A Line in the Sand

by Ray Wiss

  I bring all this up because I have only occasionally discussed our battlefield successes. By doing so, I have mirrored the Canadian media. The reticence of our news outlets to talk about those times when we wipe out a whole bunch of bad guys is astounding.

  Allow me to bring some balance into this story. We are killing a lot more of them than they are of us, and we have been extraordinarily successful recently. At our daily intelligence briefings, which I attend as one of the FOB unit commanders, we review the after-action reports of our combat units. For the past week, we have managed to kill between ten and twenty Taliban every day.

  One hit was particularly satisfying. The Taliban brought in “judges” to administer their brutal and bizarre justice in a remote area of the district. We figured out where some of these individuals were, and killed several of them with a well-executed air strike.

  This war will not be won by killing Taliban. But it can be lost if we do not hold them at bay and make it very unhealthy for them to congregate. The Canadians of Roto 7 are doing that, following in the warrior footsteps of many who have gone before us.

  Addendum, same day, 2130: It seems that the Taliban have taken umbrage at my last entry and at the satisfaction I derive from the demise of so many of their members. They have spent the last half hour attacking our perimeter. I was in the staff lounge when the first rocket hit. By the time I got outside, tracer fire could be seen going from two of our observation posts towards the rocket’s launch site. Shortly afterwards, a second rocket streaked in. It flew right to left across my field of vision. It looked like harmless fireworks until it impacted, less than a hundred metres away. A bright white flash, ten metres in diameter, suddenly appeared near the main entrance to the FOB. Even at that distance, I felt the blast wave in my chest.

  For the next half hour, the sky was lit up with tracer rounds going back and forth while flares lit up the sky.

  AUGUST 1 | The Road to Sperwan Ghar

  My orders came through this morning. “Bed” Bedard comes back tomorrow and I head for my last FOB, Sperwan Ghar, in three days’ time. To get there, I will go by road along Route Hyena. This is the main east-west thoroughfare in Panjwayi district. In 2007, this road was known as Route Foster and was the second-most-dangerous road in the world. We called it “IED Alley.” The most stressful thing I had to do on Roto 4 was to travel along this road. Things are better now. Let me explain why.

  Go back and look at the first two photographs in the June 9 entry. The top picture shows Route Hyena as it is now—paved. The top-left corner of the bottom picture shows what it was like in 2007: a dirt road. It is easy to dig in dirt, and it is easy to hide things in dirt. Those simple facts have killed a lot of Canadians.

  It has been one of our priorities to pave this road and make it a lot harder for the Taliban to hide their IEDs. The project is some months behind schedule. We could have sent in our own military engineers, and they would have had the road built in a matter of weeks. Instead, we hired a local contractor and four hundred men from nearby villages to work on this project.

  So we have a Third World company employing Third World workers. Things are not going to progress as fast as they would if we were in charge, for a number of reasons. But while these men are working for us, they have much less incentive to pick up a gun for the Taliban.

  They are also motivated to pressure the Taliban not to attack the project, and the Taliban are not immune to this pressure. The number of IEDs found on Route Foster is lower since the locals started working on it, and the number of ambushes has declined.

  In Iraq, the Americans have flat-out bribed various members of the insurgency to switch sides. A large number of these individuals have motivations quite different from those of the religious fanatics of al Qaeda. These Iraqis are not thrilled that the Americans are still in the country, but they are willing to tolerate them in exchange for financial gain. In a remarkable exchange that I saw quoted in a number of different news sources, an American officer asked one of these financially motivated fighters: “Do you still want to kill me?” The fighter smiled and answered: “Yes, but not today.”

  It strikes me that what Canada is doing here is similar to what the Americans have done in Iraq. We are doing it less blatantly and with more socially redeeming features. How Canadian!

