Training Afghan Medics: The Language of Healing Pt2

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.

Day 14: 26 Jan

Work has been gathering pace as I completed hand over and was handed my issue mobile. Friday is the Muslim religious day so we don’t go over to Shorabak for routine training and utilise the time to do team admin and training. However, this Friday our plans went awry as an ANSF casualty was brought in that we felt was suitable for transfer to Shorabak- he had a gunshot wound to an arm and a resultant fracture. I then had to kick in to action and phone all the relevant cogs in the wheel to ensure transfer of the casualty from our ambulance, to an ANSF ambulance and then to Shorabak; at the same time I had to notify the team members that were required and ensure we were ready to go. By the time we got over to Shorabak the casualty was already in the operating theatre and the Afghan team were ready to go, so the guys from my team went in to mentor them through the surgery.

The surgery turned out to be slightly more complex than first thought and took several hours but we managed to assist the ANSF surgeons in stabilising the casualty. Unfortunately he had suffered major damage to a blood vessel and so had to be returned to Bastion for more complex surgery, but the ANA surgical team did their part very well and it was felt that it was a useful mentoring opportunity. Whilst that operation was ongoing another casualty was brought in by their evacuation chain and went in for surgery immediately after the other came out. On that occasion the ANA surgical team were seen to be more than capable of coping so we left them to it and returned to Bastion. Whilst the ANA may not have the resources that we have I am most impressed with their ability to overcome such issues and work hard to save their fellow warriors.

Due to my role in theatre, and the fact that I am female and a reservist, the combat camera team came to talk to me yesterday with a view to me being involved in some kind of documentary/media piece. I was more than happy to take part but had to have several photos taken and wasn’t particularly comfortable with that- I hope they got my best side!

Day 25: 6 Feb

What is going on with the weather out here? The days were getting sunnier, the nights starting to get shorter and the temperature was getting warmer so I was looking forward to not so cold nights and warm sunny days. How wrong could I have been? Helmand has had its first snow in 12 years and it is absolutely freezing! I must admit Camp Bastion covered in snow is a sight I never thought I would see. I wish it would go now though as getting out of a lukewarm shower into a cold ablutions tent is not a pleasant experience! I went back to Shorabak for the first time in a few days today (security meant it wasn’t possible for a few days) and it was good to get back.

The staff in the Treatment Centre all remembered me and many came up to me saying ‘Leila (my ‘Afghan’ name) you are back!’ and some were hugging me in greeting. I was very pleased by their reaction as it shows how accepting they have become of me. A hug in greeting from an Afghan is not at all unusual once they know you and count you as a friend or good acquaintance. However, they are often a little more reserved about giving a woman a hug which is understandable given their culture. I am really pleased that they are happy to see me and like to talk to me as developing relationships is a key aspect of my job and doing so will give me more ability to recognise if something is wrong. If they regard us as friends then they are more likely to want to protect my team and I from the risk of harm.

Working with the ANSF in their camp does bring risks but good relationships with our Afghan counterparts is the best way to mitigate that risk I was also able to chat to several of the patients today, as many of them spoke Pashto, which at the moment is easier for me than Dari. After the small talk about family, weather, where they lived/were from etc we then spoke about their injuries (one had been shot, another injured by an IED) and their continued struggle to secure their country against the Taliban. I find their resilience amazing and in some way inspiring. Afghans are incredibly resilient people who – as they are quick to tell you – are used to decades of war and fighting, and they are pragmatic too and just get on with things. Those I spoke to emphasised that they are very proud of their country and want to do all they can to protect it for their friends and family. They do not agree with the Taliban’s methods and motives and want, as do all Afghans that I have spoken to, to be able to live in a secure country and support their family. They aren’t asking for much.

Day 26: 7 Feb

I wasn’t detailed to go to Shorabak today but I had some reports to catch up on and some general admin to do so I managed to stay busy enough. I also had a telephone interview to do with Army media back in UK to talk about my experiences as a reservist and my role out in theatre at the moment. It is going to be published in a newspaper supplement as part of International Women’s Day (March 8th). The combat camera team are planning to come over to Shorabak in the next week to take some photographs of me at work to accompany the article. That leaves me with the dilemma of which head scarf to wear….only joking- though I do have a selection as I have some from my last tour and I bought a new one when I got here. It is still bitterly cold here- so much so that we have had a few personnel injured by slipping on ice. That is not an injury pattern that we normally associate with a deployment to Helmand. Perhaps in Kabul yes, as it frequently snows there in winter, but not down here (we are quite a long way South of Kabul). Most days are cloudy too so the sun isn’t managing to get through and lift the temperature. Having done two previous winter tours though, I do know that once the sun does start to come out it usually warms up pretty quickly and in a few weeks we will be starting to complain about the heat! I have never done a summer tour though so I am not sure how I will cope with the intense heat in July/August. Ah well, I will have no choice but to get on with it!

