4/28

I had my first detainee patient today. 

The "fighting season" has officially begun and the intensive care unit has been slammed with roadside bomb and gunshot wound patients from both sides of the fight. The injuries are crazy; anything from extremity amputations to enucleated pupils to one guy's chest literally being opened up and attached to a wound vac. 

My patient suffered from a gunshot wound to the neck with an exit wound resulting in the loss of his left eye, and severe soft tissue damage from is left thigh down to his calf. He is young, probably in his twenties, although sometimes it is near impossible to tell. When the interpreter asked him his age, he didn't know it. The interpreter said that it was pretty common for people in this part of the world to not know their age. 

When a detainee comes through the hospital, a guard is assigned to watch over the nurse. We use mobile curtain partitions. I kept my partitions completely surrounding my patient's bed and monitors, so that he could not see the exit or other patients who are on the ward. I left a small opening in the partitions to walk in and out of my makeshift room, and positioned it so that the guard could have eyes on me at all times. At one point, some Afghan soldiers came in to visit their fallen comrades, and I completely shut off the partitions so that my patient could not see anyone.

I had heard horror stories of other detainee patients shouting, spitting at their nurses, and being downright hateful to everyone trying to help them. I also knew the rumors that everyone is addicted to heroin (this is the poppy capital of the world, after all, and heroin is probably the number one export for Afghanistan) so many patients who come to the hospital start going through withdrawals.  I heard of one guy yanking his urinary catheter out and then banging out all of his teeth on the metal bed frame.

My detainee patient, however, was neither rude nor going through opiate withdrawals. He mostly slept, waking up occasionally to ask for "ooba" (water) or saying "dard" (pain). After giving him something for his pain, his respirations and oxygen saturation began to dip down a little, a common side effect for this medication. I simply demonstrated taking deep breaths and then pointed at him, and he willingly complied. 

This was not the experience that I had prepared myself for this morning when my shift leader told me that I would have him. My patient is no different than anyone else I have cared for. In fact, I'm having a pretty decent day and can't complain about anything. I spoke to my senior leader, a Lieutenant Colonel who’s been an ICU nurse for years, about it.  This isn't his first rodeo. He basically broke it down for me like this; not every "bad guy" is on that side because they want to be. Some fall into the Taliban when they are children. Some become part of it because they have families to support. It's no secret that members of the Taliban have an easier life than others. These people are already uneducated far beyond my imagination. I mean, who doesn't know when their birthday is?

I'm not saying that the Taliban is ok by any means, but maybe I shouldn't be so quick to judge someone when I don't know their circumstances. What would I do if my situation was different? What would you do? 

But I did not have a patient who was spitting at me. My views might be a little bit different tonight if I did. 

I also got promoted to captain today. We did it right there in the ICU. Everyone broke away from their patients' beds so they could watch the promotion ceremony, which lasted about five minutes. The Lieutenant Colonel pinned my rank on. 

Later this afternoon, one of the British nurses called me over to her bed space. Her young Afghan patient, who had just lost both of his legs, was trying to tell me something in Pashtu. He pointed to my chest where my new rank was and then clasped his hands, gave me a thumbs up and smiled. He had seen the promotion ceremony, and although he didn't speak English, he understood what was going on and wanted to congratulate me. I'm not a super emotional person, but that resonated deep in my heart.

This deployment has already been worth it for me. I don't know how I'll feel after six months, but I'm thankful for the experiences I've had thus far. It's helped to break down some of my barriers and perceptions. It's been incredibly humbling, and this is still just the beginning.

Part 5 of a 13 part miniseries following the personal memoirs of a deployed soldier

Texas Army National Guardsmen honor the memory of Sgt. Tomas Garces, at a ceremony held in Weslaco, Texas, Sept. 6, 2014.  Garces  was killed in action,Sept. 6, 2004 and was the first Texas Army National Guard Soldier to die in combat since World War II. (Photo courtesy of Texas Military Forces)

Commentary by: Capt. Martha Nigrelle

Soldiers and family members of the 436th Chemical Company, Texas Army National Guard, released 1,000 balloons in honor of five of their fallen soldiers during a ceremony held at the National Guard armory in Laredo, Texas, Sept. 9, 2014. (U.S. Army National Guard photo by Staff Sgt. Amanda Torres/ Released)

4/25

It's funny how our perceptions of a situation or a group of people can be changed in a matter of hours.