  In this context, it is a lot easier to accept the project’s slow progress. Are the workers getting a full day’s pay for a half day’s work? Often. Is the contractor ripping us off? Certainly. If this keeps a large number of fighting-age males gainfully employed while the children of Zhari-Panjwayi go to school, is it money well spent? Absolutely.

  Making it more difficult for the Taliban to plant IEDs not only makes our life here safer, it also makes it easier for us to focus on reconstruction. Canadians hear about IEDs only when one of us dies. They do not hear about the large number of IEDs that miss us or only scratch our vehicles. But any IED blast causes major damage to the roads. This slows or halts traffic, with the inevitable economic impact that you can imagine. Because of this, a lot of our time is spent rebuilding these roads so that the Afghan people can get on with their lives. The Taliban are here to destroy. We are here to build.

  Addendum, same day: This being war, the enemy will want to have their say. So as heartwarming as the previous two pages may have been, this was also the day that we received the only casualty to come from Route Hyena since I have been at FOB Ma’Sum Ghar. A private security guard stepped on an anti-personnel mine that blew off his foot. It looks like he has also lost his right eye.

  As I had with the Afghan policeman whose head had been crushed by our armoured vehicle, I emphasized to my team the importance of not being distracted by visually impressive wounds, in this case a ruined face and a missing foot. The patient was alert, spoke in articulate sentences and had normal vital signs. His wounds were life-altering, not life-threatening.

  Nasty things, anti-personnel mines. They do not contain much explosive; their goal is not to kill, but to maim. Wounding a man removes five soldiers from the battlefield: the casualty and the four men needed to carry him off. The wounded man then needs medical care and rehabilitation. Dead men do not need care, and their evacuation can be delayed. These mines are as much an economic weapon as a military one.

  Lucky to be alive (Photo courtesy Master Corporal Julien Ricard)

  Addendum, same day, early evening: I mentioned earlier that there are many things I love about being an emergency physician. There are only a few things I dislike. At the top of this short list I would put the fact that we rarely learn what has happened to the patients whose lives we have saved.

  It was therefore a particular treat for me to be able to see in follow-up, for the first time on either of my tours, a critically injured patient who had passed through my UMS. The Afghan policeman whose head had been crushed by one of our armoured vehicles on July 23 came to the UMS after supper to have his sutures removed. His numerous facial and skull fractures had been expertly repaired by our maxillofacial surgeon at KAF. As for the eye that was hanging out of its socket, it was not blind! He was counting fingers at one metre already, and there is a good chance that his vision will continue to improve.

  He said he remembered me and was grateful for the care I had provided. Emergency physicians almost never get to hear this from the semi-conscious patients for whom we do the most.

  It was an ideal way to begin to wind up my stay here at FOB Ma’Sum Ghar.

  AUGUST 2, MORNING | None of Your Business

  We take patient confidentiality very seriously in modern Canadian medicine. When my father was hospitalized three years ago, the nurses in the intensive care unit (ICU) of my own hospital would not let me look at his chart. Like everybody else, I had to go through the treating physician or talk to my father. For some reason, the media have difficulty accepting that the same standards apply to wounded Canadian soldiers.

  We lost two more men yesterday. They were combat engineers based at FOB Wilson. Like Corp
oral Martin Dubé (see June 14 entry), Corporal Christian Bobbitt and Sapper Mathieu Allard were killed when an IED they were defusing exploded. They never knew what hit them.

  In the small world of the combat engineers these losses will be devastating: there are fewer than a hundred of them in the theatre of operations. The losses of this branch of the service exceed all others in proportional terms

  I had met both of them at FOB Wilson. They were both TCCCs who had helped out with some of the casualties we treated in June. They impressed me as calm and competent individuals, even though they seemed impossibly young. We were never more than acquaintances. Partly, I regret that very much. Partly, I am relieved—the pain of their passing would have been much worse.

  We also had one serious but non-fatal casualty yesterday, someone I did know well. We had seen each other daily, and I enjoyed his company.

