Hearts and Minds...

The war that we are fighting here in Afghanistan is one of hearts and minds, plain and simple. The best example that I can find of this concept is in the Book of Mormon, when the Gadianton Robbers are waging war against the Nephites and the Lamanites. The Lamanites as a people refuse to allow them refuge and a safe harbor from which to run their operations. Compared to the Nephites, who would give them a base from which to operate and would tolerate their actions.

It is a very similar situation here in Afghanistan. The people are not quite sure who is going to win this war, and frankly are not sure whose side they should support, wanting to be on the side of the eventual winner. Trying to convince the locals that we have the most to offer in some respects is like trying to convince the Nephites that they don't want to allow the Gadianton Robbers to operate amongst them.

The picture I posted is me, my partner, a translator (woman), a patient and his brother. This poor guy was a worker on the FOB who decided that it was a good idea to take a nap underneath a forklift. Yes, I know we can put him up for a Darwin Award for that lack of insight and judgment. He came to us after the forklift ran over his pelvis and hip. Fracturing his pelvis, upper part of this femur, lacerating his urethra (OUCH!), and sustaining other "associated lacerations". We fixed up his "associated lacerations", placed a tube through his anterior abdominal wall into his bladder, and traction on his leg. The picture was after he came back to us from Bagram where they fixed his femur. He was more grateful for us fixing his "associated lacerations" than for fixing his femur.

The reason why I tell his story is not to just show a fun picture and tell stories. He came back to us at the same time as another man who we treated after he cut his wrist with a circular saw. Lacerating tendons, nerves and arteries. The man who cut his wrist wanted us to give him money, was mad because he didn't have a ride home and generally ungrateful for us saving his hand and livelihood. The brother (dude in the Johns Hopkins T-shirt) without thinking twice gave him a handful of money so he could get a ride home. I was really impressed and humbled by the generosity of this man. These people are dirt farmers with very little, yet he was willing to help someone he barely even knew. His charity to a stranger serves as an example to me, one which I don't ever want to forget. The next time some stranger comes asking me for money, I will remember this guy and his charity. Charity is the pure love of Christ. Whether or not you believe in Christ, it comes from the same source.

I show this picture to remind myself and to show anyone who reads this that though there may be vast differences in our cultures we are all human beings. Because we are all human beings, we all have some innate similarities from which we can build relationships.

First, we are all children of God. The scriptures teach us that we are all created in his image and we know that He sent his Son so that all of his children can be made free from the bondage of death and sin. They may be Muslim and have no belief in Christ. That doesn't mean that God doesn't love them any less than I. I don't know by what province I was born the United States and raised in a family that taught me of God and Jesus Christ. I do know that God loves these people and will provide a way for them to learn of Christ and have the opportunity to accept him as their Savior. We all share the light of Christ (reference the above story).

I frequently find myself talking with the translators (many of which are American Afghani's) about the similarities between theirs' and mine religious beliefs. They are really impressed when I tell them that I have never drank alcohol, smoked tobacco or drink coffee or tea. That usually comes up when we are offered to have tea with the local shop keepers. During Ramadan, when they were all fasting, I explained how I would fast on the first Sabbath of every month. I fasted with them on fast Sunday in September. Our similarities run deep, and by capitalizing on similarities to build relationships of trust, this is how to wage counter insurgency.

Second, we all share the same emotions of love, family and community. Here, family is everything. I see fathers and mothers drive their children hours to come to follow up appointments. I have witnessed the tears of fathers and mothers, crying for the loss of their little ones. We have to tap into our common beliefs and experiences to win their hearts and minds. I know what it feels like to love my children. If you take care of me, I thank you. Take care of my children and I will fight and die for you. These people view their children as their future and their posterity as their greatest wealth.