Yesterday I was assigned to take care of an Afghan patient who I could barely stand to touch when assisting with a turn a few days ago. I looked at him, with his thick scraggly beard and dark skin, and only felt disgust. I knew he wasn't a part of the Taliban but I still had strong reservations. I had a difficult time seeing them as people. Of course, the fact that he was intubated, sedated, and missing both legs with several inches of femur on one side sticking out of his new stump didn't help. It can be hard to see past that and look at the patient as a person sometimes.

I was taking report from the outgoing shift when I learned that he wasn't just a local. He was part of the Afghan National Police, and had set off an IED while on patrol searching for Taliban. So maybe he's not so bad after all. Maybe he's just trying to make this country a better place for his family, just like our ancestors did years ago in this country for us. And unlike us, he hasn't had the same access to a life of privilege, education, and opportunity. 

Today when I came to work he had been extubated and off of his sedation, so it was even easier to interact with him. He didn't speak any English, and I certainly don't speak Pashtu, but we were able to communicate nonetheless. The look of gratitude in his dark eyes was unmistakable in any language. I fed him a banana and some French toast, and when he got transferred to the med-surg floor, I told him it was an honor and a pleasure to care for him. I don't know if he understood the words, but I'd like to think that he understood the meaning.

Working in this hospital is going to be a challenge. It's advanced yet primitive at the same time. For example, flies should never be buzzing around in the ICU, yet we have a staff of some of the most qualified surgeons in the nation here. The British may speak English, yet they have many different words for things and it can get confusing. Today one of the nurses needed to hang some fluids and asked me for a Gemini. I came back with the Gemini infusion pump. All she needed was the tubing. Oh well, at least we weren't in a code. A lot of the medications we use are the same but have slightly different names as well and not all of their equipment functions like ours. 

I know the day will come when I have to take care of a detainee. I'm not sure how I will feel about that, I guess just take it as it comes. I'm thankful, however, that my first experience with an Afghan patient was with this one. It helped break down some of the unfair and ignorant biases that I had and see them as people. 

Part 4 of a 13 part miniseries following the personal memoirs of a deployed soldier

Maj. Gen. James K. "Red" Brown, commander of the 36th Infantry Division, and Col. Rick Adams place the Valorous Unit Award on the "colors" of the 1-149th Attack-Reconnaissance Battalion during a ceremony held at Ellington Field. The unit was awarded this high honor for exceptional performance during Operation Iraqi Freedom. The 1-149th is an AH-64 "Apache" battalion assigned to the 36th Combat Aviation Brigade and earned the award for their 2006-2007 deployment to Iraq. (U.S. Army photo by Maj. Randall Stillinger/Released)

The 1st of the 149th Attack Reconnaissance Battalion (ARB) was recently awarded the Valorous Unit Award (VUA) for combat actions in the skies over Iraq, in support of Operation Iraqi Freedom.

Considered the unit equivalent of the Silver Star, the award was presented nearly seven years following their actions in Iraq. 

The 1-149th, along with E Troop, 1-104th Cavalry (Mississippi) and A Company, 1-135th ARB (Missouri), deployed for a year with the 36th Combat Aviation Brigade (CAB) in 2006 providing AH-64 “Apache” helicopter support as a Corps-level asset across the country. 

Citing the battalion’s significant impact on the war in the volatile Al Anbar province in western Iraq, the citation states, “the tenacity of the aircrews to engage the enemy and the constant drive of the units’ support elements enhanced the ability of coalition forces to bring the fight to the enemy, destroyed the enemy’s initiative and provided a safer and more secure existence for the people of Ar Ramadi, Iraq.”

The 1-149th’s success stems from their support of various units from across the U.S. military during the “pre-surge” and into the “surge” phases, one of the most deadly periods during the war. 

“The units performed superbly as a corps-level attack helicopter battalion, providing aerial weapons teams to the United States Army brigade combat teams, the Marine Expeditionary Force and Naval SEAL teams,” the citation states.

