I just got back from a mission with the Marines in the Western Desert. It was interesting to see another part of the country. We flew less than 100 feet off the ground. Near our base we flew over big vineyards with the grapes climbing on a grid of lines attached to poles about 5 feet high. Away from the Tigris floodplain, there was dry scrub. I saw many trench wells surrounded by very green plots of corn and even rice.

We were lucky to fly over Lake Tharthar, the largest body of water in Iraq. Tharthar was created by flooding a large basin containing a much smaller salt lake with flood waters from the Tigris River. When we were out over the lake, all we could see in every direction was water. I could have been flying over the North Atlantic, the scene was the same.

West of Tharthar, the land had more relief than the plains of the east. There were deeply carved wadis and flat topped plateaus. Some of the cliffs were a couple hundred feet high. We crossed the Euphrates river as we flew west . It was a green ribbon cutting through the brown desert.

Near an old Iraqi base, the perimeter was lined with tank revetments and trench fighting positions cut into the desert floor.

Fallujah looms large in all our minds, it will be a hard fight however the outcome is sure. Luckily a majority of the civilians have left the city. Things have stepped up here with more harassing mortar and rocket fire today on our base. When major operations start in Fallujah, we can expect flareups in hotspots around the country and pile on by different groups along our supply routes. Fallujah will likely take weeks as the ground commanders calibrate their offensive.

On a different note, I was interviewed on National Public Radio on Thursday last week about my nature observations in Iraq. While I was out West the interview aired in the states. I had a lot of positive comments from people who appreciated seeing Iraq from a different perspective.

Surf's up in Iraq - Western shore of Lake Tharthar


Trench Well in the desert


Crossing the Euphrates

There's a paper out today in the British medical journal The Lancet titled "Mortality before and after the 2003 invasion in Iraq:cluster sample survey". This paper that estimates 100,000 excess deaths in Iraq since the invasion has been getting wide play in the media and pile on play on anti-war websites.

I've read the paper and offer my opinion on the papers methodology and conclusions.

As my Epidemiology professor was fond of saying. In statistics you can never know the truth, you can only approximate it. The validity of that approximation is dependent on the quality of your data.

I'll leave it to others to analyzed the statistical specifics but I wanted to bring up the point that the much touted 100,000 deaths figure is not set in stone, even to the authors. For example a measure of the certainty is seen in the gigantic confidence interval in the excess death rate (8000-194000). In other words based on their data there is a 95% chance that the range of excess deaths could be as low as 8000 and as high as 194000.

A problem with estimating violent deaths on a country wide basis in Iraq is that violence is very focal, a neighborhood may suffer a disastrous event such as a major car bomb. If a neighborhood like this is included in the survey, representing virtually none of the population, the mortality estimates will be skewed towards being too high. Too me their sampling methodology is not as robust as it needs to be, I'm not sure given the situation there is one that could be. The numbers also fail my first statistical test, the believability test. When the statistics say something that doesn't seem right, its a good idea to look closely at the results. Sometimes a result may be correct, but chance in statistics can be a dangerous thing. Chance alone can produce spurious associations like linking a stock price to the grape harvest in Chile.

According to their data, if Fallujah is excluded as an extreme statistical outlier approximately 90000 of the excess deaths were caused by violence. This would be 6000 people a month for the last 15 months. I just don't see this magnitude of civilian deaths on the ground.

I don't knock attempting to quantify the health effects of the conflict. The war is a a very messy business, everyone suffers. I would agree with the study that infant mortality, at least in some areas went up because women stayed at home to have their babies because of security concerns. Violence also has claimed thousands of civilians. There is no doubt that violent deaths have increased dramatically in some areas. The authors did what they could with the data. Here is a great statement of the obvious from the paper "In this case, the lack of precision [of the study] does not hinder the clear identification of a major public health problem in Iraq - violence" - you don't say!

The authors to their credit seemed fairly rigorous in their statistics and appropriately reported their wide confidence intervals and noted the lack of precision in their data. I cannot ascribe pure motives to the press reports. First many fringe element websites as well as CNN et al. have latched onto the 100,000 number as straight fact and attributed all these deaths directly to the coalition, forgetting the Zarqawis of the world who care nothing about wholesale slaughter. There is also the spurious argument that because only a few thousand people died a year because of Saddam's regime and more people are dying now this somehow highlights the immorality of the entire operation. Very simplistic, flawed logic and very short term thinking.

