Ready, Set, Go

September 20, 2009

It is with excitement and anticipation that I head to Kabul, the capital of Afghanistan, where I will spend the next year. The U.S. strategy and mission there is under renewed discussion and scrutiny in the popular American media. In the coming weeks and months there will be ongoing debate and discussion about what we (the U.S. Armed Forces, the State Department, many other federal agencies and many NGO’s) need to accomplish in this far-off land. My hope is that people formulate their personal opinions about Afghanistan after carefully seeking out information that goes beyond the brief headlines, ten-second video/sound bites and “talking head” media hosts. The history of the region and of the people of south central Asia is complex; it is ancient, and change here will occur only gradually and with patience and perseverance. But change can occur and most citizens ardently hope and pray for positive changes -- in their own lives and for a stable government that serves the needs of the people. Our shared international goals in Afghanistan and Pakistan are simply stated – to provide defense from those that would do citizens and us harm, promote democracy and trustworthy government and business institutions, and foster sustainable development. With that in mind, and reminding readers that this blog expresses my personal observations and opinions, let me share about some of the preparation that State Department employees undergo prior to a tour to Afghanistan. For security purposes there are specifics that cannot be shared. My goal remains to give readers a glimpse into the life of one Foreign Service officer, namely a doctor for the local embassy community.

First of all, what will I be doing in Afghanistan? Similar to Dhaka I will run the primary care clinic inside the embassy in Kabul. Unlike Dhaka, this post has 4-5 times the number of Americans to be served and the health unit is also made available to some of the local private contractors that are too small to have their own health service providers. So we will be busy. Unlike Dhaka I have a team of two Foreign Service Health Practitioners to help with these clinical duties. Having worked with mid-level providers (nurse practitioners and physician assistants) for many years, I look forward to teaming up with David and Mary Ann who both arrived in Kabul last month. Kabul is a city with extremely limited health care facilities for local civilians. Since Afghanistan is a war zone, we have a close collaborative relationship with the fairly extensive military medical system. They are primarily responsible for trauma and will assist us with trauma stabilization and transport if and when needed. They are not available to our State Department personnel for acute illness, infections, chronic illness management (high cholesterol, blood pressure problems, diabetes, etc.) or mental health services. That will provide the bulk of what we do in Kabul.

We will face some interesting challenges. With the pressure to increase our presence and support to the diplomatic and development efforts in Afghanistan, there has been a more-than-doubling of the number of U.S. civilian employees posted to Afghanistan. In addition to the embassy in Kabul, new consular offices are being set up in Herat in western Afghanistan and Mazar-e-Sharif in northern Afghanistan. Additionally more and more diplomatic and development civilians are being posted in the 26 Provincial Reconstruction Teams (PRT’s) throughout the country. While “embedded” with the military on Forward Operating Bases (FOB’s) these civilian specialists will be working in the local communities together with Afghan local officials. Their jobs are to gain understanding of local needs and facilitate use of American and international resources to create successful, sustainable local projects -- built, run and sustained by local citizens and regional government administrations. But in these more far-flung areas of the country there are few health care resources. Local care in the villages and towns is not available. The FOB’s have army medics who are very helpful and skillful team members. But they have limited diagnostic capabilities and medications available to offer for the wide variety of conditions that may arise. One of my responsibilities as the first civilian doctor at the embassy will be to find ways to extend more primary care services to all of our employees – both inside and beyond the walls of the embassy in Kabul. This will be an exciting, gratifying challenge. I look forward to “digging in” as soon as I get to Kabul.

The past three weeks have been spent in training in Washington, D.C. The first week is a special Counter-Threat Course offered by the Foreign Service Institute and the Diplomatic Security team. We covered many important themes about personal threat awareness, how to keep oneself safe and minimize dangerous risk exposure. We learned important security lessons and had lots of fun at a professional race car drivers training school. During our three days there we practiced ultimate defensive driving, how to “ask more” of our vehicles when needed -- but doing so in a safe manner, and how to avoid or respond to threat situations that can occur in traffic. Graduates of the course like to refer to it as the “Crash and Bang” course.

The following week was spent taking care of the many logistical tasks associated with moving to Afghanistan. This involved helpful meetings with leaders in MED, our mental health team in MED and several high ranking State Department officials with special guidance for my work in Kabul. It also involved the unavoidable waiting in lines to change payroll/benefits info, get special embassy/military passes issued at the Pentagon, etc. Laura joined me for several days and had a very helpful meeting with the Family Liaison Office. This office offers many types of outreach and support for families of diplomats, ranging from psycho-social support during unaccompanied tours, to help with spousal career opportunities and help with school guidance issues for families with children.

This past week was filled by a course developed to ground all workers heading to Afghanistan with a basic understanding of the history, politics, culture and languages of this region. The course was extremely well organized, with experts from many spheres whose experience in Afghanistan spans many years and broad disciplines. Over half of our class has already served in Iraq or Afghanistan in the past few years, so the entire week became a compelling discussion of wide-ranging issues from practical “survival at post” topics to coordination between the international, military and civilian efforts to discussion of the corruption and crime that complicate efforts to foster a stable government that can gain and hold the peoples’ trust. The week culminated yesterday with a visit from Secretary of State Clinton who took time to come to the Foreign Service Institute to personally greet and encourage us in the work we embark upon.

Am I ready for this challenge? I believe I’m as ready as I can be. I am anxious to arrive and get to work to further our national goal to stabilize this part of the world. It’s pretty amazing to find myself, a rural family physician from Minnesota 18 months ago, participating in the defining diplomatic challenge of our time. I am honored and proud to have a role to play – that of supporting our diplomats and development workers to the best of my ability. For that opportunity I am thankful. I am also very thankful for the love, support and prayers for success and safety from my family. That is vital and is much appreciated. So it’s ready, set and GO.