During combat operations, the battalion’s fleet of aircraft sustained significant damage due to the aircrew’s willingness to fly low and stay close to the fight, often drawing fire away from the ground troops they were supporting. In addition to the VUA, aviators from the 1-149th received 12 Distinguished Flying Crosses (DFC) and 39 Air Medals for Valor in the skies over Iraq. 

Two of the DFC’s were awarded after what became known as the Battle of Donkey Island on June 30th, 2007. 

During a ground attack against 20 insurgents guarding a weapons cache in Ar Ramadi, a U.S. Soldier was wounded by enemy forces. Medevac aircraft were unable to transport the critically-wounded soldier to a treatment facility. 

A 1-149th “Apache” landed on the battlefield and placed the wounded Soldier in the front seat of the aircraft. The co-pilot/gunner strapped himself to the aircraft fuselage, outside the cockpit, and the pilot flew the aircraft and wounded soldier to a medical facility.

Col. Rick Adams, commander of the Austin-based 36th CAB, served as the 1-149th’s commander during the Iraq deployment. 

Adams, of Austin, said, “I was honored and humbled to serve with such a capable team of men and women. Their endurance and tenacity saved lives while turning the tide of combat in Iraq.” 

The deployment to Iraq was Adams’ third tour, fighting with both active duty and National Guard Apache battalions. 

“I would not trade the Soldiers, skills and dedication of the 1-149th,” Adams said.

During the ceremony, the award streamer was placed on the battalion’s guidon by Col. Adams and 36th Infantry Division Commander, Maj. Gen. James K. “Red” Brown. 

The ceremony also included the official welcome home of B Company, 1-149th ARB which recently returned from a combat deployment to Tarin Kowt, Afghanistan. 

Adams, who visited B Company during their recent deployment, said he was “absolutely impressed by the graduate level of combat they had mastered. From our time in Iraq, I knew they were highly skilled and courageous warriors, but now they were doing it in extremely challenging, high-altitude environments, which requires perfect power management.” 

“I was further impressed by the fluid and seamless integration they made with the special operations teams they supported,” Adams said.

The 36th CAB returned home from a deployment to the Middle East in support of Operation Enduring Freedom just before Christmas. 

Current proposals under consideration by the Department of Defense include the option of having the 1-149th transfer their Apache helicopters to the Active Duty forces. 

The full citation awarding the Valorous Unit Award to the 1-149th ARB:

For extraordinary heroism in action against an armed enemy of the United States: During the period Aug. 22, 2006, to July 8, 2007, 1st Battalion, 149th Aviation Regiment, and the cited units, E Troop, 1-104th CAV and A Company, 1-135th ARB displayed extraordinary heroism in support of Operation Iraqi Freedom. The units performed superbly as a corps-level attack helicopter battalion, providing aerial weapons teams to the United States Army brigade combat teams, the Marine Expeditionary Force and Naval SEAL teams working in Ar Ramadi, Al Anbar Province, Iraq. The tenacity of the aircrews to engage the enemy and the constant drive of the units’ support elements enhanced the ability of coalition forces to bring the fight to the enemy, destroyed the enemy’s initiative and provided a safer and more secure existence for the people of Ar Ramadi, Iraq. The dedication of the Soldiers of the 1st Battalion, 149th Aviation Regiment and the cited units, to continuously accomplish the mission in the face of imminent danger, is in keeping with the finest traditions of military service and brings great credit upon the units, the 36th Combat Aviation Brigade, Multi-National Corps-Iraq and the United States Army.

Commentary by Laura Lopez

CAMP MABRY, Texas (August 26, 2014) – Maj. Gen. John F. Nichols, The Adjutant General of Texas  is pleased to announce Brig. Gen. Gerald “Jake” Betty will take command of the Texas State Guard on Sept. 1, 2014, upon the retirement of Maj. Gen. Manuel “Tony” Rodriguez, who has commanded since August 2012.

Governor Rick Perry made the appointment last week. As commander, Betty will be responsible for the organization, training and administration of the Texas State Guard, reporting directly to the Texas Adjutant General.

Betty joined the TXSG in January 2006, serving first as the Director of Personnel and Administration for the organization headquarters. While commander of the 8th Regiment, Betty, served on several State Active Duty missions for Hurricanes Dean, Gustav, Dolly, Edouard, and Ike. He is currently the TXSG Deputy Commanding General of the Army Component Command.

