Hearts and Minds

Providing medical care in a combat environment is challenging on multiple levels. The most difficult aspect, in my opinion, is having to turn away people that need care but do not meet the Medical Rules of Engagement (MROE). This is an incredibly complex issue. As many of you may know, we are technically in a draw down. That is to say, we are gradually going to decrease our military foot print in Afghanistan with the goal of eliminating all combat forces by the end of 2014. This smaller foot print will also lead to a decreased availability of US medical personnel and resources. As part of this process, we are insisting that than Afghans take a larger role in taking care of their wounded, both military/police and civilian. Therein lies the moral dilemmas we have to face here at FOB Sharana.
The 1980th FST is in the process of creating a mentoring program with local Afghan physicians. Just yesterday, we did two operative cases with an Afghan "Anesthesia Technician" and surgeons. The goal is to impart knowledge, to some degree, so that these medical professionals can better take care of their countrymen after we leave.

Afghans are more like us than not. They are a proud people that want nothing more than dignity, respect, and peace. Unfortunately, the Afghan society has been decimated by countless years of war, corruption, and systemic dysfunction. The country lacks a basic societal infrastructure, and over half of its "citizens" live in abject poverty. For decades the international community has vacillated between ignoring the plight of Afghans or exploiting them for the purpose of geopolitical point scoring. As with all wars, it is the innocent that suffer the most.

This series of photos was taken during an induction sequence with an Afghan anesthesia provider. I was serving as his mentor. The patient is a 11 year old boy that was shot through the upper arm with an exit wound through the axilla. His humerus was fractured mid-shaft. The photos uploaded a little goofy, but you get the point nonetheless.

I elected to use a supraglottic airway. The child was shot approximately 24 hours prior to our encounter and was NPO.

This was my counterparts first opportunity to use a LMA.

We did an extensive irrigation and debridement as well as a definitive closure of wounds. A drain was placed and the upper arm was placed in a cast.

Major Randall Moore, CRNA
1980th Forward Surgical Team
FOB Sharana, Afghanistan