Rumors began flying early in the day about a visit from a "DV". Much of our staff was asked to show up at 1900 hours for a trip to the flight line. I was scheduled to work that night, so I was exempt. I asked the question, "What is a DV anyway?" Of course, that would be distinguished visitor you moron Hayes! Someone said it might be an actor from "The Sopranos". Big deal. Maybe it would be Jessica Simpson coming. Now that would be something... NOT! I came into work at 2000 hours for the night shift and the rumors were still rampant. The latest was that it was someone very important coming, perhaps the President.
We began making preparations for the visit. The hospital ward is usually overrun with Afghan patients. We were asked to move many of these patients to other rooms so that all the Americans were in one area. We had 5 patients involved in IED blasts who were strategically placed at the front of the ward. At this point, we were told that several patients would be receiving purple hearts. One of the patients was laying there in bed with head phones on in a pair of red and white stripped boxer shorts. I asked him kindly to please PUT SOME PANTS ON BOY! As the time of the visit came closer, the tension rose. Word was out that only those who were on duty would be allowed in the patient care areas. Because of this, a dozen or so doctors were locked into the doctor's lounge (aka "doc box") and asked to turn the video games off RIGHT AWAY. The room was guarded by an armed airman. How dare those doctors want to see this DV!
THERE I WAS, standing in the middle of the ward when the secret service guys began pouring into the hospital. The sheer size of these men was unbelievable. One of them was easily 6 feet 8 inches tall weighing 300 pounds. He reminded me of Mr. Incredible from the cartoon. Then, around the corner came the President himself! He began shaking hands with our medical technicians and nurses. He thanked each person for their service. I was standing next to one of our orthopedic surgeons. The president shook one last hand and I nervously asked myself if I should introduce myself as Dr. Hayes or Captain Hayes. It did not matter. In one quick instant, the President turned and proceeded directly towards the patients. I was staring at the back of his presidential bomber jacket. Oh, so close!
The room was called to order and we stood at attention as 2 young soldiers were awarded purple hearts for being wounded in combat. It gave me goose bumps. What else is there to say? The President continued to shake hands. He made his way over to my friend who is a nurse and they had a nice, brief conversation. (little did the President know that my friend is practically a card carrying member of the Tea Party!) In the meantime, the White House Chief of Staff approached myself and the orthopedic surgeon. He asked us where we were stationed, how long we had been at Bagram, and what it was like here. The orthopedic surgeon informed him that he had performed over 700 surgeries at Bagram in his 2 tours here.
The entourage moved on to the Intensive Care Unit. Two U.S. soldiers were patients there. Our trauma surgeon lead the President into the room. The rest of the visitors stayed outside. It was simply the President, the surgeon, and the nurse together with the patients. One of the patients had severely broken legs with large iron devices called external fixators holding the bones in place. He was not on a breathing machine and probably was able to grasp the enormity of the situation. The President awarded him the much deserved purple heart. The other patient was in critical condition. He had lost all four limbs in an IED explosion and also had much of his pelvis destroyed. He was one of the most severely injured patients any of us had ever seen. His ventilator was hissing away as the President leaned in to offer some words to him. The purple heart was laid on his torso. On his way out of the hospital, the President asked out loud to our medical commader, "How do you do what you do every day?" Many of us have asked ourselves that same question often here. After all, the realities of war are not for the faint of heart.
Tuesday, March 30, 2010
Wednesday, March 24, 2010
Life, Limb, or Eyesight
This past Saturday morning presented one of the most difficult situations that I have faced as a doctor. I was on call here in Afghanistan taking care of 4 patients with eyesight emergencies.
2 of my patients had already lost a left eye due to trauma, but both were having a very hard time excepting this fact. And, 2 of my patients had conditions that were seriously threatening eyesight in the left eye. Yes that's correct, I had 4 patients all with major trauma to their left eye. It's weird how in medicine you will see a cluster of similar conditions presenting at the same time. 2 of the patients had lost the left eye in blast injuries earlier in the week. Each day when I saw these patients they would ask me when the vision would come back in the left eye. I had to inform them that they no longer had a left eye. Saturday morning was no different. They asked about it, and I tried to be compassionate in my reply. Clearly, time is necessary for the reality of these devastating injuries to sink in and solidify.
The other two patients were even more challenging. One was a U.S. marine who had sustained facial trauma during an IED blast while he was riding in the turret as the gunner on a convoy. The butt of his machine gun slammed into his face. His check bone and eye socket were shattered into pieces. The soft structures of the eye were under enormous pressure. Our eye surgeon took him to surgery and repaired what he could. Now the issue was all the inflammation surrounding the eye. The decision was made to try the patient on high doses of steroids to calm this inflammation down. I wrote an order for whopping doses of solu-medrol (1 gram bolus then 250 mg every 6 hours for 3 days). Time would be needed for see if this would work. After about 36 hours at Bagram, the patient was flown to Landstuhl in Germany. I probably will never know if this marine will see out of that eye again. There are just too many patients to try to follow up on what happens to them. You have to move on to the next patient in crisis.