Day 30: 11 Feb

The past few days have been frustrating for me and my team. Unfortunately the threat state was raised so mentoring was put on hold. That meant we had a couple of days free; although in reality few of us were stood idle as the nurses and doctors in the team offered themselves to the hospital as extra hands/advisors, and myself and my OC caught up on essential admin. I too offered my nursing skills to the ward as two children are being treated there at present. They were happy for my help, especially as I could speak to the children in their own language. Seeing the injuries that some children sustain out here is very difficult- those particular children had been seriously injured by an IED whilst out playing and I find the indiscriminate nature of IEDs really hard. There has been so much suffering caused to innocent people who just want to be able to live a secure life.

I have also managed to organise some extra language training for me at the Education Centre here in Bastion with an Afghan tutor. It is an asset I need to make the most of as there will be no such facility in a few months time when the draw down properly kicks in. I have started my fitness campaign proper too, I am determined to regain a good level of fitness and in the back of my mind is that I will be wearing a wedding dress in October ( my fiancé and I have finally arranged the date!) and I want to look as good as I can! Today the restriction on us going over was lifted and so we were able to send three quarters of the team over. I remained behind as it was felt prudent not to send too many people until we had assessed the atmospherics over there. I ended up being quite busy as we had several ANSF casualties brought in to the hospital by helicopter this morning, not long after my team had left for Shorabak. Before they arrived the reports indicated that some were seriously injured and one not as badly (most due to an IED, one had been shot).

I gave the Liaison officer who organises the transportation of the casualties from Bastion to Shorabak a call to give him a heads up and called my team who were over there working to let them know. I then remained in the Emergency Department as the casualties were all brought in and assessed, in order to determine if they were potential cases for transfer to Shorabak. Not being experienced in trauma care (thankfully it is pretty rare in paediatric nursing in UK and blast injuries are pretty rare in the UK full stop) I found it fascinating and also a real eye opener. There were lots of people involved in caring for each casualty and their knowledge and experience was evident as each team dealt with their allocated casualty.

I have been told that the Role 3 Hospital in Camp Bastion is the best trauma centre in the world and watching the guys at work I could see why. As it turned out the hospital director assessed them as requiring the specialist care that the Role 3 hospital in Bastion can give them due to the severity of their injuries, so everyone in the ANSF Med Dev team was stood down. I had a lovely, and interesting, evening tonight as I have been invited several times to take tea (chai- green tea) with the hospital interpreters and I managed to make the time tonight. They were really pleased to see me and we sat down and talked about family, jobs, poetry (considered very important in Afghan culture) and life in general. Nearly all the conversation was in Pashto, with the occasional help for me when I couldn’t remember how to say something or understand what someone had said to me. I was really pleased that I was able to talk with them for over an hour on a number of subjects. All that work at the language school is finally paying off! They have invited me any time and I intend to join them as often as I can- but I shall try to get my family to send some Scottish food that I can take with me to thank them for their hospitality.

Day 39: 20 Feb

The past week (well just over a week) has been pretty busy so I haven’t had much time to myself. The weather is warming up and that historically has tended to mean more operations on the ground being carried out. It certainly seems to be the case now as there have been numerous ANSF casualties coming in to Camp Bastion and direct to Camp Shorabak and as a result my services have been required several times to co-ordinate patient transfer. Sometimes I have been involved in sending casualties from Bastion to Shorabak and at other times casualties have come in to Bastion whilst I have been with the team working at Shorabak, and I have co-ordinated them being received in to Shorabak Emergency Department. Not all casualties that have been sent to Shorabak have required mentor input as some had injuries that the Afghan doctors are more than capable of dealing with on their own; whilst others required a little guidance from us initially and we were then able to let the Afghans deal with the situation themselves. For 4 days in the past week I was in charge of the mentor team as my OC had taken a small number of the team up to Kabul to recce the Kabul Military Hospital.

