|Photo by Lt. Kate Hamilton|
When Rob Hazzard, a General Electric (GE) x-ray field engineer from Clearwater, Fla, had to help unload and move the newly arrived equipment at Bagram Air Base in Afghanistan, the challenge he and his colleagues faced reminded him of a different set of working conditions: “Sometimes, it kind of felt like the Egyptians building the pyramids.”
But when Hazzard says it, you can hear the easygoing good humor of someone who has been through scores of tough situations. He was merely recounting another problem solved that gave him experience to be applied next time. As it was, this assignment was considered a plum. Why else would nearly 80 volunteers step forward for combat zone work when GE had made it clear there were only four slots to fill?
Four to Go
Hazzard became one of a group of four GE employees who left for Bagram Air Base near the beginning of October 2006 to install a LightSpeed 16 CT scanner, Precision P500D radiography/fluoroscopic system, and an AMX 4+ portable x-ray unit at the new US combat support hospital. They were scheduled to return either at the end of that month or just before Thanksgiving, depending on the specific services needed.
In addition to Hazzard, the GE group included CT field engineer Dave Glanville of Albany, NY; x-ray field engineer Larry Cousar of Springdale, Ariz; and CT field engineer Roy Bailey of Syracuse, NY. All had previous military experience. Bailey, originally from England, had served in Her Majesty’s Armed Forces.
After some basic screening, extra inoculations, and equipment planning, the volunteers set off 2 weeks after the initial call for volunteers.
Hazzard’s thoughts of pyramids came early on. That’s when they were initially required to unload their equipment on-site. “We found out exactly how hard it was to move an item weighing a couple of thousand pounds without the proper dollies,” he says.
How did they move it? “We did it with lots of guys, lots of muscle, forklifts, shoring it up with wood, moving it an inch at a time, and then lowering it again, then moving it,” Hazzard says. “It was very labor-intensive. We had lots of help from enlisted soldiers. And officers jumped right in. That was one thing from my military past I’d never seen: a colonel just throw his back into something like this.”
Run by the Army’s 10th Mountain Division, the 10th’s biomeds at the base were always ready to help. “Their attitude was, ‘What do you need? Guys, we’re here for you!’ ” Hazzard says.
Improvisation Is Not Always a Comedy Routine
|Photos above by Larry Cousar|
|Roy Bailey, right, handed over the GE LightSpeed VCT to military personnel so they could begin scanning patients at the new Bagram Air Base hospital.|
Glanville and Hazzard project the self-assurance of professionals who expect to go above and beyond, and are confident they can. After all, their job is not to see that every item on a list is checked off, but to ensure the equipment they are responsible for is in top shape, because it has to serve the medical needs of injured soldiers.
Not having the proper dollies was the first obstacle for the crew. “In the US, as field engineers in x-ray, we primarily don’t do the mechanical installation,” Hazzard says. But in Afghanistan, from the moment of delivery in the parking lot to basic structural and engineering concerns with the rooms where the equipment was installed, things needed to get done, so they got it done.
Installation problems, according to Glanville, included flooring not dense enough to anchor medical equipment. “In CT we had inadequate flooring concrete,” he says. “We had to create special anchoring, and Roy Bailey was responsible for that. He epoxied the CT to the floor with special high-grade epoxy, which we don’t normally do. We worked with Turkish contractors, Afghani laborers, and sometimes people from different trades who didn’t speak English. We wore many hats. We had problems with HVAC [heating, ventilating, and air conditioning] requirements for each room. We took care of it all.”
Anticipating a certain number of possible problems, none of the field engineers left for Afghanistan “before researching what kinds of tools and equipment, or what kind of part we might need,” Glanville says. “We were pretty thorough.”
Not wanting to run into a situation where they were missing a part that might take a couple of weeks to ship over, the field engineers made sure they had extra items for almost every contingency.
Not the Ritz
When the field engineers arrived in Bagram, they learned they would be staying in deluxe suites—modified shipping containers. Of course, no one was expecting luxury accommodations, and the trip involved constant work. They spent 14 hours a day working in 90-degree heat, ate, slept, and then went back to the hospital for more work.
