NATO Training Mission - Afghanistan

     Brigadier General Qhandahr Shinwari, ANP Surgeon General, and his staff continue to objectively demonstrate that the advice and services of ANP medical mentors are becoming less important. They have shown they can independently operate their medical facilities, plan for new services, design and execute emergency response plans, develop staff projections, establish drug testing programs, recruit personnel and more. To add to their success, action is now underway to allow them to have more control over their finances.

     The past few times I met with Brigadier General Qhandahr Shinwari, Afghanistan National Police

(ANP) Surgeon General, at least one physician arrived and asked to join the ANP. At last count, 

there were 40 doctors who were awaiting approval to wear the ANP uniform. Standing in their way

was a requirement by the Ministry of Interior (MOI) Personnel Department for new officers to undergo

six weeks of police training. While acknowledging that training is important General Qhandahr,

believed that the urgency to provide medical services to Afghanistan National Security Forces

(ANSF) and their families should take precedence. His persuasive argument was heard.

     I have met many Afghan generals during my 10 months in Afghanistan. Among them, Brigadier General Qhandahr Shinwary, Afghanistan National Police (ANP) Surgeon General, stands out.

     Often we hear of Afghan successes; however, upon examining some of them in detail, we discover that either a military or civilian advisor was the primary force. That has not been the case with General Qhandahr.  His considerable independence has been the result of frank dialogue and high expectations. Early in our relationship, it appeared there was an assumption that ANP Medical Embedded Training Team (ETT) members would solve most ANP problems. (Perhaps precedent had been established.) For one difficult, high-visibility and time-sensitive issue, he said it would be okay because “…the mentors would take care of it.” My reply was that it would not support him and his team if we took independent action. That it would be best if we assisted the person he appointed as the project officer. He then identified someone to oversee the matter, which was resolved to everyone’s satisfaction. General Qhandahr’s actions were notable.

     When I arrived in July 2009, there were many activities happening with the Afghanistan National Police (ANP) medical mentoring mission. That was no surprise given the dimensions of the tasking; however, some actions quickly caught my eye due to their significant impact on ANP team workload. I’ll describe three of them.

     Perhaps the first one that made me pause was the amount of time that was devoted to managing ANP medical logistics. Supply convoys and airlift were regularly arranged by team members. When I asked why we had taken on such a major responsibility that was keeping us from our primary purpose-advising-the reply was that the Afghans were not dependable. I asked if they had been trained and knew what had to be done. I was told they had been schooled and were aware of the steps needed to move supplies around the country. When I pressed that we needed to permit the ANP medical logistics staff to handle their duties, the response was that if we did not do it, then ANP would die. What I can say is that after direct attention and discussions, the Afghans are now taking care of their medical supply shipments and their countrymen. The transition occurred in late August 2009. Since then, the fear of increased ANP mortality resulting from Afghans managing their own system has not been realized.

       For medical advisors, we have all heard that our actions must lead toward a medical enterprise that the Afghans can independently sustain. This is particularly important if we want to ensure that the investments we have made will benefit them far into the future. Both collective and individual actions can help make this so. Our physical and mental energies must be deployed at every turn. Determined and focused measures toward Afghan medical sustainability are required now.

     Many of us have visited an Afghan medical facility and seen equipment and supplies costing tens of thousands of dollars—even millions—that will never be used because there was a never really a need or because the Afghans were not ready to receive them. These are good for photo opportunities, PowerPoint presentations, award packages and evaluations but do not aid the Afghans. Most of us want to assist the people of Afghanistan, but is there true value in purchasing neurosurgical equipment if there is no qualified neurosurgeon to use it? Should a $200K dental suite be installed when basic dental chairs and instruments—that the Afghans can take care of on their own—will do the job? The dental suite, by the way, will require consistent electrical power, which is lacking across Afghanistan.

Afghan National Army Air Corps Graduates First Flight Surgeon Class                 A couple weeks ago, the Afghan National Army (ANA) Medical Command graduated its first class of medical logisticians.  To mark that monumental day, Mike Brown, the course director, said, “It is a great day to be a Soldier.”  Two days ago, it was the ANA [...]
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