We need to fully understand the capability of such a hospital so that we can understand the likely capability of the hospital currently under construction in Shorabak and therefore tailor our expectations and mentoring accordingly. I was quite happy to be left in charge (and so I should be really!) as I am really gaining an understanding of the role, how we operate, and the numerous personalities I need to liaise with and work with. Plus I now have a good understanding of the numerous bits of paperwork and reports that go with the role. I find that I am working quite long hours (as is common for many people out here), with little or no time off, but as it is interesting and often challenging work I don’t mind at all. If casualties come in late and I am called in to the hospital I find I am rarely tired as the adrenalin kicks in and I become focussed.

A casualty coming into the Emergency Department certainly sharpens the mind. I am involved in the whole process; from the initial report of an incoming ANSF casualty, to the helicopter coming in, and then the casualty being transferred by ambulance to, and assessed in, the Emergency Department, right through to the decision about treatment and onward care. There have been times when we have faced particularly difficult challenges; in particular there have been cases where the Shorabak team have wanted to send casualties to us as they have felt the casualties required the level of care that Bastion can give.

Unfortunately for a variety of reasons we have not been able to accept them. The Afghans have surprised us by then coming up with their own solution to the problem and saved the patient. We have been very impressed by that and they have seemed very proud of themselves- justifiably so. I continue to be surprised by the resourcefulness of the Afghans and they in turn continue to be surprised by my knowledge of their language and culture, so it is an interesting relationship. I am glad that I will be working as part of the mentoring team until the new hospital opens so that I am able to see our (and their) hard work come to fruition.

Pt1: Lisa’s Diary Week 1-2 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

Training Afghan Medics: The Language of Healing

Captain Lisa Irwin

Captain Lisa Irwin

Lisa’s Diary 2014 – Week 1-2

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.

Day 1: 12 Jan  

So here I am again, just over two and a half years since my last deployment, on a flight to Afghanistan for another tour. As I type this I am actually en route, flying as a passenger in a C17 aircraft, along with 15 other people and a Sea King helicopter! There is plenty of room to move around so we are actually quite comfortable (though not quite first class!), but there are no windows for us to see out of so nothing to look at. It will be quite a long journey as we have two stops and at one of them we have a stopover of several hours to allow the aircrew to rest, so mainly I plan to sleep!

So who am I and what am I doing?

I am Captain Lisa Irwin, a 45 year old mum of three who is a Reserve Army Captain in the Royal Electrical and Mechanical Engineers (REME). I have deployed twice before; the first time as a SSgt Artificer (Vehicle Mechanic running a workshop) and the second time, after commissioning, as a Female Engagement Team Commander (out on the ground in the Nad-e-Ali area of Helmand patrolling with the ground troops in order to engage with local women). I am currently on a three-year Full Time Reserve Service contract (effectively a Regular Officer but on a short term contract) and during my contract I have spent 15 months studying Pashto, the language mainly spoken in Helmand, in order to deploy as a Cultural Specialist with the Defence Cultural Specialist Unit (DCSU).

Originally I was meant to deploy on the ground, so that I could engage with locals and assist ground troops with understanding the dynamics of local people in their area of operation. However, as our mission in Afghanistan is drawing to a close we are no longer carrying out ground operations so that role no longer exists. Fortunately for me a different, and probably more interesting and exciting, opportunity arose and I am now deploying as the second in command of a team of medical personnel working with the Afghan Security Forces (ANSF) to assist them in setting up their own centre for treatment of their severely injured casualties in Helmand. I am probably well suited to the role as not only am I a linguist but I also have a medical background (I trained as a paediatric nurse after giving up engineering when my children were small).

As a result I have had to also do a crash course in the Dari language (I did a 22-week course in three weeks!) as the ANSF mainly speak Dari rather than Pashto. The role should be interesting and working in close proximity with ANSF will bring its’ challenges, but I think my pre deployment training and previous operational and civilian experience means I am well prepared for the task.

In Shorabak, next to ANA ambulance

In Shorabak, next to ANA ambulance

Day 6: 18 Jan

I am now settled in to my accommodation and have finished the initial training that is compulsory when you first arrive in to theatre. This training is a remind and revise on some things (such as first aid and shooting) and an update on the situation in theatre and how we need to act out here. Most things are similar to that which I was taught before so I feel on familiar ground- but I must remember where I am and not become complacent even though this is my third tour. I have met the guy I am replacing and some of the outgoing mentoring team, and I will start handover proper tomorrow. I have also met friends of mine already out here which is good, it is nice to meet up and grab a coffee together.