  The CF will not reveal anything about this man’s injuries. I have read articles in which reporters have been critical of the CF because of this. Various media have intimated that the CF is attempting to cover up the number and severity of wounds suffered by our soldiers.

  The CF has never defended itself against these accusations, so I will explain its stance here. Imagine for a moment that you were here with me. Now imagine that you have suffered a devastating, life-changing wound. When you woke up this morning, you were a young, healthy adult—your body did exactly what you wanted it to. In an instant, that has been taken away forever. Would you want to have your name and a description of your injuries on the front page of The Globe and Mail? Our wounded are free to participate in whatever interviews they want. It is normal that they do so only after they have had time to adjust and begin to cope with their injuries.

  So I grieve for our fallen and I shudder at the thought of the pain my friend felt when he was injured, is now feeling during his multiple surgeries and will feel through his rehabilitation. I have sent him a single e-mail, telling him my thoughts are with him and letting him know that he can count on me for any assistance he might need.

  Now I wait for him to answer. And if I can wait to find out how he is doing, so can the rest of the country.

  Addendum, August 14: The funeral service for Corporal Bobbitt took place in Quebec City the day Warrant Officer Comeau was to leave Canada. He had been back in Canada on leave when Corporal Bobbitt died. Warrant Officer Comeau requested that his leave be extended by a single day so that he could honour his fallen comrade, a man who had fought by his side for several months. He was turned down.

  That struck me and many others as completely heartless, until I learned that the engineer commander had decided that the survivors of the engineer troop* needed Warrant Comeau’s leadership and compassion as soon as possible. Seen from that perspective, I agree it was the right call.

  AUGUST 2, AFTERNOON | “Bed” Returns

  The sun was setting when one last chopper landed. A few minutes later, my old friend Martin “Bed” Bedard came crashing into the UMS. Our reunion was joyful, but before we could have a proper sit-down to talk about his vacation an Afghan civilian came in with shrapnel wounds to his legs. Not wasting a minute (and showing much less effect from the jet lag than I had) Bed assumed care for the patient. He was pleased to be able to show me how proficient he had become with the ultrasound machine. Given his obvious aptitude for using ultrasound, I had given him additional tips and training by phone and e-mail from FOB Wilson, and during our time together when I came to take over at Ma’Sum Ghar. One of the techniques I had taught him involved using the machine to detect shrapnel fragments buried in the patient’s flesh. He used this to good effect here, locating and retrieving four shrapnel fragments. With ultrasound proving that there were no other injuries, the patient was discharged from the FOB, saving a helicopter evacuation.

  “Cut deeper!” (Photo courtesy Master Corporal Julien Ricard)

  After that, we got another chance to use ultrasound in an innovative manner. An Afghan soldier came in with what appeared to be a skin infection in his armpit. Ultrasound examination showed that there was a pocket of pus beneath the skin, but it was so deep that it could not be detected by palpation (touching the patient). On ultrasound, however, it showed up as a large black space beside the ribs.

  When pockets of pus like this are present, the infection can never be cured with antibiotics alone. You have to cut into the patient and let the pus out, an operation called an “incision and drainage.” Bed had done a number of these, but none of them had ever required him to cut as far as I was telling him to. Just when Bed thought he was going to pierce the patient’s lung, we hit our target and a huge river of pus came streaming out. It was disgusting and satisfying, like so many things in medicine.

  Bed handled himself like a pro through this. The Ma’Sum Ghar UMS will be in very good hands when I leave.

  Addendum—Two Steps Forward, One Step Back: The paving project on Route Hyena I spoke of yesterday has been put on hold indefinitely. There are many reasons for this, the main ones being the ongoing Taliban threat, arguments with the contractor about money and the fact that the focus of our reconstruction efforts is shifting closer to Kanda-har City. Very disappointing. But if you can’t handle disappointment, best not to go to war in Afghanistan (or anywhere else).

