The Military October 2009

The Doctor’s War

For wounded civilians at a U.S. military hospital in Afghanistan, the gatekeeper is God.
Veronique de Viguerie

Five kids blown up playing with a land mine in the Alasay Valley, northeast of Kabul. The call came late on a slow afternoon, and the medevac crew at Bagram Air Field, the main U.S. base in Afghanistan, waited for the go-ahead to pick up its patients. But just as soldiers have rules of engagement for when and whom they can shoot, battlefield doctors have rules for when and whom they can help. And at this moment, the U.S. military’s Craig Joint Theater Hospital at Bagram didn’t have the room; some beds had to be left open in case wounded coalition troops were brought in.

The medevac crew, call sign Dustoff, grew frustrated. “Sometimes we need to step up and deal with this stuff,” said Staff Sergeant Rob Walters, senior medic for Charlie Company, 1st Battalion, 168th Regiment Medevac, a mix of National Guard soldiers from California, Nevada, and Wyoming. A moment later, a fresh call came over the radio: “You now have three patients. Two just died.” Walters groaned.

The Egyptian military, which also runs a hospital at Bagram, agreed to take the kids, and the Charlie Company helicopter roared off over the mountains. The hospital, housed in plywood buildings, is clean but cramped—think M*A*S*H—and lacks the high-tech equipment of the American facility. Most mornings, 300 or more Afghans queue outside for outpatient treatment, but the hospital has limited ability to deal with complex trauma cases, and these children had been devastated by the blast. One had a sucking chest wound, which the Egyptians would have trouble treating; the Americans agreed to take him, and only him. As nurses prepared the emergency room at the U.S. hospital, Colonel Robert Rush, deputy commander for clinical services, sweat-soaked from a workout, pulled an ER doctor aside. “If they try to bring three patients in here, tell them no. We don’t have the room,” he said.

The American military traditionally treats anyone injured on the battlefield, when time and resources allow. Top priority goes to coalition military, which includes Afghan security forces. Next are civilians injured in fighting, whether the wounds are caused by the coalition or by insurgents. Lastly, the hospital treats charity cases—birth defects, cooking accidents, falls from rooftops.

At the Bagram American hospital, even before the United States recast its focus from killing insurgents to protecting and helping the local people, the staff spent much of its time treating Afghans. Foreign coalition soldiers usually cycle through the hospital within 24 hours, moving on to military facilities in Europe. The Afghans, a mix of soldiers and civilians, might stay for weeks. In a country with poor medical care and an oversupply of the sick and wounded, the need is always greater than the ability to help. And as this year’s fighting season had warmed up, the hospital beds had filled with war-wounded, which raised the entrance bar for new civilian patients. The dismal task of deciding who would be admitted—who would live, really—fell to Rush.

The Dustoff bird landed, and a hospital team rolled the first stretcher toward the ER entrance. Rush stood outside, blocking the door. “Is that the sucking chest wound?” he asked.

“No,” flight medic Sergeant Steve Park said.

Presented by

Brian Mockenhaupt is a fellow at the Alicia Patterson Foundation and a former infantryman.

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