Saturday, July 24, 2010

Drawdown of military medicine

Six months ago, the plans for the drawdown of military, and civilian support, personnel in Iraq were public knowledge.  Reduction of military force by 50% in September 2010, and removal of all troops, with exception of training operations and diplomatic missions by September 2011; or something approximating that, anyway.

Most active duty troops are relatively young and healthy, but the sheer number of folks here leads to the statistical inevitability of strokes, heart attacks, seizures and what-ails-you walking through our door.  These cases have previously been dispersed among the many hospitals and small clinics throughout the country.  This year, we expected to see an up-tick in the number of medical admissions when the peripheral bases started to close this summer.  What we did not expect was the simultaneous increase in violence - or at least the perception of such - as there are diminishing number of facilities prepared to care for trauma patients.  In addition, the young surgical crew here is hungry, and doing far more elective cases than the previous group. 

So, these have all led to a significant increase in business, decrease in sleep, and mild regret among my colleagues as to my departure - or at least the departure of my work.  The hospital's first priority is to care for the trauma of US soldiers, and that mission will be met.  The elective procedures may start going away, and that will provide more time for the surgeons to care for trauma victims, but other services we provide are not as elastic.  The care of host nationals (HNs), for example, is, in part a humanitarian effort to win the hearts and minds of those in the areas around us.  The choice of which of the patients are chosen to receive care here, however, is somewhat arbitrary.  People will be happy when we discharge the 21 month old boy who has been here for 1 month in the hospital, a most certain rescue from death from his burns.  People are less pleased when Command accepts a terrorist with a gunshot wound over a infant with a simply reversible birth defect at the gate.  Compounding this, recently, our follow-up clinics have been canceled, so once a HN patient is discharged from the hospital, they are on their own for follow up medical care.  I liken this to dropping off an individual on a deserted island with a laptop and a cell phone.  The medical infrastrucure in Iraq simply is not mature enough, or hasn't rebuilt enough, to handle complications or complete staged procedures for complex patients.  Nonetheless, this is all part of the plan to slowly remove ourselves, and any dependence on us, from inside of Iraq.

Planning for removal of 100,000 troops and 100,000 contracted support personnel is based on some known variables, and it must remain mutable for those unpredictable surprises.  We are counting, or at least hoping for less violence during the drawdown.  For the sake of the care of the troops, if nothing else, let's hope this is an accurate assumption.

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