by Ray Wiss
JULY 24 | A Righteous Shoot?
Emergency physicians like cops. We see each other a lot in the course of our duties and we have a lot in common. Both our jobs involve some drudgery leavened by regular moments of drama. We both see people when they are at their weakest, angriest and/or most distraught. We both do shift work, that notorious killer of relationships. A lot of emergency nurses end up married to cops.
I like cops more than most people do. For the past five years, I have acted as the medical adviser for the “tactical unit” (a.k.a. SWAT team) of our police department. This relationship proved to be very useful when I re-enrolled in the CF two years ago. By the time I got back in uniform, I had already reacquired many of the infantry reflexes of my youth, thanks to the training I had done with my “tac” buddies.
Emergency physicians and policemen have something else in common: people lie to us regularly, for any number of reasons. For policemen, it only goes one way: people try to hide what they have done or what they know. For emergency physicians, the untruths cover a wider spectrum. Some people exaggerate their symptoms in the hopes of obtaining a particular treatment, commonly narcotics. Others minimize their symptoms, because they are afraid of what the diagnosis might be. Some people go either way, depending on what psychopathology is dominant in their family that particular day. And some people are just nuts.
Having to sort through all these emotions and agendas every time we are on shift gives us an ability, like cops, to “read” people. While I think I do this reasonably well, the skill is situational. It is essential to consider the patient’s social and cultural milieu before drawing any conclusions. Nonetheless, my travels have taught me that there are some universal human behaviours. I may have stumbled on one more.
One of today’s patients was Abdul Rahzak, a man in his forties. He had been shot three times by the ANP. One bullet went through his right ankle, shattering the tibia and leaving his foot hanging limply. One bullet went through his right hand, breaking several bones in his palm and wrist. The last bullet could have been the widow maker, but Allah was watching over Mr. Rahzak. The slug entered below his right armpit and exited halfway up his right shoulder blade, passing outside his chest cavity. Though he was in severe pain Mr. Rahzak was breathing normally, and ultrasound confirmed there was no blood or air leaking into his chest.
The medical management was almost mundane: bandage all the wounds, splint the broken bones, give pain medicine and antibiotics, wait for the chopper. Managing the circumstances in which Mr. Rahzak was wounded proved to be far more ambiguous.
For a guy who had been shot by the police, a couple of details did not add up. After dropping Mr. Rahzak off at the UMS, none of the Afghan policemen stayed behind. Somehow, an individual on whom they had used potentially lethal force half an hour ago was not even worth questioning, much less arresting.
Mr. Rahzak’s behaviour in the UMS was equally unusual. The patients I have treated whom we either knew or suspected to be Taliban have all had one thing in common: they have all been afraid of me well into the patient encounter. They think we are going to torture them, because that is what the Taliban do to their prisoners. It takes a long time to convince these patients that I will treat them properly.
Mr. Rahzak behaved very differently. As soon as I identified myself in Pashto as a physician, he began to relax. When I had determined that no life-threatening injuries were present, I told him: “Tah bah shah kaygee” (“You’re going to be all right”). Although I had not given him any pain medication, I could tell that the patient-doctor connection had been made. Mr. Rahzak looked at me with that mixture of awe and gratitude that is the emergency physician’s reward when patients are convinced they will be well looked after. That struck me as un-Talibanlike.
While we were waiting for a helicopter I shared this observation with the camp’s sergeant-major, Master Warrant Officer Richard Stacey of the “Strats.” He is the senior non-commissioned officer on the base and a man of infinite wisdom. He was sure he had seen the patient a number of times on patrols around the FOB, and he agreed that Mr. Rahzak did not seem “wrong.”
I was still wondering why Mr. Rahzak had been shot when I was called to a meeting a few hours later. Attending the meeting were Mr. Rahzak’s brother, three local elders (two of them “Hajis” and the other a pharmacist) and two representatives of the police training team.
The meeting began with my report about the patient’s injuries. I reassured his brother that the patient’s life was not in danger, but I emphasized that the long-term function of both his right foot and right hand could be affected. Mr. Rahzak’s brother asked if he could go to Kandahar to visit him, and we will try to arrange this tomorrow.
The elders spoke next. The nagging suspicion I’d had that this had not been a “righteous shoot” became much stronger. All three of the elders were emphatic: Mr. Rahzak was in no way associated with the Taliban. He was a farmer, and he had been tending his crops when he was shot. According to the elders, the police had opened fire without any provocation whatsoever.
I have to clarify something here. In looking back over the entries I have made since arriving at Ma’Sum Ghar, I see that I have not spoken much about the constant fighting that goes on outside our perimeter wire. The outposts within a few kilometres of here get attacked on a daily basis. The gunfire and explosions have become so routine that they are not even commented upon by those inside the FOB. If you stand on the hill behind the UMS and use binoculars to watch the walls of the outpost closest to us during one of these attacks, you can see the numerous puffs of dust where bullets are hitting.