The 4th patient was the most difficult case. He was an Afghan who works an interpreter for the British Marines. Their camp came came under attack with mortars. The patient was peppered with shrapnel to his right side sustaining some relatively minor flesh wounds. However, somehow shrapnel also flew into his left eye. He was taken to surgery and a very improbable condition was diagnosed. He had a partial retinal detachment from the trauma. This is an absolute eye emergency. The retina is a very specialized structure. It is so specialized that very few eye doctors in the world operate on it. The condition needs a retina specialist. The U.S. Air Force does not currently have a retina specialist. There may not even be a retina specialist in the entire middle east trained to western standards. We were in a bind to say the least. Many phone calls were made. Because of a plethora of factors including world politics, we had no options other than to treat him here at Bagram.
The patient was beside himself. He understood fully that his eyesight was very much at risk and the clock was ticking. For several hours on Saturday morning, he approached me time and time again asking me questions that I could not answer. I was trying to provide care to all the patients on the ward, but really the situation with this one patient was absolutely killing me. It was tearing me up. I was actually nauseated for the entire morning. I knew that in the United States this patient would get surgery and retain his vision for sure. But, that would not happen here which to me was a very bitter pill to swallow. Our eye doctor looked into options. He did not have the proper equipment here to even attempt a retina surgery. The patient's vision was 20/300 at this point, legally blind in that eye. The decision was made to try a series of laser treatments in hopes that the retina would re-attach itself. It was a long shot. Our eye doctor lasered his retina approximately a thousand times I was told. At that point, it was a waiting game. The patient stayed in the hospital for the next 4 days while his flesh wounds healed up, but of course we were all focused on his left eye. 3 days ago he had a repeat eye exam. His vision was now 20/30 in his left eye with correction. Wow! Perhaps he would see again well with glasses. Yesterday he had another eye exam.... 20/20 without correction!!! Unbelievable. The eye doctor was amazed. I was so relieved. The patient was ecstatic. His gratitude was infectious. He had us all sign a T-shirt for him so that he could remember the names of everyone that cared for him here. It was corny but 100% sincere.
To me, the restoration of his vision during his 5 day stay here was a minor miracle. We often talk about the triad of life, limb and eyesight when triaging trauma patients. When any of these three are in danger, we go to heroic lengths and do everything humanly possible. However, in this case I think the most important intervention was divine.
2 of my patients had already lost a left eye due to trauma, but both were having a very hard time excepting this fact. And, 2 of my patients had conditions that were seriously threatening eyesight in the left eye. Yes that's correct, I had 4 patients all with major trauma to their left eye. It's weird how in medicine you will see a cluster of similar conditions presenting at the same time. 2 of the patients had lost the left eye in blast injuries earlier in the week. Each day when I saw these patients they would ask me when the vision would come back in the left eye. I had to inform them that they no longer had a left eye. Saturday morning was no different. They asked about it, and I tried to be compassionate in my reply. Clearly, time is necessary for the reality of these devastating injuries to sink in and solidify.
The other two patients were even more challenging. One was a U.S. marine who had sustained facial trauma during an IED blast while he was riding in the turret as the gunner on a convoy. The butt of his machine gun slammed into his face. His check bone and eye socket were shattered into pieces. The soft structures of the eye were under enormous pressure. Our eye surgeon took him to surgery and repaired what he could. Now the issue was all the inflammation surrounding the eye. The decision was made to try the patient on high doses of steroids to calm this inflammation down. I wrote an order for whopping doses of solu-medrol (1 gram bolus then 250 mg every 6 hours for 3 days). Time would be needed for see if this would work. After about 36 hours at Bagram, the patient was flown to Landstuhl in Germany. I probably will never know if this marine will see out of that eye again. There are just too many patients to try to follow up on what happens to them. You have to move on to the next patient in crisis.
The 4th patient was the most difficult case. He was an Afghan who works an interpreter for the British Marines. Their camp came came under attack with mortars. The patient was peppered with shrapnel to his right side sustaining some relatively minor flesh wounds. However, somehow shrapnel also flew into his left eye. He was taken to surgery and a very improbable condition was diagnosed. He had a partial retinal detachment from the trauma. This is an absolute eye emergency. The retina is a very specialized structure. It is so specialized that very few eye doctors in the world operate on it. The condition needs a retina specialist. The U.S. Air Force does not currently have a retina specialist. There may not even be a retina specialist in the entire middle east trained to western standards. We were in a bind to say the least. Many phone calls were made. Because of a plethora of factors including world politics, we had no options other than to treat him here at Bagram.
The patient was beside himself. He understood fully that his eyesight was very much at risk and the clock was ticking. For several hours on Saturday morning, he approached me time and time again asking me questions that I could not answer. I was trying to provide care to all the patients on the ward, but really the situation with this one patient was absolutely killing me. It was tearing me up. I was actually nauseated for the entire morning. I knew that in the United States this patient would get surgery and retain his vision for sure. But, that would not happen here which to me was a very bitter pill to swallow. Our eye doctor looked into options. He did not have the proper equipment here to even attempt a retina surgery. The patient's vision was 20/300 at this point, legally blind in that eye. The decision was made to try a series of laser treatments in hopes that the retina would re-attach itself. It was a long shot. Our eye doctor lasered his retina approximately a thousand times I was told. At that point, it was a waiting game. The patient stayed in the hospital for the next 4 days while his flesh wounds healed up, but of course we were all focused on his left eye. 3 days ago he had a repeat eye exam. His vision was now 20/30 in his left eye with correction. Wow! Perhaps he would see again well with glasses. Yesterday he had another eye exam.... 20/20 without correction!!! Unbelievable. The eye doctor was amazed. I was so relieved. The patient was ecstatic. His gratitude was infectious. He had us all sign a T-shirt for him so that he could remember the names of everyone that cared for him here. It was corny but 100% sincere.
