Talk to Me Like My Father: Frontline Medicine in Afghanistan

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administered with the help of the Red Cross, the Mirwais Hospital in Kandahar City will take any civilian or Afghan National Police (anp) officer initially treated by us, but it won't take Afghan soldiers. The Taliban have threatened Mirwais doctors who've come to our base for clinical mentoring, and they worry that if they assist ana soldiers, their hospital will be attacked. At the Afghan military base Shir Zai, a facility the U.S. military built to be the provincial ana hospital has been sitting empty, much to the frustration of a U.S. naval officer who's been laboring to open it. Unused crates of equipment and ct scanners sit in the building, she says. We meet with the Afghan brigade surgeon responsible for the Shir Zai hospital, an educated and committed man who has watched his physicians and nurses desert one after another, afraid and demoralized. "No one from the north, where it is safe and where their families are, wants to come here," he tells us. "Kandahar has always been like this, far from Kabul and hostile to anyone from any other place." He spots Acharya among us and addresses him in Dari. Acharya replies that he speaks only Gujarati. There is a moment of what I take to be silent commiseration: South Asians surrounded by farangis, which in both languages means foreigners.

like every saturday, today local merchants line up at the base gates before dawn and submit to body searches. By mid-morning they've set up a bazaar to hawk food, rugs, hookahs, and the relics of previous conflicts: piles of ancient British Enfield rotating bolt rifles (the colonial army left behind thousands) and Soviet army uniforms, many with carefully patched bullet holes. The object lesson could not be more clear.

Genuinely multinational combat armies are uncommon. Historically, one nation dominates an effort, and bit players stand around for show. Yet 37 nations compose the isaf, each with its own generals and political masters. Aberrations in codes and procedures can lead to friendly fire, though the U.S. military prefers the "blue-on-blue" appellation. Twice Canadian infantry have been fatally attacked by American aircraft. But far more common is coalition personnel firing on Afghan allies. A few days ago an Afghan soldier riding in a truck approached a Canadian military convoy from behind; he was recognized as ana by the rear vehicle and waved forward. This was not communicated to those in the lead vehicle, who opened fire, killing the driver and sending six rounds into the passenger's evidently robust body armor and another into his right arm, breaking the bone and severing the ulnar nerve. We grafted his nerves, and in six months or so (peripheral nerves grow a millimeter a day) it will be possible to know if the surgery was successful.

Can doctors tell if fire is friendly or not? The infantry believes it should be easy to know: nato countries use 5.56 mm ammunition while the AK-47 favored by the Taliban uses 7.62 mm. Except local allied forces—the ana, anp—use AK-47s too, as do the forces of the former Warsaw Pact—the Romanians, the Estonians—and anyway, when bullets strike bone they can shatter, spraying shards of metal through the body like a satellite breaking up on re-entry. More often the full-metal-jacketed rounds go through and through, as they were designed to do. We can't necessarily tell whether a wounded person was shot by his confederates or by an antagonist, except by what is claimed. Probably, more times than we could guess, we wouldn't want to know the answer.

When an aeromedical team tells us they're bringing in an ana soldier shot in the thorax, we wonder why they're bothering—such patients usually die en route. But the shooter must have been at an extreme distance, for the bullet is palpable just under the skin over the sternum and excised under local anesthesia by Lt. Colonel Reeuvers, a Dutch surgeon. When he plucks out the AK-47 bullet, Reeuvers and his patient exchange amused grins. Reeuvers tells him to buy lottery tickets. A translator tries but both he and the patient look puzzled. "Go to the casino," Reeuvers tries again. Still only baffled nods. Then the Afghan soldier leaves our base for his own, the question of who shot him unasked, unanswerable.

february 18: The CH-47 Chinook helicopter had 22 Americans—many of them Special Forces soldiers—on it when it crashed, apparently from mechanical failure, in the mountains of Zabul Province. Eight died on impact; 14 survivors were several hours in the snow awaiting rescue. The notification of a mascal, mass casualty situation, goes out long before they arrive, allowing us to buy coffee from Green Beans, a sort of downscale Starbucks that's become as common on American military bases as its inspiration is in gentrifying urban cores.

The rescue helicopters bring the soldiers in by groups of three and four; they are all terribly cold, 29, 30 degrees Celsius, and shattered—fractured spleens, broken spines, punctured lungs, and broke-open pelvises. "Bone salad," one doctor calls it.

Cold blood will not clot appropriately and so they bleed briskly—from minor wounds as well as major ones. The blood bank begins releasing the first of the 200 units of blood needed that day.

One young sergeant is unmarked but unconscious. A ct scan of his brain confirms hemorrhaging and severe swelling—traumatic brain injury. We start him on diuretics; it will be seven hours before the evacuation team can arrive, and then a seven-hour flight to Germany.

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Photographs By: Kevin Patterson

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