Military doctors treat Afghan war's smallest casualties

BAGRAM AIR FIELD, AFGHANISTAN

04.09.2007

Courtesy Story

Combined Joint Task Force - 82 PAO

BAGRAM AIRFIELD, Afghanistan – Orphan's father worked for the Afghan National Army and the Taliban knew it. They retaliated. However, rather than seek their vengeance against his father face to face the Taliban placed a mine near his house.

And Orphan found it.

The 8-year-old boy lost his right leg and most of the flesh on his left. Lying in a bed in the Craig Joint Theater Hospital, he whimpers every time someone comes near him tearing at Air Force Maj. Alex Black's heart.

"You're angry," he explained, shaking his head. "Why does an 8-year-old have to suffer? He just went out to play. Now his life is changed forever."

Black sees many children like Orphan. He has little choice as Task Force Med's only pediatrician. The Tustin, Calif., native deployed from Wilford Hall Medical Center has the express mission of overseeing the care of the nearly 20 children per month seen at Task Force Med.

"There's a lot of children put in harm's way," Black said. "Kids are not just little adults. It requires someone who knows drug dosing and their different physiology. In the past, we've seen some errors done by doctors [who aren't pediatricians] who weren't familiar with those differences."

The largest wounds, the smallest victims

Working with children in Afghanistan is nothing like seeing them in Wilford Hall, Black said. Instead of tending to fevers and sniffles, most of the young patients Black sees are in the Intensive Care Unit, victims of landmines, gunshots and head injuries.

"We see very sick kids," he said. "About 80 to 90 percent of the kids I see are on a ventilator at some point and require a high level of care. I haven't seen anything like this in San Antonio. Most kids you see there, the worst they have is a fever. Here, all I see are kids blown up and shot."

Air Force Capt. Brandy Casteel, TF Med ICU nurse, spent nine years as a neonatal nurse before she deployed to Afghanistan. She said she was shocked when she arrived.

"Our first patient was a baby that was pretty sick," she said. "I never expected to take care of a baby again. Back home, I don't really see blast or gunshot wounds and what caught me off guard were my first trauma patients here were children."

Malice doesn't account for every child patient. Poor living conditions, filthy water and malnutrition present wholly different challenges for doctors who are forced to face maladies almost unheard of at home station.

"A lot of infections would be prevented with clean water," Black said. "Sometimes infants die from simple stomach flu. How many kids in the States have you heard of dying of stomach flu?"

According to UNICEF, children in Afghanistan have a one-in-seven chance of dying before their first birthday as a result of malnutrition and common but preventable diseases.

Fighting the odds and sometimes the inevitable

When a child comes to the Craig Joint Theater Hospital, it is usually because their odds of survival are low to begin with. Children with severe injuries are often airlifted to BAF because there is nothing more the nearest forward operating base can do. As a result, the doctors at CJTH are often the last stand between life and death.

"We've had some good saves," Black said. "We've had significant head injuries walk out of here and that makes your day."

Some days are bad days, he added.

While they can save some lives, the state of medical care in Afghanistan sometimes makes rehabilitation impossible.

"The Afghans have very little resources," Black said. "Kids we would be able to save and rehabilitate back in the States could just end up dying later. Sometimes we have to say, 'I can't save this child this time.' It's better for them to die comfortably in the ICU than leave and die painfully of dehydration. That's the hard thing about being in Afghanistan. The kids I know I can save and be rehabilitated in the States doesn't happen here. All I can do is give it all I got."

Casteel said sometimes it's easier not to know.

"I don't know what happens when they leave the base," she said. "Part of me wants to know, part of me doesn't. I don't know how I would handle it. You're here because you want to help people. At the same time, you wonder what's going to happen to them. It's a double-edge sword."

But good days outnumber the bad ones, Black said, and while some children are lost to their injuries, he said more are saved than not, with 10 children leaving the hospital in good shape for every three that don't.

Impacting the mission

While the primary mission for military doctors in Afghanistan is to treat wounded servicemembers, medical personnel recognize the impact their work with Afghans, particularly children, can have on the war effort. With media outlets quick to follow the "if it bleeds, it leads," mentality, images of U.S. doctors fighting to save the lives of the Taliban's most vulnerable victims is a very powerful one.

"The medical care Task Force Med has delivered to the children of Afghanistan has obviously had a profound effect on the children who have received treatment," said Air Force Col. Bart Iddins, TF Med commander. "However, the medical care delivered to the individual children has also had a direct and lasting impact on the families, the villages and the nation as a whole."

With 25 percent of the Afghan patients eligible for treatment at the CJTH being children, Iddins said having a pediatrician on the ground was essential.

"While the primary mission of Task Force Med is to provide combat medical care for coalition forces, a secondary mission is to provide space available medical care to local nationals who have life-threatening, limb-threatening or vision-threatening injury," Iddins said. "Aside from clearly being the right thing to do, providing life-saving, limb-saving, vision-saving medical care to the children of Afghanistan builds trust and respect between Coalition forces and the people of Afghanistan."

"We're here to take care of our own troops, but above and beyond that we're here on a humanitarian mission," Black explained.

While trauma victims are cared for at the CJTH, the provincial reconstruction teams periodically provide family care during medical civil affairs programs. MEDCAPs provide care to villages throughout Afghanistan and treat patients for everything from anxiety to ringworm.

"We offer, what would be in the United States, family practice for Afghans ranging from two to 60-year-old; men, women and children," said Air Force Maj. Tim Gacioch, Bagram PRT physician assistant.

Gacioch said the work the PRTs do in regards to the MEDCAPs is an important step in both winning the hearts and minds of Afghans and bolstering their ailing health care system.

"We're giving immediate relief by providing medicine and even an ear to listen to problems," he said. "It's the care of the children and making them aware of how to care for themselves that has impact."

Tech. Sgt. Deborah Taylor, Bagram PRT medic, said more than half of the 70 Afghans she treated during a recent MEDCAP were children.

"It's hard to see, especially with kids," she said. "You want to do more, and you wonder how much more and would it ever be enough."

While it might not ever be enough to satisfy the doctors, med techs, nurses and physician's assistants working in Afghanistan, Black said the small victories they accomplish make it worth it.

"This makes it worth it," he said, pointing at family whose young son was recovering from burns. "Watching the kids walk out better than when they came in."

When they walk out, Black fervently wishes them the best and hopes he will never have to see them in an official capacity ever again. While the impact of their work may be difficult to quantify in the present, the hope each of them share is that this younger generation of Afghans will live on, grow up and fondly remember the doctors from far away who once helped them.

• Date Taken: 04.09.2007
• Date Posted: 04.09.2007 14:20
• Story ID: 9829
• Location: BAGRAM AIR FIELD, AF