Friday, April 3, 2009

Pediatric Care

(Air Show of US Navy Intruder)

***WARNING: This blog entry contains some graphic surgical photos. Proceed at your own risk.***

During the week while walking to dinner we were treated to a mini-"Air Show." A US Navy Intruder flew over the base several times. It performed some aerial acrobatics much to the delight of those outside. It flew relatively low over the base. Picture # 1 is the best picture I could take given my resources.

One of the devastating things about war is the toll it takes on innocent people. A lot has been said recently in the news concerning civilian casualties caused be American operations. Of course, I am not in any way on the operational side of things, although what I have seen thus far makes me believe that American troops are only trying to act in the best interest of the Afghan people, and minimize any injury to them. What are not reported in the news are the devastating injuries that Afghan civilians are sustaining due to land mines, IED blasts, as well as attacks. The majority of the people that we treat here at FOB Salerno are local nationals or Afghan soldiers. In fact, we often joke that Khost hospital is on divert because local nationals come to our hospital after sustaining an injury instead of their own. But seeing the state of their health system helps me understand why they want to be treated by Americans.

Many of the injured civilians we treat are children. I am happy to do this as Pediatric Surgery is what I ultimately want to do. I also feel blessed to have Dr. D here, who is a pediatric surgeon. Picture # 2 is a 4 year old boy who suffered a shrapnel injury to his left cheek. His father drove 3 hours at night to bring him to our hospital to be treated. Now, a three hour drive in the states is one thing, in Afghanistan, it’s very dangerous, especially at night. We evaluated the child for any further injuries, and then took him to the OR to repair the injury (picture # 3). Later, as I walked out to check on the patients, I went to tell his father what we had found. I could see by the smile on his face that he felt his sacrifice had been worth it. He was pretty pleased with the results (picture # 4). I hate to think what this wound would have looked like if he had been treated locally.

Picture # 5 is the left hand of a 3 year old child. She accidentally stuck it in a generator. Electricity in Afghan cities is limited and highly regulated. Usually it is only available for specific hours during the day. In order to have electricity on a regular basis, many families rely on gas powered generators. Unfortunately, this little girl’s hand got too close to some moving parts. As you can see she lost several fingers. Dr. R, our orthopedic surgeon, took her to the operating room to evaluate and washout the wound. After several trips to the operating room, including placement of a skin graft over the back of her hand, the wounds were closed (picture # 6). It won’t be pretty, but it should be relatively functional.

Some of the most devastating injuries we take care of are burns. Picture # 7 shows the back and bottom of a 7 year old girl. She was found by American troops while visiting locals. They were horrified to see this little girl lying on the floor of her family’s home with such terrible wounds. They were told that this happened from a rocket attack. She was taken (along with her father) to the nearest FOB. She was subsequently transferred to our facility. Upon further evaluation, it was obvious that these wounds did not occur from a rocket attack. They fit the classic pattern of being placed in scolding water, mainly on the lower back and buttocks and feet (picture # 8). These wounds were also old, approximately 2 months. She was sickly appearing, due to a low blood count, and the fact that she wasn’t eating, because her bottom was scarring shut not allowing her to defecate.

Over the course of her hospitalization she would be taken to the OR on several occasions (picture # 9. First, she was taken to have her wounds cleaned and her bowels diverted. She underwent a loop sigmoid colostomy in order to allow exit of her excrement. Her back and bottom wounds were cleaned as was her foot. Dr. R. needed to remove some bone that was sticking out from her foot as she had been walking on this wound. Thankfully, she began eating again. Over the course of the next several days we allowed her nutrition to improve. She would then go back to the OR for removal of damaged tissue and placement of skin grafts (picture # 10). Upon changing her dressings afterwards, we were pleased to see that > 95% of her skin graft was healing nicely.

The bigger dilemma facing this child was long-term care. Both Dr. D and I have a limited period of time here at FOB Salerno, however, the wounds of this child will require extensive long-term care and follow-up. We didn’t believe that anyone in Khost would be able to do this, and with limited resources available at our hospital, we didn’t know if this was even possible after we left. Miraculously, through his network of pediatric surgeons, Dr. D was able to find the Afghan Reconstructive Surgery and Burn Center. It was established and is operated by Dr. Abdul Asat, an Afghan physician who has done some plastic surgery training in California. It is affiliated with the Grossman Burn Foundation out of California. After sending and receiving countless e-mails Dr. D was able to get in touch with the physicians at ARSBC, who expressed interest in assuming the care of this little girl. Additionally, he worked in conjunction with the US Embassy to help transport her from FOB Salerno to the ARSBC and pay for her care. What an impact this will have on her life. All are to be commended for working so hard to help this little girl (picture # 11). We’re grateful for the dedicated physicians at the ARSBC that give so much to the injured civilians they treat. Unfortunately, we have heard that they are having financial difficulties and hope that they can weather the storm.

Finally our Saturday was interrupted by another injured child. A 15 year old boy and his 7 year old friend were accidentally shot by the Afghan Border Patrol after an IED explosion. The 7 year old died in the helicopter on the way to our hospital. The 15 year old arrived in critical condition with a GSW to the right thigh. He was quickly evaluated in the trauma bay (picture # 12) then taken to the OR. Dr. R. put his right leg in traction due to a femur fracture. Dr. D and I spent the next couple hours restoring blood flow to his leg by repairing his femoral artery and vein that were injured by the bullet (picture # 13). He is doing well. Dr. R. will fix his femur fracture in the next couple of days. Just another day in paradise! Take care.

(Just another day at FOB Salerno)


  1. Thank you for doing this Steve. My name is Tom and I am Robyn's husband. I appreciate all that you guys are doing over there.

  2. Is there any way to donate to the ARSBC?

  3. Okay Dr. F... I just got caught up on your awesome blog! Seriously, I don't know how you do it. You are AMAZING!!! I have a great plan for that cute little girl, just ship her home to me... I'll take care of her. Then take all that "boom boom" experience you have and use it on the person responsible! (Alright, you know I'm just kidding about the boom boom part... sorta!) All those kids are very lucky to have you as their doctor. Thanks for all you are doing!

  4. This one hurt my heart. I'm so glad there are people like you that help those kids. Any idea who PUT her in the scalding hot water?! Thanks for all you are doing.

  5. Steve - you are performing an amazing service. Keep up your tireless effort.

  6. Steve!!! You are awesome!!! that's why you get paid the big bucks!!!