To me, the restoration of his vision during his 5 day stay here was a minor miracle. We often talk about the triad of life, limb and eyesight when triaging trauma patients. When any of these three are in danger, we go to heroic lengths and do everything humanly possible. However, in this case I think the most important intervention was divine.
Sunday, March 21, 2010
The Faces of Terrorism
In three months here at Bagram, I have taken care of my fair share of patients that we call "enemies of peace" or EOP's. These of course are our patients who are suspected terrorists. They are often our most challenging patients for both medical and psychosocial reasons. There is one thing that is obvious to anyone who lays eyes on the EOP's. In short, these guys are some of the sorriest looking dudes you ever want to see! It seems hard to believe that 125 pound weaklings are the heart of the Taliban. They are illiterate people with little education. Their bodies are emaciated, basically just skin and bones. Of course, this all worsens after they have been shot up and spend days to weeks in the hospital. They will often refuse to eat or talk. It is not uncommon for them to be disoriented with extremely questionable mentation. This is certainly expected in the EOP's who have been shot in the head. Nobody expects those guys to be normal again. One of them was so out of his mind that he would incessantly bang his head up against the iron bars of his external fixator which was holding his mangled arm together. He had stitches all over his head resembling train tracks. It was not a pretty sight. Actually, it was disturbing to me to see him day after day.
Until the other day I had not seen an EOP that was intimidating in the least. We as Americans picture terrorists as shady, unsavory characters of middle eastern descent. Without a doubt, these EOP's are unsavory. But this is so because they are so malnourished, weak, and discheveled. Many of them look like they could be on a commerical for a world hunger organization. And yet we are struggling in this war against the Taliban and Al Queda. I think that speaks volumes to the fact that this war is very complicated. It is clear that the F-16's that take off all night long from Bagram are not going to take down the Taliban. Technology is not the answer. Brute military force is not the answer. After all, IED's made simply from fertilizer are used to take out our million dollar, giant vehicles called MRAP's (Mine Resistant Ambush Protected). We are fighting an enemy that has been brainwashed into believing radical islam. That's a powerful force.
Today I met a young medic who works at the "detainment facility" , aka the prison. He was very disillusioned. He could not understand why the prisoners were getting top notch medical care. The prisoners get all kinds of medications there. Have you heard of Nexium? Yes it's true, we are treating heartburn in our prisoners with the "purple pill"! (Good for the pharmaceutical industry I guess) He went on to say that he could not understand why these prisoners were being held for years. If nothing else, the cost of doing this is mind boggling. I did not have any good answers for the young medic except to say that his concerns are valid and that I have similar concerns. I am trying to make sense of it myself.
Until the other day I had not seen an EOP that was intimidating in the least. We as Americans picture terrorists as shady, unsavory characters of middle eastern descent. Without a doubt, these EOP's are unsavory. But this is so because they are so malnourished, weak, and discheveled. Many of them look like they could be on a commerical for a world hunger organization. And yet we are struggling in this war against the Taliban and Al Queda. I think that speaks volumes to the fact that this war is very complicated. It is clear that the F-16's that take off all night long from Bagram are not going to take down the Taliban. Technology is not the answer. Brute military force is not the answer. After all, IED's made simply from fertilizer are used to take out our million dollar, giant vehicles called MRAP's (Mine Resistant Ambush Protected). We are fighting an enemy that has been brainwashed into believing radical islam. That's a powerful force.
Today I met a young medic who works at the "detainment facility" , aka the prison. He was very disillusioned. He could not understand why the prisoners were getting top notch medical care. The prisoners get all kinds of medications there. Have you heard of Nexium? Yes it's true, we are treating heartburn in our prisoners with the "purple pill"! (Good for the pharmaceutical industry I guess) He went on to say that he could not understand why these prisoners were being held for years. If nothing else, the cost of doing this is mind boggling. I did not have any good answers for the young medic except to say that his concerns are valid and that I have similar concerns. I am trying to make sense of it myself.
Wednesday, March 17, 2010
Hospital Happenings
Happy St. Patrick's Day! It was a good day here at Bagram. We were able to enjoy the irish holiday as much as possible half a world away from home. My sister Mary sent me a kelly green felt golfer's cap (like the ones Payne Stewart wears) which I wore at work. It was a hit. I even wore it while working on a chest tube procedure. I figured that I needed the luck of the irish on that one! The nurses had green beeds, top hats, and crowns. It was fun. We made the best of it. And, I was able to have some pretty good corned beef and cabbage over at the chow hall. Perhaps the funniest moment was when I attempted to explain the significance of St. Patrick's Day to a patient from India. I told him that St. Patrick drove the snakes out of Ireland, then admitted that I really did not know if that was true. We googled it of course. Wikipedia says it's all a myth, but deep down I want to believe it.
