Foxnews story about where I work and what I am doing...

I posted this article on facebook, but I was super excited to read this. Now that we are starting to see some slow down my big project is to develop a physician mentorship program for local nation physicians.

I proposed this project to Captain Palko (from the story) about a month or so ago and I think I surprised him. I think he was expecting us to want to start bringing Afghani's onto the FOB where we could do their operations. He was pleasantly surprised when we told him that we wanted to develop a program where we would bring the local physicians onto the FOB and engage them with a mentorship program.

In this program we will have a didactic section that has already been developed and translated into Dhari (local language). We can then get these physicians to bring complex patients, or just patients who have specific problems that we can help teach them to deal with. I hope to get the local brigade involved as well to help with the non-surgical topics and get them to take ownership of the program so when I leave in 3 months it will be self sustaining.

The pictures I loaded up are of the surrounding terrain. It was absolutely beautiful taking these pictures. My little point and shoot camer just does not do it justice. Much to Sarah's dismay it has me looking at SLR's again.

Tender Mercies...

We have been busy this week here at Shank. Someone somewhere said things were supposed to slow down once it started getting cold. I have yet to see any slow down. Before I get into my blog I will give the scoop on the photos for this week.

Yes, it is getting cold. This is evidenced by all of the snow on the mountains. Those mountains are south of us, between us and the Pakistan border. We'll see if that makes a difference in the amount of casualties. Our elevation is around 6500 feet, and those mountains are at least 11-12K feet. The lows this week are supposed to be in the 20's. This is why I think that the Nobel Peace Prize should be given to the inventor of the electric blanket. Think about how many lives are saved because of electric blankets! I can think of at least four. The nurses control the thermostat as we share a heater between out two tents. This is a huge, industrial strength heater to heat up about 400 square feet of living space. As a result, when the heater is on, it really heats up quick, and the thermostat is more of a rough estimate at best. For some reason the nurses don't like it steaming hot and they don't like to turn the heater on. Problem solved, preheat the electric blanket at "5" an hour before bed and when it is time to insert myself into the oven, turn the heat to "4" and cook for as many hours as possible. Because for every hour I am asleep, it is an hour that I am not here in Afghanistan! BTW, I would also add for strong consideration for the Nobel Peace Prize the inventor of the washable marker. How many childrens' lives have been saved because they colored on the wall with washable markers? Think of the children!

The second photo is me operating with my scrub tech, Specialist Roberts. We are doing a Hartmann's colostomy after I diagnosed my patient with a penetrating rectal injury from a mortar fragment. How I made the diagnosis is a story for my brother and I to share at the dinner table, not here on the internet. Specialist Roberts is a great OR tech and an aspiring orthopedic surgeon.

This week, I couldn't help but think about 1 Nephi 1:20. The book of Nephi, (First book in the Book of Mormon) appears to be written retrospectively by Nephi. Here is his family, being cast out of their nice home, their riches, friends and all of their own hopes and dreams for their future being thrown out the window. They faithfully follow their father into the wilderness to save their family from the destruction of Jerusalem. Nephi, again with the ability to look back over his journey says, "But behold, I Nephi, will show unto you that the tender mercies of the Lord are over all those whom he hath chosen, because of their faith, to make them mighty even unto the power of deliverance". Nephi begins the Book of Mormon with this premise: Look and see how keeping the commandments, following the Savior Jesus Christ will lead you to happiness.

To understand the "tender mercies of the Lord" we have to first understand that God is our Father in Heaven and as such loves us. We are not talking about a fleeting feeling or sympathy. I am talking about a deep rooted and eternal charity that led him to send his only begotten Son to suffer and die for each of us. We have to have faith that he knows each of us, as parents knows their children. He knows our wants, our desires, our passions and our pains. He knows what we want most and what is most important to us. This is our Heavenly Father we are talking about, he knows us better than we know ourselves. I firmly believe that He cares about the little stuff too.

Over the next several chapters, Nephi shows us how the Lord delivers him and his family from various challenges and trials. He blesses them with scriptures, families and a way to travel across the ocean to their Promised Land. In fact, this is one of the premises of the entire Book of Mormon. The next time I read the Book of Mormon, I am going to focus on picking out the tender mercies of the Lord.

