Dollars and Sense?

Money makes the world go round, right? With that in mind, I think it is important to stop and think a little bit about the cost of war. Before even considering the human suffering and the tragic loss of life, the cash that it takes to wage war is staggering. As I ate my bagel this morning and thought about the day's plan for my patients, I realized that each bite and every spread of cream cheese cost the U.S. government several dollars. How do I know this you ask? Well, last week a friend who works in logistics informed me that every warm meal I eat here in Afghanistan costs $30. A company called Fluor runs the food service. They charge the U.S. government $30 every single time an ID card is scanned on the way into the dining facility. Last week I stopped to get a cup of coffee at the dining facility on my way home from picking up my laundry. My ID card was scanned, thus, our government paid $30 for my cup of coffee. I had no idea it was the most expensive coffee I have ever had. After all, not even a quadruple latte vanilla swirl expresso with whipped cream and a cherry on top at Starbucks costs that much!



There are many government vehicles here at Bagram. I only need to walk a hundred yards from my B-Hut to see a long line of MRAP's (Mine Resistant Ambush Protected). These are the hulking four wheelers that cost one million dollars to build. They are manufactured in my home of Charleston among other places. I often see them driven on the Air Force Base in Charleston before they are loaded on a C-17 and flown to the middle east. They are so big that only 2 of them fit on the world's best cargo plane. MRAP's carry about a dozen people. The whole point of the vehicle is to save lives. Are MRAP's truly "mine resistant"? Absolutely not. We see patients with devastating injuries every day here who are victims of IED blasts while in MRAP's. This is because the terrorists are always one step ahead of us. The main road at Bagram is often gridlocked with MRAP's trying to get to their destination or leave the base for a mission. They get maybe 5 miles to the gallon of gas. I am told that the price of gas here is quite high. When you figure the cost of shipping to this land locked country, a gallon of gas can cost as much as $30. It's right up there with my cup of coffee in the dining facility the other day! Can you imagine how much it costs just for fuel alone when a convoy of MRAP's goes out on a mission and is gone for hours to days?



Several weeks ago I was able to go on a tour of the F-15 fighter jets that we have here at Bagram. We were able to meet the pilots, learn a lot about their jobs, and then of course get to see the F-15 up close. These are $55 million dollar planes that were designed in the 1970's. According to "Biff" the pilot, these are the best planes on the globe. "Biff" gave us a run down on the capabilities of these birds. His enthusiasm was contagious. He showed us the missiles that are used in close air support strikes on suspected terrorists. These cost about $55,000 a piece and they pack quite a pop. If you think the fuel for MRAP's is expensive, well, it's nothing compared to the jet fuel used for th F-15. At any given time, two F-15 crews are "on alert" for emergency missions. Their goal is to provide an air strike anywhere in their region within 15 minutes of receiving the call. This correlates with approximately how long the average soldier's ammunition will last in an intense firefight. On any given day, F-15's can be heard taking off at all hours of the day. Their roar is deafening.


The cost of running the hospital here is also quite astounding. We have 2 Afghan patients that have been hospitalized for almost my entire deployment. Both have been in the intensive care unit for weeks at a time. Both have undergone many procedures and operations. They have wounds that may never heal. Even if they do miraculously get better and walk out the door, they will be subject to the limitations of the Afghan medical system. In short, I am not even sure you could call it a medical system. The main military hospital in Kabul does not have the most basic of medications. They do not have antibiotic ointment. They do not even provide food for their patients. There is no such thing as a nursing home in Afghanistan. The medical costs for the prolonged hospitalization of both of the aforementioned patients easily exceeds a million dollars. Actually, it is probably several million dollars. The argument could be made that neither of these patients should have received the care that they did given that they have very little chance of being okay once they leave our doors. These are the hard decisions that often are not made in the heat of the moment. We as health care providers want everyone to be okay. But, it does not work that way. Forging ahead with the care of these patients essentially is making the decision to spend thousands if not millions of dollars. I wish I could say that these are the only Afghan patients I have seen in this type of situation at our hospital. If I did say that, I would be flat out lying.

I could go on and on with examples of costs that will make your head spin. Maybe this is information that the American people really should not know about it. You can go about your life blistfully unaware of all this. But for me, it really begs the question of whether or not all these dollars make any sense???