Maj. Elizabeth Vinson feeds 1-year-old
Malala as her mother, Zainab, watches.
A partnership between Salerno
Hospital, an Army field hospital in
Afghanistan, and the local ministry of
health has transformed the tent
hospital into a virtual pediatric
intensive care unit. Under the program,
patients whose cases are too
complicated for local doctors can get
care from U.S. military medics assigned
to Salerno. Hospital officials were
shocked when, one day before she was
to be discharged, Malala died.

Anita Powell / S&S
Picture And Story From Stars and Stripes
The War in Afghanistan (2001–present) refers to the intervention by NATO and allied forces in the ongoing Afghan civil
war. The war followed the terrorist attacks of September 11, 2001, in an effort to dismantle al-Qaeda and eliminate its safe
haven by removing the Taliban from power.

U.S. President George W. Bush demanded that the Taliban hand over Osama bin Laden and expel al-Qaeda. The Taliban
requested that bin Laden leave the country, but declined to extradite him without evidence of his involvement in the 9/11
attacks. The United States refused to negotiate and launched Operation Enduring Freedom on 7 October 2001 with the
United Kingdom. The two were later joined by other forces, include the Northern Alliance. The U.S. and allies drove the
Taliban from power and built military bases near major cities across the country. Most al-Qaeda and Taliban were not
captured, escaping to neighboring Pakistan or retreating to rural or remote mountainous regions.

In December 2001, the United Nations Security Council established the International Security Assistance Force (ISAF), to
oversee security in the country and train Afghan National Security Forces. At the Bonn Conference in December 2001,
Hamid Karzai was selected to head the Afghan Interim Administration, which after a 2002 loya jirga in Kabul became the
Afghan Transitional Administration. In the popular elections of 2004, Karzai was elected president of the country, now
named the Islamic Republic of Afghanistan.

In 2003, NATO assumed leadership of ISAF, with troops from 43 countries. NATO members provided the core of the force.
One portion of U.S. forces in Afghanistan operated under NATO command; the rest remained under direct American
command. Taliban leader Mullah Omar reorganized the movement and in 2003 launched an insurgency against the
government and ISAF.

Though vastly outgunned and outnumbered, the Taliban insurgents, most notably the Haqqani Network and Hezb-e-Islami
Gulbuddin, have waged asymmetric warfare with guerilla raids and ambushes in the countryside, suicide attacks against
urban targets and turncoat killings against coalition forces. The Taliban exploited weaknesses in the Afghan government,
among the most corrupt in the world, to reassert influence across rural areas of southern and eastern Afghanistan. ISAF
responded in 2006 by increasing troops for counterinsurgency operations to "clear and hold" villages and "nation building"
projects to "win hearts and minds".

While ISAF continued to battle the Taliban insurgency, fighting crossed into neighboring North-West Pakistan. In 2004,
the Pakistani Army began to clash with local tribes hosting al-Qaeda and Taliban militants. The U.S. military launched
drone attacks in Pakistan to kill insurgnet leaders. This resulted in the start of an insurgency in Waziristan in 2007.

On 2 May 2011, U.S. Navy SEALs killed Osama bin Laden in Abbotabad, Pakistan. About three weeks later, NATO leaders
endorsed an exit strategy for withdrawing their forces. UN-backed peace talks began between the Afghan government and
the Taliban.[32] As of 2013, tens of thousands of people had been killed in the war, mostly militants and civilians. In
addition, over 4,000 ISAF soldiers and civilian contractors as well as over 10,000 Afghan National Security Forces had been
killed. Information Taken From Wikipedia:
http://en.wikipedia.org/wiki/War_in_Afghanistan_(2001%E2%80%93present)
Afghanistan Flag
The U.S / Afghanistan War
Army Nurses Brave Afghanistan’s Combat Zones
By Janet Boivin, RN
Thursday December 3, 2009
“I am counting down the last 10 days or so until I go home. I can’t wait. It’s been a blessing to serve, but this six months
has been hard. Just lask week a medic I trained was my patient, and another medic I knew was shot in the head and died.
I need some time to reflect and be with my family.” — Michelle Racicot, Aug. 16, 2009

Army Capt. Michelle A. Racicot, RN, was sent to Afghanistan this past spring, shortly after newly elected President Barack
Obama decided to send 21,000 more troops there to quell a resurging Taliban. She was sent to two forward operating bases
to set up small, mobile surgical teams referred to in military terminology as an FST (forward surgical team).

An FST is a group of specially trained nurses, doctors, and medics who can operate on wounded soldiers closer to the
frontline, stabilize them, and then transfer them to a battlefield hospital for further care.