Betty was commissioned in 1973 upon graduation from Texas A&M University and holds a bachelor’s and master’s degree in education administration. He retired from the U.S. Army Reserve in 2003 and currently resides with his wife in College Station.

Betty is honored to take command from Rodriguez and is ready for the next chapter of his military career.

“I am honored and humbled to be selected for this role by our commander in chief,” said Betty. “I look forward to serving our citizens of Texas.

An official change of command ceremony will take place in October with the details forthcoming.

Commentary by Michelle McBride

Photo by Staff Sgt. Tamara Dabney

CAMP MABRY, Texas (Sept. 9, 2014) – The Adjutant General of Texas, Maj. Gen. John F. Nichols, is pleased to announce the promotion of Col. David McMinn, Texas Air National Guard Chief of Staff, to the rank of Brigadier General.

In a ceremony at Camp Mabry, in Austin, Texas, September 6, 2014, Brig. Gen. McMinn thanked the command group, his friends and family for their continued support over the years and their trust to allow him to serve his state and nation.

“It is an honor to serve with the people in this room,” he said. “Thank you very much for allowing me to continue to serve.”

Brig Gen. McMinn received his commission upon graduation from Clemson University in 1985, completed Undergraduate Pilot Training and was assigned to Pope AFB, North Carolina as a C-130E pilot in 1986. While there, he specialized in Low Altitude Parachute Extraction System Tactical Air Delivery and Adverse Weather Aerial Delivery System formation flying. 

After serving during Operation Desert Shield/Desert Storm, Brig. Gen. McMinn transferred to the Texas Air National Guard and joined the 136th Airlift Wing as an instructor pilot and later served as the 321st Expeditionary Operation Group Commander during operations Enduring and Iraqi Freedom.  

As a traditional Guardsman, Brig. Gen. McMinn has gained over 5,000 flying hours both in his role as a command pilot in the T-37, T-38, C-130E, and C-130H2 aircraft and as a First Officer for a major commercial airline.

In this image released by Joint Task Force 136 (Maneuver Enhancement Brigade), Brigade Commander Col. Lee Schnell (left) discusses observations made during the Volcano VI emergency exercise with Chilean Army Brig. Gen. Miguel Alfonso Bellet (right), commander of the 1st Brigade "Coraceros," in Arica, Chile, Aug. 20, 2014. This training event, which included a simulated earthquake and volcanic eruption, offered members of the Chilean emergency response community an opportunity to share best practices with representatives of the Texas Military Forces and the Texas Department of Public Safety. (Photo by Sgt. 1st Class Alfonso Garcia)

 Story by Sgt. 1st Class Daniel Griego

 ARICA, Chile - Natural disasters are a constant global threat, and response measures can vary wildly from nation to  nation.  The emergency preparedness communities of Chile and Texas are looking to bridge that gap in consequence  management  with long-term exchanges of best practices and training events. The most recent of which, Chile's Volcano VI  exercise,  brought together representatives of the Texas Military Forces, the Texas Department of Public Safety, the  Chilean Army,  and Chilean civilians in a robust, simulated incident in Arica, Chile. The scenario, held Aug. 18-22, featured  a simulated  earthquake and volcanic eruption that stressed the capabilities and cooperation of the Chilean Army, the  Chilean Office of  National Emergency Management, Ministry of Interior, the Carabineros de Chile (Federal Police), the  Regional Fire  Department, and many local civilian agencies.

 "It was very interesting to see how another country took on disaster preparedness and some of the things that they do that  are different from us, but are very effective," said Texas National Guard Col. Lee Schnell. As the commander of Joint Task  Force 136 (Maneuver Enhancement Brigade), the Guard unit responsible for the FEMA Region VI Homeland Response  Force mission, Col. Schnell has a vested interest in disaster response, having participated in and observed dozens of  exercises during the last four years.

 "Volcano VI took place in Arica this year," said Chilean Army Col. Edmundo Villarroel Geissbuhler, "and its purpose was to  provide the civilian authorities a training opportunity, in order to verify and update their disaster relief contingency plans. It  also allow them to check their communications flows, and interagency coordination, determining the needs of personnel,  materiel, equipment, and other resources, to successfully face an emergency or disaster caused by nature or human  influence."

