From the Big Apple to the Fertile Crescent to the Spice Isles...to the Silk Road
And so here I am again. After two years living in the tropical paradise of Grenada, attending medical school as a mid-life med student, I have returned to the middle east in the service of the United States Armed Forces. I go also in the service of Bank of America, since it to pay my mortgage that I took a leave of absence from school to take this mission. And so here I am in Kabul, Afghanistan.
The process of getting in theater was faster this time, since I went as an individual medical officer as opposed to a member of a military unit. When you deploy with a company, battalion, or larger organization, the entire group of soldiers must go to a “deployment center” for about three months to receive general combat training, mission specific training, personal gear, and field equipment.
When one deploys as an individual—which is frequently the case when a person with a specific skill set, such as an engineer, doctor, or technician—is needed to augment a unit overseas, that person undergoes much-abbreviated preparation. In my case, I reported to Fort Benning, Georgia to the CRC or CONUS Replacement Center (CONUS=CONtinental United States) for pre-deployment. 
The CRC fast-tracks individual augmentees and gets them to their overseas station in 1 week.
So, after the CRC and a 20-hour flight on a chartered jet, about 200 soldiers and 200 contractors in my class arrived in Kuwait, awaiting flights onward to our respective stations in Afghanistan, Iraq, Africa, and a few other places. Camp Ali Assalim in Kuwait is US Army’s front door to the Middle East and Africa. It is here that soldiers receive their final theater specific training, receive ammunition, and enter the war zones. All flights onward from Kuwait are on military aircraft, usually sharing space with military equipment. The camp is a collection of sleeping tents to which transiting soldiers are assigned and trailers that contain many of the amenities of home (Subway, McDonalds, Pizza Hut, a Harley-Davidson dealer, Greenbeans (a Starbucks knock-off), as well as a barber, a beauty shop, and the military post exchange. 
There is also a gym and a MWR center (Morale, Welfare, and Recreation) where soldiers can fill their days while they await flights forward. Since many of the flights are at night for security reasons the camp is more alive at night. The fact that the days can top out well over 100 degrees most of the year also drives most soldiers to sleep in the air-conditioned tents during the day. Because the majority of the occupants of Ali Assalim are in transit into and out of theater, everyone looks a little bewildered. For my part, because I was alone and of a relatively high rank, nobody told me what to do or where to go or tracked my progress, which was refreshing but confusing. Had I not been eager to get to my destination and get to work, I probably could have lingered in Kuwait for weeks. I suspect that many people to get lost in limbo there. In my case, despite twice daily checking at the Pax Terminal it took 4 days to get a seat on an aircraft into Afghanistan.
The flight into Bagram, Afghanistan took off at 0355H, flew down the Persian Gulf, skirting around Iran, taking a left at the Indian Ocean, across southern Pakistan, and into Afghanistan. Twenty soldiers and I were assigned so share the windowless cargo hold of a C17 with several hundred rounds of Illumination Rounds (mailbox-sized artillery rounds filled with pyrotechnics that are fired upward to illuminate the night sky and light up the ground for military operations).
Not that crashing in a plane could ever be a pleasant experience, but it did lead one to think about the spectacular fireworks that would have ensued had we gone down – it would have been one hell of a funeral. The flight crew invited me to sit up on the flight deck (I think one of them saw the flight surgeon wings on my uniform) and I was more than happy to strap in behind the pilots and enjoy the view.
The climb out of Kuwait was made more interesting by the faulty alarms that went off as we ascended. “Open Door” and “Obstacle ahead” were intoned in slightly urgent female tones by the computer. The pilots nonchalantly reached up and pressed cancel buttons over the flashing lights. I figured that if they weren’t worried, I shouldn’t be, so I concentrated on the spectacular view all around me. The PIC (Pilot in Command) was a woman of about thirty who looked about as stressed as if she was reading a newspaper. Indeed, she was reading checklists, dozens of instruments, as well as the heads-up display that projected navigational and engine status, communications info, and threat information onto the windscreen in front of her. She did direct the plane during takeoff with a joystick between her knees but turned general control over to autopilot once altitude was reached. Almost comically, she steered the aircraft after that by reaching over and turned a tiny radio dial to enter each new heading into the computer when waypoints were reached. The huge aircraft would then obediently enter gentle turns and level out on each new heading. Her co-pilot and she bantered jovially as the scanned instruments, and constantly monitored progress and updates. I have to say, at the risk of sounding patronizing, it was good to know that I was on the side that for all of our mistakes, finally values and depends on women in the most dangerous and complicated jobs on the planet.
