It has been almost a year since I took the position of CSTC-A Command Surgeon. In the past year, we have seen tremendous change and impact of our efforts. CSTC-A is now NATO Training Mission – Afghanistan/Combined Security Transition Command – Afghanistan (NTM-A/CSTC-A). The following vignette is adapted from a story by Dr Gary Davis, who was sitting in my “seat” as then-Combined Forces Afghanistan Command Surgeon a few years ago. It has tremendous applicability to our medical advisory mission here in Afghanistan.
A man fell into a river and was obviously struggling to stay afloat. Another man came upon him and tried to offer his assistance. “Give me your hand!” the first man said to the drowning man. No response. The drowning man continued to struggle even though he was less than an arm’s length away from his rescuer on shore. A local leader came upon the scene and instantly recognized the issue. “Take his hand!” said the local leader. The drowning man was immediately rescued. The next day, the same man fell in the river again. This time there was no one to rescue him.
What is the lesson for us advisors? If you read my last blog a few days ago, you might recognize the following “tip for success”.
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 [counterpart] 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.
I can tell you that I have changed my approach in advising the ANA and ANP Surgeons General over the past year. Soon after I arrived, I recognized that it is easy to give the Afghans “stuff”. That is why previous teams have done a wonderful job of developing physical infrastructure for the ANA and ANP. It is much harder, though, to get someone to change their behavior especially when it requires effort on the individual’s part. The change in approach has been one, honestly, of tough love. What the Afghans have the ability to do for themselves, we need to require that they do themselves. It is not comfortable to watch someone fail in an activity, especially if they are a family member, someone you love. If the Afghans are capable of acquiring and distributing specific pharmaceuticals using their funds and processes, then we need to have them do that. We as advisors must resist the temptation to rescue the Afghans at every turn. In not rescuing them, we teach them confidence in their processes and that they must make them work. If they do not like their processes, it is up to them to change them. We cannot do that for them. We can develop and even model different processes for them, but in the end the processes must be Afghan processes. The Afghans must own them. They must embrace them. They must use them…. or they will drown