The local villages around us are generally pro-Taliban. They are Pashtuns and share tribal roots with the Taliban. Up until now we have had little interaction with the locals as far as medical humanitarian operations are concerned. The local hospital will send us the patients that they cannot take care of, but there is little that we are doing to help them out. As it turns out, in my church serviceman's group are three reservists from Utah. All three comprise the Civil Affairs unit for this AO (Area of Operations). I approached them with the idea of setting up a physician mentorship program and they set up a meeting with my team and the S9 (brigade guy in charge of civil affairs). Priesthood in action! We pitched him our idea: teaching surgery, anesthesia and post operative nursing care to the local physicians. Helping them become self sustaining in their medical care in the local area. The S9 was thrilled about it and according to my sources, spent the entire day telling everyone about our meeting. There is a meeting in the beginning of November with the provincial governor and the NGO (Non-Government Organization, non-profit group) who helps administer and run the local health clinics, to sell them the idea and get things started. There are a few speed bumps: our command won't let me go to the meeting because they don't want to put anyone at risk, they are worried about where the money will come from to support the increase patient load. Their short sightedness is absolutely infuriating. These are not insurmountable obstacles and will be surmounted!

Ammon lead a massive counter insurgency effort by employing these principles: charity and service. Capitalizing on the common ground between the Nephites and Lamanites, thousands of potential enemies became allies and most importantly were brought to a knowledge of their Savior. So can we effect change, one heart at a time.


(BTW, there is a bakery not 100 yards from my tent and the baker is a local from a nearby village. If you have clothes or other items that would like to send I can give them to him and he will distribute them to local people. He is a very kind man and has a good heart.) If you need my address:
MAJ NEIL MCMULLIN
8th FORWARD SURGICAL TEAM
FOB SHANK, AFGHANISTAN
APO, AE 09364

What I Did Today...

I would like to say that there was some major, cool operation today but that just isn't the case. I wanted to write a brief blog today about the joy and appreciation of something different.

As stated before, everyday here at Shank is like Ground Hog's Day. The only thing that breaks up the monotony are traumas and for better or for worse, it has been real slow over the past few days. I expect that it will pick up again as the Talib's give one last push before the passes to Pakistan snow over.

The one project that I am working on right now is to set up a physician mentorship program with the local physicians. This area doesn't have a hospital per se, and doubt that there are any real surgeons running around. What we want to do is set it up so that local physicians can come to our hospital (aka Tent), bring their patients, and we teach them how to do minor surgical procedures. Procedures like: hernia repairs, mass excisions, and appendectomies. Once the surgery is done, we want to work with their nurses to improve post operative care and assisting them in taking care of their patients. What has happened in other areas, the local physicians get angry at the American doctors because they swoop in and start fixing all of the locals. Problem is, that leaves the Afghani physicians without any source of income. So the jist of our plan is to help support the local physicians with additional training and surgical support. We'll see how this turns out. I am pretty excited about it.

Back to the original discussion. Our FOB, for a long time has straddled the major highway that runs from southeastern Afghanistan-Pakistan border up to Kabul and to the north. Many of you in Houston would expect this to look like I-10, but you are incorrect. It looks much more like Welborn Road connecting Bryan College Station to Milican. Small, two lane road without a dividing stripe. (That is what I am showing in the one picture of the road.) In an effort to control this road, our FOB was built on two sides of the road. That started to cause some problems with movement back and forth between the sides of the FOB (East and West for lack of better terms.) So we built a bypass road around the FOB and in the last week connected the FOB, allowing free movement between the east and west sides. This was like going to Disneyland! They have a smoothie shop / barber shop where you can enjoy a nice cold smoothie and get your haircut by someone of uncertain gender attraction issues. (To put it nicely.) Today, we went over and I just got my peach smoothie and this Philippino guy (and I use that term loosely) started singing karaoke to some Michael Jackson song. He was just butchering it, so I was forced into going to the next room to get my haircut, just so I wouldn't start laughing out loud. I thought they only did that stuff in the movies!

