Setting up a hospital is no joke, especially working outside in temperatures ranging from 110 to 120 degree without shade. It makes for long, hot days. We completed the hospital infrastructure within one week after arriving at Camp Dwyer, Afghanistan. The process included 10 eight-section tempers, four two-section tempers, seven ISO containers and a lot of sweat. We also constructed living quarters, latrines and showers for more than 220 medical personnel.
The lab received two ISO containers, one for general lab services and one for blood. Both were incredibly dusty. There is no escaping the moon dust here. After we inventoried the equipment, we moved all of the equipment, furniture and expendable supplies into the lab. Everything was heavy. For the days that we didn’t have forklifts to move items from the connex to the lab, we had extra physical training in for the day. I started the deployment with three techs and they were awesome and very helpful. A lot of manpower went into connecting and organizing the two ISOs.
As a new lab officer, the deployment to Camp Dwyer was the ultimate on-the-job training experience. In school, all of the supplies were easily accessible. We didn’t have to worry about where or how we received supplies and reagents. When I stepped into my first lab, everything had standard operating procedures (SOPs), reagents were stocked or ordered, and everything had a place. Everyone knew what quality control items went with each test and everyone knew how to order the items with the proper national supply number (NSN).
Supply can be tricky if you don’t know what you are doing. In school, we conducted a method validation on the i-STAT, so I thought I was familiar with the instruments. When medical maintenance brought me four i-STATs, I didn’t think anything of it. I quickly learned that quality control on the i-STAT is more than just inserting the external simulator into the instrument. This process only verifies the electrical measurement of the i-STAT and there is wet quality control and calibration.
We were surprised to learn that the hospital ordered all of the controls and calibrators. The downside was that many of our reagents were either compromised from the heat or expired. When we tried to order replacements, we found that the SOPs and package inserts didn't clearly state the required controls needed and the NSNs.
As a new lab officer in the field, all of these things are a blur until you get your hands dirty. After my fellow lab officers and the senior lab techs arrived, quality control made perfect sense. Everything began to fall into place. The creation of SOPs, policies and procedures was a challenge due to our date given to be at full operational capability (FOC). For that, the FLIP Disk has been wonderful.
Sending out lab tests can be a challenge. Specimens have specific requirements and it can be challenging to arrange flights from Camp Dwyer to Landstuhl or to the states. There is no such thing as a direct flight from here to Landstuhl or the U.S. The use of any major overnight service from here is a pipedream.
During the early days of the CSH, the supply chain was problematic and the Internet was scarce. DCAM was not operational and it was difficult to look up product information without connectivity. I was very grateful when our Signal shop put MC4 systems online throughout the hospital. Sustaining the power supply for the hospital is a continuous challenge, especially when the outside air temperature rivals the inside of an oven.
Captain Amanda Luchinski, Laboratory Officer, 31st Combat Support Hospital, Camp Dwyer, Afghanistan