Friday, June 25, 2010


Providing a disposition for American patients going home with an injury is pretty simple.  We communicate with the flight surgeon, they arrange for a plane, and off he (or she) goes.  Discharging third country national (TCN) contractors is a little more challenging, but there is a discharge team here to help communicate with the contracting company to arrange for the patient's transport to where ever they may be going.  These patients then go on to heal in the country where they have their further therapy, or back in their home country.

The quandry comes with host nationals (HNs) - Iraqis.  Most of the Iraqi patients we see here are victims of IED blasts or local children suffering severe burns.  They often stay in the hospital for months - we may delay this to provide the best salvage possibility - but eventually, they have to leave the hospital, and they will need to be cared for by someone.  Another person will need to help them change dressings, dress and wash themselves, and often help them toilet or change their ostomy bags.  This in a country that doesn't stock ostomy bags at the local bazaar.  In this wasteland deplete of long term rehabilitation facilities, and families without the knack or funds to care for these people, we have lost more than one patient to dehydration, starvation, infection, or depression after discharging them from here.  But you cannot keep them here forever; they need to re-enter their lives.  Dr. Fajal (not his real name) is the person who shows them how to live on their own after their accidents.  Within the HN cultural context, he explains to families how to provide this care, he arranges communication between the patient with his or her family (not as routine as you may think as HNs are not let onto this base very easily), and ultimately arranges for transportation of the patient back to their home - or, if necessary, a local hospital for further staged care. 

Dr. Fajal works in this role as contract discharge planner for an American company, as a fluent Arabic, English, Turkish, Farsi-speaking specialist who gave up his career in medicine in his escape from a bankrupt Iraq under Saddam.  In his escape, he spent years as a refugee, before settling in the United States, where he acquired an ultrasonographer license after taking some basic courses, to provide for his teenage children.  The United States which did not allow his medical degree or post graduate training; the United States which decimated the remaining infrastructure of Saddam's Iraq; and, ironically, given the hazard of the job, the United States which now provides him a professional man's salary for assisting in providing a disposition to these HNs.  This is an amazing individual.

More on him later.

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