There is such a thrill of just seeing something new, even if it is the exact same stuff you can see no further than 100 yards from my tent. I was pretty ticked off though when I walked through the Battalion Aid Station on the West side. This was an actual building with tile floors and two trauma bays. Currently occupied by soldiers sleeping. I couldn't help but sit there and think about the structure that we work in and the stuff we do, when from my perspective their sick call clinic looks like the Taj Ma Hall. (I posted a picture of our operating room. We operate on the stretcher that the patient comes in on, and yes, that is an air conditioning duct that runs right down the middle of the room right over the over table.)

The last picture is of me going out on a tour of a MRAP (Mine Resistant Vehicle). We drove all over the FOB and (staying inside the wire) went out where the FOB is nothing more than desert sand. The driver was concerned that he didn't have a mounted weapon on top. I told him not to sweat it because I had my M9 and 45 rounds of 9mm. That was a lot of fun. They are going to hook me up when they go to the range and let me fire some of the cool mounted weapons. (More pictures to follow!)

When I get home here in a few months, I better stay away from Walmart because I am going to want to touch everything in that store.

Where I live and play...

Brian asked to talk about where we live. The best way to describe my little community is to call it a mining town. Where instead of scruffy miners, there are clean cut young men and women carrying fully automatic weapons. Mostly we are all in tents, called GP Mediums (General Purpose). Some of the tents have been covered with this foam stuff that provides insulation from weather and noise. It makes those tents look like big, tan, melted marshmallows. The streets are either dirt roads, which turn into mud pits in the winter or are covered with big rocks. Our compound is surrounded by 14' tall barriers called "Hesco's". Why they are called Hescos, I have no idea. All of the tents are built up on wood platforms, we have electricity and A/C or heaters. Funny thing is that the A/C is super cold and the heater is super hot, so trying to find a balance is really tough. Especially when the control box to the unit is in the nurses tent. This makes it so that we have to always be nice or they can freeze us or cook us!

I am trying to up load a picture of the front of our FST tent. This is a tent where we do all of our evaluations, resuscitations, surgeries and use the back 3rd as an ICU/PACU area. We are fortunate to have a good working relationship with the medical company and we work and play together a lot. As our unit is not part of the 10th Mountain Division (the guys who currently run the base), we are often forgotten about when it comes to upgrading our areas. The "fixed" structures on the FOB are all made out of 1" plywood, giving the place a real "old west" feel to it. The current plan that is underway is to build a run way that will be able to bring in lots of supplies and build up a large base here. That is a long, long way away. However, every time we ask the current land lords for any kind of upgrade we are met with, "Why? When the runway is built you will be moved down there anyway."

For the time being I am working on just being content with what we have, though primitive as it may be. It could always be worse! We could have split our FST sending half of the people to the Iranian border to support the Spanish and Italians in the middle of nowhere. No thanks!

The other picture was taken from atop a guard tower that overlooks the dust off landing zone, our FST is off behind the T-walls. All of the other tents are part of the tent city, somewhere in there is mine. Also the bathrooms (essentially a port-a-potty with make-up), shower facilities about a 200 yard walk (going to be interesting trek in the winter).

You can also see that our FOB is surrounded by villages which actually appear to be very green and full of orchards. This is a part of the local area that I never get to see. I joke with Sarah all the time that all that needs to happen is for me to start making license plates and I will be serving out a 6 month sentence in prison. In fact, most prisoners get a real building to sleep in, a cable TV in their room, and except for that there are not many differences in where I am an jail! Maybe I will write my congressman and ask for a license plate stamper...

Highs and Lows

I approach writing this post with great humility and with some trepidation. I am not a very talented writer and sometimes it is really hard to write how I feel. There are multiple purposes of this blog: 1) to communicate the extraordinary experiences that I am having with my family, 2) as a personal journal, and 3) to share the lessons that I am learning with whom ever wants to read about them. Some of these experiences my seem very personal. I struggle with sharing them but it is frequently therapeutic for me. Also, I don't want to forget and maybe they will serve to help someone else.

