Updates

Today, I thought I would talk about the 2 year old Afghan boy we have been treating for approx. 10% BSA burns to the buttocks, legs and groin. We have been taking care of him since 14 November. He was brought to us from a neighboring province for treatment of some burns he had gotten from an open fire that was used for cooking. Afghans use open fires for most of their food preparation. I am told that we will see more of this as winter sets in since they use a lot of oil for heating as well. Since this patient did not meet our MROE (Medical Rules of Engagement) standards, we took him in on our own. We are hoping we can transfer him to Bagram at some point to get skin grafting, but we haven't worked that out yet. We were able to get place for the father and toddler to stay on the adjoining ANP training compound. I take a short truck ride over to the compound every morning to give some anesthetics by mouth prior to bringing him to our FST for cleaning and debriding the wounds. At home, we would use IV anesthetics and keep an IV in all the time as an inpatient. We do not have the resources or bed space to keep the toddler with us all the time, so we have to adapt. Administering anesthetics by mouth makes it a little more difficult to get the dosages right since there are many more factors to take into account. I also have to be careful of the total dosage so that we don't have to keep him any longer than we have to after the debridements. We have to be cognizant all the time about utilization of resources in case of a mass casualty event, etc. I am getting better at it and I am glad that I have my PDA that has my pediatric anesthesia textbooks on it. Anyway, the father seems very appreciative and I have made several new Afghan friends at the ANP compound. One of the locals has invited me for tea (apparently, that is soomething that Afghans do socially), so I am looking forward to that soon. The Afghans seem to "check us out" every time we go over there and they all seem very appreciative that we are caring for this child. I always have my weapon on me "just in case" though. I get the sense that they are glad we are here, but don't trust us totally yet. I guess that's because Americans don't have the best track record for "keeping our word". I believe that it is important for us to stick this one out with the Afghans in order to gain their trust. I hope we can do that. Anyway, here are a couple of pictures of the little boy and father with some of our team. Oh, our patient with the crushed pelvis is still alive in Bagram. He has had a total of 70 units of blood products (20 here and 50 in Bagram) which is substantial. If he survives, that would be a major success. I also added another picture of me in the OR. It's not every day you get to carry a M-9 pistol to surgery you know....