The Afghan Refugee Projects

I have just returned to North Carolina after 13 months, having participated in what was described by some as the largest humanitarian effort ever undertaken by the United States. I had the privilege of serving as Chief Medical Officer (CMO) for Operation Allies Welcome (OAW) Projects 1 and 2. These historic projects represented some of the most rewarding activities in my 40-year medical career.

When Kabul, Afghanistan, fell to the Taliban in Aug. 2021, the U.S. Government assisted with Afghan refugee evacuation and relocation. In OAW 1, eight U.S. military bases provided food, housing, clothing, and medical assistance while the refugees were resettled. This was a well-coordinated effort between the U.S. Department of Homeland Security, U.S. State Department, U.S. Department of Defense, and a host of other U.S. government and non-governmental agencies.

Individuals that escaped the initial horror at Kabul Airport were the first to arrive in this country in August 2021. Many had been beaten, shot, and traumatized. Many of the initial refugees escaped with nothing more than the clothes on their backs. Often bewildered in a new country with new customs, the Afghan families needed our medical care and support to transition to their new lives.

At our site, we rapidly erected Alaska tents that would serve as our medical facility for the next six months. We assembled a medical team of 500 outstanding medical personnel. Our clinicians included physicians in Family Medicine, pediatrics, Internal Medicine, obstetrics, Emergency Medicine, public health, and other subspecialties. Our nursing, midwife, medical technician, behavioral health, EMT, pharmacy, and linguist interpreter colleagues provided excellent support for the operations.

Our OAW 1 site provided over 40,000 medical visits over the initial months. The medical tents provided 24-hour well care, urgent care, and emergency services. We cared for over 300 pregnant women, and coordinated nearly 200 deliveries with local hospitals. Each day would provide new challenges, especially during the COVID outbreak. We needed to be able to identify possible infections less-commonly seen in the U.S., including malaria, active tuberculosis, leishmaniosis, measles, and polio. Pediatric congenital issues that we encountered included cardiac anomalies, orthopedic anomalies, and metabolic disorders.

I had the privilege of escorting a governor, U.S. senator, congressional members involved with the armed services, military generals and admirals, and many other governmental and military leaders through our medical tents. One of the visiting brigadier generaIs was a former Family Medicine residency director, allowing us to discuss our similar pasts.

Some of our staff were former or active military staff, and many had served in Afghanistan. For those who had lost their own blood or watched the loss of loved ones in Afghanistan, this project took on great emotional meaning. Their dedication to the projects was an extension of their overseas mission. I have deep gratitude for the military members and leadership whom I was able to work with on a daily basis.

The Afghan children were the ones who stole my heart. Afghan families are large, averaging about eight members per family (and they travel to the clinic as a group). The children wanted to play, smile, and make friends.

My medical office was a Conex (metal container) that was located steps away from our negative airflow isolation tents. While our public health team performed daily visits to the isolation families, I would gown and mask to visit the families in isolation whenever possible. Every evening when our medical work slowed, children would gather to kick a soccer ball or bump a volleyball with me. While many could speak no English, and I was slow to learn Dari and Pashto, we still communicated with our shared joy and play.

I was asked to return as CMO for the second project. OAW2 was a smaller project housed in a conference center. OAW2 was in a more controlled physical environment, but I missed the shared camaraderie with the clinicians and Afghan “guests”

(as we referred to them) of the tents!

In OAW2, we coordinated with the State Department to bring in individuals with more complex medical problems. We performed over 6,000 patient visits in the clinic. Resettlement of individuals with complex medical issues was often a complicated process. Coordination was required with outside specialists and hospitals, and for future medical care in the communities to which they resettled.

I was honored to work alongside a number of family physician leaders in military and public health leadership positions. Having previously worked in private practice and university settings, I was surprised at the number of family physicians supporting U.S. military and U.S. public health service operations. These colleagues may have less visibility in our specialty, but their dedication and work earned my respect.

As I reflect back on my long medical career, I believe that my varied family practice experiences prepared me for the OAW projects. My time working at a tuberculosis and Hansen’s Disease hospital in India helped with possible infectious disease identification. My years in private practice, sports medicine, procedural medicine, dermatology, and in emergency medicine helped in the coordination of 400500 patient visits a day in OAW1. My exposure to other specialties serving as residency director and teaching at the universities, and my prior leadership experience as a medical director helped with supervision of the many specialties.

As I come to the twilight of my medical career, I can look back on the progress of our specialty. I believe that the breadth of Family Medicine represents its strength, flexibility, and future. I salute the many family physicians in the government, military, and public health sectors. During the OAW projects, I saw family physicians directing various medical specialties in the unified care of needy human beings. I was honored to participate in such a historic medical mission.

I believe the specialty of Family Medicine will continue to train clinicians and leaders that well serve our specialty and all of medicine. The future shines bright for our specialty. Thank you for supporting me over the years, and for permitting me to share this story with our members.