I find that more often than not, I am listening to my sister's music while I am writing. Her music inspires me and she is one of my many heros. If you, my reader, has never had the opportunity to listen to her music, you should check her out on Facebook and see what you are missing.

The past 48 hours have encompassed some of the lowest moments and the highest highs of my deployment. I share these experiences so that you can see the contrast and see what I have experienced and hopefully draw some lessons of your own.

It began Thursday morning with casualties arriving around 0430, after a brief interlude for lunch (that was considerate of the Taliban), there was a particular soldier who arrived to my team in extremis after sustaining an extremely severe injury. (You can tell how sick they are by how hard the helicopter lands. They nearly broke their landing gear.) He arrived and coded in the ATLS area (Advanced Trauma Life Support), we were able to get a heart beat back and after consultation with our neurosurgeon in Bagram we decided that his only chance was to aerovac him to Bagram where he would need to undergo massive brain surgery. At this point his chances of survival were slim, but we loaded him on a helicopter in a desperate attempt to save him. Due to his tenuous condition, I and my CRNA (anesthesiologist) flew with him. Three minutes into the 25 minute flight, his heart stopped again, we coded him again. I did chest compressions for the next 22 minutes until arriving at the ER in Bagram where he was pronounced dead. I resolved that I was not going to call him during the flight, and we would get him to Bagram. We did everything we could do, it just wasn't enough.

Upon return to Shank, I just didn't want to talk to anyone. I just wanted to be alone with my thoughts and my own prayers. I think of the mother, the father, and wife and children who lost their Dad. I could only pray that the Lord would let this guy know that I did everything I could. I reaffirmed my testimony that our Lord and Savior descended below all things, so that he would know how to succor his children in need. It wasn't the soldier who needed his aid, but it was the physician who needed healing at that moment.

I finally got to bed around midnight and an hour later we started taking casualties again. We were busy all night and I was able to get back to sleep around 0600. After a few hours of sleep, we were told that there were more casualties. There were three soldiers coming in, all with gun shot wounds. One was quickly deteriorating and the other two appeared stable. My partners took the severely wounded one while I would take care of the other two. Of my two, one was stable and the other had a nasty femur fracture.

After looking at their x-rays, I ran into a chaplain. The chaplain asked me if I was Major McMullin? "Yeah", I replied. "Are you a Mormon Elder?", he asked. "Uh, yeah". He proceeded to tell me that one of the soldiers under my care was a Mormon and wanted a priesthood blessing from a Mormon Elder. It was the one who was minimally injured. However, he was the one who watched two of his buddies die and performed life saving care for the one soldier now in the operating room. This soldier had been stationed at a remote location and was the only Mormon on his post. So there in the middle of the ICU and amidst the chaos, I was able to give my patient a priesthood blessing. It was a very spiritual experience. After the dust and chaos settled down a bit, the local serviceman's group leader and I were able to administer the sacrament to him. I will never forget how grateful he was to get that priesthood blessing, and how grateful I was that I was worthy to place my hands on this faithful brother's head and pronounce a blessing from his Father in Heaven upon him. I rededicated myself to always living worthily to be able at a moments notice, be an instrument in the hand's of the Lord to do bless his children.

That evening as I sat by his bedside, we talked about Captain Moroni from the Book of Mormon. Who led his people during a time of war against the Lamanites. How was it that they were able to maintain their spirituality during that time of strife? To such a degree that Mormon was able to decree that "there never was a happier time among the people of Nephi..." (Alma 50:23). We talked about Moroni (the son of Mormon) who witness the destruction of his people. Many times we overlook that this likely included brothers, sisters, maybe a spouse and children. Yet, he was able to carry on and perform the important work that the Lord had for him. The Book of Mormon was written by warriors.

This experience was one of the highs of the past several weeks, and it really helped me overcome the sadness from the previous night to be able to serve this brother. (There is your hint to the answer for my previous question.) I am so grateful for this opportunity.