Thick and Thin

Taking a stroll around the ward at Craig Joint Theater Hospital here at Bagram Air Field can be kind of a surreal experience at times. If you stop to take notice of some things, it can reveal a lot about our world actually. In the area of the hospital where I work, there is one large room full of hospital beds known as the Afghan Bay. Right next to it is a similar room called the American Bay. The Afghans populate the Afghan Bay and likewise all Americans (and coaltion troops) go into the American Bay. One of the things I have noticed is the stark contrast in the nutritional status of the Afghans versus the Americans. In short, we are thick and they are thin!

The average Afghan is clearly malnourished. They are usually just skin and bones. It becomes very obvious when you pull back their hospital gowns to examine their wounds. There is absolutely no subcutaneous fat on the vast majority of Afghans. They are rail thin. We keep tabs on the "I and O's" of most of our patients. All fluid that goes into the body and all that comes out is recorded. It does not take long to see that the Afghans take in a significant amount less than the Americans. This is partly because the food we offer them is western and is not palatable in many ways for them. But, I think that the Afghans are simply used to taking in hardly anything. Their bodies have adapted. We are taught in medical school that in order to maintain your hydration status, you have to take in "maintenance fluids" based on your weight. The Afghans take in maybe half of this "maintenance fluids" day after day. Yet, they live on.

On the other hand, the average American is overweight. We know that. It's not that much different in the military population surprisingly. The American patients are pretty much always taking in their "maintenance fluids" and then some. We never have to worry about nutrition with these patients. They can have devastating injuries and we know that they will not have any problems healing as long as we in the medical field do our part. In a trauma hospital like we have here, nutrition is highly importaint. The Afghan patients are having lots of post surgical complications. Without a doubt I attribute it in large part due to their malnutrition. You cannot build healthy tissue without the necessary building blocks. It's a real problem. The other docs and I were brainstorming about this recently trying to figure out how we could get the Afghan patients to eat and drink more. We are trying to get them to drink high calorie shakes. And, we recently put out a "chai station" which has tea for them all day long. Chai tea is a big deal here. We'll see if these small changes help.

We have the exact opposite problem in our culture... we eat way too much. All you have to do is go into the staff lounges at the hospital to see this. We have boxes of candy, cookies, chocolate, granola bars, trail mix, hot chocolate, and many other foods with little nutritional value. Food is everywhere. You can't get away from it! At 2 in the morning I will find myself downing a giant peanut butter cookie to reward myself for admitting yet another trauma patient. There is no reaston to do this. But, it is like a reflex. I don't even think about it most of the time. I see food and I eat it. I have to consciously think to NOT eat. On the other hand, we have to practically beg the Afghans to eat more. One day not too long ago I got frustrated with this and launched into an eating pep talk in the middle of the Afghan Bay. It was like Knute Rockne's "win one for the gipper" speech except the message was to just please "eat one for the doctor"! They looked at me like I was nuts. Hilarious.

Alright, I better get off my soap box here. After all, I'm starting to get hungry!