 Not unlike our response plans and interagency agreements here in the United States, the disaster operations in Chile must  be tested and certified in accordance with high standards of efficiency.

"The purpose of the exercise was to validate the current emergency plans incorporated by the various participating agencies in attendance," said Sgt. 1st Class Alfonso Garcia, the International Affairs NCO for the Texas Military Forces. "The exercise players used a computer system that controlled and monitored the development of events during the disaster exercise."

The exercise primarily took place at the University of Tarapaca. Members of the Texas Military Forces and Texas Department of Public Safety were invited in order to provide feedback and share best practices from their own disaster management experience. 

"Here was an exercise and you had elected officials, their staffs, all engaged in this exercise, and that's difficult to do anywhere," said Schnell. "They really immersed themselves in the exercise. That was probably the thing that most impressed me, how everybody came to the table, it wasn't just the military and first responders."

Throughout the week, Chilean authorities met with the U.S. delegation to discuss not only the ongoing exercise, but also previous encounters with disaster response, such as this past April's magnitude 8.2 earthquake that hit Chile's coast and created a seven-foot tsunami. This background in natural incidents was instrumental in their successful validation at the university and in effectively discussing large-scale response measures. Other topics of discussion included logistical hurdles created by natural disasters and how to reach geographically isolated areas within their respective areas of responsibility. 

"During the exercise, they had the chance to interact with the Chilean representatives involved in it," said Villarroel Geissbuhler, about the Texas visitors. "They met representatives of the Chilean National Police, Army, government, Air Force, Navy, NGOs, etc., discussing with them different topics of mutual interest. At the end of the exercise, Col. Schnell also provided input during the AAR, not only from his perspective, but also from the Texas Military Forces and the U.S. Army South perspective, allowing the Chilean authorities to hear a different point of view. That will certainly be used as part of the lessons learned."

Interagency cooperation was a recurring theme for the week, as the two nations shared with each other how their militaries worked alongside civilian authorities. By inviting both civilian and military members of Texas' consequence management community, the Chilean forces were able to gain a neighboring perspective on asset allocation and the need to include all stakeholders in support of the citizens.

"While we attended the exercise in the role of observers and not evaluators," said Texas Department of Public Safety Capt. Luis Najera, "I feel it was important for the Chilean military forces and civilian authorities to understand the roles between the Texas Military Forces and the Department of Public Safety in Texas' response to emergencies. The Chilean government clearly understands the need to have all their governmental resources working together to respond to emergencies and natural disasters."

With so much on the line, the priority throughout the exercise was how best to serve the citizens of Chile in the fight to save lives. By sharing best practices through long-term partnerships like this, service members, first responders, and civil servants ensure a state of constant improvement and cooperative relationships.

"There was no doubt," said Najera, "that there was a strong commitment by both civilian and military authorities to continue to improve their country's emergency management response."

Airmen from the Texas Air National Guard observe a section of the Rio Grande River. The airmen are serving at the Texas-Mexico border in support of Operation Strong Safety. (U.S. Army photo by Maj. Randall Stillinger

By Maj. Randall Stillinger
36th Infantry Division Public Affairs

WESLACO, Texas - The Texas National Guard began taking up their observation posts along the Rio Grande River last month in an effort to reduce the amount of criminal activity in the border region.

Members of the Texas National Guard were mobilized by Governor Rick Perry to support the Texas Department of Public Safety (DPS). 

This group of soldiers and airmen were the first troops to occupy positions along the river in support of Operation Strong Safety.

Utilizing high-powered optical equipment to observe sectors along the river, the National Guard acts as a force multiplier and allows DPS to focus on their law enforcement role in the region.

One soldier, who lives in the Rio Grande Valley, said that he “volunteered for this mission to help his community.” His last mission was in support of Operation Enduring Freedom in Kandahar, Afghanistan.

The soldier, who asked not to be identified for security reasons, was one of over 2,200 that volunteered for the up to 1,000 positions on this task force. He was in the first group of service members to man observation posts along the river.

“I’m a little nervous as we get ready to go,” he said. “but we’ve been trained really well and I know that we’re ready for this mission.”

“We’re doing it for a good cause. It will definitely have an impact.”