The most direct route to improved health in Iraq is the quick demise of several thousand individuals responsible for the majority of the deaths of civilians. I reject the argument that coalition military action is the primary public health problem in Iraq.

The sky in the east is orange, the sun will be up in a few minutes. I had the last glimpse of the lunar eclipse about 10 minutes ago as the moon faded into the lightening sky. We were lucky here in most of Iraq, totality came at 5:23 AM, before sunrise.

I woke up at 4:30 and went outside to see a dark bite out of the top of the moon. Over the next hour the shadow progressed, revealing a dark reddish-orange moon with an ever decreasing bright crescent until totality came.

The Blood Moon seems to be auspicious for the Red Sox at least, in the 8th inning they are up. Let it not be so for the insurgents but instead one of impending doom.

Today was an earlier than usual morning for me. I woke up at 3:30 in order to get to the flightline to try to get a seat on a plane for a mission. By 6 AM it was obvious that I was going nowhere. We will have to put in a request and get me officially manifested. Sometimes Space-A works, often it doesn't.

My roommate gave me a 9mm to carry, since its much easier to lug around. This is a good idea in the Green Zone because they have started restricting long guns from certain areas. I suspect this stems from the fact that very few senior officers carry and M-4 or an M-16. Keeping the riff-raff out. Where I'm going I felt much more comfortable carrying my M-16 and over 200 rounds as opposed to a 9mm pistol and 30 rounds.

The plane flying to where I'm going is a small flying box called a Sherpa. They fly less than 100 feet off the ground to avoid enemy fire. By the time you hear the Sherpa it has passed over. An unfortunate side effect is that the risk of bird strike is high and every pilot in theater has hit at least one flock.

On another front, National Public Radio would like to do a story about my birdwatching antics here in Iraq. I talked to the producer a few days ago and we had a nice chat. I have to arrange a good time to get interviewed. Hopefully people can hear that despite the images of chaos and destruction, one can find both peace and beauty here if you look.

In the PX this evening my roommate and I went to pick up prizes for tomorrow's Halloween Bingo. We ate diner at Burger King, the first time I've eaten there since it opened. Some of our guys seem to have reverted to an all fast food diet consisting of Burger King and Pizza Hut commodities. Paper Burger King bags and Pizza Hut boxes fill up many a garbage can around here.

In the checkout line at the PX we met an Australian doctor working in the hospital. She and I chatted about some of the same places in Indonesia where we both had visited.

I'm jealous of my sister. She is in Thailand visiting relatives. Eat some nice weird fruit for me and try some of the roasted termites please. Give some to Mr. Baby too.

We are getting ready for the fight in Fallujah. The timeline is classified but everyone including the insurgents know its coming. It will be a symbolic fight for them and us. A successful outcome is needed to allow elections in the region.

Other than harassing fire we are fairly quiet in our area. A couple of rockets came in today.

I heard of an unfortunate thing that happened this morning. A civilian contractor in his 60's suddenly died while waiting to go home. The Air Force medics tried to use the AED to shock him but his heart wouldn't get going again.

I'm starting to think more about getting back home and getting back to my job. I still won't leave until next year but we have more days behind us than in front. This week my colleagues are attending an annual scientific meeting which we usually attend together and present some of our research findings from the last year. Next month they will be in Miami at the Tropical Medicine meeting....I'll really miss that. It is by far the most interesting meeting I go to. The get together before the meeting has the absolutely best food and drink. I also missed the Trop Med meeting last year because of my mobilization.

At home my wife is expecting our 5th child this spring. Thankfully, I'll be home for the baby. She is doing a fantastic job holding everything together, but it is very hard sometimes. Our friends and family have been very supportive and help a great deal with babysitting, food, cleaning the house, yardword and just being there. I couldn't be doing my job here without their help.

