Medicine in Afghanistan

It has been an interesting week in Afghanistan. The weather has turned and spring is here. Days are beautiful, about mid 70s, but still cool at night. Still need a fleece at night. Unfortunately, with the nicer weather, we have gotten busier, but still not too bad.



This is one of our kids injured last week with a grenade fragment. He is doing pretty well. Someone gave him the squirt gun and he was fearless with it. I can't show his face for security reasons.



I learned a few things about Afghanistan. One of our translators is a former Afghanistan physician. He left here in the 1980s and came to America eventually. He never licensed in the US, so he worked as a lab technician. He has been back in Afghanistan now for about 2 years translating for us. Interesting, since the war with Russia, the medical system has gone down hill. A good majority of the better trained doctors left. Their formal medical school is a joke. Training is poor at best. People who gained experienced as a medic in their military or other medical background, moved up the ranks to fill the void, so they became doctors and surgeons. Not many do any residency here. Therefore, there are really a lot of quack doctors here. They don’t have a medical board, so anyone who has the money can buy a degree. So when you go to a doctor here, you don’t know if he/she knows what they are doing or not. No wonder the average person here doesn’t trust the doctors. My daughter,Kristin, who is in 3rd year of medical school would be a full fledged doctor by now over here.

Most of the time we don’t operate on the local people unless it is the Afghan military or maybe a relative of a council man and we politically are trying to bring good will to this area. The other day our general surgeons operated on a local for a hernia. Supposedly, he had his hernia fixed before. When the surgeon got in there, he found all fresh tissue. If the patient had it fixed before, there should be a lot of scar tissue around. There was none. So whoever fixed him before, just made an incision and closed him up. They never touched the hernia. That was why it came back and we had to fix him. Imagine the field day that the lawyers would have back home.


We, the doctors, have offered to help out the locals, but it is difficult. The command won’t let us go off the base because it is too dangerous. The translator told me that the Taliban is kinder to the medical personal because they use them too. Whenever he leaves the base and comes back, he gets stopped by the Taliban and checked out. The Taliban still control a lot of the back roads in the mountains here. I am not so sure that the Taliban would give me the same courtesy.

We had to do sandbag duty this week. The bunkers are lined with sandbags and with time, they tend to slide down. So we formed a chain gang and restacked them and also added new ones. It wasn’t too bad. The good thing is that it is still a little early for those little critters to be hiding in the dirt or between the bags as we picked them up.



Can you guess which one is me?





We also have a Wii game here. We actually use it for true medical reasons. For our traumatic brain injured patients, often their coordination and thought process are slow. On the Wii game, they can do a baseline, then test them everyday until they are back to normal. This one tests their balance. I haven't hit normal on mine yet, so they are keeping me here for a while longer.


Tom

A Day at FOB Shank

This is a view of the tents. If you look close, past the tents, is the open field that we run the perimeter by the hesco wall. You can barely see one of the guard towers at the edge of the field. This is where they are building the landing strip out of clay and dirt. If it rains, it turns to mud and the planes can't land.

The weather is definitely getting warmer. I don’t know if we are going to get any more snow or not. Yesterday, I bet it was at least mid 70’s. It was actually hot outside. I went running with a group of 20 something year olds. We covered about 4 ½ miles. They were kind to me. They would lead the way and when they were far enough ahead of me, they would come back for me. The path is all dry dirt, sand and stone. When a truck or MRAP would drive by, it would kick up a wonderful cloud of thick dust. Sure made my breathing a lot more challenging. I am still coughing up crap. I was in bed by 8:45 PM last night. Thank goodness we run every other day and not every day.


This is a close up of a small village just outside our FOB. In front is the hesco wall, which is basically a 8 or 10ft tall burlap bag with wire mesh, filled with dirt and rock. It is pretty effective for stopping things, especially things that go boom.