The symbolism of a woman flying one of the most advanced and powerful machines the world has ever seen over battlefields in countries that continue to subjugate women…well, I’ll let you create your own metaphors, but it made my heart swell with pride to be on her team.
It was apparently the first time this crew had flown this route as they made a point of pointing out the sights along the way including the giant palm tree shaped sand island in Qatar and the world’s tallest building. 
The Persian Gulf was peppered with oil drilling platforms brightly illuminated with electric lights and natural gas flames. Had it not been for the solid line of lights along the shores, the gulf would have been almost indistinguishable from the shore.
Dawn broke as we crossed the border over Pakistan. Even from 30,000 feet the land in southern Pakistan appeared dry and barren. It was hard to see how anyone was able to scrape out a living down there. That being said, the shapes of the sand and rock were dazzling in their variety, and no doubt hid many wonders. 
At one point, the sand looked exactly like an electron micrograph of bone…I guess medical school has affected my vision.
Gradually, the land began to undulate, and green patches appeared in the valleys, along with villages. The snow-covered Hindu Kush mountains appeared ahead to the left and we knew we were over Waziristan in southern Afghanistan. The villages and fields belied the fighting going on in this region, the land of Pashtos and last stronghold of the Taliban. The sun peeked out above the distant mountains, the pilots took pictures of each other with the snowcaps behind them, and we entered the flightpath into Bagram, the main airport in Afghanistan.
Bagram
Bagram, or “BAF” (for Bagram Air Field) is similar, I imagine, to a goldrush town. Not that I have ever been to the Klondike, of course, but so I have read. Because BAF is the main point of entry for all personnel entering Afghanistan, it is teeming with people. Members of all the armed services from the US, NATO, and other armed services mix with dozens of contractors, government personnel, NGO (non-government organizations). The variety of uniforms and weapons that are slung over shoulders and from belts are so varied and colorful, there is an almost evil Dr. Seuss quality to it. All day and night, the sidewalks are as busy as mid-town Manhattan at rush hour, but the proportions of civilians to soldiers is reversed. It is so crowded with service members that saluting becomes comical – I walk entire blocks chopping my hand up and down in obligatory response to salutes.
The population has grown so fast during the recent upsurge in incoming troops that the infrastructure is having difficulty keeping up. The few sidewalks are being torn up to install cables and plywood and packing crates are laid out over the work areas. Workmen pop out of holes at all hours of the night, startling the pedestrians walking by. The main road, called “Disney Road” is an almost constant traffic jam of civilian and military vehicles.
Many buildings are only half completed because contractors have taken their advance money and absconded. Tents have been erected to accommodate the organizations without buildings. Many of the structures are soviet era leftovers, from the Russian Invasion of the 80s, and there are living quarters made from stacks of shipping containers. Incongruously, in the middle of it all, the USO is set up in a little wooden Swiss-style ski lodge type house next to the military air terminal.
At one end of Disney there is the Bazaar, where the PX (Post eXchange – a sort of military Walmart) is set up and this is surrounded by local vendors selling everything imaginable. There is also a Popeyes, a Burger King, and a Starbucks. The latter were shut down last month because GEN McCrystal noted that there were too many fat soldiers, and also felt that there was something that just seems wrong about having fast food in a warzone (I’m inclined to agree).
I arrived in BAF at 0600H and after pounding some really horrible coffee walked down to the hospital to announce my arrival and present my medical credentials as instructed back in the States. Nobody there had any idea had any idea what to do with me, however, so the medical director took me on a tour of the facility and then took a copy of my packet to humor me. After learning that there were no flights leaving for Kabul for 24 hours, I found the Medevac company and met with their flight PA and commander and crew. They obligingly allowed me, as a fellow aviation crewmember, to sleep in their ready lounge (where the on-call crew often hangs out while they await emergency calls) for a few hours. Bright and early the next morning, I was in line for the Kabul flight (in fact, my bags were already on the plane) when I got ambushed by the Brigade Surgeon of the unit I was supposed to be joining. I almost escaped…but as it turned out, meeting him, giving him my credentials, and undergoing the obligatory rollover and IED training was a good thing. But, it meant another four days delay of me getting to my duty station.
Rollover training and IED training are obligatory for all new arrivals in Afghanistan. The prevalence of IEDs (improvised explosive devices) in Iraq and Afghanistan have driven the United States to field more heavily armored vehicles.