I am sore. The Army 10 Miler went well. I managed to run it in around 90 minutes. The race was well attended with people coming in from some of the outlying FOBs and we even had a few Brits and Aussies.

At the 3 1/2 mile mark we had our first turn around. As I approached the turn the first of the runners came past me running the other way. Way out in front of everyone was a guy wearing a blue shirt with a large Superman symbol on his chest. He was running so fast I first thought he was on a relay team, I was sure he'd fade. He never slowed down, Superman won the whole thing, 10 miles in 56 minutes.

It was a good diversion for a few hours.

The turn-in in Sadr City is winding down and will soon enter the next phase, verification of disarmament by going house to house. Some of the yahoos tried to get a bit more money for removing the IEDs but no dice. In the last few days truckloads of weapons were being turned in. I think the total for anti-tank mines is around 9000, thousands of RPG rounds, mortar tubes and rounds. I've seen the list and it is huge. We know not all the weapons are gone but it is significant progress. After verification a huge public works program will try to rapidly improve the infrastructure and provide jobs to the locals. Unfortunately I have seen little positive in the press about it.

The idiots who kidnapped the CARE director on her way to work have managed to accomplish something. They have somehow got Al Jazeera to criticize them. They had a story in which insurgent leaders in Fallujah condemned the kidnapping as unjustified. I hope things turn out well for her. To date all female hostages have been released but I don't put it past them to break tradition.

The pace of work is picking up. We need to maintain operations while preparing to transition things to our replacing unit. The clinic is busy with routine things like orthopedic injuries and respiratory infections. I will hopefully leave my base a few more times in the coming months on some missions. I enjoy seeing the different parts of what's going on in the country. I'd love to get up into the north. Some of our guys drove up to the Turkish border accompanied by the Iraqi National Guard. They told me the mountains and the rivers were beautiful, a completely different landscape than we have around here.

We are back to wearing all our gear (helmet, Body Armor) when we are outside. Full battle rattle. We have been getting an increased amount of mortars and rockets coming in so the base commander thought it was a good idea.

The insurgents have been for the most part laying very low. We all expect some sort of push by them before Ramadan is over. Our operations are keeping them off balance, though they will get their shots in when they can, like the suicide bombers in the international zone.

Between now and the elections at the end of January is a pivotal period for the country. If we can maintain the momentum, we can tip the balance in the right direction.

At home in the US, the leaves have turned and are falling off the trees, my wonderful wife carries on taking care of our four children. I wish I could be with them. A few days ago the baby pulled herself up and stood for the first time. The other three children clapped and cheered. They insisted that my wife take a picture of all of them together. Its very hard missing things like that but the work we are doing here is important and I don't regret coming here.

Its CQ time again. I get to stay up all night and with my trusty CQ runners, make sure the place doesn't burn down, answer any calls during the night, make sure the generator doesn't run out of fuel, and take people who need to catch flights out down to the flightline.

We had a nice dust storm today when a cold front came through. Sand blowing, covering everything with a nice coat of light brown dust.

Our local guys have returned, there had been some specific threats against workers at the beginning of Ramadan. They are all fasting for Ramadan, as is one of our soldiers who is Muslim. During Ramadan, observant Muslims are supposed to read the entire Koran, which is split up into 30 parts, one to be read each day. There are several special days during Ramadan, some are exclusively observed by the Shi'ia and others like the night of power are recognized by all. The night of power is night they believe the Koran was revealed to Mohammed. The actual night itself is said to be hidden to encourage observance throughout the month however it is often observed on the 27th night.

Ramadan for us is considered a higher risk time because some insurgents see it as an auspicious time for attack. The Koran says the night of power is "better than a thousand months" meaning acts of charity, prayer, etc gain a better than at other times. Some also extend this to "martyrdom". We expect the risk of suicide bombers to be very high around this time at the end of Ramadan.

The push is on to get all the absentee ballots back home. Everyone was encouraged to register and request an absentee ballot and was given every opportunity to do so. I sent mine off in the second week of October. In the chow hall the post office has a notice that they will be flying all absentee ballots overnight express until November 1st. Even if someone didn't get a ballot from their district they have blank emergency ballots that can be filled out and sent in.

