Greetings again from Kabul! Our advising mission of the Afghan National Army (ANA) and Afghan National Police (ANP) continues to progress steadily. Every day has new challenges and opportunities to excel. It can be long, tedious, and even frustrating work; but the investment of your work here makes small, incremental progress in building sustainable ANSF health care capability and capacity that will pay huge benefits over time in a stable government for the Afghan people.
As I have settled in, I have become more aware how subtle differences in how an approach to a situation can mean the difference between small but satisfying successes or crushing, frustrating failures. In my introductory message to you in March, I gave several “tips for success.” Here are a few more borne of my experiences in Afghanistan:
- Use “nice persistence.” This is the follow-up corollary to “Play well with others.” In other words, do not bludgeon someone the first time if they do not get you what you want on your timeline unless it really matters. Appreciate everyone’s honest hard work.
- If at first you don’t succeed…change your approach. This is slightly different from what we heard as children: “…try, try again.” One definition of insanity is doing the same thing over and over again expecting to get a different result. If your first attempt to get a mentee to do what you think needs to be done does not work, try a different approach, seeking to understand and address their underlying motivations and concerns.
- Check facts rather than succumbing to rumor and innuendo. Definitely do not participate in negative speculation about a mentee’s motives. Ask yourself, “Is this illegal, immoral, truly unjust…or just different?” If your mentee’s thoughts and actions are just different from your own, that is what you will need to work with.
- Understand limitations of systems (Afghan and Coalition) and personalities. Just because your counterpart says that they agree with your ideas does not mean that your mentee will be able to implement your ideas. If possible, help your mentee figure out how they can change their system in their way for improvement of their system.
Speaking of improving systems, there is a maxim which says “That which is measured improves.” CJ-Surgeon staff is developing metrics and measures of effectiveness which we hope will guide us in our efforts to fulfill the ANA and ANP Surgeons General’s mission, vision, and goals. Our five goals address high quality healthcare systems, efficient use of resources, access to high quality healthcare, healthcare training, and expansion of healthcare services provided. These five goals are in prioritized order of ANA and ANP medical leadership. We will start small and simple in our metrics collection, analysis, reporting, and actions. First, to develop metrics proficiency among advisors and partners. alike, we are comparing hospital staffing patterns to bed occupancy rates. We are already using this information to advise and assist the ANA Surgeon General to move new and experienced MEDCOM staff to the regional hospitals where they are so clearly needed. In the future, we will add metrics like antibiotic usage rates in primary settings to improve clinical practice patterns. Ultimately, we will use these metrics to improve ANSF healthcare systems as they promote the security and safety of Afghanistan.
As we enter the next rotation cycle of NTM-A/CSTC-A advisors, let me say welcome to all our new medical advisors and bid a fond adieu to those of you who have completed their tour of service. Your efforts, challenging as they undoubtedly have been, are collectively deeply appreciated by the people of Afghanistan. Thank you as you continue your service to the United States back at home station.