The FST Racicot set up at FOB Ghazni was part of Secretary of Defense Robert Gates’ new mandate that there be an FST
with medical evacuation capabilities in each province in Afghanistan so that every wounded soldier, Marine, and airman
would receive advanced trauma life support within an hour of being injured, as they do in Iraq. Gates said he knew that
with an influx of service members, and a tough, tenacious enemy, there would be an increase in deaths and injuries among
U.S. and coalition troops.

His prediction was correct. As of Oct. 23, there have been more U.S. military deaths in 2009 — 253 — than in any year
since the U.S. went into Afghanistan in 2001, according to www.icasualties.org/OEF/. There were 155 U.S. deaths last year
and 117 in 2007. August proved the deadliest month so far with 77 U.S. deaths. There were 70 deaths in September.

“I know that we save a lot of lives,” Racicot wrote in an e-mail Aug. 23. “And our FST is known for our skill so if in flight
[medevac team members] have issues with patients crashing on them, they will stop and have us evaluate them in
emergencies. I also know that having our FST here enables patients to be seen and do damage-control surgery. We can
save lives of soldiers who would die if they had not stopped for care at our FST first.”

FOB Ghazni is in eastern Afghanistan, not in the southern part of the country in Helmand Province where the heaviest
fighting takes place. But heavy fighting occurs near Ghazni, as well, it’s “just not reported,” Racicot said in her e-mails.
The violence, she added, increased leading up to the national Afhghan elections this summer.

“We had a badly injured soldier the other day. He was in a convoy and his MRAP [mine-resistant, ambush protected]
vehicle was hit with so much C4 [plastic explosive] that the force of the explosion caused a degloving of his sacrum and
shattered his coccyx,” Racicot wrote. “He was in severe spinal shock. We had him on Epi and Vasopressin. After we
transferred him to BAF [field hospital in Batgram], I went to the showers and cried. I think it is time for me to have a
break, but then I feel like I need to stay and care for our soldiers.”

Racicot returned to the U.S. on Sept. 6. She is now assigned to Brooke Army Medical Center in San Antonio.

Racicot is only one of the many nurses, physicians, medics, and corpsmen who have accompanied the thousands of
additional service members heading to small outposts in Afghanistan. These highly trained medical teams are as important
to the fight as the counterinsurgency tactics that soldiers and Marines will use against the Taliban, said Col. Susz Clark,
RN, the second in command of the Army Nurse Corps and the former top Army nurse in Iraq.

“Combat healthcare is proving to be an important ‘weapon system’ in its own right,” says Clark, deputy chief of the ANC
and, from 2007 to 2009, chief, clinical operations/deputy commander for nursing, TF 62 Med, Baghdad.

Although it may seem incongruous to describe medical care as a weapon, Clark explaind that the medical units caring for
the wounded in the counterinsurgencies in Iraq and Afghanistan need to be as flexible, agile, quick, and adaptive as
combat troops in these unpredictable environments. (For more about Clark’s concept for a new, smaller, and more mobile
medical unit, see sidebar).

Based on her experiences in Iraq during the 2007 surge when thousands of additional troops were dispersed to small
outposts in Iraqi villages, Clark learned medical units needed to be even smaller and more adaptable, she said in a phone
interview with Nurse.com.

When Racicot arrived in Afghanistan this past spring, she was asked to set up a fully functioning FST in less than three
weeks with minimal supplies, equipment, and personnel. The team had less than half of the 20 personnel that usually
comprise an FST.

She also had to integrate, assess, and train a Polish medical team also located at FOB Ghazni. “Integrating the Polish team
with our team proved to be a work in progress,” she wrote. “With each trauma and a resulting after-action report, we have
improved our trauma process.”

Many times the wounded who are transported to a U.S. medical unit are not American or coalition soldiers. Instead they
are Afghan men, women, and children, who have been hit by rocket propelled grenades, improvised explosive devices or
land mines, as Racicot learned.

“I had an interesting moment one day when I was filling out an application for a master’s degree program. One question
asked, ‘Briefly describe your experience working with cultures other than your own.’ Before I could type my response, I
was asked to fly with the medevac team to evaluate three pediatric patients hit with shrapnel from a rocket propelled
grenade. We flew to a remote FOB, and I was greeted by one of the Polish medics who attended my classes.

“One of the children had an eviscerated bowel and was having shortness of breath and nausea. While I was covering his
wounds and drawing up medication to give him, he would not let me let go of his hand. I later learned that he did not
survive. It was a reminder that even with all we can offer with medicine and surgery, sometimes it isn’t enough.”

Janet Boivin, RN, is a senior staff writer for Nursing Spectrum and NurseWeek magazines.

Front Lines Streamlined
One of the Army Nurse Corps’ two top nurses has proposed that a new combat unit called a medical capability team be
created to better meet the needs of a counterinsurgency war environment and “to transform front-line care”.