Tomorrow will be my first opportunity to go over to the ANSF camp, Camp Shorabak, and meet the Afghans we are mentoring. I am very much looking forward to that. I am really hoping this job is interesting and rewarding as I am out here for almost 9 months. I will get R&R (a break when I get to go home for 14 days) but it is still a long time to be away from my children and my fiancé.  I have been made aware that there may be other taskings for me that sound quite interesting, and will get me out of Camp Bastion, so I am hoping that they come off to add a bit more variety. Whilst Camp Bastion is a huge place, and at the moment we have excellent welfare facilities (I say at the moment as they will start to shrink as we pack up to leave), being here can still feel quite restrictive- we can’t just walk out of the front gate!

Day 7: 19 Jan

A day of ups and downs:-

The main up was finally going to Shorabak (the Afghan National Army (ANA) camp) to meet the Afghans my team are mentoring. The guy I’m taking over from introduced me and when they heard I could speak Pashto (and a little Dari) several came over to talk to me. They seemed thrilled that I could speak their language and many of them wanted to speak to me. I had also decided that I would wear a head scarf when working with them in deference to their culture and many of them commented on how nice it was and how much they liked it. All positive stuff. Another up was the outgoing hospital staff putting on a little entertainment this evening as they had formed a choir. The singing was great and there was some joke telling and also leek eating (raw leeks) as it was a Welsh unit. Great fun was had by all I think.

Remembrance parade 2013- with my youngest son Sam

Remembrance parade 2013- with my youngest son Sam

The down was a phone call with my 13-year-old son with him sobbing his heart out for 10 minutes which resulted in a few tears from me too. I know he is happy at his boarding school (usually) and that the school is used to this as all the children have a parent in the forces, but I still feel so guilty and wish I could be with him to give him a hug. Sometimes the separation from your family is so hard. My daughter has also been quite ill since I left (paramedics had to be called) and will probably need an operation in the future so that is playing on my mind too. My problems are no worse than others though and I know if things were serious then the there is a system in place that would get me home. So I just need to get on with the job in hand.

Day 10: 22 Jan

My handover continues and I am starting to get a handle on what the job entails and the numerous personalities I have to liaise with. It will take me a while to remember names but at least I know their faces and can hopefully put them in to the context of the appropriate job! Yesterday I went over to Shorabak again and was again very well received. The rest of my team were talking to their Afghan counterparts and finding their feet reference their task for the next three months (although I am here for eight-nine months most of the team are here for three, a few for six).

At the moment it is all about developing relationships and an understanding so that we are able to effectively communicate with, and thereby mentor and advise, the Afghan healthcare team that we are mentoring.  We will face challenges; one being the language barrier (although we have excellent interpreters), and my own language skills will hopefully prove useful, another will be trying to remember that we cannot expect the Afghan medics to work to the same standards that we are used to.  They do not have the same facilities and nor do they have the same level of training, such as nursing degrees or even the same level of literacy, but our job is to try to bridge the gap where we can and help them to help themselves.

As long as we remain flexible and believe in what we are doing I believe we can be successful and make a positive difference. A major challenge is difficulty acquiring sufficient blood products required for some operations, but we are working on a solution with the Afghans. They are setting up an emergency donor panel so that it will be possible to transfer 1 or 2 units to a patient immediately after donation, so we are looking forward to a case where a suitable patient presents and we can mentor them doing a transfusion. One aspect of our role is what we refer to as ‘reactive’ mentoring. At the moment we are still bringing some ANSF casualties in to Camp Bastion via our helicopter casualty evacuation chain.

When such casualties arrive at Bastion we try to send them to Shorabak where possible so that their own medical chain can treat them. Should such a casualty present to the hospital in Bastion one of my roles is to be at the hospital to arrange for the casualty to be transferred to Shorabak for treatment, if it is felt that the Afghan medical staff will be able to successfully treat them. At the same time I would activate a number of my team and take them over to Shorabak to mentor the Afghans as they treated their casualty.

Not all ANSF casualties arriving at the hospital in Bastion are suitable for transfer at the moment, although we are working with the Afghan medical team to increase their capability, so I may be called to the hospital as a casualty arrives and once their situation becomes clear I, and the team, may be stood down.

Read Lisa’s page: Captain Lisa Irwin, Medical Mentor

Read Lisa’s previous blogs from 2010/2011:

Lisa’s Diary 1: October-December 2010

Lisa’s Diary 2: January-March 2011