Group Develops Afghan Forces' Health System

By Christen N. McCluney
Emerging Media, Defense Media Activity

June 24, 2010 - A medical advisory group is working to develop health care capabilities and create medical and health care training programs for Afghanistan's security forces.

"We have a large mission to develop the Afghan national security forces health care system," Air Force Col. (Dr.) Schuyler K. Geller, NATO Training Mission Afghanistan command surgeon and commander of the Medical Training Advisory Group at Camp Eggers, Afghanistan, said during a "DoD Live" bloggers roundtable yesterday.

Geller said the group's mission is to get the health care system running to a completely self-sustainable level, for both the army and police, in all operations.

The group has about 155 medical mentors placed in the offices of the surgeons general for Afghanistan's national police and army around the country, as well in the national military hospital in the Afghan capital of Kabul, regional hospitals and the police hospital.

Geller said the group is facing many obstacles in developing the health care system, but the most-pressing issue is a lack of physicians to fill vacancies at the facilities. "They are 37 to 39 percent filled," he said.

A lack of recruitment for Afghan military doctors and the duration of medical school in Afghanistan contribute to the physician shortage in the country's security forces, Geller said. The process, he said, takes seven years from the time of high school graduation to the completion of a medical program.

"The universities probably produce over 100 physicians every year, but a very small portion of those join the army or police at the present time," he said.

The group hopes to attract more doctors to the program, because there are more physicians in Afghanistan than there are jobs available for them. Geller said one of his main priorities is to aggressively attract unemployed physicians to the security forces medical system. The team also has a deficit in allied health support, and has developed branch schools with an Army-based curriculum to help in creating more positions for nurses. The school graduated 20 licensed practical nurses from the program last year and doubled the number of graduates this year.

"We expect to meet all of our nursing deficit through training within the next two, to two-and-a-half years," Geller said.

The group also is starting a physician's assistant program in the fall, with at least 80 students enrolled. This program will help with the deficit in military doctors throughout the system, especially in battalions where the coalition is providing health care until the Afghan forces' health care system can stand on its own.

Geller also said the group is training women to work in the health system. Since Afghan forces have no female combat medics because of cultural customs, the majority of women serve as nurses in pediatrics and obstetrics departments.

"We are training women in skills that they can exercise in their home community so that they can live at home and go to work," Geller explained.

When asked about the medical technology in Afghanistan, Geller acknowledged that it could be better, but said the Afghans have surgical capability and adequate technology.

"What is really needed is very simple preventive medicine and treatment and treatment of infectious disease," he said. "That kind of thing has the biggest impact."

Many areas of the Afghan forces' health system are becoming self-sufficient and will be turned over to the Afghans, Geller said. The school for combat medics has been in place for close to three years, he said, and is almost ready to be transitioned entirely to the Afghans to run on their own.

But before the system can completely be turned over to the Afghan security forces, he added, quantity and quality issues must be solved. When the group has enough physicians in place, he said, then, a select group can go through improved graduate-level medical programs and receive more hands-on clinical training.

"I believe that within the next four or five years, both the quantity and quality problem here will be significantly resolved," he said. "Our specific area in developing the Afghan national security forces health care system is a value."