Heart and Mind

22 Aug 2010


Kandahar, Afghanistan

We recently had a child in the ICU who had an IED fragment traverse through his frontal lobe of his brain. He had a pleasant, white bearded grandfather who spent hour after hour at the bedside of his grandson, coaxing him toward recovery.  Grandfather knew a bit of English, which is very atypical here.  At one point we proposed a plan for the child in which he would have a catheter placed in one of the ventricles of the brain, tunneled via subcutaneous tissue, and placed into the abdomen.  This life-saving procedure, called a ventriculo-peritoneal shunt, or "VP shunt,"would drain the excess spinal fluid that accumulated in the brain.  The only problem is that we could not do this procedure here as we did not have the shunts.  Because of our often suboptimal supply system, it could be weeks before we could get a shunt to Kandahar.  We proposed sending the child to Pakistan to have the procedure done there.  Grandfather stated bluntly to our neurosurgeon, "Why would I besmirch your name by sending my child there?"  He further explained that he felt our surgeon had saved his grandson's life up to this point, and he was confident the boy would ultimately get better based on interventions up to that point.  He felt the need to tell us that Americans are beloved by him, and throughout his village.  It would be a sad day indeed, when we leave.  We wryly noted later that we had won over one heart and one mind in the grandfather.  Incidentally, the boy did get better, and was determined not to need the VP shunt after all.

Yesterday I went with three other docs and our translator back to Camp Hero, likely my last visit there.  I had a sack of toys yet to give away to the kids that folks had sent me.  After visiting the children's ward and handing out the toys, I rejoined our surgeons in the OR.  Two patients had been prepped for surgery and our surgeons were essentially training their surgeons on some relatively complex procedures.  The first involved a patient whom we had cared for at the ROLE-3.  He had had his arm nearly blown off by an IED.  The hand was still viable but the flesh on the forearm and around the elbow had been largely been blown off.  In order to allow the remaining tissue to heal enough to take a skin graft, our surgeons had sewn his arm into his abdomen.  Our surgeons were cleaning up the now immobilized arm.  This is a fairly amazing procedure as far as I am concerned.

Sign at the entrance to the Camp Hero Operating Room - unnecessary in the US.

I looked over to the OR table 6 feet away with another patient being attended to by one of the Afghan anesthesiologists.  He was using his bare hands to start an IV, going to various sites on the patient's arm without using alcohol to clean the patient's dirty arms.  So in adjacent beds I was witnessing  third world medicine being practiced next to state-of-the-art medicine in the arm-to-abdomen patient.

Our surgeons scrubbed into three procedures yesterday before we were called back to the ROLE-3: an 18 month old child had a fragment from an IED penetrate her posterior skull, and as we would soon find out, was still lodged in her brain.  The mother had died in the IED blast.  Another heart and mind to be won in this 18 month old child.