Week of the Spleen

(The entrance to Haji-Mart)

Time to write again. This week was definitely more interesting than the last. Although the weather remains beautiful in Salerno, it is still winter in other parts of Afghanistan. I am reminded about this as I look upon the snowy mountains that surround us, especially to the north. Because of this the trauma work remains relatively slow. To pass time, I will sometimes visit the “Haji” mart (Picture #1). As I mentioned before, it is a market where local nationals (who have been screened) can come on base and sell their wares (picture #2). For the most part it is junk as seen in any market within the developing world. It does contain some things often seen in Afghanistan, such as rugs (picture #3) as well as items made out of marble (picture #4). There is a man who also makes custom tailored suits. As many of you know, in 2003 when I went to South Korea for a medical conference, I bought a tailored suit. It was very well done. I’m planning on getting one while here as well.

(Afghan rugs)

(Marble dishes)

Most of our activities of the week came from the Local National Clinic. This clinic is within the hospital itself. Local people pass through the two gates to get on base. Off base is referred to outside the “wire.” There are two perimeters of the base itself. An outside “wire” with a gate that is manned and guarded by the KPF (Khost Police Force). These are local Afghans who have been trained by Americans and provide the police force for the area. I have never been to the gate, but it apparently has a station with a metal detector that the locals need to pass through. They are then escorted to the American gate at the inside “wire” where they finally make it on base. The clinic is run by a local doctor, Dr. R who has been doing it since 2001 (picture #5). He is a great person and is a contact point for locals who need medical care. He also acts as a primary assistant on many of the procedures. This occurs at a great personal risk to his life. Therefore, he has to come on base Monday morning and stay until Friday evening, when he goes back to his family for the weekend. I’m grateful for his service and willingness to provide care for his countrymen.

As mentioned in the title, this was the week of the spleen. Beta-Thalassemia is a disorder of the oxygen carrying component (hemoglobin) of the red blood cells. Individuals who have this disease have not only abnormal production of the blood cells themselves, but early destruction of these cells as well. The clinical manifestations of this disease are determined by its severity: mild, intermedia, major. This can be seen as a mild anemia that is asymptomatic to severe anemia requiring frequent transfusions beginning in infancy. The severe form is often accompanied by iron overload of the body and it's associated complications, which are many. I, myself, have Beta-Thalassemia minor. Other than my girlish figure and pale appearance, I suffer no real complications. Children with the major form of the disease have a characteristic look (picture #6).

One of the functions of the spleen is to remove old and damaged blood cells. Therefore, in children with a more severe form of Beta-Thalassemia, their spleen enlarges known as splenomegaly (picture #7, spleen indicated by blue crosshatch marks). Normally it should be roughly the size of a clenched fist. In addition to relieving abdominal discomfort, removing the enlarged spleen in these kids theoretically prolongs the period of time between needed blood transfusions. Unfortunately, this procedure only treats a symptom of the disease, and does not cure it. Therefore, we limit this procedure to those children who are truly symptomatic from their splenomegaly and require frequent transfusions. This week we removed very large spleens from two pretty small children (picture #8). We don’t have laparoscopic capabilities here at Salerno, so everything is done open. Having been doing primarily laparoscopic surgery at Wilford Hall, it has reminded me how much fun open surgery is as well. It is still quite challenging to get the enlarged organ out of a “relatively” small hole. (Thank you Dr. Nelson for all the spleen experience, as well as to those mentioned before for the pediatric experience). Having children in the hospital has also reminded me how much I truly love pediatric surgery (picture #9). I really can’t see me doing anything else long-term. Take care.