FORWARD OPERATING BASE FENTY, Afghanistan — In the rugged mountains of Nangarhar province, medical aid is often unavailable. Ground ambulances usually take hours to reach the nearest clinic, and attempts to get an air medical evacuation through Afghan government channels can take a week.
This means that border police officers who are seriously wounded in the isolated regions often succumbed to their injuries before any medical help can reach them.
American advisers say that training the Afghans in emergency medical care and logistics has become their top priority, and they’re optimistic about the progress they’ve made so far.
Because the Afghans had no battlefield medical services in place in the past, the local U.S. Security Force Assistance and Advisory Team has set up training programs that teach local police how to provide emergency trauma assistance to officers wounded while on duty. Combat Life Saver training teaches soldiers and police how to deal with life-threatening injuries, such as the loss of a leg in an explosion.
Capt. Jeremy Sharp, the American medical adviser for the Afghan National Army’s 201st Corps in Nangarhar, said the Afghans weren’t used to planning for medical support as part of an operation.
But by mid-December, about six months after Sharp started medical logistics training, the Afghans had set up a mobile forward aid station to accompany units on a major route-clearance operation. If a police officer was wounded in the course of the mission, an ambulance wouldn’t lose precious time driving all the way to the closest permanent clinic.
"I’ve been coaching them [to do that] for like six months," Sharp said. “This is leaps and bounds from when I first got here, which was really no planning.”
U.S. and NATO combat forces are due to depart Afghanistan at the end of next year. But the coalition plans to leave behind a team of several thousand advisers who will continue to train the Afghan security forces. Most of these advisers are slated to work at the headquarters of larger units, rather than at the tactical level, as they have done up to now.
Dr. Abdul Niamat, the top medical official for the Afghan Border Police’s Zone 1 in Nangarhar province, praised the training and said he’s seen the results in the field, particularly when medics transfer casualties from one ambulance to another.
“In the past, they didn’t know how to carry a casualty,” he said. “They didn’t know how to stop bleeding.”
But Niamat says that there is still an inconsistent and inadequate supply of first-aid kits. For now, the local border police must get the vast majority of their combat life-saver kits from the Americans because the Interior Ministry won’t provide them. Other basic medical items are also rare.
That shortage has resulted in an extremely high mortality. Niamat estimated that the local border police units currently lose more than half their wounded members.
Lt. Col. Andrew Pekala, head of Security Forces Advisory and Assistance Team Blue, 4th Brigade, 10th Mountain Division, said the Americans are trying to fix the systems that should keep Afghan police supplied. They are shifting from a “push” system, where the central government in Kabul decides what to send out to each unit, to a “pull” system, where units keep track of what they’re using and submit requests what they need.
That means looking over the Afghans’ shoulders while they perform perhaps the least glamorous and most ubiquitous task of war: paperwork, Pekala said.
But sometimes, Niamat says, this strategy isn’t a complete success.
When he talks to the Interior Ministry, he said, “They tell us that we are not the only zone, that they support all of Afghanistan.”
He complained that a one-size-fits-all mentality leads to irrational decisions, like giving an outpost in a violent, isolated region the same supplies as a police headquarters in a quiet interior town.
Sediq Sediqi, a spokesman for the Interior Ministry, denied that the border police are given inadequate provisions.
“Medical supply or any other supply for the [Afghan National Police] or Border Police is of course a top priority,” he said. “We do not have any kind of shortage.”
Another adviser, Capt. Jeffrey Boch, said that sometimes the needed supplies just aren’t available at the central level. He said the border police in Zone 1 are now expecting to get 300 combat lifesaver kits from the Interior Ministry, the fruition of a concerted effort by ministry officials.
Still, despite these difficulties, the advisers say the progress achieved this year makes them optimistic that the Afghans will get these issues sorted out and be able to carry on by themselves in the future.
Capt. Santiago Pimienta, who works with the Afghans to train combat lifesavers, told Stars and Stripes he was “very confident that by the time we leave (the Afghans) will have the capabilities they need.”