All the Red Sox and Yankees fans woke up at 3 AM this morning to watch the 7th game in the series. There were a lot of happy Red Sox fans by the time I got up because of a Red Alert. One of our subordinate units is from Massachusetts and there was undoubtedly mayhem in the clinic this morning.

Yesterday was a pretty relaxing day for me. I slept late and then read Isaac Asimov's I, Robot a collection of short stories revolving around his 3 laws of robotics. I finished that book in a day. In contrast, I've been slowly digesting another book that is considerably denser called Nabokov's Blues. It examines the second passion of literary giant Vladimir Nabokov of Lolita fame. He was a very serious amateur lepidopterist specializing in a group of small butterflies referred to collectively as the Blues. I remember visiting the insect collections at Harvard Museum of Comparative Zoology (MCZ) several times and seeing a small framed photo of Nabokov sorting butterflies over one of the benches where he worked in the 1940's. Its interesting putting more context in that photo and learning about his contributions to butterfly systematics.

Our Jamaican soldiers, of which we have quite a few, have been cooking some good food. One of the guys came back from leave with all sorts of goodies. We had jerk chicken on Friday along with corn meal dumplings and fried plantain, I had some little fruit in the lychee family that somewhat resembled longan which they called guinep. Today they cooked salt fish and akee Jamaica's national dish.

As expected, there has been an increase in attacks since Ramadan started. These attacks continue to be ineffective potshots on our base. Today we had 3 Red Alerts, all the rounds landed outside the wire. To me this means that they are having trouble getting close enough to the fence because of our patrols.

The amounts of weaponry turned over to the police in Sadr City is astounding. We are talking about hundreds of mortar tubes, thousands of mortar rounds and antipersonnel mines and a gigantic array of everytype of other weapon you can imagine from AK-47s to RPGs up to a 500 pound bombs, hundreds of 155mm artillery rounds and hundreds of thousands of rounds of rifle ammo. At first I was skeptical because Sadr has pulled this trick before, using it as an opportunity to rearm. In the past turn-ins we only got a few hundred inoperable old rifles, this time we are getting far more than expected. Its proved so effective that the amnesty program and weapons buy back is likely to be expanded to other parts of Iraq. This is another sign that the locals are sick of the destruction and willing to help clean up the problem.

There has been a theater wide lull in enemy activity for the past week. Attacks are significantly below norms. The conventional wisdom is that there will be a surge during Ramadan as happened last year. Ramadan starts tomorrow.

The insurgents see Ramadan as an all or nothing chance to prove that the Iraqis and coalition cannot maintain security. They will go all out because they know that time is not on their side.
The winter rains will limit their freedom of movement and they know if they can't bring massive destabilization and, more importantly, massive doubt in world public opinion they will fail. If they fail, the momentum of the government and the new security forces coming on line may leave them fatally weakened. We have started an major offensive of our own leading up to Ramadan to blunt their efforts.

Ramadan also happens occur at the same time as the US elections and the start of voter registration in Iraq.

In our neighborhood the bad boys have not been successful in their attacks, it seems that they are having difficulty even getting shots over the wire. The maneuver elements have been sweeping up a large number of weapons caches which appears to be putting a serious dent in the bad guys supplies. To me just the fact we are finding the caches is a positive sign. It means the locals are now more willing to tell us where they are. My guess is like in Samarra and Fallujah they see the insurgency as only affecting them negatively and are acting accordingly.

Today two suicide bombers got into the International Zone for the first time, places that I walked by less than a week ago. It was not totally unexpected. One was the Bazaar area and the other was the Green Zone Cafe. Both areas were off limits to US personnel since a bomb was found at the Cafe by a sniffer dog on October 5.

On our camp, the amenities keep coming. This week both Burger King and Pizza Hut opened on post. The place was swarmed. Personally my favorite place to eat is the Iraqi National Guard chow hall, which is only open for lunch. Last week I had lamb, hummus and Iraqi flatbread along with some excellent Basmati rice cooked by some of the Indian KBR workers. Very few US soldiers eat there.

The weather has been getting milder. Today it only got to 97 degrees. The mornings are in the high sixties, which is perfect. There are a lot more clouds these days. During the Summer there were no clouds for weeks at a time.