In an article in the U.S. Army Medical Department Journal last year, Col. Susz Clark, RN, deputy chief of the ANC and
former top nurse in Iraq from 2007 to 2008, says medical units must be as swift and adaptable as the soldiers and Marines
who are being sent to smaller villages and outposts in Afghanistan and who are the targets of rocket-propelled grenades,
improvised explosive devices, and landmines.

MCTs would at a minimum consist of an emergency medicine nurse, emergency medicine physician, and a specially trained
medic. Care would be organized around patient-care problem sets such as resuscitative, surgical, intensive, and acute care.
Healthcare professionals would be assigned to an MCT, preferably at the start of their careers, and then would train and
deploy with the team throughout their careers.

More healthcare personnel could be added to the MCT to provide additional types of care or accomodate increased patient
capacity depending on the needs of the combat unit to which the MCT would be attached, Clark told Nurse.com in a phone
interview. For example, a unit might be tasked to a combat support hospital, an area support medical company, or a
forward surgical team.

Combat medical care was dramatically reorganized after Operation Desert Shield/Desert Storm when the Army, Air Force,
Navy, and Marines all realized the military needed smaller, more mobile units that could provide resucitative and surgical
care closer to the frontlines. The well-known MASH units of World War II gave way to combat support hospitals and
forward surgical teams that brought nurses, physicians, and medics closer and more quickly to the front lines than ever
before.

Training for an MCT would be more team oriented than the training that currently exists for military medical units.
“There is a need for better preparation of health professionals in teamwork,” Clark wrote in her article. “Many studies
have identified teamwork as a requirement for high-quality, safe care.”

Although team-delivered healthcare is found in Army military facilities, current combat care is different in that many of
the teams do not meet or work with each other until they deploy into the combat zone, Clark says. The MCT would be a
small, interdependent group of professionals who regularly work and train together, optimally from the start of their
careers, in order to develop into highly proficient specialized medical teams that can provide combat healthcare to specific
groups of patients immediately upon arrival into a combat zone, she adds.

But based on Clark’s experiences in Iraq during the 2007 surge when thousands of additional troops were dispersed to
Iraqi villages, she learned medical units needed to be even smaller and more adaptable than they are.

“In a counterinsurgency environment, such as Iraq or Afghanistan, medial care must occur ‘curbside to combat’ for the
wounded to optimize care delivery and prevent degradations in combat operations,” she says.

Compliments Of  
NURSE Magazine
Click On NURSE Logo To Visit
Pictures Of Nurses In Afghanistan
Click On Bagram Airfield Logo To Visit
HELMAND PROVINCE, Afghanistan. Amy Zaycek,
the severe trauma platoon nurse with the Female
(Courtesy Photo)
Click On SCRUBS Logo To Visit
Pictures Taken From SCRUBS Magazine
Department said.
killed in Sunday's blast in the Zhari District of Kandahar Province were Sgt. Patrick C. Hawkins, 25 of Carlisle,
Pa.; Sgt. Joseph M. Peters, 24, of Springfield, Mo.; and Pfc. Cody J. Patterson, 24, of Philomath, Ore.

All four service members were killed by an improvised explosive device while conducting combat operations in
Kandahar Province, Afghanistan.
Army officials said 1st Lt. Moreno was on her first deployment to Afghanistan.
She was born June 25, 1988, in San Diego, Calif. After graduating from San Diego High School, she was
commissioned in the U.S. Army as a Nurse Corps officer after graduating from the University of San Francisco
with a bachelor of science degree in nursing.  Moreno completed the U.S. Army Airborne Course 2009 at Fort
Benning, Ga., and the Army Medical Department Officer Basic Course 2010 at Fort Sam Houston, Texas.
Moreno was then assigned to Madigan Army Medical Center, Joint Base Lewis-McChord, Wash., where she
served as a clinical staff nurse on a medical surgical unit. She volunteered and was successfully assessed and
selected into the U. S. Army Special Operations Command Cultural Support Team program and deployed in June
2013.

“Our unit mourns the loss of 1st Lt. Jennifer Moreno,” said Lt. Col. Patrick J. Ellis, Commander of 3rd
Battalion, 75th Ranger Regiment. “She was a talented member of our team who lost her life while serving her
country in one of the most dangerous environments in the world.

"Her bravery and self-sacrifice were in keeping with the highest traditions of the 75th Ranger Regiment. She was
making a difference in Afghanistan and that legacy will live on. The Moreno family is in our thoughts and
prayers.”

Moreno's awards and decorations include the:  
Parachutist Badge, Army Achievement Medal, National Defense
Service Medal, Global War on Terror Service Medal and Army Service Ribbon.
1st Lt. Moreno was posthumously awarded the:  
Combat Action Badge, Bronze Star Medal, Meritorious Service
Medal, Purple Heart, Afghanistan Campaign Medal, and NATO Medal.