Story by: Sgt. Adrian Shelton

Posted: September 5, 2014

LAREDO, Texas - Texas Military Forces service members provided medical services to Rio Grande Valley area residents during day one of Operation Lone Star at the Civic Center in Laredo, Texas, Aug. 4, 2014.

The annual five-day training exercise provides dual opportunities for cooperative efforts among Texas Military Forces, local civil authorities, and Department of State Health Services and access to health care for people of all ages in South Texas. 

“It is a disaster preparedness exercise in which joint federal, state and local forces, as well as different agencies with many volunteers, provide free medical services to underserved members of the community,” said Erika M. Juarez, the Department of State Health Services public information officer at the Laredo Civic Center’s Medical Point of Dispensing. “This is the one time of the year they can get these medical services.”

Operation Lone Star, now in its sixteenth year, provides free blood pressure checks, cholesterol and diabetes screenings, hearing and vision exams, sports physicals, immunizations and limited dental services. 

Due to the additional number of military personnel, “we are able to provide more immunizations than last year,” said Sgt. 1st Class David I. Soto, the non-commissioned officer in charge of approximately 58 Texas Army National Guard personnel at the Laredo Civic Center MPOD. Soto, who works as a paramedic and military leadership course instructor in San Antonio, and is in his second year of working at OLS, said that many of the service members have or are seeking medical degrees.

This year’s Operation Lone Star is being conducted in Laredo, Mission, Rio Grande City, Pharr-San Juan, and Brownsville, from Aug. 4-7, 8 a.m. to 4 p.m. and Aug. 8 from 8 a.m. to 2 p.m. 
Those who wish to receive services or want to know more information should contact their county health department or dial 2-1-1.

4/22

Today has been extremely long and cumbersome.

We have been in country for a little less than a week. It's a bit of a commute to the hospital -A little over a mile to be exact. I tell myself its like walking to work back home.

The past three weeks were spent training with our British and Danish counterparts in a hospital exercise meant to simulate the military hospital we are assigned to in Afghanistan. The days were long, and the nights were spent carousing at the local pubs. It was one of the best times of my life. I mean, when you combine pints of beer, massive amounts of fried potatoes, and cute British soldiers to flirt with, what's not to like?

While we were there, the Boston marathon bombing took place. All of a sudden, our situation, and the reason as to why we are here as soldiers, became real again. No matter how much fun we are having while training or how much everyone around us claims that things are winding down and we should have a quiet summer, the fact is we are still at conflict.

The trip to Afghanistan took almost three days. Even in the dark, I could tell that our base was a small bustling city that never sleeps; a far cry from the primitive settlements that I had experienced in Iraq ten years prior. 

We took a few days to get settled into our barracks and adjust to the time difference. Tensions have started to arise and attitudes have begun to come out. No one is on their best behavior anymore, and small things like invasion of personal space and consumption of personal time are making people cranky. Generally, I try to be laid back and keep a positive attitude, and I can usually fool people even on my worst day. 

Today, however, was our first full shift at the hospital. The ICU wasn't particularly busy, just a couple of Afghans who had been hit by IED blasts. It would normally have been an easy day but we butted heads with the UK from the moment we began our shift. We barely knew where any supplies were, which sucks when your patient extubates himself ten minutes into the first shift.  Also, it has become painfully clear that the US and UK have some very different nursing methods. It's very hard to set aside our evidence based methods of patient care and adopt someone else's protocols. Ah well, it's only the first day. Hopefully within the month tensions will subside and we will all be able to care for our patients harmoniously.

Then there's the issue of our patient population. As a nurse, or any healthcare provider for that matter, we are sworn to provide care no matter the circumstances. I never thought that would bother me until now. Our patients today were just Afghan locals, and although I gave the best care that I could, it was difficult to not have a completely biased opinion about them. What am I going to do when I have a detainee? I used to pride myself on being able to separate myself from issues such as these. A few months ago, I had a patient back in the states that had a history of incarceration for homicide and I never thought twice about it. Maybe it's the years I spent caring for the soldiers in the wounded warrior ward that makes me a little sick to my stomach now. I have seen firsthand what the Taliban is capable of.  Now I'm supposed to save them?

Part 3 of a 13 part miniseries following the personal memoirs of a soldier