Another fun thing we are doing is "Mustache March". It is a contest that frequently goes on during deployments. Here at Bagram, all of the doctors are growing mustaches. At the end of the month, there will be prizes. Cash will be given out for the sleaziest, the cheesiest, and the most pre-pubescent mustaches. 17 days into it, I am a little surprised with mine. The hair is almost all blond and it is not nearly as thick as I expected. Nevertheless, I kind of like it. I feel like my brother Pat back in the eighties or something.
March of course brings the college basketball tournament. We are all excited for March Madness. Our brackets were turned into today for our pool among the professional medical staff. I have Ohio State winning it all. It's a long shot, but I figure that you have to choose a long shot to run away with first place. We'll see. The games will be on during the middle of the night here, so we'll have to watch highlights and tape delayed games.
Of course all of these "happenings" are simply a distraction from the job at hand. The mission goes on every hour of every day. The hospital has been and will continue to be extremely busy. We have seen over twice as many trauma patients this year as we did last year at this time. It seems that the stream of blown up soldiers (mostly Afghans) is never ending. Each day we have to do our best to deal it and whatever fun distractions we can find helps to keep us all sane.
Another fun thing we are doing is "Mustache March". It is a contest that frequently goes on during deployments. Here at Bagram, all of the doctors are growing mustaches. At the end of the month, there will be prizes. Cash will be given out for the sleaziest, the cheesiest, and the most pre-pubescent mustaches. 17 days into it, I am a little surprised with mine. The hair is almost all blond and it is not nearly as thick as I expected. Nevertheless, I kind of like it. I feel like my brother Pat back in the eighties or something.
March of course brings the college basketball tournament. We are all excited for March Madness. Our brackets were turned into today for our pool among the professional medical staff. I have Ohio State winning it all. It's a long shot, but I figure that you have to choose a long shot to run away with first place. We'll see. The games will be on during the middle of the night here, so we'll have to watch highlights and tape delayed games.
Of course all of these "happenings" are simply a distraction from the job at hand. The mission goes on every hour of every day. The hospital has been and will continue to be extremely busy. We have seen over twice as many trauma patients this year as we did last year at this time. It seems that the stream of blown up soldiers (mostly Afghans) is never ending. Each day we have to do our best to deal it and whatever fun distractions we can find helps to keep us all sane.
Friday, March 12, 2010
My Favorite Patients
Happy Friday Ya'll!!! Today is a good day. I worked this morning and now I am off for the rest of the day. My colleague Dr. Greene is manning the ward. Tomorrow I will do the same for him so that he can also have a little mental health time. My recent posts have been perhaps a little negative and maybe too intense as well. Today I'd like to write about my favorite patients so far here at Bagram. Hopefully, this will lighten it up a bit.
The first patient was a heavily muscled U.S. Air Force member of Korean descent. I am not exaggerating about the muscle. He was so pumped up that his arms would not even come close to resting at his sides due to severely hypertrophied latisimus dorsi muscles bilaterally. We'll call him Sergeant Strong. He came to the hospital for abdominal pain and was found to have what is know as an ileus. This is when your bowels just stop moving. We do not know why he developed it, perhaps too many clean and jerks. The treatment involves putting a tube through the nose down into the stomach (NG tube) to suck out the gastric contents. Also, there is no eating or drinking for several days for "bowel rest". So, Sergant Strong had a tube jammed down his nose/throat and was not allowed to eat. He went along with it for a while, but pretty soon he got antsy and started walking the ward. Picture a pumped up Korean dude with a tube in his nose (which makes you talk all nasally) walking around the hospital in his Air Force physical training gear ... it was priceless. He came up to the nurses station and asked, "Can I have some roast beef?" Heck no!!! But, this was a legitimate question considering Sergant Strong eats over 5,000 calories a day in support of his weight lifting habit. He starts the day with 6 hard boiled eggs for pete's sake. That's a lot of protein! Anyway, Sergant Strong was a very good sport about it all and eventually things started working again for him. We brought him 2 hard boiled eggs for breakfast and he was elated. I discharged him from the hospital on quarters (barracks restriction) with gym priveleges for 72 hours. Keeping him away from his weights any longer seemed cruel and unusual to me. Rumor has it Sergeant Strong place third in the Bagram Air Field bench press competition last week.
Another great patient was a Greek officer who was medically evacuated to Bagram from a NATO base in Kabul. He had been playing an intense game of basketball and apparently went in for a slam dunk. Unfortunately, he lost control of his body, came crashing down, and slammed his head against the basket's supporting pole. He was knocked out for 30 minutes. Wow. We'll call him Captain Crash. In the Bagram ER he had a Head CT Scan done which looked okay. But, he was not doing so well physically, so I was asked to admit him to the hospital. Upon examination, I found a burly Greek man stripped down to his boxer briefs who was minimally responsive. I jammed my knuckles into Captain Crash's sternum and he barely responded. We admitted him to the ward. Six hours later, he was still very drowsy and was not making much sense at all even to the Greek doctor that came along to him. We had a heck of a time getting this mountain of a man into a wheel chair. Another Head CT Scan was done. This one revealed bleeding into the brain in multiple areas. He actually had scattered Subdural, Intracerebral, and Subarachnoid Hemorrhages for all you medical folks out there. I was astounded. Our neurosurgeon was consulted. Luckily, Captain Crash did not need surgery. He would likely get better without any intervention. We continued to watch him closely administering large amounts of morphine for his killer headache. Slowly but surely, Captain Crash came around. The only Greek doctor in Afghanistan stayed by his bedside the entire time. Two days later, Captain Crash was functioning normally despite a persistent giant headache. He actually spoke excellent English and I learned that he was an engineer. He was a heck of a nice guy. As we wheeled him off the hospital ward, he thanked us all profusely for his medical care. The greek military reacted quickly arranging for him to be picked up in Germany. We loaded him on a plane and sent him back home for further recovery. I am sure he is doing well back in his beloved homeland of Greece right now.
