Dispatches from Kandahar

September 11, 2009

Hi everyone,

Sorry for sending out this email so late in my deployment (Im only
here another couple of weeks!), the pace at the hospital has been
busy.

In Aug, we set records for the number of cases done in one day, and
the number in one month. Its good we have two teams on each day to do
surgery (last year we had one team). As you hear in the media, there
is a lot of fighting going on around Southern Afghanistan. A lot more
of the casualties are American.

We are waiting for the new hospital to be built. It will be nice - an
actual concrete building! It should be ready before my next trip back
in 2011.

The base is getting more and more crowded. There are over 20,000 persons
on the camp. At the south end of the camp, they put up tents and
housing and called it South Park. Now they are already building
another suburb south of that called Deep South.

The gym here is brand new and quite nice. Located ~20 ft from my
quarters! Its crowded in the mornings and evenings - so I try to do
my big workouts in the early afternoon on my days off (my schedule is
24 hr on / 24 hr off). On my days off there will be meetings and
miscellaneous stuff, but its good to be able to recharge, especially
after dealing with some of the traumas that we manage in the trauma
bays and OR.

NATO Gym

Just so everyone knows what my role here is as an anesthesiologist, I
work in the trauma bays when casualties arrive, Im in the OR during
the surgery, and I assist with pain management and sedation issues in
the ICU. Patients arrive every day. Usually as a result of IED
(Improvised Explosive Device) blast injuries. They usually come
several at a time.

I am on the trauma team for patients with life threatening problems
that involve airway, breathing or circulation. After assisting with
resuscitation, we bring patients to the operating room once we
determine what needs to be done, and who goes first. The usual problem
we manage is massive bleeding. Our initial goal in the OR is Damage
Control surgery - control the bleeding, prevent contamination (sew up
intestine), and pack wounds. Then patients go to the ICU for further
stabilization.

In the OR with Sanjay Gupta from CNN

We also do a lot of neurosurgery, because we have the only
neurosurgeon in Southern Afghanistan.

I would never get to do this kind of work at home. It is valuable for
when I return home to Victoria Hospital, which is also a Trauma
Centre. The patients we see in Kandahar are mostly young males, with
an enormous physiological reserve and can survive a great burden of
injury. But we also see a lot of kids, including babies.

Burns are a common problem. One 10-year-old child we cared for with
severe burns from a kitchen fire came to our hospital a few weeks ago.
He and his 4-year-old sister were the only survivors of their family
from IED blasts and shootings in their village. He was burned while
preparing a meal for the two of them. The only support they had were
neighbours who looked in on them from time to time, otherwise it was
just two kids looking after themselves. Fortunately, he recovered
nicely.

OR-Team

It has been a great experience here. Rewarding, but troubling at
times. Its hard not to be affected by what we see here.

Im looking forward to getting home with my family. I dont know how
my wife manages on her own with our three children! We are already
planning some kind of vacation together when I get home.

Take care all, hope to see you soon! Please forward the email to
anyone interested if I neglected to include their address. Thanks!

Brian