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Medical advisory team helps Afghans help themselves

  • Published
  • By Tech. Sgt. Jennifer Lindsey
  • Air Education and Training Command
"Patience," was the answer Maj. Ruben Garza gave when asked what he learned from his recent 12-month expeditionary assignment in Kabul, Afghanistan, and advises Airmen preparing to head to the country as part of the troop increases there this summer.

The Air Education and Training Command Medical Support Division deputy chief returned to Randolph AFB, Texas, in February from the deployment that captivated his heart and mind as he helped improve to the Afghan National Police healthcare system.

"Everything moved a little slower than I was used to," said the deputy chief, who prior to his deployment juggled a $25 million budget for AETC directorates and coordinated issues with 13 bases, but was new to the cultural challenges the mentorship role presented. "I learned not to rush things -- take time to think, then plan, rethink the plan, and then act on the plan."

The 19-year veteran was one of an 11-person Afghan National Police Surgeon General Embedded Training Team under Combined Security Transition Command-Afghanistan that convoyed 45 minutes almost daily through the war-torn, congested streets of the nation's capital to the ANP hospital located only 15 miles away on the city's west side. The team of physicians, nurses and public health officers and administrators advised their Afghan National Police hospital counterparts on ways to enhance healthcare for 82,000 police, and 575,000 family members and other beneficiaries.

Although many on the team had experienced deployments, this was their first mentorship assignment and first assignment to take them "outside the wire."

"The experience of being health diplomat to the ANP healthcare system was life-changing," said Lt. Col. Sean Murphy, the team chief, now serving with the Air Force Medical Service Corps at Ft. Detrick, Md. "Over time, we worked very closely with our Afghan counterparts to help them overcome even the most challenging obstacles, including security, funding and culture, to make measurable steps forward in securing their country and building healthcare system that their beneficiaries could count on."

As a hospital administrator advisor and mentor to the hospital commander, Major Garza coached his Afghan partners even on administrative practices that seem fairly common, such as maintaining a medical records filing system. Hospital healthcare providers simply created a new record on each patient during each visit if the record wasn't readily available, the major recalled. Later the records were stacked and packed away in storage. To improve patient care, the major encouraged that only one patient record be created per person and file it for easy retrieval to record patient care on subsequent visits, but he left up to the hospital administrators how the records would be filed.

"I found the Afghans open minded, but I had to give the people I mentored time to analyze the problem and come up with a way to make it work for them," he said. "We wanted an Afghan answer to the problem, not an American answer."

Another challenge was to encourage the start of a healthcare network to reduce the 75-percent mortality rate for Afghan National Police casualties incurred on the front lines or while patrolling the country's borders, said Major Garza.

"Their medical system didn't have the infrastructure or the mobility ours has," he said. "Each Afghan agency was centered on taking care of only its own people. The army only cared for its army soldiers. The police only cared for its policemen."

To hearten the idea of Afghan health agency communications and resource sharing, the advisory team conducted a meeting of national healthcare leaders in the first Afghan Medical Leadership Summit, which took place on U.S. Army Camp Eggers in Kabul. Additional coordination and cooperation of U.S. Army transportation, U.S. Air Force trauma care, Afghan army transportation, and Afghan army and national police healthcare, the major said. The result: a dramatic drop in the mortality rate to 35 percent.

When his team wasn't advising at the hospital, they also traveled to remote villages, providing immunizations and generalized medical care to the men, women and children for whom medical care is more of a luxury than a routine due to lack of money, availability and transportation.

To help advance "health diplomacy" and encourage creative thinking about Afghan healthcare issues, Major Garza and Colonel Murphy began coordination while still deployed in November 2008 for Brig. Gen. Qandahar, the Afghan National Police Surgeon General, who had never visited the United States, to attend the American Conference of Healthcare Administrators in Chicago in March, about a month after the deployed team returned home.

"I wanted to help expand his horizons -- for him to see how things are done by different agencies across the pond," the major said.

At the event, the major also shared his deployment experiences with conference attendees who hadn't been to Afghanistan, but expressed interest in helping its people.

"Don't be afraid to go over there," the major shared with professionals at the conference. "You can only do good for the people there."

Within one year, the Afghan National Police Surgeon General Embedded Training Team had more than 80 accomplishments to its credit and drove about 230 convoys, logging more than 7,000 miles helping influence hospital improvements such as infection control and providing better medicine.

"The experience has given me a different outlook at how lucky we are to have systems in place that care for people," he said. "We provide top-notch healthcare for our members that the Afghan systems lack ... but it is achievable with a little help from U.S. mentors."