46 AJN ▼ December 2010 ▼ Vol. 110, No. 12 ajnonline.com Editor’s note: AJN asked army nurse Christopher A. Vanfosson to file periodic reports on his and his team’s work in Afghanistan. In the coming months, he’ll keep readers up to date on their ex- periences and how it feels to provide care on a battlefield. The Road to the Front The forward surgical team arrives in Afghanistan. W e are in Pul-e-Khumri, a small industrial city in the Baghlan Prov- ince of northern Afghanistan. The Hungarian Provincial Recon- struction Team has a base here, housing soldiers from Hungary, Germany, Montenegro, and Cro- atia, and civilian contractors from Great Britain, South Africa, India, Pakistan, the Philippines, and Af- ghanistan. For the next year this will be my home, as well as that of several other members of the U.S. Army’s 541st Forward Sur- gical Team (Airborne). The team includes trauma specialists and surgeons trained to work directly on the battlefield, as close to the point of injury as is practical and safe; but in Pul-e-Khumri our role will be different. Here we’ll es- tablish a new surgical capability where previously medical support was provided by military combat medics assigned to various inter- national armies. Until our arrival, patients needing surgery were sent to a hospital more than 50 miles away. In a combat zone, this can mean hours of travel. We’re settling in, but the road here hasn’t been an easy one. A change of plans. Our for- ward surgical team comprises 20 surgeons, nurses, and medics and is based on the east coast of the United States. The team was orig- inally scheduled to be split in half during our yearlong deployment, with both groups heading south: ours to the Zabul Province and the other to the Paktika Province. But when we arrived at Bagram Air Base, north of Afghanistan’s capital city of Kabul, we learned that our half of the team would instead go north to Pul-e-Khumri. Our change in mission, how- ever, wasn’t effective immedi- ately. We’d need a few weeks to organize and move equipment and supplies. My commander, a general surgeon, pulled me aside and asked if I’d be willing to travel to the northern and eastern re- gions of Afghanistan, making contacts and gathering informa- tion and supplies in preparation for the move. A RECONNAISSANCE MISSION At the time, little was known about northern Afghanistan, ex- cept that there wasn’t much of a medical presence there. The re- gion was largely under the control of North Atlantic Treaty Organ- ization (NATO) forces, with few American troops nearby. I was asked to determine the best place to set up a base for our forward surgical team, how our supplies could be moved around the region, what type of communications ca- pabilities would be available to us, and how patients could be evacuated to area medical facil- ities. I was to report back to senior army medical leaders—physicians, nurses, and administrators who are part of the 30th Medical Bri- gade, based in Germany, which controls all medical units in Afghanistan. The information I gathered would help them to bet- ter define our mission and make long-term plans for medical capa- bilities in the region. I’d been a middle-level nursing leader in the army before—in my previous position as a nurse manager—but I’d never had this type of responsibility in a com- bat zone. I found this recon mis- sion to be a little overwhelming at first, but as I began to better understand the task, I became more confident in both my abil- ity to coordinate the team’s move and our collective ability to exe- cute the mission. At NATO bases near Mazar- e-Sharif and Pul-e-Khumri, I met with various troops to discuss the needs of my team. Then I flew to another base in eastern Afghani- stan before heading back to Bag- ram. Along the way, I acquired bandages, fluids, surgical instru- ments, and medications. I also ob- tained communications equipment, such as computers, radios, and cell and satellite phones. Additionally, I sought assistance in moving the equipment and people on my team to Pul-e-Khumri. Because we’d be es tablishing a fixed surgi cal capabil- ity, we needed a great deal of equip- ment, some of which required special methods of transport. Language barriers and equip- ment and technology incompat- ibilities between the various NATO troops made my task challenging. Most NATO forces, I discovered, didn’t know what a