In August 2005, I was one of several NPs on a yearlong mission to serve as medical advisers to the Iraqi Army. We were part of the Coalition Military Assistance Training Team (a section of the Multinational Security Transition Command-Iraq), which was tasked with training and equipping the Iraqi security forces. I was assigned to a 10-man team on a small, remote base named K1 on the northern outskirts of Kirkuk. I was the senior medical adviser to the base clinic, which provided complete laboratory, pharmacy, radiology, and dental services. Two other medical advisers and seven nonmedical personnel completed the team.

Training and equipping the clinic's Iraqi nurses, medics, and physicians with American medicine and equipment was sometimes challenging. Because some of the equipment wasn't designed for local use, we had to be creative in adapting it to the Iraqi environment: the air and water were often compromised by dust and other contaminants, and the electrical generators were unreliable, resulting in power surges and outages. One striking example of a field-expedient solution involved the clinic's portable ventilators. When the clinic ran out of the necessary tubing, we got one of the ventilators working again by adapting suction tubing and using a makeshift connector. To make the connector, I whittled a nonessential hard-plastic part from the suction equipment into the required shape with a pocketknife.

During the early days of the clinic's operation, the local medical supply warehouse, run by the Iraqi Ministry of Health, provided inadequate supplies of antibiotics and pain medication. We had extra vehicle first-aid kits. I convinced the clinic director to offer several kits to the warehouse manager in exchange for the drugs we so desperately needed. The first-aid kits were such a hit that we were able to trade them for a three-month supply of medication.

I learned early in my military career that making friends and networking enables you to get things done in times of need. During my tour I made a concerted effort to get to know members of the U.S. Army's 101st Airborne Division and a U.S. Air Force contingent stationed at Forward Operating Base (FOB) Warrior, who also had missions at K1. On my trips between K1 and FOB Warrior, I made it a point to visit all my contacts. These relationships proved helpful when I had to address the difficulty of hazardous waste disposal. The local incinerator was 15 miles away over dangerous roads-the terrain was rough, and ambushes and roadside bombs were common-and disposal fees were excessive. Learning that a surplus portable incinerator had arrived at the FOB, I quickly arranged through my contacts to have it transferred to the Iraqi Army at K1. I hired two Iraqi civilians, a plumber and an electrician, to connect the incinerator to the clinic's generator. After some creative electrical work-lacking a connecting cord, the two civilians scrounged electrical cables from old buildings and spliced them together-the clinic soon had an operational incinerator.

We also put the Internet to good use. For example, the clinic also served as an equipment supply point for surrounding units. Three Land Rover ambulances destined for one of those units arrived and were not combat ready: each lacked a full set of keys to its doors, including the door to the rear treatment compartment. I located the Web site of the ambulances' manufacturer in neighboring Turkey and e-mailed the company with the assistance of my Turkish interpreter. We made the $50,000 ambulances fully combat operational by having three new sets of keys express delivered to FOB Warrior.

Americans are not the only ones to use field-expedient measures. Several of the Iraqi Army ambulances at K1 were used to transport patients over dangerous roads to hospitals in Kirkuk. To make the ambulances less conspicuous to insurgents, the Iraqi clinic director exchanged the license plates for the kind used on civilian ambulances. He also ordered his soldiers to wear civilian clothes during transport missions. As a result, no clinic staff or patients were injured during these missions.

I agree wholeheartedly with author Mary Sarnecky that it takes attributes such as flexibility, creativity, audacity, and pragmatism to solve unconventional problems. I would add this motto: Never take no for an answer-keep asking until you find the person who says yes.

Curtis Aberle, MSN, RN, APRN,BC, FNP

Major, U.S. Army, staff family NP at Brooke Army Medical Center, Fort Sam Houston, TX. Contact author: [email protected]. The opinions expressed in this article are those of the author and do not necessarily reflect the views of the Department of the Army or the Department of Defense.