Military Review English Edition May-June 2014 | Page 63
M E D I C A L O P E R AT I O N S
residents who worked and lived with FSE personnel
had to be thoroughly vetted before gaining entry.
The final critical enabler for TK FSE’s COIN
operations was highly motivated, strongly dedicated personnel who were committed to the mission. Without such personnel, the FSE could not
have participated in complex, often demanding
medical COIN operations. Basic understanding
and acceptance of the cultural differences between
FSE personnel and their local national patients were
vital as well. Included in the personnel essential to
accomplish this mission were the embedded interpreters who lived and worked with the FSE every
day. These team members, in addition to interpreting, also provided links with local health authorities
and valuable cultural insights. The value of embedded interpreters was multiplied as they worked in
the medical environment—learning and practicing
basic medical skills, narrowing the cultural gap
between host nation patients and coalition medical
providers, and becoming true medical interpreters.
The expansion of TK FSE’s mission into COIN
operations revealed some notable difficulties as
well. When operating in the midst of an active insurgency, security was always an issue. FSE operations
had to remain flexible within a variable security
environment. Planning missions with inherent
adaptability helped to mitigate some security difficulties. Another complication in the FSE’s COIN
operations was the broad cultural gap between
FSE providers and Afghan residents, community
stakeholders, and patients. Continually fostering a
clinical environment in which such differences were
acknowledged and accepted, as well as encouraging cultural education by the embedded interpreters, was vital in enhancing cultural understanding
among FSE personnel.
The easy part of the FSE’s mission was providing
medical care to the sick and injured—this is what all
medical personnel have trained for. The hardest
and most important TK FSE COIN mission was to
decrease local reliance on coalition medical assets
so Afghans eventually could provide medical care
independently. The intricacies encountered in
focusing on training our local partners to better
prepare them for caring for their own populace
proved vexing. We strived to incrementally
increase our partners’ capacity to care for their own
people. Continual reinforcement of and adherence
to the fundamental COIN principle of enhancing
indigenous capacity and maintaining a mission
profile consistent with this principle helped mitigate some of these difficulties.
Conclusion
Integrating a forward-deployed U.S. surgical
unit into the indigenous host-nation health sector
in the midst of a COIN operation was a new
approach to medical operations in COIN. TK FSE
joined the SOTF COIN offensive to an unprecedented degree, its missions garnering measurable
positive outcomes in the health care capacity of
Uruzgan Province and beyond. The education of
local Afghan and partner force medical providers
by U.S. military medical providers fulfilled the
COIN principle of increasing indigenous health
care capacity without unsustainable traditional
direct health aid. The depth of TK FSE’s involvement in the indigenous health sector allowed for
long-term relationships with local Afghan entities
that could continually adapt to a changing environment. These relationships resulted in partnerships that were the foundation for the success of
the FSE’s medical COIN operations in southern
Afghanistan. The TK FSE experience was beyond
the unsustainable humanitarian assistance efforts
of most medical COIN operations. Operations
were low cost and high value, and they resulted in
dramatic and sustainable gains. TK FSE’s resounding successes in increasing Afghan health sector
capacity represent a framework for future COIN
medical operations. MR
NOTES
1. Richard W. Thomas, Ensuring Good Medicine in Bad Places: Utilization of
Forward Surgical Teams in the Battlefield (academic research paper, U.S. Army War
College, Carlisle Barracks, PA, 2006), 18.
2. Report prepared for the Office of the Secretary of Defense, Counterinsurgency
in Afghanistan, Seth G. Jones, (Santa Monica, CA: RAND Corporation, 2008), 100.
3. Sebastian L.V. Gorka and David Kilcullen, “An Actor-centric Theory of War:
MILITARY REVIEW
May-June 2014
Understanding the Difference Between COIN and Counterinsurgency,” Joint Force
Quarterly (1st Quarter 2011): 17.
4. Matthew S. Rice and Omar J. Jones, “Medical Operations in Counterinsurgency Warfare: Desired Effects and Unintended Consequences,” Military Review
(May-June 2010): 49.
5. Jones, 130-31.
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