Sergeant Strong and Captain Crash were great patients. These are the type of patients that make medicine fun. Both cases ended up with happy endings. My hope is that experiences like these will keep me engaged and excited about practicing medicine for the rest of my career.
Monday, March 8, 2010
Looking Back to Afghanistan 2008 - Part 2
Hello everyone. Happy Monday! Another week has come and gone. I'm now well into the middle third of my deployment as I previously stated. Honestly, the long hours are kicking my butt right now. There are no days off here. I must persevere. Maybe I can look back to 2008 to help me get through this.
As I alluded to in my last post, there were many lessons learned at Camp Alamo in 2008. Right off the bat it was obvious that Afghanistan is a third world country. The poverty is shocking. The lack of what we consider to be basic necessities is striking. The first thing I noticed at the Afghan base was that there was no soap. Yeah, that's right there was not a bar of soap, a container of liquid soap, or a bottle of hand sanitizer anywhere in sight. This included the barracks, the dining facilities, the clinic, and even the head general's bathroom right outside his office. The bottom line is that soap is not a normal thing in this society. It's that simple. I was horrified. For six months I did everything that I could to get soap all over that base. I failed. It was not for lack of trying. There were forces so far out of my control that it made it nearly impossible. The bottom line is that I first had to convince the Afghans that soap was an important thing. The doctors and the medics understood it. The army recruits did not. Most of them were peasants. We sent out an order for 10,000 cases of soap for the Kabul Military Training Center. It never came. Why? Quite frankly, the person at the other end of this order probably threw the order away. After all, if that entire base never had soap before, then why would they need it now? I could have easily written a letter to Proctor and Gamble to get a ton of soap. But, that would be a temporary solution. And, in this war temporary solutions are pointless. Changes and improvements need to be sustainable. We failed on soap, but we did make some progress on needles. When I arrived at the Military Entrance Processing Station (MEPS) Clinic, hypodermic needles and syringes were being thrown directly into the garbage. American tax dollars were paying for all Afghan army recruits to get 6 vaccinations upon entry into the Afghan National Army (ANA). Those needles went into a garbage can and were mixed in with garbage from all over base. I was disgusted by this. One day, a garbage worked stepped on a needle and developed a raging infection. He almost lost his leg. Something needed to be done. With the help of my colleague Major Ron Greenaway and one of our interpreters, 500 red plastic buckets were purchased. We began using those as sharps containers. We effectively eliminated this work place hazard. It was probably our biggest success in my time there.
The most enlightening and fulfilling aspect of my job as an Afghan trainer was getting to know the Afghan doctors. I worked with 9 Afghan doctors and physician assistants. A few of them were very smart and talented. A few had potential. Several of them had no business being in medicine. Nevertheless, I spent hours getting to know them. We talked about their lives. We talked about their medical training. We talked about their opinions on the war. What I learned is that the average Afghan lives a life of fear. They are afraid of violence from the terrorists and the Taliban all day every day. They fear for the safety of their families. The fact that they were members of the ANA was a secret outside the gates of the base. Wearing an army uniform casually in the streets of Kabul is a death wish. Maybe that has improved in the last 2 years, but I doubt it. The Afghans value family a great deal. A normal greeting is to say hello then immediately ask how their family is doing. They would always ask me how my family was doing. Most of them live with or near their extended families. Marriages are arranged. My friend Yama got engaged while I was there. I asked him how he could deal with an arranged marriage. He simply said that he trusted his family 100% to find the right person for him. I thought that was pretty cool, especially since I am a single guy with many ridiculous experiences in the dating world! One other thing that we talked about at length was religion. Yeah that's right, I even broached this controversial subject with my Afghan friends. They were all muslims of course. I was there during the muslim holy month of ramadan. Things basically shut down for 4 weeks. It's not that much different than our holiday season when you think about it. Muslims of course have many different customs that Christians. But, I think that the values taught in their religion are pretty similar to what I learned growing up catholic. They believe in regular prayer and are more disciplined at doing this than most Christians. I think the most important thing that I learned is that only a very small percentage of muslims are extremists that make up terrorist cells. This is not ground breaking information, but it was important to for me to confirm this first hand. In the end, I make some good friends. I truly do consider Dr. Yama, Dr. Zaman, Dr.Farid, Dr. Masood, etc good friends. It's unfortunate that I will probably never see any of them again.
