Western trio brings lessons of war home

University of Western Ontario faculty members Brian Church, Ray Kao and Vivian McAlister have made almost 15 trips to Afghanistan over the last five years as members of the Canadian Forces Health Services (CFHS).

Having performed countless surgeries on injured soldiers and Afghan citizens, you could not blame them for wanting to wash away the physical and mental memories. But out of the pain of war come lessons learned.

And some of those lessons, in fact, can be incorporated right in our own backyard.

“The combat role placed great responsibility on the Canadian Forces Health Service,” says McAlister, a major in the Canadian Forces, speaking on Canada’s completed combat mission in southern Afghanistan.

Canada began its Afghanistan War involvement in January/February 2002, and would escalate to a peak of 2,500 Canadian Forces members deployed to Kandahar province in 2006. The last command team returned home in July 2011.

A total of 158 Canadian Forces members were killed during the mission. More than 2,000 were injured.

The medical team designed a system to provide emergency care and evacuation for Canadian troops injured on missions. During their time in Kandahar, the team provided this care to NATO forces as well as the Afghan people.

The severity of injuries was the worst of any war, McAlister adds. And he has seemingly taken a lesson from each.

McAlister, Kao and Church have written scientific papers on their experiences in Afghanistan and been published in the Journal of Trauma and the Canadian Journal of Surgery.

“Successful completion of that mission is historic and CF medical officers sat down and documented not only how each section of  CF health services organized and delivered care, but also how lessons were learnt and applied,” McAlister says.

These include blood transfusion protocols in trauma; critical care including dialysis in austere circumstances; and management systems for mass-casualty incidents.

“These lessons were applied when we went to Haiti after the earthquake and some of these lessons have found their way into civilian practice in Canada,” McAlister adds.

Koa, who spent a total of more than nine months in Afghanistan as director of intensive care at the Canadian-led Role 3 Hospital, says learning in Kandahar has been paramount from a culture, people and medical point of view.

“Learning is a part of everything that we do,” says Koa, a lieutenant commander with the Canadian Forces. “Medical care is poor in Afghanistan. I do not think I have learned any new tricks, but I learned that human beings are tolerant and able to endure harsh environment and economics. I believe I have learned from the Afghans on how to live with less and appreciate life from a non-materialistic way.”

With the combat mission complete, McAlister says people assume Canada has left the country. In reality, only the focus was changed. Approximately 950 Canadian soldiers remain in the capital of Kabul training local soldiers and police and mentoring Afghan medical staff.

The new focus of the mission in Afghanistan, which will last until 2014, requires even greater dedication from members of the Canadian Forces, McAlister adds. He says the experience of he and his colleagues is helping this task considerably.

“For the CFHS this new role requires even greater commitment. Our task is to mentor the Afghans as they rebuild their health-care system,” McAlister says, who along with Kao and Church will return to Afghanistan this year. “Few people realize Afghanistan had a well-developed medical system prior to the recent series of wars that started with the Soviet invasion.”

As part of that new role comes a new attitude and approach.

“The new role requires a second skill of academic health-care givers: the ability to teach. This challenge is also special because our goal is not to replicate ourselves, which would be pointless because Afghanistan is not Canada,” McAlister says. “Instead, we have to mentor health-care givers to meet their responsibilities within their own mandate and environment. At the same time, we have to be careful not take over these responsibilities as this would undermine their system when we leave.”

Kao knows the rebuilding of health care in Afghanistan is a tremendous undertaking.

“We needed, first of all, to deal with the cultural divide in Afghanistan and the differences between ourselves and the Afghan people before we can undertake the task of mentoring,” Kao says. “They need to be re-build from the ground up when there is no infrastructure to help them to produce the kind of health-care system they need.”

While building from the ground up – literally – can be a good thing, Kao admits it will take a least a few generations do to so, but “as long as we give them the tools and the resources, eventually they will be able to stand on their own feet to make this work.”