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. 61