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.