She is survived by her mother, Marie V. Cordero, and her sisters Jearaldy Moreno and Yaritza Cordova of San
Diego, Calif., and her brother, Ivan F. Moreno, currently serving in the U.S. Army.
God Bless Our Combat Nurses
Click On Logo To Visit Nurses "In Memoriam"
Song Is "Revolution" By The Beatles
They like watching scary movies and hanging out with their families.
They have a 6-month-old puppy that’s going through a “chewing phase.”
They are, by all accounts, just like any other young couple.
Except for one thing.
Hallett, 22, is a retired Marine and triple amputee who lost both legs, his right arm and two
fingers on his left hand to an IED in Afghanistan when he was 19.
And since then, the couple
has taken on the obstacles created by Hallett’s injuries together, while also forging a path for
others in similar situations.
Sitting in a Fort Collins coffee shop Thursday, the two listed different organizations designed to
help wounded veterans.  The Honor Group gave Hallett an all-terrain wheelchair he can
eventually use on hunting trips. American Strong, based in California, took him to a truck race
once, where he got to ride in one of the vehicles. Sit Means Sit has been helping the couple
train their service dog, Cash. And Homes for Our Troops is working on building them a house
on a Windsor plot donated by developer Martin Lind, who runs Water Valley Land Co.
“The military and veteran community I feel isn’t really as strong here as it was in San Diego
(where Hallett rehabbed his injuries),” said MacVean, 21, who is her fiancé’s full-time
caregiver. “It’s weird coming from there, where there were so many amputees and veterans, to
here, where it’s very rare to find someone his age who he can relate to.”
That’s why the couple makes a point of getting out into the community and supporting
nonprofits that benefit veterans. They wear T-shirts advertising organizations and attend
different events or volunteer days.
“Maybe if there are any amputees around here who don’t know of any resources, we can help
them find some,” MacVean said.  Both MacVean and Hallett grew up in Fort Collins, where
they went to school together at Ridgeview Classical Schools. They first started dating in the
eighth grade.
“He used to tease me all the time, you know, like flirting,” MacVean said. “And he would steal
my backpack, and we would pass notes a lot in class. Teachers would have to separate us.”
But, because MacVean’s family thought she was too young to date, her father told Hallett to
come back in five years when he had achieved his dream of joining the military, and her family
would give him a second chance.
The two separated. MacVean went to a different school; Hallett moved out of state. He
graduated from Job Corps and enlisted in the Marines when he was 17.
“Sure enough, five years later, he was injured; and then after he fully recovered, he added me
on Facebook, and we just hit it off,” MacVean said.

After his injury in October 2010, Hallett spent months in and out of an intensive care unit in
Bethesda, Md., and eventually ended up in San Diego, where he went through rehabilitation.
“I’d look at her picture and I’d think about (messaging her) and then I’d wait and say, ‘No, not
yet,’ and then last summer, I thought it was time so I added her (on Facebook), and she
messaged me,” Hallett said.

MacVean flew out to visit Hallett in San Diego a couple of weeks later.
“At first, it was weird to get used to (his injuries) in my mind, but once I saw him, it wasn’t
even a big deal,” Mac-Vean said. “When you see him, you just notice the person and who he is
on the inside. He’s still that same kid from eighth grade.”
MacVean eventually moved out to San Diego to be with Hallett. Months later, surrounded by
her family on Thanksgiving, Hallett proposed.
“Since I didn’t have my legs, I got down on my stumps,” Hallett said.
“And I was sobbing,” MacVean added.

After getting engaged, the two decided they wanted to raise their family in Colorado so they
moved back to Fort Collins in December 2013. Their wedding will be in Estes Park on June 14
— their one-year anniversary.
“It’s very encouraging and inspiring,” said Hallett’s grandmother, Kathy Paris. “Their love is
true; it’s a very genuine love, and when you’re with them, it’s just enlightening.”
Paris said the first thing you see when you look at Hallett is always the smile on his face and,
even when he was just in the beginning stages of dealing with his injuries back in 2010, he
stayed positive and always said he was “good,” no matter what.
“It’s like he didn’t even miss a beat; he just kept going,” Paris said.

As his grandmother, Paris said she was afraid Hallett would worry about being able to find
someone after becoming an amputee.
“I just wanted him to know that God had a plan for him,” Paris said. “And when Rachel came
into his life and they reunited, she was his angel. She can do no wrong in my eyes. She’s just a
pure, sincere woman.”

As far as them wanting to help others in similar situations, Paris said it just goes to show you
what kind of people they both are.
“They’re not closing a chapter on anything, they’re opening a book on how they can help other
people,” Paris said. “It’s a blessing and privilege to be in their lives,” she added.

This was sent to me by a friend and Rachel MacVean is the daughter of a friend of hers.
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