FORWARD OPERATING BASE SHINWAR, Afghanistan - The young Afghan soldier lay in great pain on a cot at an army base, his uniform pants cut up to his thigh so medics could clean the wound in his right knee where he was shot fighting insurgents.
The medics bandaged him and gave him morphine and an IV bag of fluids. But they couldn't stitch up the wound or give further care because there's no medical doctor at the base in the eastern province of Nangarhar. The base's two-room medical facility is run by a dentist, and its nine medics have only basic medical training. The wounded soldier had to wait overnight in the clinic until it was safer to drive him about 50 kilometers (31 miles) to a more sophisticated medical facility in Jalalabad.
The Afghan National Army faces a shortage of doctors, even as the number of wounded soldiers soars during a fierce wave of Taliban attacks. While the U.S.-led military coalition has praised the Afghan security forces' rapid growth and improving skills, its military medical program hasn't kept pace.
The Afghan National Army has only 632 medical doctors - 72 short of its goal - to care for about 177,000 soldiers nationwide. At the same time, its clinics are having equipment, supply and logistical problems.
The result is bottlenecks at the field clinics, where wounded soldiers can wait hours or days to be transferred to a hospital. Such delays can increase the risk of medical problems and lengthen the time it takes to recover.
The Afghans also can no longer rely on the U.S. military's medical system as international forces reduce their presence in the country. The U.S. isn't giving the Afghans any medical equipment, and medical evacuations by American helicopters are limited. The withdrawal of U.S. combat troops is set to be complete by 2014.
More than 330 Afghan army soldiers have died so far this year, according to a tally by The Associated Press, though it's not clear what impact the doctor shortage had on their wounded because details on Afghan casualties could not be obtained through NATO or the International Security Assistance Force.
Last year, more than 1,200 Afghan soldiers died, compared to more than 550 in 2011, according to data compiled by the Washington-based Brookings Institution.
The medics at Forward Operating Base Shinwar in Nangarhar have gone through 7-week combat medical course, and they are often paid more than enlisted soldiers and know how to read and write. But beyond that, they often have little experience.
American medical adviser Sgt. Connor Quinn, who serves in the 1st Brigade Combat Team, 101st Airborne Division, said he's working to encourage the Shinwar medics to treat their wounded before transporting them to the nearest medical facility. Quinn's Fort Campbell, Ky.-based unit advises the Afghan military on a variety of staff and operational issues.
"I've been trying to teach them what to do at the point of injury," such as stopping major bleeding or keeping airways open, said Quinn, 26, a U.S. Army combat medic from San Martin, Calif.
Most wounded soldiers from Shinwar are transferred to the brigade medical facility in Jalalabad because it's fairly close by ground, and calling for a helicopter from the army's fledgling fleet can often take more time than driving.
Afghan clinics also face problems with equipment, supplies and training.
At Camp Parsa, a large Afghan army base in Khost province in the east, the medical facility is clean and spacious. Afghan National Army Col. Shazad Gul, the officer in charge of the medical clinic at Parsa, is a pharmacist by training. He has a staff of physician assistants and medics, but what he really needs is medical doctors and surgeons for his 13-bed medical facility.
When the clinic sends up paperwork asking for more medical supplies from the ANA's warehouse, Gul complains that most of the time the medication requests aren't filled correctly or they are given expired or nearly expired medications.
American adviser Staff Sgt. Nathan Lethgo said the X-ray machine has been broken for more than three months, and he has been working to get the medical staff on the phone with the equipment technician to try and figure out the problem.
"We want to get them to learn how to sustain their own equipment," said Lethgo, a 29-year-old from Brentwood, Tenn., serving with the 1-61 Cavalry Regiment, 4th Brigade Combat Team, 101st Airborne Division,
Meanwhile, Lethgo was trying to get two of the clinic's physician assistants in a medical trauma training course run by the coalition forces, but their paperwork was lost. He has to start the process over again, likely pushing back their training until later in the summer, during which the main fighting season in Afghanistan is under way and they'll be needed in the clinic.
The Afghan colonel shrugged and smiled, saying through a translator that these are "new Army problems."
A more sophisticated medical facility is located in the mountains in Gardez, but the roads are sometimes cut off in the winter months. The Afghan Air Force has fewer than 50 Mi-17 helicopters, and the fleet must balance the demands of evacuating casualties against moving troops and supplies.
"If they had more helicopters spread out, they could use them more," Lethgo said. He's hopeful that by the winter, the Afghan Air Force will have expanded its fleet.
Afghan soldiers are at risk every day, not only from the bullets, roadside bombs and vehicle wrecks, but also from their living conditions.
The Afghan soldiers have a lot of gastrointestinal issues, stomach problems and diarrhea, due to the conditions on their bases, said Quinn, the medical adviser at the Shinwar clinic. When trash sits out in the heat without being properly disposed, or when their water pump isn't working, the soldiers get sick, said Quinn. The ANA also regularly sends out medics to the smaller units to administer vaccinations for common diseases.
"Preventative medicine is a big push," said Quinn.
Quinn wants the Afghan medical staff to get regular training that will continue to build their confidence and skills. He was trying to arrange to have the ANA medics continue their training with ANA commandos after the advisers leave.
"They are good at taking care of casualties, and they know what right looks like," Quinn said. "Now it's time for them to walk on their own."