Recreation for these volunteers consisted of a bazaar on the base every Friday where local residents sold their handmade products.
“We had satellite phones to call home,” Glanville says, although he adds that they were not too reliable. Internet access proved intermittent as well, but the team members and their families knew this going in and—after all—they were there to work.
|The GE field engineers in Bagram stayed in “deluxe suites”—modified shipping containers.|
Considering their location in Afghanistan, they all felt relatively secure—despite the periodic sound of mine blasts. Someone did try to smuggle a rocket-propelled grenade launcher onto the base, but fortunately, it was an unsuccessful attempt.
None of these field engineers exhibits the slightest braggadocio. Like field engineers, BMETs, and clinical engineers everywhere who have “earned their stripes,” they take justifiable, matter-of-fact pride in their ability to think their way out of any problem and make things work, citing Larry Cousar as their number one problem solver. Recalling a 1980s TV series about a resourceful agent who could build anything with a Swiss Army knife, duct tape, and brainpower, Hazzard says, “Cousar wins the MacGyver award.”
One thing that cannot be overstated is the pride the field engineers feel about the contributions they have made. “It was an honor to serve my country and company,” Glanville says. “My sacrifice was minor compared to others overseas.” And you know Glanville means it when he says, “If asked, I would do it all over again without hesitation.”
Hazzard echoes that sentiment: “Knowing we were giving our guys top-of-the-line equipment to help them when they got injured and [getting] the chance to save lives—that was incredibly humbling for me. It made me extremely proud knowing we were helping our guys, first and foremost, in a combat situation, and knowing down the road this will help civilians as well.”
25 Miles South—2 Years Earlier
In 2006, when the GE team had visited Bagram Military Base, there were minefields near the gates. In the first half of 2004, when Larry Feenstra, director, clinical engineering, Loma Linda University Medical Center (LLUMC), Loma Linda, Calif, traveled to Afghanistan on a very different project, he could stroll down a city street in Kabul without military escort.
That does not make the Afghan capital, 25 miles south of Bagram, some kind of Disneyland, but at least Feenstra could take in Kabul’s famous “Chicken Street,” where almost anything can be bought from local merchants. Not that he had much free time.
Feenstra accompanied a group of his colleagues to Kabul in response to a request from the Ministry of Health of the Islamic Republic of Afghanistan. The request? To determine the feasibility of LLUMC getting involved in managing the Wazir Akbar Khan hospital. Each team member evaluated specific aspects of the hospital facilities and staff. In addition to Feenstra, the team included Richard H. Hart, MD, DrPH, chancellor of Loma Linda University; Jerry Daly, MSLS, Loma Linda director for the Afghanistan project and director of the Del E. Webb Memorial Library; Roy V. Jutzy, MD, professor of medicine, LLUMC; and Jan Zumwalt, MS, MBA, RN, executive director for case management, LLUMC.
LLUMC had been involved in Afghanistan for 45 years, originally providing faculty and consultation resources to Kabul Medical Institute in 1962. During the Soviet occupation in the late 1970s through the early 1980s, LLUMC’s involvement was temporarily suspended. Then, about 9 years ago, the Taliban government contacted Loma Linda about once again supporting medical education in Afghanistan. LLUMC agreed.
After September 11, 2001, and the fall of the Taliban, the new government requested LLUMC’s support. A new Loma Linda University Center was constructed at Kabul Medical Institute.
Although LLUMC’s longtime connection is to the Kabul Medical Institute and not Wazir Akbar Khan hospital, the hospital has a historic importance in the city of Kabul. Students from the Kabul Medical Institute have traditionally completed some of their training at the hospital and the decision was ultimately made that LLUMC would assist in managing the hospital.
The Task at Hand
Before that decision was made, Feenstra compiled a list of suggestions that, at a minimum, would help the Ministry of Health get things going in a manageable direction. Once formally engaged on the project, the question became: What would it take to make Wazir Akbar Khan a functional facility with adequate equipment once again?
“This hospital in Kabul was empty when we arrived, and it looked like it was in ruins,” Feenstra says.