This week I observed a tender mercy of the Lord. If you remember my last posting, there is a soldier from Utah that was going home for the birth of his first son. He left Afghanistan on Monday morning, traveled for more than 20 hours to Salt Lake City. While driving home from the airport with his 38 week pregnant wife on I-15 she went into labor, and a few hours later, his son was born. I don't believe in coincidence, only divine intervention. I know he wanted nothing more than to spend his R&R time with his wife and newborn. The Lord made it happen that they could have that time. Link to the KSL story: http://www.ksl.com/?nid=148&sid=8651687

In each of our lives, we can see tender mercies extended to us. It can be so easy to allow the whispering of the adversary to blind us from what the Lord has extended to each of us. I am humbled and amazed at how merciful He has been to me and my family. On of the greatest mercies that I have received of the Lord is my eternal companion, Sarah. Followed closely by my little own little ones. It doesn't end there. I can go on for a long, long time detailing the many ways that I have been blessed.

The principle lesson that I have learned over the past several years, is encapsulated by the love that a Father has for his children. As a father, I want all of my kid's dreams and desires to become a reality. If we live our lives in such a way that the spirit of the Lord can guide us, He will lead us to happiness.

Afghanistan has taught me many lessons about life, and about myself. I am truly grateful to my Father for giving me the opportunity to be here. For the past 14 years, I have wanted to be right here. I have fasted and prayed many times, that I might be an instrument in the hands of the Lord to bless his children on the earth. To be an answer to the prayers of hundreds of loved ones, back at home who kneel every night and ask God to protect their fathers and bring them home to the ones they love. It is hard being away from my best friend and my children. They are growing up so fast and I miss being with them. This is but for a brief moment me, yet for others it will be an eternity.

Inspiration...

Tonight I wanted to update my journal and I wasn't quite sure what to write. Usually when I get this block in my mind I turn on my sister's music. She has composed, performed and recorded a number of religious songs. If you have never had the chance to listen to her music she has a phenomenal voice and the words speak of her life and love of the Savior. It is one of the most uplifting things I have amidst a world of chaos, death and destruction.

There are a few other inspirations that I have around me. Some are here in Afghanistan and most are at home. Tom Hanks produced a HBO series not long ago called, "Band of Brothers". This TV drama explored the deep reasons surrounding why soldiers fight? The end analysis was that they fought for the guys next to them, not for some super high and lofty ideal or patriotism. It was their brother next to them. Some of my inspirations around me here in Afghanistan are the guys that I work with. Many of these enlisted medics and nurses come from very humble beginnings, poor families and hard lives. This is reflected at times in their behavior and language. But their passion and commitment is reflected in their work. Just yesterday, the local contingent of Afghan Army was smoking right next to their ammo supply point, which caught fire and promptly exploded. This yielded our first true mass casualty event, where there are multiple severely wounded arriving all at the same time. This requires a significant amount of coordination, communication and trust in our nurses and medics. 11 patients, 4 major operations and 8 hours later, the dust settled and all of my team performed remarkably. All of these guys have so much potential and I love hearing about their aspirations and plans for their future. It gives me hope for them and their families to leave behind the worlds that they came from.

The other group of "Brothers" that inspire me here in Afghanistan are the guys in my serviceman's group. I can't think of a better bunch of guys. This week, Staff Sergeant Hancock of Springville Utah is going home on R&R to be with his wife at the birth of their third child. It makes me choke up when I think of this faithful soldier, going home to his wife and family for 2 weeks. To see his little baby, then leave them behind so he can answer the call of his nation. SPC Bennett was married just before being deployed. While most newly weds are embarking into the lone and dreary world together, they are trying to get to know each other over the phone and through letters. SSG Chiu is a quiet, and very intelligent Non-Commissioned Officer who is an electrical engineer by training. He too has left a family to come here to this place, which redefines "lone and dreary world". They are all committed to building this place into a nation. That would mean that we can come home. 1st Lieutenant Andy Stockhoff is our group leader. Her served his mission in Alabama and is the project engineer for the biggest project, probably in the entire theater. He is orchestrating the construction of a massive runway that can handle large Air Force cargo planes, allowing us to project our military power throughout this region. All of these guys are amazingly faithful and just being around them make me a better person.

If this war were left into the hands of people like these guys, there is no victory that would escape us.

Sydney, my oldest daughter inspired me this week. She wants to play parks and rec basketball! The big challenge is that it is on a co-ed team. She went to the skills assessment session yesterday and according to Sarah did quite well. She was one of three girls there. The good thing is that she is taller than most of the boys and is pretty athletic. She was really nervous, but pushed through and showed her courage.