Insurgents have responded to the appearance of better armor with bigger bombs, of course. The result if not the goal of larger bombs, is to roll the vehicles over. While the armor is usually not pierced, flying equipment, weapons, ammo boxes and tumbling soldiers within the vehicles is capable of being lethal. Consequently, everyone undergoes "rollover training" upon arrival in-theater in which we are strapped into full-sized vehicles mounted on gantries, and flipped upside down. The experience of being flipped upside down—even without undergoing an explosion— is surprisingly disorienting and distressing, so it is well-worthwhile to experience it in a safe and controlled environment. In these conditions we can learn how to extricate ourselves and injured comrades (cut the belt and fall onto the ceiling or door, find footing, open unblocked door) and get out of the vehicle while under fire. In some ways, this rollover training is harder than the water survival training I underwent at flight surgeon school. In that training we are also strapped in and flipped over, underwater in that case, but the buoyancy makes escape from the seatbelts a little easier...of course you have to do it while holding your breath in a sinking helicopter, so I guess they each have their charms.
The IED training was also impressive. It turns out that because the Taliban are running out of old artillery shells and mines to convert to IEDs, they are making explosives out of household and industrial chemicals. As a result, the training now includes recognition of the explosives ingredients, lab setups in homes, and suspicious injuries on locals seeking medical attention. In addition to the lectures there is presentation of videos of Taliban attacks — Taliban operatives always film their attacks both so they can prove they were successful and collect their money, and also so they can be posted on-line for propaganda. The final portion of the training involves walking though a village that is set up within a secure warehouse complete with roads, bridges, culverts, and structures, all rigged with simulated booby traps, trip wires, and pressure plates that set off small explosions when we blunder into them. The instructors teach us how to spot the triggers and markers, and how to respond appropriately. Surprisingly, we are now taught to respond slightly differently each time (while following basic survival principals) so that the enemy doesn't exploit predictable responses and set secondary charges that explode in the places to which we have retreated. and IEDs so that we can walk through and learn to recognize the traps set for us.
While I was frustrated to be delayed in my travels, the training was well worth it.
After four days in BAF, I finally got a flight down the valley to Kabul, fifteen minutes away. Kabul International Airport has the unfortunate acronym KIA (which in army parlance means “Killed In Action.” Perhaps as a way of circumventing this, everyone just calls it “Keeya.” My ride to Camp Phoenix in Kabul is in an armored convoy in the center of which is an armored Winnebago known as the Rhinoceros. The concept of an armored recreational camper is strange enough, but it got even weirder when I got inside and found a gunport (with instructions on how to use it: “break glass security cover with barrel before firing. Extend barrel outside of bus before firing”) next to my seat. Ozzie and Harriet take the family to war.
The trip through town is my first real taste of Afghanistan. There are the donkey carts, the blue burkhas, the groups of three and four (!) men on motorcycles, roadside markets, groups of men squatting in clusters talking and drinking chai, children running up to the convoys giving the thumbs up sign. After the IED training, I expect every car and bicycle to blow up. Every piece of garbage on the road looks threatening. The roads are jammed with vehicles and Afghan police and soldiers are everywhere. The town is incredibly busy, and appears to be thriving. The women may be covered up, but somehow they keep the beauty and bridal shops on every block in business. Every public building downtown is fortified with tall concrete barriers and legions of soldiers.
When I arrive at Camp Phoenix, I am met by Staff Sergeant Robello. SSG Robello is about my age, a paramedic in civilian life, and about 210lbs of Boston tough. There isn’t anybody he won’t fight, and he has no patience for officer pomposity or Army idiocy. We are promptly friends. Recognizing that I haven’t slept in several days, he quickly sets me up in “Legoland,” the stack of conex housing units in the center of the camp occupied by senior officers. Technically, since this is a base crawling with lieutenant colonels, colonels, and generals I’m not a senior officer but SG Robello has a reputation for getting what he wants, and I am quickly installed in a Lego block.
The next five days are spent alternately reading my medical review books and recovering from jetlag. I find myself falling asleep at 1100H, again at 1700H and then being wide awake and going to the gym at 0300. The gym is packed, so I’m not alone in my suffering. I learn that there is still infighting between the officers as to where I am supposed to be working – consequently, I have no work. The clinic on base is already overstaffed and underutilized, so there is nothing to do there. And so I read and nap.
I learn that my destination is Camp Dubs in Darulaman, a neighborhoom 10 miles south of center city. Going from one base to another should be a simple arrangement - I could actually walk out the front gate a take a taxi - but that would be a little risky. Instead, I have to wait for an armored convoy to be arranged to which I have been specifically assigned.