This evening we pulled the tables and chairs out on our patio and played bingo with some people from the Air Force.

I've just come back from a short visit to the Green Zone in Baghdad. We now call it the International Zone. I needed to go down for a meeting at Brigade.

Early Friday morning I hopped on a Blackhawk with a few other soldiers heading to the IZ. This time we flew without the windows, which made for a windy ride. The fields on the way to Baghdad now are filled with corn. Most of it is just flowering. We also passed over a huge expanse of date palms, probably a couple square miles worth.

As we passed over the Baghdad suburbs there were big differences between the neighborhoods. Some were slums with little huts made of sheet metal and garbage everywhere, others had large houses with neat gardens and clean streets with Mercedes and land rovers parked outside.

As we approached the International Zone and the Tigris River that bisects the city I saw the first large buildings I had seen in Iraq. The unfinished Saddam the Great Mosque rose like a huge grey monolith out of the city. There were also the highrise hotels, the Al-Rasheed, the Mansoor, and the Sheraton. We passed over the hands of victory monument with the huge crossed swords and the Monument to the Unknown Soldier that looked like a squat flying saucer.

We piled out of the helicopter and made our way to the US embassy, the former Republican Palace. Civilians and military were eating breakfast in one of the hallways made into a dining area. We checked in with some of our folks working there and then took a twenty minute walk up to the place where we were staying.

The building where we stayed was part of a complex of little villas set in a park like area with ponds, green lawns, flowering shrubs, luxurious trees. This area used to be the stomping grounds of some of Saddam's closest cronies.

The IZ is an area of several square miles with controlled access, making it a bit safer than some other parts of Baghdad. Unlike other Bases where we operate, over 10,000 Iraqis live in the International Zone. Street crime is sometimes a problem. One guy working at the hospital was recently stabbed and barely made it. It is recommended that people travel in groups, have a magazine in their weapon and avoid traveling at night. Private security guards are everywhere checking IDs and controlling access to compounds.

I spent an hour wandering around the gardens and the ponds. There was a small palace I visited overlooking the Tigris. The ponds had a resident flock of domestic geese that made a racket when I walked by them.

My stay was not without incident. During one of my meetings we heard an explosion and the entire building shook violently. We all moved to an internal hallway. The lobby of the building was filled with local women in colorful pastel headscarves taking cover. People said they thought it was a car bomb, but we later found out that a 107mm rocket had impacted on the otherside of the building within our compound. The explosion killed 3 Iraqi security guards and injured a soldier. Unfortunately the bad guys still sometimes fire into the area.

When I was not at my meetings I walked around a saw some bombed out palaces and ornate gates. At the end of one road was a checkpoint called "Assassins Gate" where multiple car bombs have gone off trying to run the barriers. The area I was walking around was the target of the "shock and awe" bombing at the beginning of the war.

Early one morning I made the mile or so walk out to the Monument to the Unknown Soldier and to the Hands of Victory parade grounds. An Iraqi policeman gave myself and another soldier a private tour of the monument. The structure is like a big pancake with metal ribs and a clamshell sheltering a glass and metal box containing a stainless steel sarcophagus of an unidentified soldier from the Iran-Iraq War. From the top of the monument we had good views of the city, still shrouded in morning fog.

We flew out of the IZ at night. As we walked to the landing zone there was a lot of small arms fire on the far side of the Tigris. We waited a while at the LZ and chatted with an SF officer who agreed that the International media is a big problem and seems bent on seeing only the bad. In Samarra they took a news crew into the mosque after the Iraqi Special Forces secured it, showing all the weapons captured and the fact that they hadn't done any damage to the structure. The news crew apparently had other plans for their story about collateral damage and Coalition Forces overkill. Mayhem sells.

The weather was weird and we had a little rain and a lot of lightning. Flying out of Baghdad was visually impressive. The lights of the city spread out beneath me in every direction. A couple times a minute the city would be lit up by a flash of lightning.

It was good to get back to my home base. Its a little bit less claustrophobic than the International Zone.


