At the beginning of August 2021, during the early stages of opening my practice, I decided to take an opportunity that I would be forever grateful for. The organization International SOS was looking for physicians and other health care providers to join a massive once-in-a-lifetime operation at Fort Lee military base. At the time, the country was attempting to end the war in Afghanistan quietly. We were told that there would be a few thousand interpreters with the families that would need immigration physicals at the base prior to being resettled in different communities around the country. The immigration medical exams are required for immigrants and refugees to identify health conditions that may make them inadmissible to enter the U.S. Typical conditions include communicable diseases and mental disorders associated with harmful behaviors. These exams can only be performed by a physician, which meant that we were urgently for this operation. Within a week of learning about the opportunity, I was on my way to Virginia. Upon my arrival, I came to realize that I was one of the first three civilian physicians on the mission. The first few days were mostly setting up field tents as our command center and medical area. I met some incredibly hard-working and devoted medical providers, EMTs, pharmacists and nurses. I was impressed by how fast contract workers could set up a new tent, provide Wi-Fi and stock the entire area with supplies. All of this was done during the hot and muggy summer days in Virginia. The staff was trained on the workflow and the few medical emergencies that we could possibly encounter. COVID complicated things as it usually does, since every refugee needed to receive a COVID vaccine and test on arrival five days after their arrival. Initially, most “visitors” (as they were called) stayed only three to four days since their accommodations had already been arranged before their arrival. After a few weeks of minor chaos and disorganized and under-resourced medical care, we finally achieved a workflow that accomplished the goals set forth by the military. However, by August 16 — things got real. As everyone in the country would soon find out, this was much more than a small assignment. Images of evacuations at the airport in Kabul and teenagers falling off military planes stunned the country. Where were all these unplanned refugees going to end up? The base could hold 2,000 visitors tops at the hotel where they stayed. We were hearing reports of 90,000 refugees stuck at locations across the world. The military kept us in the dark and put much of the mission on hold while they figured out a plan. Meanwhile, our guests needed medical attention. The initial four-day stay was now indefinite. At one point, it seemed like every visitor had a stomach issue. It was not like they were being provided our finest dining. Our medical tents had over-the-counter medication and a few options for antibiotics. As providers, we could write a prescription to CVS, but since the refugees barely had identification, let alone health insurance, CVS was not willing to front the bill for their medications. At best, we could get them a generic blood pressure medication. I have worked with Medicaid patients for my entire career, but this was a completely new level of lack of access. Emergencies were treated as such, and anyone needing life or death attention was transported to a hospital. The language barrier was another challenge since English was not a commonly spoken language, although many of the refugees were Afghan interpreters who did speak English. When things became chaotic, we saw fewer interpreters. We did hear stories of people worried for their loved ones back home. We would listen to the anxiety in their voices about not knowing what was happening or getting firsthand accounts of what the experience really was like in Kabul. Anxiety was a common complaint, yet without therapists and anxiolytics, what could I really do other than listen and empathize? This helped some but may have been a waste of hours waiting to see a doctor for others. Meanwhile, we still had the pressures from the military to provide immigration exams. This was a rollercoaster of emotions with long periods of downtime followed by brief intense periods of scrutiny and blame. The actual exam was a basic exam that a first-year medical student could complete without difficulty. Somehow, we always seemed to do something wrong that caused a stir. We worked alongside the Air Force doctors who had to leave their practices in San Diego at a moment’s notice to spend an unknown amount of time in Virginia working on this assignment. I was in awe of the life of a military physician. As my time in Virginia was winding down, I had already made some new friends and reacquainted with an old one. I had convinced my co-resident from residency at the Institute for Family Health in Harlem to join me. Luckily, Dr. Afari Dwamena had some time in his schedule and was passionate about this work. Anyone who has gone through residency knows that getting to spend a month with a former colleague and friend is rare and special. We went through a difficult experience together which made the time pass effortlessly. At some point, I was starting my practice and would need to return to Tampa. After a few weeks in Tampa, the locums agency reached out to me again. This time they were requesting that I return to the mission at a different base in New Jersey. The military was constructing a refugee camp at the Joint Base McGuire-Dix-Lakehurst near Trenton. The “visitors” would have the same urgent care needs along with immigration physicals. This base was much larger than Fort Lee. Fort Lee had about 1,500 visitors. By the time I arrived in New Jersey, Fort McGuire had 15,000 Afghan people waiting to be relocated to various parts of the country. They were living in a small town of their own. At least half of them were children who did not know what was going on, only that they were now in America and could play all day freely without the threat of any danger. Although the refugees were stuck without any idea of when they were leaving, they seemed happy. They were surely having more fun than I was. Life still had to go on. Weddings, religious ceremonies and festivals were a common aspect of life on the base. Medical care was still subpar and difficult. There was a high turnover of doctors and nurses and no real way to keep medical records. Medications were in short supply. When in doubt, I had to just give the patients 20 tablets of ibuprofen, Tylenol or Pepcid and hope for the best. Yet every patient was grateful. I had never been a part of a national news story. Yet, for about a month this summer, the front page of every news outlet had a story connected to the work we were doing. What the Army, Navy and Air Force did in such a short period of time was a minor miracle. I’m a better person for having witnessed what can be accomplished when we come together to help a community in need. The temporary job allowed me to keep the lights on at my practice. The permanent experience gave me a sense of purpose in treating people in need of help. Source
