SMHS grads serving in North Dakota’s Army National Guard describe their experiences in Iraq and Afghanistan—and how neither place is as different from home as one might think.
Nearly 5,000 miles separate Bismarck, N.D., from Iraq’s arid Babil province.
Despite this distance, the two locales are more alike than not— at least if the arbiter in question practices emergency medicine.
“There are similarities—both are rural areas, far from tertiary medical centers,” admitted Craig Lambrecht, retired member of the North Dakota Army National Guard and former president of Sanford Health – Bismarck, from his office in the state’s capitol city. “We rely on first responders here, just like on the battlefield. And both regions focus on stabilization and getting the patient to a definitive care environment where care can be delivered. This might mean air evacuation or providing care right there in the field.”
Lambrecht’s colleague Todd Schaffer agreed.
“We do everything [in rural North Dakota]—ER work, nursing home patients, clinic patients, hospital patients,” said the physician over the phone from Bismarck, comparing his medical training in North Dakota with his Guard experience abroad. “That really served me well to get ready for combat where you may be the only person responsible for the health and well-being of anywhere from 1,000 to 3,000 soldiers.”
Both physicians-soldiers should know: they are among the several UND School of Medicine & Health Sciences (SMHS) graduates who followed up their medical training in North Dakota by practicing medicine on the battlefields of Iraq and Afghanistan with the Army National Guard and/or Army Reserve in the last two decades. And both credit the experience with molding them into the health professionals they are today.
A native of Wishek, N.D., Lambrecht joined the Guard in 1983, just after learning he had been accepted into the UND School of Medicine & Health Sciences MD program.
After graduating in 1987, the future health system president began an emergency medicine residency in Wisconsin. It was there that Lambrecht learned his unit was being deployed to Kuwait.
“I was in my senior year of residency when the first Gulf War broke out in 1990,” he said. “I wanted to volunteer because I thought I had skills that could be beneficial. Our residency director Joseph Darin, who was a Vietnam trauma surgeon, told me to go—even though I wasn’t yet fully trained in emergency medicine. So, I went.”
Lambrecht was sent to Texas for a month to train and was literally on the runway waiting to take off for Kuwait when the conflict ended and his team was told to stand down. He was given a similar opportunity a decade later, though, when the United States again found itself in the Middle East.
Deployed to Iraq in 2004 and 2006, Lambrecht served as the senior medical officer and field surgeon for his Guard unit at an outpost 80 miles south of Baghdad called Scania.
“Well, I’m an adrenaline junkie,” Lambrecht admitted. “From a medical training standpoint I was eager to make a contribution. What I had no idea about was the emotional component unique to soldiers in an environment like that—where you’re getting shot at and have to shoot back. That’s the stuff you don’t realize until you’re there and it really affects you.”
Such experiences also affect how medicine is practiced back home, said Lambrecht, describing how the military has always led the way in updating best practices in the emergency setting.
“For example, tourniquets are crucial to the survival of people on field,” he said. “But if you look at what happens in the civilian setting, you hear that people are trained to be careful— not to have tourniquets on too long or too tight or the extremity won’t be viable, and so on. Well, if you have someone bleeding out you just have to tie off whatever you can. And because of the experience we had in Iraq and Afghanistan [with urban warfare and roadside bombs], the pre-hospital and emergency worlds are attuned to what we learned there. So a simple thing like protocol for tourniquets has shifted a bit back home.”
Lambrecht calls this “freedom” to do what is needed for people on the battlefield a breath of fresh air.
“That was one of the joys—it sounds strange—of practicing in a war environment: you just get to do the right thing, now, with extraordinarily well-trained people that just own the situation and run to the point of contact. It is an incredible environment to practice medicine in.”
For Carrington, N.D., native Todd Schaffer, who has served in Iraq, Afghanistan, and Ghana, the poverty of resources in such surroundings made him a better physician as well.
“You bring that mindset home after practicing in an austere environment,” he said. “Here we have literally every technological advance at our fingertips—CT scan, MRI, blood work back in an hour. Over there—say Ghana—there was no blood work, no X-rays, nothing. You had what the patient told you and your exam skills. In Afghanistan, you might be able to draw blood, but you might not get results for a week or ten days, if at all. So you learn to prioritize and ask if you really need something, which makes you better with your exam skills.”
SMHS graduate Todd Schaffer, MD, in Afghanistan, 2010
After graduating from the SMHS in 2002, Schaffer, who enlisted in the N.D. Army National Guard in 1992, began a family medicine residency in Grand Forks. Earning his full commission in 1999, Schaffer went on to play many roles overseas—including battalion surgeon and staff physician— before taking on more responsibility as Commander of the Guard’s State Medical Detachment. In addition to practicing privately in Bismarck, today he is the N.D. Army National Guard’s State Surgeon, a role previously held by Lambrecht.
“I always had the idea in my mind that I’d join the Guard,” continued Schaffer, who earned a degree in pharmacy from NDSU before matriculating with UND’s medical school. “I like going into the field, rolling in the mud and dirt. So I decided to join in part to help with school, but mainly to serve my country. I truly believe we need to give back.”
Although not involved in direct combat operations “outside the wire” in Iraq and Afghanistan, Schaffer’s team nonetheless took much fire, and he treated a variety of injuries and health conditions on soldiers and civilians.
In the Army you have to “care for everything from common complaints—ankle sprains and back pain—to more serious things like combat trauma,” he quipped, explaining how he wasn’t presented with too many surprises, perhaps with the exception of leishmaniasis, a parasitic disease spread by sand flies. “I’ve been extremely pleased with everything I’ve encountered [in the military]. The Guard has shaped itself into an operational unit at the forefront of units ready to go out at a moment’s notice. What we do is not about us—we’re there to support the soldiers and help them do their job.”
Exactly the sort of thing you might expect a physician in Bismarck to say about any patient, civilian or otherwise.