A New Adventure

Three weeks ago Laura and I moved to Santiago, Chile to begin our new assignment with the U.S. Department of State. We've had many experiences since my last posting. Time to bring those of you who are interested in our comings and goings up to date.

Wrapping up in Afghanistan:

In August I was fortunate to host my colleague, Dr. Tom Yun, for a week in Afghanistan. He is serving as the head of the Office of Medical Services for the State Department. We visited the army posts I worked with in Kabul along with the French military hospital where I often collaborated with doctors and nurses from France, Portugal and Germany that make up the staff. We obtained clearance and transportation to fly (in a 19-passenger twin-engine plane) to Bagram, our main American military hospital stabilization/evacuation point. This is an amazing site were hundreds of young soldiers' lives are saved from disastrous injuries each month. If injured soldiers make it from the field to this hospital, their onward survival rate is 98% or higher. Revised methods of dealing with trauma are emerging from the wars in Iraq and Afghanistan. Among them are deployment of more surgical specialists closer to the battlefield, very rapid helicopter evacuation from any point in the country (usually less than 30 minutes from time of injury), early application of tourniquets in wounds of the arms and legs (every soldier carries at least one tourniquet and knows how to use it), and early, vigorous use of massive blood transfusions in the early resuscitation of victims. It was my last trip to Bagram, a chance to thank the outstanding American military docs and nurses I had worked with throughout my year in Kabul.

We then visited the ancient city of Mazar-i-Sharif in northern Afghanistan. The U.S. is remodeling a 1920's hotel into a consulate, planned to open later this year to serve diplomatic and development needs in this relatively stable part of the country. The American diplomatic personnel located here are currently housed with a Swedish military company, while the regional health care is managed by a German command. Both groups were hospitable and are doing great things on behalf of the NATO mission in Afghanistan. Dr. Yun wanted to visit a Provincial Reconstruction Team (PRT) near the frontier to understand medical care at the outposts. I was pleased to arrange a visit to the only Norwegian-run PRT in the far northwest corner of Afghanistan. While this area had been fairly peaceful, 2010 brought an increase in IED attacks and instability. We saw an excellent set-up in the Norwegian trauma stabilization unit, the well-honed helicopter recovery units and also the drone mini-aircraft used for surveillance.

The final leg of our journey was to Herat, an ancient city on the Silk Road of ancient times on the west side of the country. By Afghan standards this has remained the most prosperous city in Afghanistan. We are establishing a consulate in this city as well to meet the growing needs for U.S. Government advisers and aid workers. We attended the dedication of a new well on the outskirts of the city that will serve several semi-nomadic tribes that now live there. Just prior to the Ramadan season of fasting, the mayor of the city hosted a luncheon of business and regional governmental leaders that Dr. Yun and I attended in a beautiful pavilion just outside the city. The war is never too far off, however. The day we arrived a car bomb had exploded along the route we would have driven from the airport, so a round-about detour was quickly arranged. We passed the burned-out hulk of the truck the next day en route to the luncheon. In Herat we met with the Spanish and Italian medical teams that have responsibility for that sector. Medical care in Afghanistan is an area of great cooperative efforts. It was fascinating to meet medical colleagues and exchange information and tips/stories of our varied but aligned experiences.

The remainder of the Afghan tour was spent busily caring for patients, increasing capacity in the health unit and working on transition plans for my replacement. All in all, it was a fascinating year full of growth and challenge. Believe it or not, I had plenty of fun. The only really tough part of the year was family separation for several months at a time.

Taking a break (of sorts):

I arrived home on September 15. Every two years in the Foreign Service a four-week break is earned between international tours. Although Laura and I had planned to travel to the Southwest U.S. for hiking and camping, I decided in the end to use the time to have and recover from foot surgery. It was time to deal with some life-long and now progressive problems with a bunion and hammertoes. The surgery went fine, but recovery from three bone revisions/fusions takes time and I am still in a boot-like “cam walker” for another few weeks. We used the recovery time in Minneapolis to relax, catch up with family and friends and do some reading.

In November/early December Laura and I were students in an intensive introductory Spanish course at the State Department's Foreign Service Institute in Arlington, VA. We had four hours of class each day with 3-4 students and a native-speaking instructor, 2-4 hours in language lab and another few hours of evening study. Laura, after studying this past year, was several levels ahead of me at the beginner level. But we enjoyed being full-time students for 7 quick weeks focusing on language without distractions. We used weekends for some local tourism, a quick trip home for Thanksgiving and a swing down to South Carolina to visit Mike's brother, Dave, and his family. Despite the tough winter hitting the East Coast in December and January, we enjoyed great late fall weather and left D.C. the day after the first mild snowfall.

We spent a beautiful, snowy week in Minnesota during Christmas. Time spent with any and all branches of our family is especially valued with our itinerant lifestyle. By December 27 we had done all the packing, had shipping companies pick up our Household Effects (HHE) and headed off to Chile.

South America – the next adventure

So now we find ourselves in the beautiful, bustling city of Santiago – such a difference from Kabul. Chile has thrived from ongoing business growth, mining exports, along with active produce and wine production /exportation in the past 20 years. It is a strong ally of the United States in South America and an important model for regional neighbors – demonstrating the value of stable, democratic governance, a strong private business sector, and the stability that results from investments in education, infrastructure and equitable social programs.

My work here will be quite different from what I did in Afghanistan. While I will offer primary care clinic services in the Embassy health unit as at other posts, here I have a host of excellent hospitals and internationally trained physicians for referrals. It will be similar to working in an American city. But the assignment is in large measure a regional supervisory position. I will travel regularly to Bolivia, Paraguay, Argentina and Uruguay to supervise the small Embassy health units there. They are staffed by nurses and nurse practitioners. Each of the countries has varying needs for health care and varying levels of quality in available local providers. I will be the supervisor, mentor, educator for these teams and health adviser to all American personnel in these Embassies. Building relationships with local medical providers and hospitals is another important duty. I will provide health education and advise Embassy leadership on pertinent regional medical issues. I love the variety of opportunities that this job presents and look forward to the travel in this region.

Laura is evaluating priorities for being active here as well. With her more advanced Spanish she has already been more active and engaged in the community and met a number of interesting people. Last summer she earned graduate credits that led to a certificate to Teach English as a Foreign Language and may seek a role in volunteer or paid work in this area. She hopes to remain flexible, however, so she can accompany me on some of my trips and make regular visits to Minnesota to assist in the care of her parents and see our adult children.

Santiago is a bright, beautiful city nestled at the foot of the towering Andes mountains. We arrived at the peak of summer, with sun every day and temps in the 80's. We live in a lovely 12th floor apartment in a modern area of the city – just blocks from the Embassy and a short walk to a Metro subway station. Local shops and dozens of great restaurants are nearby. There are some biking paths nearby that can reach fairly broad areas of the city. We look forward to buying a car fairly soon and being able to explore the beautiful countryside outside this city of 7 million. We are near the wine-growing central valley of Chile, and less than one hour driving to the mountains to the east and two hours to the Pacific beaches to the west. We are now in a position to host visitors, unlike our previous posts, and look forward to those that want to stop down for a Chilean adventure. Our first visitors will come in March, when son Mark, daughter Mary, and former exchange student Kwang-Hee arrive for a week. That will be our first chance to take a break and explore the region out of Santiago.

Laura and I have so appreciated the warm greetings from so many friends and family, and the wonderful chance to meet new and interesting people at every turn. We thank all friends and family for their outstanding support and look forward to keeping in touch in the months and years ahead.