Inspiration is all around us, we just have to look for it. Inspiration comes through our interpretation of people, their actions, reactions and how they handle the daily struggles of life. I have learned over my few short years that everyone has a story and as we interact the web of our lives in spun and meshed together such that if we will allow it, and look for it, we can be inspired at every turn.

Before closing, let me discuss the pictures briefly. The top picture is of me and one of my ICU nurses, SPC Garcia. The patient was operated on earlier that day and after the OR wasn't doing so hot. His blood oxygen saturation was low and his heart rate up. We are in a pretty austere environment here and don't have many of the nice adjuncts that we normally do in the US. We rigged up a mask to a ventilator to basically act as a bi-pap mask (like what people with bad sleep apnea have) to forcefully blow oxygen into his lungs, opening up collapsed segments. This worked like a charm and fixed him right up. Victory, one ABG at a time!

The second picture to me tells a story of American ingenuity. American by the flag we hung up in our OR, and ingenuity by the Dewalt power drill on the surgical field. Again, we are in an austere environment and don't have much to work with. We needed to stabilize a bad fracture with long wires that would have taken forever to get in by a manual hand drill. We kept the wires sterile but used to power drill to make our efforts more efficient and in the end saved us a lot of time and energy.

Inspiration...and necessity... the mothers of invention. Below is just a cool video! Enjoy!

Updates...

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Finding things to write about are actually pretty difficult. Some days there really doesn't seem to be anything interesting at all to share, let alone anything that I think others would find value in. It is probably because those things have become mundane and common place to me. There are times that I am convinced that I am serving some prison sentence for a crime committed by my evil twin.

Yesterday was Halloween, yes here in Afghanistan as well. My wife and kids thought it would be a fun idea to send me a whole lot of candy and an pinata! Oh were they right! I packed as much candy as I possibly could into that thing. The picture above is of the pinata wearing a mullet wig (business up front and party in the rear!). I took some video with my camera of the guys taking their aggressions out on the poor thing. Ironically enough, it was the chaplain that broke it open! Some cried foul and insisted that he had help from above. We have an abundance of candy right now. Too much in fact. (I have already lost 20lbs during this deployment.) After the pinata we made a campfire and roasted marshmallows and made smores. I highly recommend the reese's peanut butter cup smore. Or so I have been told.

Little things like that go a long way to building morale. What makes a team come together and turns a group of people into a cohesive unit is really the guy next to you. How each person sees themself as a person of worth, then understanding how they fit into the team and into the "big picture". Doing this allows them to participate in the processes that are being undertaken. I think this applies to a Forward Surgical Team, and business or even to the plan of salvation.

Church was a lot of fun tonight. It is a fun group of guys. I hung out for a while after church talking with the guys who comprise the Civil Affairs (CA) unit here at our FOB. They are all from a reserve unit in Utah and two of the three have been deployed previously. They are helping me get a program, that I wrote about in a previous entry, off the ground. Essentially, we want to bring in physicians, they don't even have to be surgeons, and train them to do surgery. They bring in the patients to us for evaluation, we teach them how to evaluate and diagnose, and how to do the operations. We will be starting out with small stuff like hernias, appendectomies, lumps and bumps. We would also like to teach them about anesthesia and post operative care. We are working through these guys because they are just as excited about it as we are. We currently have little to no presence in the local communities. They send us their disasters to try to fix. We really want to teach them and empower them to take care of their own people.

The CA guys were sharing some frustrations about how the war is being portrayed in the media. This past week they delivered enough cold weather clothes to a local womens' shelter to take care of the widows here in the area for the next 5 winters! (By the way, it gets really cold here.) These guys go out and find projects to help the locals, they are helping teach the local governments how to run and function as a cohesive body. I decided that if I wasn't here as a surgeon, I would love to work as a civil affairs officer. They seem to be doing so much good and are the true players in a counter insurgency.

The ideas of central government are foreign to these people, let alone self determination and democracy. I think a lot about what I learned regarding governance during my junior and senior years of high school. The basic concept of government is that we give up rights and freedoms in return for a system of order. To convince these people that they should look after their neighbor and that the government is there to serve the people and not themselves is completely alien. Though sometimes I wonder if our own leaders have not forgotten this as well.

The second picture is of me and my partners here at the 8th FST. We are waiting for a trauma to arrive and I had just gotten of the treadmill at the gym. These are great guys and I really enjoy working with them. The one next to me is Dr Brian Helsel, and the one in the blue cap is Dr Matt Hueman (Hee-man).

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...