As I end my 90-day deployment in Afghanistan, some observations on life, liberty and the pursuit of freedom and democracy in the Hindu Kush mountains. I most fondly thank my long-suffering bride of some 47 years for letting me have this "Last Hurrah" for an old man, since I would not have come here if she had protested. The experience has been unbelievably rewarding—worthwhile if only in getting to know the band of brothers (and the 17 percent sisters) in this modern army. In asymmetric warfare everywhere is the front line and everyone is supposed to be an infantryman, so the girls carry their weapons at all times just like the guys.
The holiday lull ended with a sudden infusion of trauma, both explosive high-velocity missile wounds and civilian vehicular injuries, which we take care of by default.
These people, half of whom are reservists, most of them on their second and third deployments, are incredibly uncomplaining, dedicated, patriotic and competent. Unfortunately, I believe we are using the armed forces up at what appears to be an unsustainable rate. I am afraid that the "stop loss" or back door draft program is going to have a negative impact on the future structure of our forces, particularly the Reserves and National Guard.
During the winter, the bad guys still pop off a rocket now and then to remind us they are around, but aside from that part of Afghanistan that borders and juts into Pakistan, things remain pretty quiet. Our side has been conducting operations to try and smoke them out prior to their traditional spring offensive but they are reluctant to engage in firefights, apparently waiting for warmer weather.
We still get casualties but mostly from the infamous IEDs (improvised explosive devices) and from children stepping on land mines. The IEDs appear to be equal opportunity weapons, like land mines, targeting civilian as often as military vehicles. During the lull in the fighting, my elective minor surgery, third molar, cleft lip and reconstructive business picked up, so I have managed to stay moderately busy.
The International Committee of the Red Cross contributed to the workload, bringing in a prisoner from the Afghan army jail for reconstruction of a facial gunshot wound from last summer. The individual was injured in a firefight with the Afghan army and initially treated at the U.S. hospital. He was released with an appointment to return for follow-up one month later, which he failed to keep because the Afghan army arrested and has been holding him since. He was seen by the Red Cross in one of their inspections of POW conditions and referred back to us for continuing treatment.
When they brought him in, I admitted him to remove a large area of necrotic bone from his jaw and scheduled him to return after that healed to revise the scarring of his lower lip, which was causing continuous drooling. These things are normally taken care of by us if we did the shooting, but taking care of someone shot by a third party was a new one. When we care for prisoners they present a security problem for obvious reasons and require a round-the-clock armed guard. The Red Cross thought that posting an armed guard on the young man was unnecessary since he was "only 17 years old." Right! As of now, he has been treated, his scars revised, and he has been returned to the Afghan army prison.
Deployment of the reserve field hospital I have been assigned to is scheduled to be over in March. It is being replaced with an Army combat support hospital out of Fort Gordon, Ga., which left some of the "90-day docs" in limbo not knowing whether they will stay with this new unit, go home or be reassigned somewhere else (Iraq?). Fortunately, my tour is over at the end of January, so I don’t get involved in the switch.
The holiday lull ended with a sudden infusion of trauma, both explosive high-velocity missile wounds and civilian vehicular injuries, which we take care of by default. Since Afghans do not use seat belts, and consider riding in the back of the truck, or on a motorcycle without a helmet, a perfectly reasonable way to travel, we see vehicular trauma that is becoming increasingly rare in the United States due to the seatbelt and helmet laws.
Injuries associated with the face striking the windshield or the dashboard, such as Le Fort’s fractures, are not uncommon here, and the worst such injuries I have seen have been here. Burns are also a common problem and are usually associated with a child falling into the household fire pit, and mother trying to get the child out of the flames. The general surgeons end up with the equivalent of a burn fellowship treating them. Some of the pathology we have seen in the civilian population has been almost unbelievable.
Our little field hospital has turned into the primary referral center in the country for pathology in addition to trauma.
Untreated dental infections that become life threatening are not uncommon in a country where the per capita GNP is $180 and the literacy rate is 15 percent. However, the dental health of the local population is surprisingly good, most likely because of the absence of sugar in the diet.
I have seen, and treated, pathology which I read about in the "doctor books" but never imagined I would see in the flesh, such as noma, yaws, untreated basal cell carcinoma in an adult with half his face eaten away and a child with a massive facial infection secondary to Behçet’s syndrome, or "silk road" disease. This is appropriate since our hospital is located on what used to be known as the "Silk Road." Our little field hospital has turned into the primary referral center in the country for pathology in addition to trauma. Unfortunately, we are constituted as a military combat support facility, which means many medical specialties are only represented coincidental to other assignments (our gynecologist and plastic and reconstructive surgeon are otherwise assigned). We do not have neurosurgery, E.N.T. (ear, nose and throat) or pathology represented at all, which poses obvious problems.
The hospital general dentist and I provide dental care to all comers from the coalition forces, State Department personnel and employees of KBR, Titan and other civilian contractors. Equipment designed for occasional field deployment has been in continuous use for three years and is beginning to show its age.