Corn Fields


Baghdad Suburbs


Park behind my house


Gate on the road to Monuments


Monument to the Unknown Soldier


Closeup of clamshell and sculpture containing the sarcophagus


Hands of Victory parade grounds

This morning we had our PT test. Its not a requirement in a combat zone but since we have the opportunity we took one. As we were waiting to start the run I was watching 3 white storks circling above us. We heard a loud boom and the red alert siren so we all sprinted to the motor pool building and hung out until we went green. Afterward we finished the run. I came in a minute slower than last time, but I also had a few less red blood cells.

The temperature is still getting up over 100 during the day. Yesterday was a bit weird weather wise. The morning was overcast and cool. It even sprinkled a few drops.

I've noticed some Samarra spin regarding civilian carnage and the locals not wanting us there. I know some civil affairs guys going up to Samarra for a couple of weeks so I'll have first hand accounts. They are very annoyed at the international press on the coverage of what they consider a very successful operation that the locals welcomed. As usual the press is for the most part staying bunkered up in Baghdad and sending local stringers up to get the story, mostly short on objectivity.

I met some people from a forward surgical team today. The poor guys have been here for 9 months and now have been ordered directly to Afghanistan. The FSTs or Fast Teams as we call them are unique small units that bring Trauma Surgery and ICU capability to the battlefield. They set up operating sites in remote areas and stabilize patients unit they can be evacuated.

Around midnight last night a blood call came over the radio. Since I was the type they needed I went over to the field hospital and gave a pint. Because platelets only have a shelf life of 5 days the blood bank doesn't stock any. When a patient needs platelets on our base they are given fresh whole blood. Not the ideal situation, but better than nothing. Other higher level facilities have plateletpheresis machines that can separate out platelets.

Because I have been in an area endemic for both Malaria and Leishmaniasis I will be deferred from donating blood for a year after I leave, as will all the military personnel in Iraq. The reason I was allowed to donate here is because everyone is exposed here and finding a non-exposed donor is impossible. Most of the packed red cells and plasma we use here are collected in the US and shipped. Local donors are just used when platelets are needed or in the event blood bank stocks are depleted. This happened in April when the hospital had 100 traumas in 24 hours.

I have a PT test on Wednesday. We'll see how I do on my run. I'm not expecting any world records. Yesterday I ran 7 miles so I'm not too worried. At the end of the month I'll be running in the Army 10 miler.

Statements made by myself and others about Samarra are being taken to task by some in light of the new combat operations there. I will make some clarifying remarks because some people like Kos have characterized positive statements as blatant propaganda with no basis in fact.

I said that Samarra was a symbol of progress because we had been expecting for months that the place would be another Fallujah-like stronghold. The insurgents had free reign from May until September because our focus was elsewhere and they were relatively contained. The fact is that we were pleasantly surprised when it became apparent that large numbers of the insurgents, including foreign fighters were drummed out of town or at least laid very low because the residents were fed up.

The 1st ID did roll unopposed into the middle of the city and met with the new city government. This does not happen in a city under the control of insurgents. Facts on the ground started to change in the past 10 days. There were indications that some of the insurgents were returning. We knew that there were a few die-hards remaining and laying low who would need to be kicked out by force, the time was deemed right to carry out a large scale city wide sweeping operation, planned months ago. The characterization of progress in Samarra still holds. There are pockets of resistance that do need to be eliminated. I expect less than a week of fighting. The government reported over 80% of the city under control by this afternoon. Not exactly massive resistance. Then again, the Iraqi army commandos stormed the famous Golden Mosque early on, precluding another protracted Najaf-like standoff at a Shi'ia holy site. We learn, we adapt.

The real story remains that the people of Samarra chose to take things into their own hands and make the insurgents at the very least unwelcome, many did leave. The Samarrans chose and we are more than happy to help them. To use the clearing operation of a few hundred insurgents in a city of over 100,000 as a rallying cry for some peoples beloved idea of our descent into chaos is based largely on corrupt wishful thinking. The situation is not static, nor do we expect it to be. We have setbacks and disappointments, like the return of some insurgents, but my assessment of Samarra is much more success than failure. I think the maneuver element commanders would agree.