The outpost closest to us, on the other side of the Arghandab River, is manned by the ANP. These men are poorly trained, poorly led and often corrupt, and they have a large number of drug addicts in their midst. To make things worse, this particular detachment of police is from a different part of the country. They are primarily Dari speakers who speak Pashto poorly.
This is a recipe for disaster. Barely competent cops spend their days cooped up in an outpost getting shot at by people they do not like and with whom they have trouble communicating. When they come out of their outpost, possibly after one of their mates has been killed or injured, they probably have blood in their eyes and dope in their veins. At that moment, they are about as far from being professional policemen as it is possible to be. It was entirely believable that they had shot Mr. Rahzak on the spur of the moment out of blind rage.
So far, so bad. But then, what I found to be the most fascinating part of the meeting began. The two Canadians with me, Leading Seaman Andy Hewlett of the Civil Military Cooperation, or CIMIC, and Constable Ferris McLean of the RCMP, engaged the Afghans in a discussion that encapsulates how we will win this war.
They began by acknowledging the strong likelihood of wrongdoing by the police and committed themselves to sitting down with the officers involved to get their side of the story. This might sound routine in the Canadian context, but it is a revolutionary concept here.
In Afghanistan, the men with the guns have always made their own rules. Anyone who could not stand up to them has had to accept their behaviour, no matter how abusive.
The idea being put forth here was radically different. This time, other men with guns, in this case Canadians, were willing to take the side of the weak and confront the police. I take it they have done this a number of times in the past, with at least some success, because the elders reacted very positively to this commitment on the part of my fellow Canadians.
Throughout the conversation, however, the Canadians emphasized that the Afghans themselves were responsible for their own future. When the elders asked that the police be transferred out and replaced with a unit of the ANA, Leading Seaman Hewlett replied that he understood that the army was much more honest and effective than the police, but there were not enough of them to man all the outposts. He then stressed that much of the responsibility for improving the situation lay with the Afghans themselves. It was n
ot enough for the elders to complain about the police. They would have to reach out to the police—their fellow Afghans—and try to build bridges between the police and the community.
Constable Ferris McLean, RCMP (left), and Leading Seaman Andy Hewlett, CIMIC
Constable McLean then went further and emphasized that it was unacceptable that the outposts were being attacked every day. Although he did not explicitly state it, he made it crystal clear that he expected the elders to exert their influence to convince at least the more moderate members of the insurgency to leave their area alone. Although they did not reply directly, it was easy to tell that the elders got his message. Constable McLean went on to offer to mediate a face-to-face meeting between the elders and the leaders of the local police, precisely to try to forge some links between the two groups.
As in every civil war, there are a range of motivations on both sides. Although there can never be any compromise with al Qaeda and the more extreme members of the Taliban, there exists within the Taliban movement a spectrum of political opinions. Many people on this spectrum can be convinced to renounce violence. This will be a necessary step in the ending of this war: isolating the truly evil people from those who have legitimate complaints against the government but who have chosen illegitimate means of seeking redress.
THE CIMIC
Most people have never heard of the CIMIC, but when you hear about Canadians soldiers doing reconstruction work, this is what you are hearing about. The civilian agencies, such as the Canadian International Development Agency (CIDA) and the Department of Foreign Affairs, do not send their personnel into an area as dangerous as the Panjwayi. So it is up to Leading Seaman Hewlett and the CIMIC team to manage the money we are putting into the reconstruction of this shattered area.
A good chunk of this money goes to pay claims against us from people we have hurt or owners of property we have damaged during our operations. We are guests here, and we pay for any damage to our rented accommodations. It can, however, be tricky to sort out legitimate claims from illegitimate ones. There is an enormous incentive to try to rip off the (by local standards) incredibly rich foreigners.
This goes on in all developing-world countries. Very often, the response of the Westerner is to become angry at the sometimes-blatant fraud without appreciating the human misery that motivates it. Try to think of how far you would go to improve the lives of your children if you were living in conditions such as these.
Leading Seaman Hewlett and the CIMIC team have a much more mature and constructive approach. Realizing when they arrived that a number of claims were suspicious, they changed the process whereby the claims were paid out. They involved the local Afghan leadership and tightened up the documentation process. By making the leaders accountable to their people, they killed two birds with one stone: the people get to see that not only those with connections get their claims processed, and the leadership must be aware of what is going on with the local people.
The claims process is a two-way street. A lot of information flows into the CIMIC during its interactions with the locals, some of it militarily very useful. When the procedure for making a claim was made more arduous, the amount of information being provided to the FOB Ma’Sum Ghar CIMIC decreased. Some CIMIC people concluded that the locals had been angered when the claims process got tougher and had decided to clam up. Then they realized that the amount of information being provided to the FOB Wilson CIMIC remained unchanged, even though it was using the same stricter claims criteria. It turns out the Taliban in the Panjwayi had targeted Afghans who interacted with the CIMIC. Taliban methods can be quite convincing, in the short term.
