This week we will be talking a lot about Afghanistan and the impact of the President’s speech. Having spent a fair amount of time there, including a trip just a couple of months ago, I am always reminded of the human impact of any conflict. I am reminded there are consequences to all those booms and explosions we see on television. I am reminded of the horrific injuries I saw due to IED explosions where young men and women are robbed of their legs, and their lives. I am also reminded of the remarkable sacrifice the doctors, nurses, medics and all the medical personnel make every single day out there. They truly risk their lives to save the lives of others.
Medicine and the military are embraced in an awkward dance and no where is that more true than in Afghanistan. Because of the terrain, most of the med evac missions are carried out by chopper. They typically have 20 minutes to fly to the patients, 20 minutes to stabilize and treat, and 20 minutes to get the patients to more medical care. It is one golden hour. Right now, even as I write this, these medics are sleeping in forward operating bases just behind the front line troops – with their boots on, and eyes half open in dusty desert tents waiting to get the call. Waiting for a chance to save their fellow soldiers who got the call before them.
Truth of the matter, nearly three-fourths of the time, the call they get is to take care of an Afghan local or soldier. In fact, if you look at the breakdown of operations performed at the coalition force run Kandahar Role III, the largest trauma hospital in the country, most are performed on Afghan patients. The local medical system in Afghanistan lacks the infrastructure to take care of most of these sorts of injuries. There is only one vascular surgeon in the country, two neurosurgeons and really no ability to perform cardiac surgery. It made me wonder what will happen to patients with trauma a year from now or in five or ten years.
If you look at pure numbers, for every 10,000 troops, 127 will be wounded in action. A tenth of those wounded will have traumatic brain injuries and several others will need amputations. Still others will have serious burns. It costs close to $20,000 per soldier to provide field care, and if you add in an air evacuation, the cost is closer to $50,000. At the Kandahar hospital, doctors are performing close to 300 operations a month, and that number is expected to increase over the next few months.
Of course, these numbers are meaningless to the tens of thousands of troops in Afghanistan right now and the tens of thousands about to head there. As you watch the speech tonight and the analysis over the next few days, try and remember the medical staff there as well. They are the ones embraced in that awkward medicine and military dance – they are the ones trying to repair the ravages of war.