3: Lisa’s Diary 2014

Pt4: Lisa’s Diary 2014

Pt5: Lisa’s Diary 2014

Read Lisa’s previous blogs from 2010/2011:

Lisa’s Diary 1: October-December 2010

Lisa’s Diary 2: January-March 2011

Training Afghan Medics: The Language of Healing Pt5

Training Afghan Medics: The Language of Healing Pt5

Lisa’s Diary 2014

Captain Lisa Irwin

Captain Lisa Irwin

Captain Lisa Irwin is a REME Reserve Officer currently on a three-year Full Time Reserve Service commitment with the Defence Cultural Specialist Unit.  She has spent 15 months learning Pashto and Dari before deploying to Camp Bastion to be the 2 IC of a team of medical personnel set up to mentor Afghan medical personnel. This is her third tour of Afghanistan and her second blog, as she blogged during her last tour in 2010/2011, when she was deployed as a Female Engagement Team Commander.

 

31 Mar

Rest and recuperation

I have been lucky enough to have been able to go home for almost two weeks’ rest and recuperation this month so I haven’t been over to Shorabak as much as usual over the last few weeks. It was lovely to go home though and see my fiancé and children. I also managed to go up to Scotland to see my parents and siblings, but driving to visit everyone did mean that I was almost glad to come back to Afghanistan for a rest!

My fiancé and I managed to go and see our wedding venue in Scotland and it is lovely so we are both really happy and looking forward to the big day. I also managed to fit in a shopping day with my daughter and bought her bridesmaid’s dress. She looks absolutely beautiful in it and without doubt will overshadow the bride, but as the bride is me, and I am a very proud mum, I do not mind at all!

Happy New Year!

Whilst I was away there weren’t many casualties so things quietened down a lot for the team, and in particular for my Commanding Officer and the Sergeant Major who was covering for me. The team continued to go over to Shorabak on routine visits to carry on with mentoring tasks but there were fewer reactive mentoring cases. My R&R also coincided with a few changes on the team and we now have a completely different set of clinicians. The General Surgeon, Orthopaedic Surgeon and Anaesthetist changed over as doctors do shorter deployments than the other team members, so there were some new faces when I returned. They weren’t completely new to me though as I had met them when training prior to coming on tour.

Customary Afghan food to celebrate the New Year.

Customary Afghan food to celebrate the New Year.

When I was on R&R Afghanistan celebrated its New Year (their New Year is usually around 21 March) so before I went on leave I made sure that the team were aware of the relevant cultural practices and had plans to take some food to Shorabak to share the New Year celebrations with our Afghan colleagues – and importantly that they also knew how to say ‘Happy New Year!’ in Pashto. The Afghans had a two-day holiday to celebrate the occasion so the team didn’t go over on the actual day but celebrated with them when they returned to work afterwards.

A cake decorated with the Afghan flag and the words 'Happy New Year'.

A cake decorated with the Afghan flag and the words ‘Happy New Year’.

When the team arrived at the medical centre they were taken to the ANA Colonel’s office and as is customary the food was set out on a cloth on the floor. The team sat cross-legged on the floor (not always easy for Westerners!) and ate the food with their hands, which is traditional Afghan custom. I was told by the team that the food was delicious, which I was not surprised about as I shared meals with Afghan families several times during my last tour.

The ANA hospital personnel were also very appreciative of the cake that the team had commissioned for them (pictured). It is always good to share these experiences with our Afghan colleagues as it shows an understanding and appreciation of their culture which is something we must always remember.

Observation sangar collapsed

Although casualties have been fewer of late I have still been called in on occasion when an ANSF casualty is en route to Bastion to arrange for transfer of the casualty to Shorabak where possible. Dependent on the extent of the casualty’s injuries the mentoring team will often go across to assist the ANA clinicians. Sometimes we get calls from the hospital in Shorabak asking us to review patients that they are concerned about, which involves bringing them over by an escorted ANA ambulance. One such casualty came in to the hospital a couple of days ago; he and several of his colleagues had been injured when an observation sangar collapsed. The ANA medics had noticed that this patient’s condition in particular seemed to be deteriorating and asked for the help from the Role 3 hospital at Bastion. On arrival he was assessed as having suffered a crush injury to his chest which had probably caused air and/or blood to escape in to the chest cavity, which was making breathing difficult. Further tests revealed the initial diagnosis to be correct so the team in ED prepared to insert a chest drain to rectify the problem.