There is another aspect of the CIMIC’s work that is, for Leading Seaman Hewlett, far more satisfying. This involves reviewing various submissions from the local population for projects to improve their lives. To date, they have spent about three-quarters of their money on “social” programs. These include schools, health clinics and immunization programs. The rest of the money has been spent on economic development, including enhancements in the transportation infrastructure, the creation of a farmers’ market and the purchase of various pieces of machinery that the district can then lend to the farmers, among others. Programs like this give the people hope. And it is hope that keeps them away from the Taliban.
JULY 25 | HLTA
A small group of very happy soldiers left the FOB today. I thought it would be interesting to explain where they were going.
Every Canadian soldier in Afghanistan, during his or her tour of duty, goes on a three-week vacation. Any other organization would call it that: a vacation. The army, being the army, gives it a complicated name, which it then reduces to its initials.
HLTA stands for home leave travel allowance, which is the money given to the soldiers to use on their vacation. Somehow, the term for the funding morphed into the vacation itself, as in: “I am going to Thailand for my HLTA.” I pointed out to a few soldiers that this means they are going to Thailand to get money, when really they are getting money to go to Thailand, but my grammatical brilliance was not appreciated.
Organizing the HLTA generates more institutional angst than any other aspect of our mission. Joe wants to go to Disneyland with his kids during his wife’s holidays while Suzanne has to be the maid of honour at her sister’s wedding. Both events take place at the same time, and each of these people is responsible for covering the other. You can see how this would give our commanders more than a few grey hairs.
Geographically, Afghanistan is a good place to start a vacation. With a pocket of cash and almost a month off, one can reach tourist destinations that are generally hard for Canadians to visit. Many soldiers take advantage of this opportunity to visit Europe, Africa or Asia. This last option is particularly appealing to young single male soldiers and generates a predictable number of visits to the UMS for problems of a “personal” nature, most of which respond well to high doses of antibiotics.
The HLTA is wildly popular, but I can’t help but wonder about its effects on our combat effectiveness. From section to battle group, a unit’s commander and its second-in-command train for well over a year to go to war together. They get to know each other intimately. Then, during the time they most need each other, they both take almost a month off. That has always struck me as a weird way to run a war.
JULY 26 | The Home Front
General Rick Hillier once asked a group of soldiers about to deploy to Afghanistan what their most important mission was. They replied that it was to defeat the Taliban, support the Afghan government, protect civilians and other things of that nature. The general disagreed. He told them that, first and foremost, they had to support their families back home.
I have taken this admonition to heart. Although it is a point of honour that I call my daughter every day, there are very few days in which I do not find a few minutes to make a separate call to my wife. With my global satellite phone and the greatly improved Internet connections of this rotation, I am able to be much more supportive of my wife and daughter’s day-to-day activities than I was during my first tour. Claude and I discuss all family issues as much as we would if I were at home, and I participate in the “administration” of the family’s affairs. So far, I have scheduled medical appointments for both my wife and daughter, booked flights for them, organized child care, sorted out financial issues and resolved various emergencies in our extended family. I even “babysit” long-distance, keeping Michelle entertained on the phone when Claude needs several minutes of uninterrupted time.
But today is Claude’s birthday. Flowers ordered from the FOB and gifts bought before my departure notwithstanding, there is no way for me to make this day what it should be for her. Very few women (and, let’s be honest, even fewer men) would tolerate a relationship like this. But for us, it works.
And for all the uncertainty the war brings to our immediate future, we have decided to take the most life-affirming and forward-facing step possible: we will adopt a second child, thi
s one a little girl with special medical needs from Vietnam. She will be two and a half years old when we get her, which means that the effects of a prolonged stay in a developing-world orphanage will be more severe than they were for Michelle, who came into our family when she was only fifteen months old. We will have our work cut out for us.
JULY 28 | Dogs of War
The expression “dogs of war” refers to mercenaries, people who will be soldiers for whoever will pay them. I described some of them in the June 10 entry (“The Contractor”). There are a couple of guys here for whom this expression could not be more apt. Call them Luis and Alvaro.
Luis and Alvaro come from two countries in Latin America. They live at the opposite end of the FOB from me, and I was unaware of their presence here until recently. Our paths crossed while we were waiting in line for supper one day. I noticed two men wearing Canadian uniforms and speaking Spanish. I speak Spanish fluently, so I struck up a conversation with them, mostly to learn how two Latinos had ended up here.
Luis and Alvaro are the handlers of the FOB’s bomb-sniffing dogs. The CF has contracted an American company to provide these services for our combat teams. The American company hired these gentlemen, who had been police dog handlers in their respective countries. Only in this globalized, semi-privatized war could you find the Canadian Army employing a U.S. company with South American subcontractors to fight in an Asian war.