For the last six years, Western faculty members Ray Kao, Brian Church and Vivian McAlister have spent numerous months in Afghanistan providing advanced surgical and medical care to coalition, Afghan civilian and enemy casualties.
Part of Canadian Forces Health Services (CFHS), the trio played a significant role in establishing the North Atlantic Treaty Organization (NATO) Role 3 Multinational Medical Unit (R3MMU) at Kandahar Airfield, Afghanistan, the first-ever NATO multi-national field hospital involved in combat operations.
Recently, Canada’s role in that unit was recognized by NATO with the Dominique-Jean Larrey Award, only the second time NATO’s Committee of the Chiefs of Military Medical Services has granted their highest honour for medical support.
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. A total of 158 Canadian Forces members have been killed during the mission. More than 2,000 have been injured.
In late 2005, CFHS was given command of the R3MMU in southern Afghanistan. Taking over from the U.S. Army Combat Support Hospital, CFHS’s mission was three-fold: treat coalition soldiers, including Afghan National Security Forces; treat civilians injured as a result of the conflict; and treat any civilians who presented any life-threatening medical problem that was within the capability of the hospital.
Kao said preparations for such work drew on past experience and planning, with eight complete hospital contingents trained and deployed in rotation. The three joined others training in Petawawa, Ont., where they ran through a rigorous battery of military training, including battle-fitness tests, endurance tests, weapons handling, among other requirements.
When McAlister was deployed in 2007, health care in Afghanistan had been destroyed by war. Hospitals were targeted for bombing, staff for assassination.
“The difference (today) is amazing,” said McAlister, speaking from Afghanistan, where he is stationed until February. “Now, the hospitals are rebuilt and the care is quickly catching up to the developed world. Afghanistan needs doctors and specialists, the medical schools are working again, and Canada made this possible by restoring security.”
Canada’s time at the helm of the R3MMU has seen the highest survival rate ever recorded for victims of war, added McAlister, a major in the CFHS. And some of those lessons can be used at home.
“The lessons learned regarding mass-casualty management at the R3MMU should influence how mass-casualties training is conducted in both the civilian and military settings,” he said. “The emergency department management and triage of these casualties represented only the initial stages of managing mass casualties. Managing in-hospital resources – such as imaging, laboratory, blood bank, O.R. (operating room) and intensive care – are all critical components that require central coordination to effectively deal with mass casualties.”
When Canada first assumed command of the R3MMU, the facility consisted of an inpatient ward of 11 beds, three designated as high-intensity/critical care. There were two surgical teams, each consisting of a general surgeon, orthopedic surgeon, anesthesiologist, two nurses and two technicians. Additional medical specialists included a general internist, oral surgeon and radiologist.
During Canada’s watch, the hospital expanded to 20-30 ward beds, 5-8 designated as high-intensity/critical care. The hospital now boasts two CT scanners, three operating rooms, endoscopy capability, digital radiography and ultrasonography.
It also had a robust blood bank, another of the adaptations Canada undertook. Initially, the blood bank consisted only of packed red blood cells and fresh frozen plasma, with no provision for the potential of mass casualties draining the bank, which would leave the hospital without blood products and no immediate chance for resupply.
The CFHS soon deployed what McAlister called the ‘walking blood bank.’
“Volunteers from the deploying Canadian Forces contingent were identified and screened as potential blood donors,” McAlister said. “In theatre, if fresh whole blood was desired, a camp callout was made for the walking blood bank. The donors would arrive, receive rapid screening again in theatre and would donate blood for immediate transfusion. Excess blood would be stored.”
McAlister contends Canada’s three-year stretch in Afghanistan was productive, with hospital personnel treating more critically injured casualties than any conflict since the Korean War.
Currently, McAlister is working in Kabul with post graduate medical education programs, particulary responsible for advising on surgical residency training. He and his Afghan colleagues have written residency curricula for general surgery, urology, ENT and orthopedics. The Royal College of Physicians and Surgeons of Canada have provided considerable help, through Dr. Ken Harris, the former chair of Western’s Department of Surgery, who is now the college’s director of education.
McAlister added members of Western’s Department of Surgery have also assisted the effort with advice including faculty members Drs. Ken Leslie, Brian Taylor and Mike Ott and general surgery administrator Christine Ward.
Kao and Church mentored at the hospital in Mazr-e-Sharif, the fourth largest city in Afghanistan. They, along with others, are rebuilding Afghanistan’s health-care system and to train providers – from laboratory staff and dental assistants to medical specialists and surgeons – by developing residency training programs in general surgery, orthopedics, urology, internal medicine and critical care.
McAlister expects the second year of residents this year, and transitioning to independent Afghan delivery of educational programs by 2014.
“Canadians are winning the hearts and minds of the Afghan people. So, in their own way, they learn they do not need to be encompassed by the Taliban idealism, but use their own independent mind to ensure a safe and prosperous Afghanistan,” Kao said. “It has been a humbling and great experience to be a part of – to provide a service to Canadian soldiers, NATO soldiers and the Afghan people. The experiences that I have attained help me to be a better human being, to do the right thing rather than the expected.”
For McAlister, despite the years of war, friction and conflict, he sees Afghanistan getting back to being the proud country it once was in the very near future.
“I have seen a lot of misfortune and am more appreciative of the good life we have in Canada,” he said. “I have made a lot of friends here in Afghanistan. I hope they learn from their contact with us that it is possible to create a good life in Afghanistan.”