Monday, April 5, 2010

Law of diminishing providers

Easter was my first break from the daily blogging.  I would like to say this is due to my devotion, and I decided to take a day of rest, but I would be exaggerating.  The truth is, after Jesus died for our sins, people started trying to die here, in force.  After the weeks of boredom with intermittent hysteria, the past several days have been more of a prolonged hysteria, just now settling to flatuent murmur.  This week: burned babies, heart attacks, 3, yes three, projectile-in-brain traumas - all of whom survived, without serious deficit (well, one is blind in one eye, and one cannot move his left arm) thanks to the swift handling of our adroit neurosurgeon. [See - some of our counterparts in Afghanistan actually just removed a live round from a patients head].

I just described some trauma, but the majority of what we are starting to see now, in the setting of relative peace after the election of Alawi, are non-traumatic injuries and illnesses:  heart attacks, meningitis, cellulitis, strokes, etc. etc.   With over 100,000 troops, and 100,000 contractors in Iraq, we are statistically destined to see a proportion of these types of cases, with the remaining being seen at small FOBs (foward operating bases) throughout the country.  As has been publically disclosed, with the post-election drawdown, the expectation is to close all of these FOBs, and exit the theater via a handful of larger bases.  If the convoys of servicemen leaving these FOBs are attacked, there may be considerably more trauma at the hospitals which remain; read: us.  But even in the best case scenario, with no attacks, we will start to see a much larger proportion of injuries and illnesses that any town of 200,000 people might see. 

The draw-down has also meant shrinking assets and space, not just personnel.  So, now that can potentially be seeing considerably more patients, we have 1/2 the space for ICU patients, 1/2 the space for regular ward patients, and 1/2 the staff to care for them.  This is very much likely. 

No surprise to anyone, but everything in the government moves slow, and the changing of missions in the medical corps are no exception.  As we see little of these cases now, we generously care for all active duty, most contractors, and assortments of HCN (host country nationals).  As the volume increases, the mission will have to change, or we will just not have the beds available for American soldiers when we need them.  Think of it this way: the Iraqi health care system is in shambles, and the best care in the country right now is likely here at this theater hospital (scary thought).  Baghdad is a city of over 10 million people, and most of the sick ones would come here if they could.

I am a worker bee, and have no effective role in defining policy.  We have, however, been sending feedback  up river.  Let's just hope and pray that the those mining the locks haven't gone out for a 2 hour lunch. - this is a little peak at our cozy hospital ward, busy even at 0300.

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