Well, I must get going back to work. A ward full of patients is waiting for me. This morning alone we admitted 10 patients all before 10 in the morning. We are busy to say the least and this will likely continue through the spring and summer. So, when the going gets tough, I can look back at my previous deployment knowing full well that I can make it through this just like I did in 2008.
As I alluded to in my last post, there were many lessons learned at Camp Alamo in 2008. Right off the bat it was obvious that Afghanistan is a third world country. The poverty is shocking. The lack of what we consider to be basic necessities is striking. The first thing I noticed at the Afghan base was that there was no soap. Yeah, that's right there was not a bar of soap, a container of liquid soap, or a bottle of hand sanitizer anywhere in sight. This included the barracks, the dining facilities, the clinic, and even the head general's bathroom right outside his office. The bottom line is that soap is not a normal thing in this society. It's that simple. I was horrified. For six months I did everything that I could to get soap all over that base. I failed. It was not for lack of trying. There were forces so far out of my control that it made it nearly impossible. The bottom line is that I first had to convince the Afghans that soap was an important thing. The doctors and the medics understood it. The army recruits did not. Most of them were peasants. We sent out an order for 10,000 cases of soap for the Kabul Military Training Center. It never came. Why? Quite frankly, the person at the other end of this order probably threw the order away. After all, if that entire base never had soap before, then why would they need it now? I could have easily written a letter to Proctor and Gamble to get a ton of soap. But, that would be a temporary solution. And, in this war temporary solutions are pointless. Changes and improvements need to be sustainable. We failed on soap, but we did make some progress on needles. When I arrived at the Military Entrance Processing Station (MEPS) Clinic, hypodermic needles and syringes were being thrown directly into the garbage. American tax dollars were paying for all Afghan army recruits to get 6 vaccinations upon entry into the Afghan National Army (ANA). Those needles went into a garbage can and were mixed in with garbage from all over base. I was disgusted by this. One day, a garbage worked stepped on a needle and developed a raging infection. He almost lost his leg. Something needed to be done. With the help of my colleague Major Ron Greenaway and one of our interpreters, 500 red plastic buckets were purchased. We began using those as sharps containers. We effectively eliminated this work place hazard. It was probably our biggest success in my time there.
The most enlightening and fulfilling aspect of my job as an Afghan trainer was getting to know the Afghan doctors. I worked with 9 Afghan doctors and physician assistants. A few of them were very smart and talented. A few had potential. Several of them had no business being in medicine. Nevertheless, I spent hours getting to know them. We talked about their lives. We talked about their medical training. We talked about their opinions on the war. What I learned is that the average Afghan lives a life of fear. They are afraid of violence from the terrorists and the Taliban all day every day. They fear for the safety of their families. The fact that they were members of the ANA was a secret outside the gates of the base. Wearing an army uniform casually in the streets of Kabul is a death wish. Maybe that has improved in the last 2 years, but I doubt it. The Afghans value family a great deal. A normal greeting is to say hello then immediately ask how their family is doing. They would always ask me how my family was doing. Most of them live with or near their extended families. Marriages are arranged. My friend Yama got engaged while I was there. I asked him how he could deal with an arranged marriage. He simply said that he trusted his family 100% to find the right person for him. I thought that was pretty cool, especially since I am a single guy with many ridiculous experiences in the dating world! One other thing that we talked about at length was religion. Yeah that's right, I even broached this controversial subject with my Afghan friends. They were all muslims of course. I was there during the muslim holy month of ramadan. Things basically shut down for 4 weeks. It's not that much different than our holiday season when you think about it. Muslims of course have many different customs that Christians. But, I think that the values taught in their religion are pretty similar to what I learned growing up catholic. They believe in regular prayer and are more disciplined at doing this than most Christians. I think the most important thing that I learned is that only a very small percentage of muslims are extremists that make up terrorist cells. This is not ground breaking information, but it was important to for me to confirm this first hand. In the end, I make some good friends. I truly do consider Dr. Yama, Dr. Zaman, Dr.Farid, Dr. Masood, etc good friends. It's unfortunate that I will probably never see any of them again.
Well, I must get going back to work. A ward full of patients is waiting for me. This morning alone we admitted 10 patients all before 10 in the morning. We are busy to say the least and this will likely continue through the spring and summer. So, when the going gets tough, I can look back at my previous deployment knowing full well that I can make it through this just like I did in 2008.
Friday, March 5, 2010
Looking Back to Afghanistan 2008
I left Charleston for this deployment 11 weeks ago today. That seems like so long ago. The middle part of this deployment is here. This is when you are a little numb to everything. I am now completely used to seeing soldiers that are all blown up. The hospital is filled with them right now. It seems normal. Just the other night I had to assess an Afghan soldier in the trauma bay who was on a ventilator and had a blown up leg. It was routine. 11 weeks ago that would not have been the case. I guess you could say that I have come a long way. Nevertheless, my world is a tiny one right now from a geographical standpoint. I work a hundred yards from where I sleep. I eat a few hundred yards down the road from where I work. I exercise at the gym up the road from the where I eat. You can easily get caught up in this and forget about the bigger picture. You can get lost in your own little world. When this happens I find it helpful to look back and think about past experiences. I learned a lot on my previous deployment, so maybe those lessons learned can help me in the here and now.
