Saturday, May 22, 2010

Life, limb or eyesight

Friday is the Muslim holy day.  On May 21st, it was a pleasant evening in Khalis, and a crowd of locals were relaxing outside of a coffee shop in the busy market, enjoying the change in weather.  A vehicle containing an improvised explosive device exploded in front of this crowd, and destroyed many shops.  The blast killed 30 people, and left another 4-5 dozen injured. 

As this town less is than 15 minutes from here, we started to receive report that the bulk of the seriously injured patients were on their way here.  This caused an initial panic, and in the end we only received 2 of these patients, one who had minor injuries, and ther other, who came to our ER pulseless, had his leg amputated, but who is now eating breakfast and happy to be living.  There were rumors that the road and bridge over the Tigris from Khalis to this base was blocked - presumably, by terrorists - but I have no idea of whether or not this was the case. 

Given the quality of care we have provided for many Iraqi citizens here, we have daily requests from outside of the gate for admittance and care at our Joint Theater Hospital.  Obviously, we are not set up to become a local trauma hospital (or community hospital for that matter) for ill and injured Iraqis, but the policy, as stated by people above me who make policy, is to accept only patients from the community who arrive at the gate with risk to life, limb or eyesight.  The same day as the aforementioned bombing, for example, a head-on collision just in front of the base led to 5 trauma patients (all of who survived, and 3 of whom have already been discharged) come in to our ER simultaneously. 

The "life, limb or eyesight" policy has its holes, but does, at least, provide some humanitarian assistance to truly urgently ill patients.  It is a tough call for a 20 year old Army medic to make, however, with only a walkie-talkie to the ER to help sort through information.  Head-on collisions, for example, are particularly dangerous, and lead to high-impact low-survivability trauma, so taking these 5 patients from the accident, when only 2 of them really ended-up having urgent needs, is acceptable.  There are those who try to game the system, as you might imagine.  Patients are sometimes driven to the gate, unloaded from a still-moving vehicle (sometimes supine from a pick up truck), as the delivery vehicle speeds away.  When this happens, the patient often has IVs and a name bracelet from another local hospital.    We do what we can for these people, but you can imagine how this makes steam come out of my bosses ears.

And it can lead to confusion.  A young burn victim who alights himself making a bomb gets free admittance and care, but an infant with a potentially fixable birth-defect, may be denied and returned to the hands of a sobbing mother, destined to go without a life-saving (eventually) procedure.  Children with cleft lips are turned away, even as our head and neck surgeon has no planned cases.  Though all of these decisions are made through reason, and with the best interests at heart, many people - outside of the gate, and within the hospital - cannot reconcile these decisions.  Sometimes, it is the greatest challenge to win hearts and minds.

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