The ANA medic who had brought him over asked if he could watch the procedure as it would be a good learning experience for him – with the added bonus that he spoke some English and could act as an interpreter. I stayed too and translated from English to Pashto to the medic, who was then able to translate my Pashto into Dari for the patient (my Dari is pretty basic). It was a slightly unusual set up but it worked! It certainly tested my language capability as I had to explain every step of the procedure; not only so the patient knew what was happening but also so the medic understood what was happening. I think my brain was fried afterwards!

Pt1: Lisa’s Diary 2014

Pt2: Lisa’s Diary 2014

Pt3: Lisa’s Diary 2014

Pt4: Lisa’s Diary 2014 

Read Lisa’s previous blogs from 2010/2011:

Lisa’s Diary 1: October-December 2010

Lisa’s Diary 2: January-March 2011

Training Afghan Medics: The Language of Healing Pt4

Lisa’s Diary 2014

Captain Lisa Irwin

Captain Lisa Irwin

Captain Lisa Irwin is a REME Reserve Officer currently on a three-year Full Time Reserve Service commitment with the Defence Cultural Specialist Unit.  She has spent 15 months learning Pashto and Dhari before deploying to Camp Bastion to be the 2 IC of a team of medical personnel set up to mentor Afghan medical personnel. This is her third tour of Afghanistan and her second blog, as she blogged during her last tour in 2010/2011, when she was deployed as a Female Engagement Team Commander.

 

7 Mar

The past week has been a challenging one for the ANSF Med Dev Team and a tiring one for me.  We have been busy with routine visits to Shorabak when possible but also busy doing some reactive mentoring.  The Shorabak hospital has been relatively quiet so the guys in the team carried out teaching on things such as airway management rather than direct patient care and encouraged the Afghan medics to carry out necessary reorganisation of equipment.

Whilst the guys were teaching my role was a little interpreting, chatting to everyone to maintain relationships and assisting in teaching.  I had a book of Afghan poetry which was written in Pashto, and I showed it to some of the patients as I know that poetry is an important part of Afghan culture.  They were surprised that I had such a book and even more surprised that I could to read it. I read some poems to patients who were unable to read (in the past many Afghans were unable to attend school) and they really appreciated it. It was such a simple thing but elicited a warm response from everyone in the hospital, patients and staff alike.

VIP visit

Ed Milliband visited the hospital at Camp Bastion.

Ed Milliband (left) visited the hospital at Camp Bastion.

We had a VIP visitor to our team in March.  Ed Milliband was visiting Bastion and as he was coming to the hospital he visited our team due to our mission being considered important.   He seemed a personable man and listened intently as my OC, Fletch, explained exactly what we do and introduced the rest of the team.  He seemed interested in our role but I am sure that is a skill that all politicians quickly develop!

Preparing for surgery

As the week progressed the ANA were due to start a large military operation and therefore we started to prepare for a potential increase in casualties.  As the casualties started to come in I was frequently called in to the hospital to be there as the casualties were brought in by helicopter.  Once the casualties arrived I waited for the doctors to decide if the casualties could be treated at Shorabak, or remain in Bastion, for those who could be transferred I co-ordinated the transfer of the casualties to Shorabak.  Some of them were suitable to be transferred without the team going over to mentor and others required mentoring.  Our aim is to take over cases that are slightly complex and useful for us to mentor in order to increase the Afghan doctors’ knowledge and confidence, but not so complicated that they may be overwhelmed or not yet have the capabilities needed.

The current set-up is a bit like a field hospital, and the new hospital being built will not be ready before July, so it would not be fair to the doctors or the patients to send over cases that are currently too complex.   One of the first suitable casualties required abdominal surgery, and the operation was more complex than had been done at Shorabak before.  However, the patient was assessed to be stable and suitable for transfer.  We decided to take over only the team members that were needed, rather than the whole team, and gained permission to stay over slightly later than normal (our working hours in Shorabak can be restricted depending on the security situation).  So the smaller team, with our Force Protection, headed over.