  AUGUST 3, MORNING | The Panjwayi Comprehensive Health Centre

  I formally handed command of the UMS back to Petty Officer “Bed” Bedard yesterday, so today was a day off. As when Captain Lafortune had replaced me at FOB Wilson, I no longer had any direct responsibilities other than to be available in case of a MasCal event. I therefore used some of my free time to help the CIMIC people with a project that is near and dear to their hearts and in which I was happy to become involved: local health care.

  The FOB UMS cannot deal with all the health care needs of the local population. The only exceptions to this are injuries caused by the war or those that present an immediate threat to life, limb or eyesight. Our primary mission is to support our warriors, and we must always be ready for a massive influx of casualties. As well, we must not undercut the nascent Afghan health care system.

  This means that the villagers around FOB Ma’Sum Ghar will go to the local clinic when they are ill or injured. But the conditions in Zhari district are reproduced here in the Panjwayi: all the other clinics in the district have closed due to security threats. As in Zhari, only the one that lies within range of the machine guns of our FOB observation posts has remained open.

  The CIMIC people wanted to know what the clinic’s capabilities were and if there was any way we could help them, but they had not had any contact with the clinic staff. I agreed to try to help them in this regard. My first opportunity to do so came a few days ago. One of the Canadian officers mentoring the ANP had to have a brief meeting with the police chief. Out of courtesy, our officer offered to walk over to the police station, a few hundred metres from our FOB’s outer walls. Since the clinic is built right beside the police station, I asked the mentor officer if I could come along: I could visit the clinic, then he could go next door and meet the police chief. We called ahead, and the director of the clinic said he would be happy to meet me.

  That sounds innocent, does it not? A doctor dropping in on a colleague to have a look at his facility. Whenever I am in a foreign city, I try to visit one or more emergency departments. There is always something to be learned during such a visit. It is also a wonderfully human experience to make such a link with another person: no matter how different our respective societies, our practice of the healing arts provides an instant connection.

  But while the doctor-to-doctor exchange was quickly agreed upon, putting the two of us in the same room was a major undertaking. Even in broad daylight, the risk of a Taliban attack on Canadian soldiers (or indeed on the police station itself) was so high that it was impossible Combat patrol, well spaced for the mentoring officer and me to simply amble over. The FOB had to put together an escort of several soldiers to take this short walk with us. />
  Combat patrol, well spaced

  Like true professionals, the escorting soldiers left nothing to chance. They treated this like any other patrol: a map was drawn on a whiteboard showing the route we would take; the route was analyzed to estimate where ambushes were most likely to take place; an “order of march” was developed that assigned specific places in the column to each member; timings were worked out and agreed on; the evacuation plan we would use if anyone got wounded was discussed. We also came up with a plan to return me at high speed to the UMS in case the FOB received word that casualties were arriving while I was away.

  The same professionalism was on display when we moved out. With only a few hand motions and fewer words, the group started down the road. The correct interval was maintained between all the patrol members: close enough so that we could concentrate our gunfire against any enemy, far enough apart that an explosion would not kill more than one of us. Approaching civilians were waved off to a safe area and, when necessary, were searched in a thorough yet respectful manner. Weapons covered each soldier’s “arc of responsibility” so that there were always eyes on a 360-degree circle around the patrol.

  “The Panjwai Comprehensive Health Center” (the sign at top left announces “No Weapons,” in Pashto and English)

  When we got to the clinic, the patrol stopped to provide security outside the building while their medic, none other than my good friend “Junior,” came inside to act as my bodyguard.

  I was able to meet both of the doctors working at the clinic. The older one is the director of the clinic. He has been practising for thirty years, the last ten here in Bazaar-e-Panjwayi. The younger one is in his second month of practice. I also met the pharmacist and the laboratory technician. We had a very interesting discussion about the general state of the clinic, the prevalence of various diseases and their approach to various clinical scenarios.