Inshallah

Kandahar, Afghanistan


Peace Garden (my term) in front of the hospital: 
The color green is virtually nonexistent here...

Inshallah means "If God wills it."  It is a commonly used phrase in these parts, perhaps reflecting the capriciousness of fate that local people feel in these parts.  Or as Edward Gibbon might say, "the vicissitudes of fortune," and around here there is not much "fortune."  I am sure thirty years of war interlaced with rule by the Taliban can make one say "Inshallah" quite a bit.

We see many local Afghanis in our hospital, to include children.  They are usually flown in from the Forward Operating Bases in southern Afghanistan.  In my week here we have had four children, only one the victim of trauma - a five year old boy hit by a car in a local city with multiple fractures to the skull.  We had a particularly sad case of a 7 year old girl who was transported here after having a surgical repair to her bowel.  Her small intestines were filled with worms and could no longer pass stool.  The local surgeons attempted surgical repair but the wounds became infected and she developed septic shock, at which time she was transported to our hospital.  Here she received state of the art care, had 3 revision surgeries, and had been resuscitated appropriately, surviving her sepsis.  She needed a skin graft, which is exceedingly difficult to do.  Through much effort we had engaged a Kabul-based French hospital, secured funds for treatment and transfer, and were awaiting word of acceptance.  The girl's grandfather, who was her spokesman, finally tired of the waiting, and refused to wait any longer on word from the French hospital.  Inshallah.  If she dies, I want her near her parents, he said through an interpreter.

The base chapel, behind barricades and the ubiquitous water bottle boxes

Inshallah indeed.  We all felt she could survive, and we found out shortly after she left that the French hospital had finally accepted her.  There were many difficult-to-suppress emotions circulating through the ICU - anger, sadness, and a bit of Inshallah on our parts as well.  We all are aware that life is difficult here to say the least.  It's probably no exaggeration to state that a child born in Afghanistan has a slightly better than a coin-flip's chance of reaching adulthood.  This 7 year old was about the size of my youngest daughter at 2 and half.  Once one makes it to adulthood, life continues to be tough.  One of the departing ICU docs told me that when they are young, they look about half their age whereas once they get to their 20s they look double or triple their age.  The girl's grandfather, who may have been in his late 40s or early 50s looked like a wizened 75 year old.

As the young girl was being gurneyed to the medevac helicopter I caught a glimpse of her as I was putting in a central venous catheter into our newest patient, the 5 year old boy struck by the car.

Inshallah.