Afghan medical providers increasing level of care
August 8, 2013
PAKTIKA PROVINCE, Afghanistan -- As Afghan forces increasingly take on more and more responsibilities, one large and sometimes overlooked priority is the medical care of Afghan fighting forces. They had the luxury of relying on an extremely robust and well trained medical capability provided by U.S. and other coalition forces. From medical evacuation to training and supplies, International Security Assistance Force was the primary medical lifeboat for the care of wounded and sick Afghan forces prior to the adoption of the Security Forces Assistance Brigade model. Afghan medical providers in Paktika will soon be on their own to provide care that was once only a phone call or short ambulance ride away.
Afghan National Army 1st Lt. Abdullah Nasir, a trained physician assistant, is the senior medical care provider for the 3rd Kandak, 2nd Brigade of the Afghan National Army's 203rd Corps, and will soon feel the brunt of that mission. Soldiers in his kandak are responsible for securing the central and eastern portions of Paktika Province. Based out of Forward Operating Base Orgun-E, he has literally been a lifesaver since arriving five months ago.
He took charge of an aid station with no primary care providers and staffed mainly with junior medics, who had little more than basic medical training. Since, he has steadily increased the aid station's capabilities through hard work, dedication, and a desire to teach.
"He is a very self-motivated teacher and he makes my job easier," said U.S. Army Sgt. Tomas Martinez, a combat medic and the medical adviser for the Security
Force Advisory Team Green 3, partnered with 3rd kandak.
According to Martinez, Nasir is determined to ensure every Soldier in the battalion has a basic understanding of combat medical care and has also been integral in improving sanitation practices and the overall medical care for his charges.
Nasir spent 24 months training as a PA at the Afghanistan Military Medical Institute in Kabul. He previously worked as a pharmacist and, when he first joined the Army, was actually in training to detect mines. Upon learning of the physician assistant training program, he decided to change career paths.
The PA program is modeled after U.S. military PA training, which is designed to create front line primary medical care providers at the battalion level. Speaking through an interpreter, Nasir, who actually does have a working knowledge of English, feels like his training made him fully capable for the medical mission he has been assigned. He and his medics are now able to care for the more severely wounded casualties that previously would have been brought to the U.S. side of the FOB for care.
"I have started doing more medical procedures on the sick and wounded and we can hold patients longer," said Nasir.
When questioned directly about problems or challenges facing his aid station, he actually refrains from listing a single one.
Martinez will quietly and respectfully dispute a lack of issues with his Afghan cohorts. A primary challenge is getting timely medical evacuation assets. Coalition Forces have reliable MEDEVAC capabilities and until recently Afghans could utilize them at will. However, due to the CF drawdown the Afghans must now rely on their own forms of evacuation in most cases. Nasir's area of operations has only a handful of helicopters dedicated to evacuation of the wounded.
"Nasir almost has to beg for aero-medical assets," said Martinez.
Driving a patient to a higher level of care on Afghan roads is a more perilous alternative. With the constant threat of IEDs, ANSF soldiers avoid it unless absolutely necessary.
Another challenge is navigating the new acquisition process for medical supplies.
"They are still getting used to the 'pull' instead of the 'push' system for resupply," said Martinez.
Afghan medical sections are now required to request the supplies they need through their logistical channels as opposed to just waiting for them to be sent. Previously, Afghans could also receive basic medical supplies from their coalition counterparts. Now, however, the amount and types of supplies that can be transferred from CF to the ANSF have been limited. This forces Afghan medics to rely almost solely on their own supply system.
As FOBs eventually transfer from coalition to Afghan control, a small cache of medical supply is sometimes left to ease the transition process. However, a more reliable logistical process is vital to sustain a constant flow of medical supplies.
U.S. Army Lt. Col. Michael McCown, M.D., the battalion surgeon for 2nd Battalion, 14th Infantry Regiment, witnessed one major issue facing the Afghan forces, integrating medical care with the other Afghan security agencies.
He describes a lack of synchronization between the Afghan Local Police, Afghan Border Police, National Directorate of Security and the ANA medical team at FOB Orgun-E. The ALP, ABP, and NDS have 'a few medics' according to Nasir, but Martinez admits coordinating the treatment and evacuation of their wounded has been difficult.
Since his arrival however, Nasir has played an important role in building the necessary trust among the various agencies operating around Orgun. McCown said that, whereas before the ALP would completely bypass the ANA aid station and just show up with wounded on the American's doorstep, they will now almost exclusively take their sick and wounded directly to the ANA for treatment.
As CFs draw down their presence, McCown and medical personnel from 2-15 FA and 2-14 IN have instituted a joint medical training program to help improve chances of a successful handoff when that time eventually arrives. He hopes to help Nasir and his senior medical personnel, 'adapt to our approach to trauma care,' but also provide a 'realistic scope of practice' that they can sustain given their limitations.
However, McCown has seen hopeful changes occur. The Afghans are less likely to seek U.S. help with their wounded, both in treatment and evacuation. Nasir now rarely approaches him for advice in handling a sick patient and instead uses his own medical advisors. As with every aspect of the transition process, McCown knows there will always be 'growing pains', but based on what he has seen since arriving last winter, he said he feels 'confident they will be functioning on their own' once U.S. forces leave.
Martinez also predicts a slight dip in effective medical care for the area once the U.S. leaves, but with providers like Nasir, he believes it will only be a temporary drop and will eventually improve with time and experience.