Thursday, January 20, 2011

Army Reserve and National Guard Suicide Rates

Interesting reports today about increased suicide rates in the Army Reserve and National Guard. I haven't looked at the actual data, but I wonder if the rates are actually increased or if the reporting has improved both in terms of quality and quantity, hence we now know more about the population. We don't actually know that much about the Reserve and National Guard population because it is so transitory. It only gets together one time a month. Units are being filled with people from various parts of the US for deployment then split up again once everyone comes home.

I can say that I dearly miss the colleagues I served with in Afghanistan. We are spread across the Southeastern US, rather than in a one-block radius on a military post in Kabul. Many were added to my reserve unit at the last minute--me included--and we were the "loose ends" group, as one of my friends called us. Always behind in training, always at late night sessions trying to catch up while the rest of the unit prepared. I don't know if their mental health is poor--they are too far away, and I am too consumed with getting myself back to work to tune in to them. We have texted and called for brief chats. Amazingly, I didn't have time to have a "social" life in Afghanistan, working 16 hour days, but I knew that they were always there. Funny people with vivid interesting lives, doing the best they could do in a hard environment. And now there's a little hole where they were. I'm back at work in a supportive environment, with super colleagues. But most have never worn body armor, fired an M4, run to catch a helo carrying 40 pounds of gear in 120 degree heat while herding frightened Afghans and trying to act like the situation was all normal, or worse yet, stood at a memorial for 5 young soldiers killed by a crazed attacker, or hung out with a 3-star general at 1:30 in the morning and listened to his stories of other's bravery and loss, watching him weep and laugh under the pallid flourescent lights. While I'm glad to be home, it's just a different world, with its own demands and rigors. If you come home and don't have support, I can see where your spirit would nosedive.

Wednesday, January 19, 2011

war or health?

Blood and Milk Blog

So, I'm slow on the uptake here. I just figured out that there's a brilliant blogger who has been blogging about International Aid and Public Health for quite a while, and who has even contributed comments to one of my rants. Check out the Blood and Milk Blog for some good reading.

Tuesday, January 18, 2011

The Great "Pointing of Fingers" Game: USAID and NGOs versus DoD.

The Washington Post ran a series two weeks ago about the issues surrounding the military's use of the Commander's Emergency Response Program monies to rebuild Iraq and Afghanistan. Nothing new was divulged--the program is unproven and therefore subject to attack. There is no real strategy for its use, and examples of wasted effort abound. Ho hum.

A letter to the editor appeared in response to the articles, which I have copied:

Washington Post
January 11, 2011
Military-Led Aid Projects Doomed To Fail In Afghanistan
It is no surprise that military aid projects in Afghanistan are "crumbling under Afghan stewardship" ["In Afghan hands, aid projects neglected," front page, Jan. 4]. The troops are armed with good intentions, but they often neglect basic development principles, owing to a lack of expertise on aid and mounting military and political pressures.

Afghanistan's National Solidarity Program is a better alternative. Under this proven model, called "community-driven reconstruction," local engagement and accountability are as important as bricks and mortar. Afghan staff members from agencies such as mine help organize village groups and determine what they need most and who will be responsible for the viability of a school, clinic or road. It's laborious work that emphasizes local knowledge and local ownership as well as sustained commitment - indispensable if Afghanistan development is to have any hope of success.

Military-led projects erode established humanitarian principles of impartiality and independence, fail to win hearts and minds and - we now know - are ineffective. The White House, the State Department, the Pentagon and Congress need to act on the growing evidence showing that the militarization of aid is folly.

Michael Kocher, New York
The writer is vice president for International Programs at the International Rescue Committee.
Editor's Note: The article by Josh Boak appeared in the Current News Early Bird, January 4, 2011.

The author is elegant in his ability to touch on all the "points" against DoD, making bizarre assertions based on faulty assumptions that are oft repeated. For example, in his editorial about Afghanistan, Mr. Kocher claims that "military-led projects erode established humanitarian practices...". I wonder if Mr. Kocher realizes that there is a war in Afghanistan? The military is not engaged in trying to influence the social development of Afghanistan for humanitarian reasons, but rather as a way to win the counter insurgency.

Second, the Afghan National Solidarity Program is not "proven", nor is it an alternative. Afghanistan is not a landscape that can only contain EITHER the military OR the Afghan National Solidary Program as the author seems to assert. And particularly since neither program is proven.

Finally, the conclusion that Congress et al should act on 'growing evidence' against militarization of aid is quite a leap of logic. Wait, I thought we were talking about Afghanistan?

The continued rhetoric from USAID and the NGOs against the military is provocative, for sure. However it's not neccessarily productive. What is needed is less provocation and more serious analysis and discourse about the complicated context we find ourselves in. The continued claims against the military's effectiveness at 'nation building' are well worth investigating. The pragmatic problem, however, is that there are no alternatives regardless of what any analysis would find. For example, in Afghanistan, it was my experience that USAID wouldn't work in areas which are too unsafe (undefined), and they also won't work in areas which are too safe and developed as it would be a waste of resources. Sure, the military is inefficient and cumbersome and makes mistakes. Inexpert. But what's the alternative? The cries from USAID and the NGOs would be more effective if they were backed up with an alternative course of action that is proven and effective. As the book "The White Man's Burden" describes, we have spent billions in aid and assistance, and yet the world seems no more friendly nor less impoverished.

Friday, January 14, 2011

War and Health blogs

You've got to hand it to War and Health/Conflict Health guru (nearly as insane as being called a "Drug Czar") Chris Albon. PhD candidate and world traveller, Chris has NEVER missed a beat. While I was contributing to the mire in the land-of-no-internet (aka a NATO command in Afghanistan), Chris was in South Africa with an equally challenging lack of internet access. The difference was that he somehow managed to maintain his blog and I did not. This editorial, highlighted by Chris is really interesting:

Hats off to the brilliant Chris Albon. Read Conflict Health early and often. There aren't many blogs with such high quality and relevancy.

Mortality rates decrease in Afghanistan

The New York Times has an interesting article about the reduction in mortality rates from injuries in Afghanistan.

Thursday, January 13, 2011

News Flash: Climate Change will cause Disease

So, the drum beat of disease as a national security threat continues. Nothing new in this piece in the Kansas City press (click on title), but I have Laurie Garrett's book, "Betrayal of Trust" here on my desk in line to be read. It will be interesting to see if this crescendos -- issues seem to wax and wane.

New Assistant Secretary of Defense for Health Affairs

Dr. Jonathan Woodson has finally been confirmed as the new Assistant Secretary of Defense for Health Affairs! This is good news. TRICARE is the largest health care system in the world and the Assistant Secretary runs it, as well as the extended rest of the military health system. There is mounting pressure to reduce the costs of providing health care services to beneficiaries (which number around 9.6 million and include soldiers in Afghanistan, retirees in Germany, and families here in the states). The acting secretaries (which have been numerous) can only 'stay the course' and not make any significant changes. Hence any reform is nearly impossible. So it is good news that we finally have someone appointed, and shame on Congress for taking so long as Dr. Woodson was nominated in April of 2010.