War on Terrorism

Monday, August 16, 2010

Physician Mentors Afghan Doctors

By Army Sgt. Spencer Case
304th Public Affairs Detachment

Aug. 16, 2010 - Air Force Maj. (Dr.) Robert Sarlay Jr. has become fond of a quote by T.E. Lawrence: "Better the Arab do it tolerably than you do it perfectly." Not that he considers himself a modern-day Lawrence of Arabia.

Ordinarily, Sarlay -- a Dallas native who now resides in Dayton, Ohio -- is a man of less exotic tastes. When he's not practicing emergency medicine at Wright-Patterson Air Force Base, Sarlay spends time with his wife, Betsey, and 3-year-old daughter, Carina, and plays catch with Raven, a German shepherd that fetches logs rather than sticks, he said.

Since his arrival to Forward Operating Base Lightning in June, Sarlay has worked as a mentor for his Afghan army counterparts at the Paktia Regional Medical Hospital. As a member for the medical embedded training team at the base, he describes his current job as equal parts administration and diplomacy.

In a nutshell, Sarlay's job is to help his Afghan counterparts overcome bad habits that either are culturally ingrained or have accumulated after more than 30 years of war.

Sarlay, who is used to working 16-hour days that the uninitiated would find grueling, said his current assignment is much more taxing mentally and emotionally than any other assignment he's ever done.

"It's easy for me to do patient care, because I'm well-trained and well-versed," he said. "It's much more difficult to develop processes for the [Afghan army]."

Sarlay completed medical school through the military's Health Profession Scholarship Program at the University of Texas at Houston. After his internship at Houston, he received his first job as a doctor with the 7th Bomb Wing's 9th Bombardment Squadron at Dyess Air Force Base, Texas, in 2000. After five years as a flight surgeon, he was transferred to Wright-Patterson, where he worked in emergency care.

Sarlay said his formal duties as a mentor for Afghan army medical personnel are only the tip of the iceberg. Most of his work is done on the informal side, he explained, where he expends effort trying gently and diplomatically to coax his counterparts into adopting standards that doctors in the United States take for granted.

"It's a lot of sitting and drinking [tea] and talking about why it's good to have standards," he said.

Standards include things such as keeping proper records for patients. As Afghanistan's political situation decayed, he said, so did Afghan doctors' record-keeping habits.

"I'll ask them, 'What if you go to Kabul and don't come back? Will [the other doctors in the hospital] know what was done with this treatment?'" he said. "They'll say, 'Because we all talk together in the morning.' And I'll say, 'But what if one morning you don't?'"

In the course of his planning and administrative work, Sarlay occasionally has the opportunity to practice hands-on medicine. A few weeks ago, the hospital received an Afghan border policeman who had to be treated for bruising of the lungs caused by being near a high-explosives detonation. With Sarlay's help, the hospital staff learned how to manage ventilated patients.

"They're slowly, progressively improving," Sarlay said of his Afghan counterparts. "When you're here for six months, you don't necessarily see it, but when you talk to people who have been here two or three years ago, you do."

One person who has seen it is Air Force Lt. Col. Bernard L. Vanpelt, a pharmacy mentor with the embedded medical team, who has been at Forward Operating Base Lightning since March.

"We've seen progress with providers becoming more proactive with regard to trauma issues," said Vanpelt, who hails from St. Louis and is stationed at Moody Air Force Base, Ga. He noted the addition of an intensive care unit since his arrival as one such improvement.

Vanpelt added that Sarlay's efforts are helping the Afghan practitioners improve.

"By his being in that leadership room with the doctors, he'll have an impact -- indirectly, mind you -- on how the doctors understand and adhere to the newly established standards," he said.

Sarlay said he looks forward to returning home to Dayton in about six months, where he will resume his practice of emergency medicine. He also hopes to be selected for the residency in a two- to three-year aerospace medicine program that would allow him to be board certified to evaluate the health of pilots, among other things.

Meanwhile, he said, he's making the most of his current assignment. "It's unlike any other assignment I've ever had and probably ever will have," he said.

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