Enrique Luna: Nursing Student Contributes to Emergency Medical Unit in Afghanistan

While many students in the School of Nursing are already working in the medical field as they earn their bachelor’s or master’s degree at California State University, Dominguez Hills, Enrique Luna is experiencing what will probably be the most challenging assignment. Capt. Luna, a registered nurse and CNOR (Certified Nurse, Operating Room) is currently working at the Salerno Hospital in Afghanistan. He has been assigned to the outpost near Khowst for the last nine months, where he has helped to provide aid, care, and treatment for wounded and sick United States and coalition troops as well as participating in humanitarian efforts by assisting cases that the local hospitals cannot handle.

Although Luna relies on nearly 20 years as a hospital corpsman in the Naval Reserve and 11 years as an RN, he says nothing truly prepared him for the May 13 suicide bombing that took place outside of Camp Salerno. It was “one horrific day I will never forget,” he says.

“Medical institutions in the United States, both civilian and military, train for mass casualty incidents but will never know their degree of preparedness until [an] actual event happens,” Luna says in an email interview. “We quickly adapted to the circumstances and did an outstanding job of saving many lives that day. Lessons learned from this... will only improve our preparedness and performance for the next time this happens.”

The threat of the “next time” is something that Luna and the Combat Support Hospital (CSH) soldiers at Salerno Hospital have to live with each day. He says that the hospital’s commander, Col. Cynthia O’Connell, makes a great effort to alleviate the stress as much as possible through maintaining a positive work atmosphere.

“Stress is dealt with by many means at Salerno Hospital, much of it being humor,” says Luna. “Think of Hawkeye Pierce and the gang on ‘M*A*S*H*’. Our leadership is very accommodating in letting us vent and decompress by allowing a certain degree for individual expression, with relaxed uniform standards within the confines of the hospital building, unique departmental decorations, and BBQs and [sport] competition days. The stress builds up every day but the commander's ‘finger on the pulse’ allows us to stay human.”

Another challenging aspect of the job for Luna and his colleagues is administering medical care while being sensitive to the cultural mores of the Islamic population in Afghanistan.

“As a health care provider, you must accept that every aspect of an Afghani’s day-to-day life is dictated by Islam,” he writes. “For example, while we are trying to expose their injuries during trauma resuscitations, they will make every effort to cover themselves up no matter how badly injured they are. Also, their nutritional intake is hampered by an apprehension to eat the meals that we provide, even though we take full measures to [follow] their dietary guidelines.

“You must adapt to their way of thinking... and just accept things as they are in order to get your job done,” Luna continues. “The knowledge and experience I have gained here can help me be more open-minded and accepting of the different array of patients back home...more so than when I left. [We] just treat patients with dignity and respect [and] don't take anything personally.”

Amid the war-torn atmosphere, Luna and the hospital staff also perform more routine treatments. Salerno Hospital houses a daily local national clinic where U.S. military physicians work in conjunction with Afghani doctors to provide follow-up care and consults for post-surgical patients, and procedures such as pediatric splenectomies due to β-Thalassemia (a blood condition that causes anemia), thyroidectomies due to iodine insufficiency, and the treatment of burn injuries. Luna has served as the officer-in-charge of the operating room, emergency section, and the clinic. He credits his education at CSU Dominguez Hills with enhancing his abilities as both an RN and a military officer.

“My leadership and departmental management abilities have been greatly enhanced by incorporating my knowledge gained from MSN courses such as healthcare policy and economics and nursing ethics,” he says. “I approach and assess my patients here the same as I did during my clinical rotations for community/public health, home health, and health assessment. I [now] have a lot of valuable knowledge and insights to share with classmates and instructors with respect to practicing nursing management and leadership under austere conditions.”

Out of the 30-plus CSH soldiers at Salerno, Luna says that half are students with many completing their degrees via online courses or through the camp’s education center. Luna looks forward to returning home to San Diego in August and resuming his online studies at CSU Dominguez Hills. He thanks Dr. Carole Shea, coordinator of the MSN Pathway program for enabling him in both his academic and military careers.

“Being young and immature, I didn't earn the greatest grades as an undergraduate student,” he says. “I am grateful to Dr. Shea for giving me the chance to prove myself in this demanding program. She has been wonderful by offering advice and encouragement and is graciously supportive of my military service.”

Luna has had two previous deployments in support of Operation Iraqi Freedom and Operation Enduring Freedom as a U.S. Navy hospital corpsman in Kuwait and Iraq, arriving five days before the 2003 invasion of Iraq. This is his first deployment with the U.S. Army.

An alumnus of San Diego State University with his bachelor’s degree in psychology, Luna earned his associate degree in nursing at Grossmont College in El Cajon, Calif. in 1998. He says that his choice of CSU Dominguez Hills’ online MSN program was based on the university’s reputation as “one of the innovators of online education.”

“I've met and worked with many RNs who earned their degrees from [CSU Dominguez Hills] and they had nothing but praise for the nursing program. In addition, [the university] is on the U.S. Army's list of ‘Recommended Online Schools.’ All these things made CSU Dominguez Hills the perfect choice for me to pursue my educational goals.”

- Joanie Harmon

Photos above: Combat support hospital (CSH) soldiers run to unload an incoming MedEvac carrying wounded to Salerno Hospital.

Combat support hospital soldiers treat a five-year-old Afghani girl was riding a motorcycle with her father and two brothers on Thanksgiving Day when they ran over an IED (improvised explosive device). Her father and one brother were killed by the explosion, which left her with deep lacerations and her other brother with a mangled leg and missing forearm.

Luna writes: "She had the presence of mind to get up and run back to her village to fetch her grandfather for help... this poor man saw his dead son and grandson but was able to carry his granddaughter and injured grandson back to their village. I still get emotional... recalling that day and Thanksgiving will never be the same for me again."

(L-R): Staff Sgt. Anthony Jones, medical technician, United States Air Force; col.Robert Monson, certified registered nurse anesthetist, U.S. Army; Lt. Col Kevin Von Fricken, cardiothoracic surgeon, U.S. Army; and Sgt. Rayven Carlos-Vidal, medic/licensed vocational nurse, U.S. Army.

All photos courtesy of Capt. Enrique Luna