When we arrived at the hospital the casualty was already in the operating theatre being prepared for surgery so the surgical team scrubbed up and went in to mentor the ANA doctors carrying out the operation.  Meanwhile one of our nurses and I went in to the ward to see how many patients there were and make sure everything was up to date. I chatted to the medics and patients that were there, including two patients who remembered me talking to them in the Emergency Department in Bastion hospital – I suppose a blonde, white woman speaking to them in Pashto probably makes me quite easy to remember!

As the operation progressed I was frequently checking on progress to see if we were going to be OK for time.  I also reminded the Afghan medics that they needed to prepare a bed space for the patient to return to when he came out of theatre, with oxygen, monitoring equipment and other such things that a complicated post-op patient would need.  Once the surgery was complete, the patient was taken to his post operative bed for overnight monitoring and care, and we were able to return to Bastion – the team satisfied with a job well done.  The drive back to Bastion was slightly surreal as I had never driven through Camp Shorabak in the dark before but other than feeling slightly more vulnerable we didn’t encounter any problems.

8 Mar 2014

Talking to the patients on one of the ANA hospital wards at Camp Shorabak.

Talking to a patient on one of the ANA hospital wards at Camp Shorabak.

The next day was almost a repeat of the previous day, with several more casualties coming through, some of whom remained in Bastion hospital and some of whom were transferred to Shorabak.  Of the ones transferred to Shorabak another required abdominal surgery so again the team was stood up to go over and mentor the case.  This time the as the surgery was ongoing there was another casualty with a gunshot wound to deal with, so three of us cleaned, irrigated and dressed his wound.  We then moved him to the ward but no sooner had we done that than word came through on the radio that the Afghans were bringing in 3 seriously ill casualties evacuated by their own helicopter.

Immediately I started chivvying the Afghan medics to make sure the Emergency Department was set up to receive them as the medics haven’t yet fully grasped the concept of preparation and tend to be more reactionary.  At the same time I had to keep an eye on how the surgery was progressing as I was aware that we had a limited time in Shorabak.  Eventually it became clear that the operation wasn’t progressing as planned and that we needed to take the casualty back to the hospital in Bastion, and at this stage there was no sign of the Afghan casualties.  So after numerous phone calls and radio messages we loaded the casualty into an ambulance and we all returned to Bastion.

Casevac’d for needing to pee!

The next morning as I sat at breakfast reflecting on the past 2 long days my phone rang again as more ANSF casualties were en route.  No relaxing breakfast for me then as I headed in to work.  There had been an IED incident that resulted in a number of casualties and some were on their way to Bastion.  On arrival the most seriously injured were immediately taken in to the Role 3 Hospital Emergency Department for assessment and treatment but one casualty appeared to have only minor injuries so he remained in the ambulance while he was assessed, as it appeared likely that he could be transferred straight to Shorabak.  However, although the assessing doctor couldn’t find any obvious injuries the casualty was still grimacing in pain.  Unfortunately due to the number of casualties all the interpreters were busy with other injured Afghans and so I climbed into the ambulance to speak to him to see if I could find out where he was in pain.  Quite quickly I discovered the source of his extreme discomfort….he had an extremely full bladder and was desperate for the toilet! Once he had been able to pass urine he was absolutely fine (apart from a slightly sore back).  Possibly the first time someone has been casevac’d for needing to pee!

After yet another full and busy day I eventually crawled in to bed, exhausted.   I suppose this is how my life is going to be for the next few months, with me taking advantage of any breaks I can get but acutely aware that I can be called in at any time.  I wouldn’t have it any other way though as I enjoy the challenge and variety that the role can bring and I really enjoy being able to interact with the Afghan personnel and hopefully positively influence them.  It may be small steps but I really do feel that my job, and more importantly the work of all of the ANSF Med Dev Team, is making a positive difference.

Pt1: Lisa’s Diary 2014

Pt2: Lisa’s Diary 2014

Pt3: Lisa’s Diary 2014

 

Read Lisa’s previous blogs from 2010/2011:

Lisa’s Diary 1: October-December 2010

Lisa’s Diary 2: January-March 2011