In May of 2008, I deployed to Camp Alamo which is small forward operating base outside of Kabul. Our mission was to help train the Afghan National Army. Physically, our camp was surrounded by the Kabul Military Training Center. This is thought to be the "premier" Afghan military base. (You'll understand the quotations around premier later) The majority of basic and officer training for the Afghan National Army occurs here. There were 300 coalition troops at Camp Alamo. We had American, British, French, Polish, and Romanian personnel there. We formed an embedded training team or ETT. In other words, each of us was there to train the Afghans in his/her respective field. U.S. Navy logistics officers worked with Afghan logistics officers on developing a supply system. British drill sergeants trained Afghan drill sergeants on how conduct training. Polish infantry trained Afghan infantry on how to shoot. You get the picture.
I was assigned to the Military Entrance Processing Station (MEPS) Clinic. My job of course was to train Afghan doctors and medics. The MEPS Clinic was essentially there for recruit physicals. Basically, every single breathing human being that wanted to join the Afghan Army came to our clinic for a military physical. This was the only such clinic in all of Afghanistan. We were there to make sure the recruits were fit for military service. Sounds simple, right? Well, there was a lot more to it than you might imagine. The MEPS Clinic was a snapshot of a third world nation. Each day approximately one hundred new recruits would arrive by bus. They were coming from all over Afghanistan and their journey often took 3-5 days to arrive at our doorstep. The vast majority of the recruits had nothing but the clothes on their backs. The poverty was shocking to someone like myself that grew up in a middle class suburb of Cleveland. Malnourishment was painfully obvious especially when we would examine their musculoskeletal systems from head to toe. In addition, 3-5 days on a bus produced incredible amounts of body odor. Those smells are permanently burned into the recesses of my brain! I do not wish that upon anyone. It had to be taken in small doses especially at first. Some of the Afghan doctors even wore masks during the exams. I felt that was inhumane, so I never did that. Over 90% of the Afghan Army recruits were illiterate. Most had no idea how old they were. After all, birth certificates do not exist here. Many of the recruits had drug problems. We estimated that 30% were frequent users of hashish, the drug of choice in this extremely poor nation. The decision to do drug testing went up our chain of command. It was decided to forego drug testing because after all we were trying to build an Army not disqualify 30% of the guys from the very start. We only disqualified recruits if they were actively "high" at the time of the exam. That was painfully obvious sometimes.
In the six months of my deployment to Camp Alamo, we did well over 10,000 recruit physicals. Looking back, it was quite an experience overall. I'll try to relay some of my "lessons learned" in my next entry. Right now I am off to work the evening shift...
In May of 2008, I deployed to Camp Alamo which is small forward operating base outside of Kabul. Our mission was to help train the Afghan National Army. Physically, our camp was surrounded by the Kabul Military Training Center. This is thought to be the "premier" Afghan military base. (You'll understand the quotations around premier later) The majority of basic and officer training for the Afghan National Army occurs here. There were 300 coalition troops at Camp Alamo. We had American, British, French, Polish, and Romanian personnel there. We formed an embedded training team or ETT. In other words, each of us was there to train the Afghans in his/her respective field. U.S. Navy logistics officers worked with Afghan logistics officers on developing a supply system. British drill sergeants trained Afghan drill sergeants on how conduct training. Polish infantry trained Afghan infantry on how to shoot. You get the picture.
I was assigned to the Military Entrance Processing Station (MEPS) Clinic. My job of course was to train Afghan doctors and medics. The MEPS Clinic was essentially there for recruit physicals. Basically, every single breathing human being that wanted to join the Afghan Army came to our clinic for a military physical. This was the only such clinic in all of Afghanistan. We were there to make sure the recruits were fit for military service. Sounds simple, right? Well, there was a lot more to it than you might imagine. The MEPS Clinic was a snapshot of a third world nation. Each day approximately one hundred new recruits would arrive by bus. They were coming from all over Afghanistan and their journey often took 3-5 days to arrive at our doorstep. The vast majority of the recruits had nothing but the clothes on their backs. The poverty was shocking to someone like myself that grew up in a middle class suburb of Cleveland. Malnourishment was painfully obvious especially when we would examine their musculoskeletal systems from head to toe. In addition, 3-5 days on a bus produced incredible amounts of body odor. Those smells are permanently burned into the recesses of my brain! I do not wish that upon anyone. It had to be taken in small doses especially at first. Some of the Afghan doctors even wore masks during the exams. I felt that was inhumane, so I never did that. Over 90% of the Afghan Army recruits were illiterate. Most had no idea how old they were. After all, birth certificates do not exist here. Many of the recruits had drug problems. We estimated that 30% were frequent users of hashish, the drug of choice in this extremely poor nation. The decision to do drug testing went up our chain of command. It was decided to forego drug testing because after all we were trying to build an Army not disqualify 30% of the guys from the very start. We only disqualified recruits if they were actively "high" at the time of the exam. That was painfully obvious sometimes.
In the six months of my deployment to Camp Alamo, we did well over 10,000 recruit physicals. Looking back, it was quite an experience overall. I'll try to relay some of my "lessons learned" in my next entry. Right now I am off to work the evening shift...
