Lisa’s Diary 2014
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.
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.
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
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.