Story and photo by Chief Petty Officer Leslie Shively

CAMP LEATHERNECK, Afghanistan — Just as Benjamin Franklin brought the Colonies together with his “Join or Die” snake, U.S. Navy Capt. Jeffrey Timby likened the importance of developing a trauma care system in Helmand and Nimroz provinces to fusing a head on a snake.

His initial impression of the state of the emergency healthcare system in Afghanistan came during a healthcare development meeting with the Afghan National Security Forces. At the meeting, he said he had an epiphany of sorts.

During a break, he was walking with the interpreter for the Afghan National Army’s 215th Corps surgeon. “Dr. Timby, I’ve been here for three years and we have never done anything like this. I am so excited to see you,” the interpreter said.

“This was the first time an effort was made toward organizing the disparate efforts of a large number of people toward a common goal of a medical program of training for the Afghan forces,” Timby, Regional Command Southwest’s surgeon, said.

Although the Basic Package of Health Services program had been implemented by the Afghan Ministry of Public Health during 2009, with trauma and trauma-related care identified as priorities; plugging emergency medical response into current infrastructure just one year ago was impossible.

“There was no ambulance system, no 911 to call,” Timby said. “It’s a blank slate. Without a police and fire dispatch system, there cannot be an emergency dispatch system. Without a communications network, there cannot be a dispatch system.”

Timby realized training medics would have to be the first step toward building a medical emergency response system.

“It’s a chicken or the egg thing,” he said. “If a guy gets injured, who is going to take care of him? Well, you need a medical system, which means you’re back at the start of the vicious circle. You can’t have any of it if you don’t have people.”

Given the low literacy rate in Afghanistan, training medics using a textbook-based curriculum was also impossible. So, the surgeon and his team looked at alternatives. The British Advisory Group had been working with the ANA’s 215th Corps putting together a skills-based, hands-on apprenticeship program – teaching by demonstration.

Timby’s team took the on-the-job-training model, amplified it with videography and photographs producing a training curriculum covering point-of-injury care: hemorrhage, airway, breathing, circulation.

“It was excellent and that’s where we started focusing our efforts,” Timby said. “In December alone, we graduated more than 90 medics. Other classes are now standing up and about every three months they will be able to graduate between 60 and 90 medics per session.”

Prior to implementing the OJT model of teaching, only 17 medics graduated between March and October last year. The team took the program further.

“The medical program that we’ve put it place, grown and matured has been handed over to the Afghans,” said Chief Petty Officer James Cartier, Combined Medical plans and operations chief, adding that Afghans now train their own people.

Cartier said a literacy course is also offered with medical training. “It promotes a very favorable outcome in which you have a literate, independently functioning Afghan medic.”

In cooperation with RC(SW) C9, the unit responsible for development, governance and reintegration, the team also developed a unified, self-supporting Afghan medical system that will include emergency response for military, police and civilians.

“It’s definitely saving lives. I am very pleased at the success our team has been able to accomplish here,” Cartier, a native of Beauford, S.C., said.

Timby foresees continuing the program once he returns to his home in Norfolk, Va. He plans on inviting Afghan surgeons for a two- to three-week familiarization itinerary of U.S. emergency response systems, and returning them to Afghanistan to implement improvements as necessary.

Calling the arrangement a “brain trust,” he said lessons learned from applying the knowledge and capabilities of remote-area care in places such as Montana, Wyoming or even Alaska could be used in Afghanistan for the benefit of both countries.

“Alaska is bigger than Afghanistan and 10 times more remote,” Timby said. “We do it there, why can’t we do it here?”


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