Monday, March 1, 2010
Scratching My Head
Time is marching on thank God. It's March n0w, which means I have about 4 months to go on my deployment. A lot has happened in the 10 weeks I have been here. And, much more will happen in the coming weeks. We will continue to see a plethora of horrific injuries as the casualties roll in to Bagram Air Field. Back home, the debate on health care rages on with no end in sight. At the same time, each day here I become more confused about who gets medical care in this world and why. Let me explain.
It's a fact that on any given day at Craigh Joint Theater Hospital the majority of our hospitalized patients are not Americans. Our medical staff is 100% American (90% Air Force, 10% Army). We treat all branches of the U.S. military as well as troops from our coaliton partners. Just today I did a cardiac stress test on a female Polish soldier. But, the majority of our patients are Afghans as we make our daily rounds through intensive care and the ward. It's striking to see a hospital filled will Afghans. Some stay for long periods of time. We treat them unitl we can be relatively certain he/she will stay alive outside our hospital. Needless to say, it seems ironic that we are over here spending the majority of our time taking care of foreigners.
The Chief of the Medical Staff has the difficult job of deciding who comes to our hospital and who does not. I do not envy him in the least. We are like the Mayo Clinic of Afghanistan. We have the most resources of any medical facility for hundreds if not thousands of miles. But, our resources are still finite so tough choices have to be made every day. Of course any American who is injured in the line of duty will be accepted at our hospital without exception. Our primary mission is to treat trauma patients. Not long ago we had one foriegn contractor who fell off a building while working construction just down the street from the hospital. He came to our hospital on death's door. He was talking but had an impending sense of doom. That's an ominous sign. He was taken to the Operating Room immediately. His spleen was completely torn away from the surrounding structures. Our trauma surgeon saved his life. If he had not been so close to our hospital he would have died for sure.
A fair amount of humanitarian medical care is done here as well. Not long ago 2 Afghan kids with severe burns were in our hospital. Our plastic surgeon did a series of procedures on them. Both patients still have a long way to go. For whatever reason, they were accepted at our facility and we are doing for them everything possible. They will be back for more surgeries in the future. A lot of resources are being used to help them. It's a good thing. But, I guarantee there are many other burn patients out there in Afghanistan who are not coming to our hospital for world class medical care. It's reality.
In the end most doctors and nurses just want to treat patients. We do not want to think about who gets what care and why. We want to do everything we can to help anyone that we can. But, is that really okay? Extraordinary measures are taken to save the lives of prisoners here. Not long ago a prisoner received 4 units of activated factor 7 in the trauma bay during his resuscitation. It is man made clotting factor. It costs $5,000 a dose. In less than 1 minute, $20,ooo was spent to save the life of an accused terrorist. Does that make sense?
I could go on and on all day with examples of similar situations. I do not pretend to understand it all. Sometimes I am simply left scratching my head.
It's a fact that on any given day at Craigh Joint Theater Hospital the majority of our hospitalized patients are not Americans. Our medical staff is 100% American (90% Air Force, 10% Army). We treat all branches of the U.S. military as well as troops from our coaliton partners. Just today I did a cardiac stress test on a female Polish soldier. But, the majority of our patients are Afghans as we make our daily rounds through intensive care and the ward. It's striking to see a hospital filled will Afghans. Some stay for long periods of time. We treat them unitl we can be relatively certain he/she will stay alive outside our hospital. Needless to say, it seems ironic that we are over here spending the majority of our time taking care of foreigners.
The Chief of the Medical Staff has the difficult job of deciding who comes to our hospital and who does not. I do not envy him in the least. We are like the Mayo Clinic of Afghanistan. We have the most resources of any medical facility for hundreds if not thousands of miles. But, our resources are still finite so tough choices have to be made every day. Of course any American who is injured in the line of duty will be accepted at our hospital without exception. Our primary mission is to treat trauma patients. Not long ago we had one foriegn contractor who fell off a building while working construction just down the street from the hospital. He came to our hospital on death's door. He was talking but had an impending sense of doom. That's an ominous sign. He was taken to the Operating Room immediately. His spleen was completely torn away from the surrounding structures. Our trauma surgeon saved his life. If he had not been so close to our hospital he would have died for sure.
A fair amount of humanitarian medical care is done here as well. Not long ago 2 Afghan kids with severe burns were in our hospital. Our plastic surgeon did a series of procedures on them. Both patients still have a long way to go. For whatever reason, they were accepted at our facility and we are doing for them everything possible. They will be back for more surgeries in the future. A lot of resources are being used to help them. It's a good thing. But, I guarantee there are many other burn patients out there in Afghanistan who are not coming to our hospital for world class medical care. It's reality.
In the end most doctors and nurses just want to treat patients. We do not want to think about who gets what care and why. We want to do everything we can to help anyone that we can. But, is that really okay? Extraordinary measures are taken to save the lives of prisoners here. Not long ago a prisoner received 4 units of activated factor 7 in the trauma bay during his resuscitation. It is man made clotting factor. It costs $5,000 a dose. In less than 1 minute, $20,ooo was spent to save the life of an accused terrorist. Does that make sense?
I could go on and on all day with examples of similar situations. I do not pretend to understand it all. Sometimes I am simply left scratching my head.
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