Airmen mentor Afghans at Kandahar Regional Military Hospital

Published Feb. 2, 2010
By Staff Sgt. Angelique N. Smythe
451st Air Expeditionary Wing Public Affairs

KANDAHAR AIRFIELD, Afghanistan -- At the Kandahar Regional Military Hospital in Kandahar, Afghanistan, Afghan patients lie in wards, the intensive care unit, the operating room or the emergency room. Afghan doctors and nurses stroll throughout the building reading charts, caring for patients and performing operations. Right next to them are American medics - simply watching and mentoring.

Col. Lorn Heyne is the chief of the Medical Embedded Training Team for the Kandahar Regional Military Hospital on Camp Hero, Afghanistan. He has a team of 10 medics, including two doctors, who must teach the Afghan medical professionals as much as they can within six months.

This is the fourth team of medical mentors who have been in this two-year-old hospital.

As their morning began Jan. 30, 2010, Afghan and American doctors sat together in a meeting to discuss important issues. Junior Afghan doctors reported to senior Afghan doctors on problems or changes within patients.

Next, they performed rounds, walking throughout the hospital, checking on each patient's status.

Dr. (Lt. Col.) Mark Antonacci, a physician mentor, and Dr. (Capt.) Ryan McHugh, an anesthesiologist mentor, and the Afghan doctors discussed each patients' symptoms and problems.

"This gives them the opportunity to learn how to manage each person's case," Colonel Heyne said. "They'll talk about what transpired over the last 24 to 48 hours and if anything needs to be done differently, such as medication therapy or discharge."

Their first stop was the ICU.

Their one-year-old ICU was recently lauded by Abdul Siawash, Afghan Office of the Surgeon General deputy surgeon, as the best in the country.

"We're very proud of the the ICU capabilities that we've offered the Afghan warfighters," Colonel Heyne said. "The American mentors have helped develop this ICU capability and have taken it from nothing to what one deputy surgeon has called the best in the country."

On this particular morning, they had one patient in the ICU.

"As future operations begin, we expect to have a lot more," Colonel Heyne said, referring to the upcoming increase of coalition forces within the region.

This patient was a victim of a vehicle accident and suffered a severe head injury. He'd been in a coma for 10 days and had just begun to move a little. This was a good sign, Dr. Antonnaci said.

"As the doctors ask the Afghan physicians questions, it reinforces the learning and gives our mentors an idea of where they are in their learning process, and we'll be able to facilitate continuing medical education to help them further address the needs of the patients," said Colonel Heyne.

Next, they visited the hospital's four wards which mostly contained patients needing orthopedic medical attention or surgery.

One patient had an infection in his foot bone.

"They don't have any other treatment, so they have to amputate it," an interpreter explained.

Another patient had an appendicitis.

"He did not get to the hospital on time, and so he has to have surgery," the interpreter said.

As this group of physicians continued their rounds throughout the wards, another group surrounded an elderly woman who'd just been admitted to the hospital's emergency room.

The woman, approximately 70 years of age, had a stroke and had become unconscious after a fall.

Dr. McHugh rushed in to oversee all that was being done for the woman. He asked questions of her condition and what had occurred.

"Has she ever had heart problems before?" he asked the woman's relative.

To the Afghan physicians he asked, "Which monitor did you use?"

"This is the good monitor we want to use on her," he advised.

"Good job putting the oxygen on her," he said to the Afghan team.

Senior Airman Benjamin Spittler, who served as a mentor for emergency room procedures, placed EKG, or electrocardiogram, leads on the woman's very lean body. Without much body mass, he had to be sure not to place the leads directly on her bones. He explained his actions to the Afghans as he did this.

"You should probably put them on and then teach them afterward," Colonel Heyne said.

"Yes, I've walked through it a couple times," Airman Spittler said.

"Our mission is not 'to do' (medical procedures)," Colonel Heyne said. "Our mission is to mentor and advise the Afghan providers. As we do different medical techniques, we verbalize what we're doing with the interpreter to help the Afghans learn the Western technique of doing something. We're not here to provide Western medicine. We're here to enhance the medical capabilities they have now. We accomplish our mission by teaching them as patients come in and through mentorship."

