Lieutenant Colonel (Ret.) David P. Ferris deployed twice to Afghanistan in support of Operation Enduring Freedom, in 2003 (for a year) and again in 2006 (for 15 months). Based out of Bagram, Ferris had come from the US Army Special Operations Command (USASOC) Command Surgeon's office ultimately to lead the cooperative medical assistance efforts as well as functioning in both operations and logistics. Cooperative medical assistance provided a range of medical - including enormously influential veterinarian services - service, training, mentoring and coaching in accordance with a shifting scale of need and preparation. The state of host nation medical capacity in Afghanistan was austere, according to Ferris, as was the general appreciation of US and coalition military commanders of how to integrate medical outreach in a civil affairs context. As Ferris observes, if a manual existed for providing medical support under these operational and strategic circumstances, civil affairs should write the doctrine. In the largely rural and agricultural Afghanistan, providing veterinary medicine outreach proved to have outsized influence in terms of convincing the Afghan population that they could come forward with information - in an instance noted, revealing the existence of a very large munitions cache - though not in a quid pro quo. Providing cooperative medical assistance was a complex mission that required balancing an assessment of indigenous capacity (generally limited to non-existent) with an understanding of the commander's intent as well as integrating other elements of support, like those from the US Agency for International Development or various non-governmental organizations. Ferris stressed that it is critical to understand that medical action and care in support of counterinsurgency and stability operations have to be viewed not through medical lenses but though civic action ones.

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