Tuesday, December 28, 2010

A military hospital's all-encompassing mission...Saving lives, no matter whose

No other way to say it....the Medical Professionals at KAF and across Afghanistan make a big difference for all over there.....God Bless them all.

A military hospital's all-encompassing mission

By David Brown
Washington Post Staff Writer
Sunday, December 26, 2010

KANDAHAR AIRFIELD, AFGHANISTAN - Most of the time, this war-theater hospital crackles with danger and expertise, its staff members working to keep alive people who would be dead if they ended up almost anywhere else in the world.

But some of the time, often in the morning, it's quiet and almost empty, except for a few recuperating Afghans stoically watched over by family members and, today, a young girl in a pink robe exploring the corridor outside her room in a wheelchair.

The hospital, which opened in May and is owned by NATO, is an odd mix of urgency and relaxation. It features patients whose stays inside its $40 million walls are both shorter and longer than any in contemporary U.S. hospitals.

American soldiers critically injured on the battlefield spend only a day or two here, many unconscious and on ventilators, before being sent to Bagram air base, then to a hospital in Germany and on to the United States.

At the other end of the continuum are the Afghans who make up about half the patients.

They also come aboard medevac helicopters. They get the same immediate treatment as U.S. soldiers. Then they stay, often for weeks, until they are well enough to be transferred to a nearby Afghan hospital or discharged.

Some are Afghan soldiers or members of the national police. Many, however, are civilians or Taliban insurgents. It's often difficult to tell the latter two apart, and to the workers at the hospital, which is run by the U.S. Navy, it's largely irrelevant.

Pediatricians in war zone

About 15 percent of the patients are children. Most are here because of the consequences of war. But there's also a steady trickle of patients who have cerebral malaria, burns from kitchen fires, car accidents, snake bites and obstetrical calamities or have fallen from roofs, where families sleep in hot weather.

"Those are probably the hardest cases, when the kids come in," said Cmdr. Eric Peterson, 40, an emergency nurse. "I don't think people expect that when they come over here."

The Navy did expect it, and planned for it.

"This is the first time the Navy has sent a pediatrician as part of a wartime role," said Capt. Jon Woods, 45, a pediatric intensive care physician. "It is a recognized part of our mission."

'New paradigm' in care

Pediatrics isn't the only addition to what is considered possible and necessary in war-zone medicine. The hospital also has an interventional radiologist, who can snake catheters into bleeding sites that surgeons cannot reach. It has a 64-slice CAT scanner that would be the envy of any radiology department in the United States. It has a neurosurgeon.

"This is a new paradigm, having a neurosurgeon in-theater. But I frankly can't imagine not having this capability," said Cmdr. Steven Cobery, 44, a neurosurgeon who did 120 operations between April and mid-October.

One of the consequences is that some Afghans receive care here and at a sister hospital at Bagram that would be unimaginable elsewhere in Afghanistan. In some cases, it would be rare in the United States.

For example, Woods recently flew to a forward operating base where a newborn had been brought after a difficult delivery. The baby, four hours old, had persistent pulmonary hypertension and meconium aspiration - both life-threatening lung conditions. On the flight back, Woods breathed for the child with a squeeze bag and an endotracheal tube and gave her drugs to keep her out of shock. It was ICU care in a helicopter, delivered by a pediatric intensivist.

The child stayed in the hospital for six days, recovered and went home. The alternative destination - if she had survived to get there - would have been Mirwais hospital in Kandahar City, which has a single ventilator for infants.

Of course, many of the Afghan patients would not need heroic medical treatment if not for the U.S.-led war, now in its ninth year. And much of the time the circumstances of a civilian's wounding are unknown or ambiguous.

To accommodate long-staying patients, the workers at the Kandahar hospital have set aside a room for praying. Relatives are permitted to spend the night in the patient's room. Staff members often get food for the families from the dining hall (and hold it until after sunset during the Muslim holy month of Ramadan). When a patient dies, the face is turned toward Mecca, the big toes are tied together with cloth as prescribed by Islamic law, and someone is called to say the proper prayers.

"We try to be as culturally sensitive as we can, given the mission," said Lt. Cmdr. Timothy Broderick, a nurse who heads the intermediate care ward.

Saving lives, no matter whose

Although the hospital is important to the "hearts and minds" campaign, the military realizes the openness of the doors could compromise the main mission of saving troops' lives. Consequently, if a certain number of beds are filled, the hospital will not take civilians unless they have been injured in combat. Except for the exceptions.

"We always take neurosurgical cases," said Capt. Michael D. McCarten, 58, the commanding officer. "If there is a potential for a life-saving intervention, we'll take them."

In the spring, an Afghan man arrived with his 14-year-old son, who had fallen from a tree. The man had taken the boy to one forward operating base, been turned away and taken him to another. ("Just like in the United States, parents here are very persistent," Woods said as an aside, as Cobery, the neurosurgeon, told the story.)

The boy had a skull fracture. Cobery removed a section of the skull to decompress the swollen brain. He put the skull fragment under the skin of the boy's abdomen, where it would survive until the brain had fully healed. Three months later, the father returned with the child. Cobery put the piece of skull back where it came from. Case closed.

The care and solicitousness extends to Taliban fighters, as well. The only difference is that they are under armed guard until they are handed over to other authorities.

Cobery said, "Not one time has it come into my medical decision-making not to do something for someone because he's a bad guy. To someone, he's a good guy."

Several months ago, the hospital treated a man in his 20s, reportedly a Taliban fighter, who had had one leg amputated very close to the hip joint. The stump had become infected, and the infection had begun invading his pelvic cavity, an ominous development. The doctors told him that they were not sure they could save him.

"He started to cry," Woods recalled. "He said he just wanted to see his wife and kids again."

The orthopedic surgeons mixed bone cement with two antibiotics and fashioned the concoction into small beads. "In the States, this stuff is manufactured. We were our own manufacturing plant here," Woods said. The doctors packed the wound and the pelvic outlet with the beads, then put the patient on extra-high-dose intravenous antibiotics.

He survived.

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