The Craig Joint Theater Hospital sees patients from all over Afghanistan, with medical issues ranging from kidney stones and appendicitis to trauma battle-related issues including loss of limbs, loss of eyesight, shrapnel, concussions and traumatic brain injury (TBI).

"These injuries are what the hospital staff works with. It's the unseen scars that we deal with," said Air Force Chaplain (Capt.) Gary Willeford, a member of the hospital Religious Support Teams (RSTs). "We deal with the emotional and spiritual effects of war that have taken their toll on our warriors. Issues of faith may come up with the traumas that they have experienced. We come along side of our patients and remind them that God has not forgotten them in the midst of their crisis."

Paralleling the wide range of services the hospital offers are the diverse backgrounds, military branches, religions, cultures, and nationalities of the patients. Two sets of Air Force chaplains and chaplain assistants provide religious support and spiritual counsel to this group of U.S. service members, International Coalition Forces, and local nationals.

"We are faced with many different patients from different cultures and faith backgrounds," Willeford said. "We try to treat each one with respect and honor their faith and culture by showing them kindness. It seems to be greatly appreciated."

This approach extends to even the most unique patients: those who are considered enemies. Willeford recalls hearing an injured Taliban soldier communicating concern for his personal safety to his interpreter as he was being treated in the trauma bay.

"Being a patient in the trauma bay is hard enough. You are naked and laying on a bed with medical folks poking and prodding," Willeford said. "Doctors take a Hippocratic oath to do no harm, but the enemy does not expect compassion. After he realized they were going to do everything they could to take care of him, he incessantly thanked the nurses and doctors for not killing him. He couldn't believe we would take care of him. The way we handle enemy patients makes me proud to be an American!"

Ministry of Presence

As part of the wide range of patients the medical staff sees, the hospital also treats local nationals within coalition force humanitarian efforts -- such as malnourished infants and young children with cancer. Though language can sometimes be an obstacle, the teams have learned gestures and phrases to communicate effectively and respectfully. Often a visit and a prayer from the chaplain, no matter the language barrier, helps bring peace and comfort to those being treated.

For U.S. forces in particular, though, the Air Force RSTs have found a great way to connect with servicemembers from all branches: by helping them connect to their social networks.

"We provide mini laptops that have access to the WiFi network," said Air Force Chaplain (Capt.) Michael Johnson. "The laptops are very popular with the patients because they provide means for the patients to communicate to friends and family -- often for the first time since being admitted, via Skype, instant messaging, Facebook, or email, etc."

But often, something even more simple than internet connection does the job to provide comfort to servicemembers in pain.

"I'm usually one of the first ones they see at Craig Joint Theater Hospital since I respond to all traumas in the trauma bay," said Air Force Chaplain Assistant Tech Sgt. Brian J. Ramirez. "When wounded warriors come in the trauma bay they are usually in pain and scared. I've seen many times an instant comfort come over them as the chaplain is praying for them."

"Many patients have a parental kind of trust that they bestow upon you, even though you may have never met them," Willeford said. "They will say 'Padre, thanks for praying' or 'can you hold my hand for awhile?' Being at the side of wounded human beings in these times of need is a place I feel blessed to be. Just to be caring for them. If I can physically or tangibly do something or get something for them, I will. But most of the time, if they know someone cares and is watching out for them and praying for them it allows them to relax and de-stress."

Chaplain and chaplain assistant RSTs maintain confidential communications with those they counsel, which helps them connect with service members on a deep level.

"[The patients] pour out their hearts to us," said Staff Sgt. Charles White, a chaplain assistant. In the hospital setting, chaplain assistants support the chaplain in providing religious support to both patients and medical personnel. This includes visiting patients with the chaplain, talking with service members, referring individuals to the chaplain for counseling, preparing chapel for religious services at least weekly, and leading activities that support morale.

"By being an extra set of eyes, I see trends amongst personnel that the chaplain might not see," White said. "Being enlisted gives me more of an opportunity to talk with the enlisted personnel who may be intimidated by talking to the chaplain [as an] officer."