To pass the time I went out into Kabul on a civil affairs mission. It is odd that the US Army is doing work that one would think would be done by the State Department and other civil agencies, but there you are. Despite the obvious drawbacks, it is a good thing I think. This is just speculation on my part, but Afghanistan is a culture built around survival and toughness (one Afghan recently told me, "Aghanistan can be invaded in one day, but can never be conquered"). Consequently, I think the chiefs are more likely to listen to people they respect - fellow warriors with whom they have fought - than civilian "outsiders" (faranghee) who might be perceived as soft and naîve. This mentality is not without precedent: the Ghurkas were respected and adopted by the British Army, Buffalo Soldiers were so named by American Indians as a sign of respect, the Harlem Hellcats (a WWI infantry regiment that was the first American Expeditionary Unit to fight in WWI) were named by their German opponents, and the Marines to this day wear the Mamaluke sword given to them by Arabic brothers-in-arms after fighting the Barbary pirates in Tripoli). This kind of Club and Glove philosophy doesn't fit neatly into either the far Right or Left wings currently shaming our country, but I think it has plenty of historical precedent. The hard part is to know when the transitions are necessary. I suppose that is what Teddy Roosevelt meant by "Walk softly but carry a big stick." It's too bad it takes so long for our country to remember the glove part once the clubs start swinging. I am reading Descent into Chaos, about the lead up to and execution of the Afghan war, and Civil Affairs wasn't just forgotten, it was deliberately excluded.
That said, I am struck by the changes that have taken place in the Army over just a few short years. The emphasis has shifted to what the Army calls "COIN", or COunter INsurgency through civil works. The new philosophy is to deny the Taliban public support by pumping money into schools, police stations, and community projects. The battalion that I am assigned to manages about twenty of these projects, sending out missions on a daily basis to check on progress of building by Afghan contractors and community policing by police. Convoys go out to the projects fully armored and with guns up, but when reaching the destination, the helmets and sunglasses come off. Most soldiers seem to enjoy the interactions. The observations of the soldiers are predictably infused with ethnocentrism and xenophobia, but to be fair that probably occurs amongst the Afghans as well. The important thing is that we are slowly learning from each other, and the interactions are garnering respect. Dari and Pashto words are making their way into soldiers' vocabulary. Wearing Afghan scarves around the neck with uniforms is de rigueur amongst the soldiers and mercenaries, although the latter tend to accessorize them with conspicuous beards.
The equipment on the battlefield is completely new as well. Although up-armored Humvees are still used, many convoys are now conducted in gargantuan armored MRAPS (mine resistant armored patrol vehicles) of various types. Army and Marine uniforms are now flame retardant and include firefighter type gloves and hoods, the vehicles are wired for sound and GPS, the seatbelts are aviation-style 5-point restraints. Since everyone has headsets and the switches are set to open communication the crew is in constant communication about possible threats from surrounding vehicles and possible IED placements (on bicycles, in piles of trash, in parked cars, in culverts). The discussion also includes commentary, on the passing vehicles and pedestrians, and business establishments, and of course since the soldiers are primarily me how to discern the various qualitative attributes of Afghan women under their blue burkhas [hint: it involves their footwear].
The outskirts of town are a strange mix of industrial yards full of modern construction equipment interspersed with shacks. The roads are choked with overstuffed cars and motorcycles, bicycles and donkey carts. Children run up to and in front of the vehicles when we slow down, and smile and offer thumbs up to us. Many adult men also smile, but just as many frown or simply ignore us. Most women wear blue full coverings, but one quickly learns to distinguish the poor from the wealthy and young from the old by the condition of the burkha and posture within it. Their reactions to our presence remains a mystery, however.
As we get deeper into town, the number of buildings and businesses increase, of course, and it is surprising how brisk business is. Kabul businesses cluster together by type, and the result is "the mattress district," the "bridal district," "the bicycle district" etc. When we drive past a cluster of motorcycle repair shops with hundreds of motorcycles being repaired out front on the street, the soldiers name it the "Hadji Davidson" district. As we wind through town, we pass through a bazaar that is as busy as any in the states. The traffic is congested, modern merchandise jams the sidewalks and smartly dressed Afghanis in new Western style clothing mix with traditionally clothed Kabulis. Mercedes and Lexuses mix with traffic. Glimpses of freshly painted mansions appear between the multi-story buildings. There is no sign of war here.
When we arrive at the police compound, the convoy commander goes inside to meet with the local neighborhood leaders and I remain outside to get to know the police. These men are jovial enough, but every one of them bears scars of the violence that has dominated Kabul’s recent history. They show me around the compound and I take note of the motorcycle sidecar that is bricked into a wall, and a live grenade that is embedded between two stones in the wall. Over the wall is a playgound and the remains of a forlorn amusement park that probably hasn’t seen much activity in a long time. Just before leaving I am summoned inside to evaluate one of the elders who has an eye problem. I see him, recommend that he sees an eye doctor in Bagram, and we depart.
