It’s been a traumatic start to the day for Major Johnston, the medic in charge of Forward Operating Base (FOB) Shawqat’s hospital. Literally.
At dawn she was called from her bunk in the hospital’s welfare area to attend to an Afghan policeman who had just done his best to split his skull open by falling from the back of a speeding police pick-up truck.
It’s serious, but the soldier is lucky that treatment is so close to hand.
Trauma is something the Major doesn’t see so much of these days:
We’ve had a couple of road traffic accidents. Two weeks ago I treated an Afghan policeman who had a gunshot wound, and before that an Afghan soldier who’d fallen off a sangar,” she said.
This is the Major’s second tour. Her last, two years ago, was dramatically different:
HERRICK 10 was very challenging, with multiple trauma incidents. When I finished that tour I was a little despondent. I found myself wondering if the sacrifices I’d seen were paying off. Would things turn out for the better? I was unsure about how I’d feel about coming back.
But having returned, Major Johnston has seen in very real terms how different things are. For the first half of her tour, at any rate, her role has been similar to that of any GP.
As the regimental medical officer for the Royal Scots Dragoon Guards, the mentors for the Afghan National Army based at FOB Shawqat, Major Johnston looks after around 350 people, including the battle group’s super-fit Royal Marines of 45 Commando, and those transiting through; like the unfortunate cameraman from BBC Scotland, stricken almost straight away with diarrhoea and vomiting (D&V), condemning him to three days in the isolation tent:
So far it has been such a contrast to my last tour. Mostly it’s been about providing primary care for things like coughs and colds, skin complaints and a lot of muscular skeletal injuries - the Marines like their physical training, they push themselves hard.
Beyond the turned ankles and skinned shins that come as part of life for hard-grafting Bootnecks, Major Johnston will keep an eye on how these military athletes fair over the tour:
You tend to find that as you get to the end of a deployment, the number of cases of illnesses like D&V increase, as the months of hard work can affect individuals’ resistance. It will be interesting to see if the exceptional physical fitness of the Marines helps their immune systems to cope better than other troops.
Major Johnston’s job also has a pastoral role these days, which is partly why she beds down in the office; not just to be on hand for patients, but to provide emotional support when it’s needed:
It’s quite a small base for so many people, so I find that the guys sometimes come in here just for a chat and to get away from the pressure cooker of FOB life for a while.
Much of the Major’s work is advisory, how to avoid fungal complaints in a hot sweaty environment, and the benefits of wearing long trousers when relaxing and the mosquitoes are biting:
It’s been very different and very exciting,” she said.
Avoiding fungal complaints, exciting?
Well not that so much, but the change in tempo has meant that the Major has been able to spend more time getting out to the villages to work with the locals, identifying local health professionals (there are currently two qualified midwives and two who are qualified to give vaccinations in the district), looking at health issues and giving locals simple advice:
I especially enjoy engaging with the women. But the level of ignorance in some of the rural areas is a concern. Two days ago I was asking some women how they would deal with a cut. They said they would rub soil into it. Given the amount of faecal material around, that’s not a good idea.
At district level there are examples of good health management, but because of the security threat, until now, communities have not been able to move around and pass on knowledge:
The women are clearly pleased about the security that the Afghan Police are maintaining, and grateful that it means they can access education.
Finding a way to pass on tips for simple medical treatments throughout the community is important. At the moment there are four government clinics in Nad ‘Ali which are providing this information.
Currently people tend to go to the doctor with anything, partly because they now can, and partly because they don’t know how to cure simple complaints.
The Provincial Reconstruction Teams are developing a training programme on the health issues of childbirth, and basic medical health education is being introduced in the schools:
Infant mortality and death in childbirth is a serious problem, as are preventable diseases caused by malnutrition. At shuras I have attended, the elders are clearly worried about the health of their women and children,” said Major Johnston.
This is a long process, but at least we have got the ball rolling.
This article is taken from the August 2011 edition of Defence Focus - the magazine for everyone in Defence.