The doctors discussed transporting the patient to the Kandahar Airfield Role III Hospital for a CT, or computed tomography, scan of her head. This would also provide a good opportunity for one of the Afghan doctors who'd shown interest in learning about neurosurgery to better learn how to read a CT scan.

"This is a pretty typical day," Colonel Heyne said. "Sometimes we have mass casualties as operations start to take place. My first day, we had two mass casualties. The first one had 18 patients; the second one had 16 patients. They were both within an hour of each other. It can be very hectic at times, but they are learning and doing a very good job of patient management."

As the previous group made a stop to one of the last wards, an Afghan orthopedic doctor, Dr. Shimwari, pointed out a patient who seemed to have a unique situation. The patient had had a gunshot wound to his distal thigh approximately eight months prior. The injury had not healed correctly.

"Now he has a deformity, which can be seen when he walks, and he wants the doctor to fix it for him," an interpreter said. "His leg is also short and (Dr. Shimwari) wants to elongate his leg to fix it."

"We're fortunate here in Kandahar to have one of the best Afghan National Army orthopedic doctors," Colonel Heyne said. "Dr. Shimwari does an outstanding job."

When an Afghan National Policeman from the Helmand District lost his leg after hitting an improvised explosive device was told he would be transferred to Kabul, he requested instead to be sent to Kandahar as he was aware of the expertise that existed there and knew of the capabilities of Dr. Shimwari.

He was admitted to the operating room for a cleaning of his amputated leg and closing of the skin in preparation for an artificial leg.

Maj. Joey Burks, an operating room nurse mentor, watched over the Afghan doctors' operations.

Next to him was another ongoing operation in which Afghan Dr. Hassan Gul worked to fix a patient's deviated nasal septum.

A diverse team of mentors work to provide as much mentoring as possible for the Kandahar Regional Military Hospital. The pharmacy trainer mentors in the laboratory and also works with the dentist. In addition, a Canadian dentist visits from the Kandahar Role III Hospital to augment the dental mentoring team. The medical service officer mentors the administrator. The medical administration technician mentors the patient administrator. And the medical logistics technician mentors the logistics depot.

"Hopefully, our team will expand as time goes on and we'll be able to provide mentoring in more disciplines," Colonel Heyne said.

"We have some young doctors who are learning; some graduated from medical school last summer," Colonel Heyne said. "They are really doing a very good job in their off duty time in listening to our mentors as they do rounds and continuing medical education. They really have a desire to learn, to do better and to promote healthcare in the Afghan National Army."

Because many of the Afghan doctors have private practices, each time they do a continuing medical education class, it gives them an opportunity to learn, go downtown and teach others who are within their practice, such as civilian nurses or civilian doctors.

"It's an opportunity for them to teach them what we taught," Colonel Heyne said. "It builds capacity within the Afghan healthcare system, not just the Afghan National Army, but the whole Afghan health system. With this capacity they can treat the Afghan better in their clinics. We're excited about what we do here because we're not just helping the Afghan National Army, we're helping all of Afghanistan. Hopefully, when we leave, we'll leave a part of the knowledge base that we have in Western medicine."

The doors of the Kandahar Regional Military Hospital are open to treat all Afghan National Army, Afghan National Police and civilians. There is also a women and children's health clinic opened on Tuesday mornings.

"A lot of the Afghans will only take care of people from their own tribe, from their own organization," Colonel Heyne said. "However, Colonel (Abdul) Baseer (Elaj) has opened his doors to see anyone if they are injured, if they are sick or if they need to see a doctor. Kudos to Colonel Baseer for opening those doors."

Colonel Baseer is the commander of Kandahar Regional Military Hospital.

The hospital doors have also been opened to treat Taliban members, who are treated as well as any other patient, but are held in a detainee room.

An interpreter recalled that once when the Afghan 205th Corps commander visited patients within the hospital, he also visited a Talib patient.

He asked, "How are the people? How do you find the Americans in this hospital?"

The interpreter said the Talib replied, "They are really good. They treated me and I just cannot believe it. Look at what they've done for me."

When the commander said, "They've taken care of you, now what are you going to do?"

The Talib responded, "I pray for them."