Feenstra now faced a task that might have seemed at least as challenging as that faced by the field engineers in Bagram. He began the evaluation by assessing what the standard of care was in the region and asking what services were typically available in other facilities. To answer that, Feenstra says, “We did get to tour several other hospitals. There is a veterans’ hospital fairly close by. We went to a children’s hospital, too.”
Another part of the challenge concerned equipment that had originally been located in, or intended for, the Wazir Akbar Khan facility. “We were trying to put tabs on where the equipment from this facility went,” Feenstra says. “And we were trying to determine how much of that would come back. There was actually some new stuff that had been donated by other countries, but none was currently at this location where it was supposed to be.”
To add to the confusion, there were clinics on the grounds that were not exactly part of the hospital. At one clinic, for instance, radiology procedures were performed. Another, according to Feenstra, existed as “a sort of stand-alone blood bank that was operational, but wasn’t considered part of the hospital; it was being run by the Red Cross.”
|An old fuse panel at Wazir Akbar Kahn hospital —where only 30% of the wiring worked.|
Feenstra’s troubles did not end there. “Only 30% of the wiring worked,” he says. Red Cross volunteers were overseeing electrical remodeling when the Loma Linda group arrived, and although well meaning, were trying to perform sophisticated clinical engineering duties but did not have the proper biomedical experience.
Normally, six or so emergency outlets and normal power might be required for each hospital bed. But here, Feenstra was confronted with one large, outdated outlet for each bed.
When it was a functioning medical facility, additional electrical problems had occurred when patients’ family members would attend to the patient’s general comfort. The hospital did not have a fulltime working cafeteria and when well-intentioned relatives plugged in rice makers they had brought to feed their hospitalized relatives, it would often cause a short circuit. The ultimate result was that only one third of the wiring functioned.
The Value of Experience
Feenstra drew on his previous experience to determine what it would cost to maintain and run equipment at Wazir Akbar Khan hospital. Previously, he had worked with a colleague on a benchmarking study that assessed various hospitals across the United States. With the assistance of engineering managers throughout the country, he put together information about groups of medical equipment and estimated what it would cost to maintain. That information—also part of the spreadsheets Feenstra used to make assessments for an equipment replacement plan at LLUMC—laid a foundation for equipment organization in Kabul.
“I took that information with me to Kabul on my computer and used it as templates,” Feenstra says. With that data, he came up with some overall numbers for medical equipment replacement and maintenance costs for Wazir Akbar Khan hospital.
|Larry Feenstra with an old EKG in a long-term care clinic located on the hospital grounds.|
A New Culture
More than just rectifying equipment problems, Feenstra and the rest of the group attempted to bring an entirely new health care culture to the hospital. “Health care was supposed to be free for the citizens, but how do you provide health care where the government doesn’t even have a tax base?” Feenstra asked.
Previously, when the hospital was operational, “Physicians would actually work there in the mornings, then they’d go to their home private practices. So, although health care was supposed to be free, people couldn’t really get the care they needed unless they paid for it,” he says.
Feenstra described how, with the help of US government funds, the Loma Linda team got the Kabul physicians to work full time at the hospital, returning it to a system completely under the auspices of the Afghan government.
Another important aspect of laying a foundation of self-sufficiecy at the facility was making sure installed equipment could be serviced on the premises. “While we were over there, we saw vehicles with ‘Siemens’ on them, so it ended up that we bought some Siemens monitors that could
be supported there, because they had direct support in Kabul,” Feenstra says. “Some other vendors had their closest support in Dubai, which is a long way away for sales and service.”
Thanks to the work of Feenstra and his colleagues, Wazir Akbar Khan is now a working hospital that provides a much-needed service in the Afghan capital. With new dorms for visiting Loma Linda health care professionals, Loma Linda maintains a continuous presence at the hospital. With a committed staff of full-time health care professionals, working equipment, and a new culture of health care introduced by LLUMC, the value of Wazir Akbar Khan hospital to Kabul’s citizens continues to grow.
David Tandet is a contributing writer for 24×7. For more information, contact .