Religious Support in a Combat Zone

As RSTs in a combat zone hospital, these caregivers face a unique challenge of helping healing service members find hope while also encouraging them to experience the grief process at their own pace.

"It is definitely not for everyone," Johnson said. "You have to want to be here and sit with the patients in their pain without trying to 'fix' their emotional state. The most difficult part is letting them work through the grief process in their way. Some of the challenges are in ministering to those who come in from IED [Improvised Explosive Device] blasts. Many of them have lost limbs and are beginning to realize that their lives will be drastically different. Sometimes they are still grieving the buddies they just lost."

One of the hardest things for these RSTs, which most service members can relate to, is being away from their families. For these caregivers though, who work alternating 12-hour shifts, compassion fatigue is a very real threat. Also called secondary traumatic stress, compassion fatigue can affect individuals exposed to trauma and suffering, and can result in anxiety, stress, and a feeling of hopelessness.

Johnson recalls an indirect fire (IDF) attack on June 18, 2013, and remembers feeling stunned as medical personnel rushed casualties and injured Soldiers into the hospital. Recognizing that he would be in the way in the emergency room in the time immediately following the attack, he directed his mission to honoring the fallen. After checking the identification tags of the casualties to determine their religious preference, he prayed over each of them. Later, the chaplain provided a supportive presence as Soldiers gathered to grieve and say goodbye to their teammates -- "to allow them time to hurt for their fallen comrades," as Johnson described it.

"I was stunned by the events, but I knew that I had to take charge of the situation and provide for the spiritual needs of those in the room," Johnson said. "I knew that any words I could utter would be inadequate, so I sat with them and joined them in their grief."

Tech Sgt. Brian Ramirez had just returned back to his dorm after a 12-hour shift when the IDF alarm went off.

"I was exhausted and had nothing left in me at that time," Ramirez said. "I was given no info -- just return back to work. I knew something bad had happened at that point."

When he returned to the hospital, he faced a frantic atmosphere as medical staff rushed casualties into the facility.

"I was getting overwhelmed. I was not sure what I needed to do next. Things seemed to be moving very fast. Moments later, Chaplain Johnson asked me to go find some water for the Soldiers [who had survived the attack]. My training clicked in and things slowed down. I remembered my training taught me to take care of people's basic needs at this point."

Caring for the Caregivers

Part of the RST's job is to provide religious support to the medical caregivers as well. They do this by building relationships with the staff and providing opportunities for counsel, prayer, or just talking with them about their experiences.

"Being deployed, we all experience some of the same things; stress, being away from family and friends," White said. "Working in the hospital, we all see the same traumas and deaths, though it affects others a lot more."

Working long and stressful shifts, the RSTs recognize that they need to carefully monitor their own wellbeing so they can effectively take care of others.

"We need chaplains, too," Johnson said. "Interaction between day and night shift can be as much about processing the events of the day as it is about turnover. It helps to have a chaplain that is experiencing the same things to be able to relate to and process with. We also had to write a significant event each week that became an especially therapeutic exercise to help process the difficult traumas."

The fact that each chaplain and chaplain assistant operates as a team means they always have a partner to work through whatever challenges their shifts may bring.

"I have a chaplain assistant that goes with me on my entire visitation," Willeford said. "When I am especially hit hard with someone's situation, we talk and are able to release our stresses by prayer and just talking it through."

As caregivers to the ill and severely injured in a combat zone, the medical staff and RSTs work together to help patients heal inside and out. For those who have experienced trauma and loss, the chaplains and chaplain assistants seek to provide comfort and hope through prayer and counsel.

"It reminds me of our frailty and our resilience," Willeford said. "We all need to be cared for and are dependent upon one another for our health and welfare. It reminds me of the hope we have in God when sometimes a situation that looked like there was no hope turns and hope is reborn. No matter what our physical condition is we have a purpose and make a difference in the world. Some of our wounded warriors have come close to death, and then come back stronger spiritually than they were before their traumatic event. They truly are heroes. We recognize the whole person: mind, body and soul."