During the day, it is much nicer, but at night still need a coat ,or a fleece is what we wear a lot. It is typical desert, warm during the day and cold at night. With the warm weather we are seeing more activities and unfortunately injuries. The other day one of our convoys was dismounted in a village right outside our gate. One of the unfriendlies threw a grenade over a wall into a crowd so no one saw him. One of our soldiers had some small injuries, but 2 kids, a 7 and an 8 year old were injured. One had some serious abdominal injuries. Our general surgeons did great and he needed a few operations, but we anticipate he will be ok in the long run. I took care of the little girl. She lost half of her ankle bone, the talus. I am reoperating on her today again. I suspect she will have a limp the rest of her life. When we prepped her for surgery, it took me a few minutes just to scrub the thick dirt and mud off her foot. I doubt if she wears any shoe, maybe sandals at best. A podiatrist could busy 24 hours a day out here. Plus the kids are all small and look malnourished. I thought she was about 4 or 5 years old. I was really surprised to learn she was 8.


Dr Sucher and I were out the other night watching the laser show put on by our airforce gun plane, the Spectre.



The skies have been clear at night. We were outside looking at all the stars. There must have been several thousands of them in sky. I bet I saw the entire Milky Way. There is very little reflective light from any bases or cities around here, so we can see quite a bit more sky than what we can see in Chicago. Interesting, some of our planes were putting on a light show for us. They were blowing up something in the mountains just outside the FOB. You couldn’t hear it, but their rockets or whatever left a green tracer laser like path to the mountains. Then you see a small flash in the mountain side. Fun to watch but I wouldn’t want to be on the receiving side of it.




We rotate putting on lectures for the medics and nurses. I was demonstrating where we insert the pins on an arm for an external fixator










One of the local national military sustained a femoral shaft(thigh bone) fracture. I am inserting one of the pins to connect to an external fixator

Tom

The FST

This is the entrance to our FST, the 909th. All injured patients are brought through these doors. There is a tent just to the left where all patients are stripped to a blanket only, to make sure no weapons or suicide bombs are smuggled in.


Things are going ok. I am getting into a routine of seeing patients, getting a work out in the morning and being available for consults and traumas. Most of the traumas injuries we see are in the local nationals, as we refer to them, mainly the Afghanistan military and some police. I am always suspicious if they are good guys or some bad guys who made it into their military and are spies for the Tailbon. Either way, if they are brought in injured we do our best with what we have to take care of them.


This is our OR with 2 beds. Only one time did we have to use both beds at the same time. The blue structures are the arm boards. We move them to the side, then carry the injured on the stretcher and place then on the table. We operate with them on the stretcher (litter).



This is our ICU (Recovery Room) with a stretcher holder in place. We keep patients here until arrangements are made to helicopter them to Bagram.



One of our vascular surgeons did a great job saving a local national’s leg the other day. Their vehicle, a pickup truck, was hit by an IED. The Afghan military have very little to protect themselves, just the body armor and their AK -47. They don’t have MRAPs like we do. Anyhow, he had shrapnel tear through an artery in his leg. Our medic who first responded put a tourniquet on him; otherwise, for sure he would have bled to death before we have been able to treat him. We stabilized him, resuscitated him, and took him to the OR. In the OR, we explored his leg, found the artery with a big gaping hole in it. The vascular surgeon put in a bypass, a gortex graft that basically looks like a flexible straw. He tied this in above and below the hole. This restored the circulation to the rest of the leg and saved his leg. If he would have been treated by the local hospital, he would have ended up with an amputation. Once he was stable, he was transferred to Bagram for definitive surgery.
I am including pictures of my work facility. It is not quite like the hospitals back home. We don’t have a doctor’s lounge or locker room or even a scrub sink. We have an ACLS (essentially our ER or evaluation room), an operating room and what they call ICU, which is actually our recovery room. From the ICU, if they are critical, the Medivac helicopter will pick them up and fly directly to Bagram for further treatment. If the injuries are not too bad, once they are stable, they are transferred to another tent which is essentially a holding area.


Woke up one morning this week to this stuff. The good thing is that it is gone by the next day.




I am working with a Czechoslovakian doctor on a local national military leg. I am doing a fasciotomy for an open fractured tibia. Because of anticipated swelling, I release the thick band of fibrous tissue (fascia) that holds the muscle in place. The swelling can get so intense that it can block the circulation to the muscle and nerves, causing them to die.








Closer view of the surgery. I eventually perform the same thing on the other side of the leg. I also applied metal fixation (external fixator) to stabilize the fracture.


Tom