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Talk to Me Like My Father: Frontline Medicine in Afghanistan

In Afghanistan as well as Iraq, the military is running out of doctors to patch up wounded troops—and civilians caught in the crossfire. One doctor's frontline diary from Kandahar.

it's late january, and on my way to Kandahar I stop at a facility called Camp Mirage that sits on a clear desert highway and shimmers in the early afternoon heat. It serves as the support base for Australian, New Zealand, and Canadian forces in Afghanistan and the Persian Gulf. The camp exists, and yet officially does not: The Host Nation does not acknowledge it, forbids its mention publicly. Uniforms must not be worn off the base, nor may taxis be hired to bring personnel back from shopping trips in the closest city. Soldiers who've served their six-month tours and are at Mirage awaiting flights home affect postures of world-weary and taciturn indifference, while the 19-year-olds coming in gaze around slack-jawed.

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Thirteen years ago, I was a captain in the Canadian army, a medical officer in an artillery regiment, and bored to the point of catatonia. I had enrolled for a tour of duty partly in an effort to pay for medical school, but I was also drawn to an entirely fantasized idea of distant deployments and U.N. peacekeeping, anything to get me out of dusty and predictable Manitoba, where the idea of exotic exists only in the context of dancers in Saturday-afternoon bars. As it turned out, I was attached to a base in Shilo, Manitoba, a vast, windswept expanse of whitewashed clapboard huts tossed up during World War II. I was 25 when I arrived there, and had 400 young men and a small clot of aggrieved women to care for. They were none of them sick. If any one of them had anything in the way of important illness, they would have used it to insist on a posting to a city. My day's work was done by 9 a.m. The rest of the day, I napped on my desk. Little puddles of drool accumulated beneath my chin.

Today, after years of sitting on their hands in Kabul, the nato-led International Security Assistance Force (isaf)—especially Canadian, Dutch, and British forces—has moved into the southern provinces of Uruzgan, Helmand, and Kandahar to wrest control back from the Taliban. For Canada, which closed its last military hospital in 1998, it is like nothing since Korea. It quickly became clear that uniformed personnel were too few to staff the Canadian-run combat surgical hospital at Kandahar Airfield. An appeal was put out for help. Within a few months, several nurses and doctors with whom I work on Vancouver Island had all signed up for brief rotations for the Kandahar icu. I did too.

Is There A Doctor On The Base?

10,853 U.S. physicians and dentists served in Korea, fewer than half via the "doctor draft."

30,000 U.S. physicians and dentists served in Vietnam. Only 100 had been drafted.

Today, the U.S. Army has 4,200 physicians on active duty worldwide.

There are 32 active U.S. military doctors serving the 25,000 U.S. troops in Afghanistan.

There are 96 physicians, 18 general surgeons, and 9 orthopedic surgeons serving the 146,000 U.S. troops in Iraq.

The U.S. Army has 2 pediatric surgeons.

20 children are seen at the Bagram Air Base hospital in Afghanistan each month.

The U.S. National Guard is offering health care professionals $30,000 in bonuses for three-year commitments.

Canada offers medical officers enlistment bonuses of up to $225,000.
—Nicole McClelland

I board the C-130 Hercules along with soldiers from the 2nd Battalion, Royal Canadian Regiment. There's an air of taut and humorless anxiety I do not recall from my own days in uniform. I wear a Kevlar helmet and body armor over my jeans and sweater. The other two civilians aboard are an agitated bouffant-going-gray foreign-service officer and a lithe goateed man who, when I ask him what is bringing him to Afghanistan, replies, "this and that." He could be a hairdresser or software engineer but for a certain exaggerated yet quiet intensity. He says his name is Greg. The foreign-service officer asks him how long he will be in Afghanistan. "Two, three months," he says. She nods, and begins telling animated and self-congratulatory stories of her last spell in Kabul. He listens but doesn't pay her much attention.

Three and a half hours later we begin our descent into Kandahar Airfield, a giant base from where isaf coordinates its attempts to control southern Afghanistan. It is from Kandahar that the Taliban first emerged in 1994 and where it finds succor today. Kabul is now almost safe: Girls go to school; the markets are full. In Kandahar, where the cloak of the Prophet is kept, bicyclists explode themselves next to soldiers trying to build roads.

After landing, we're ushered into a devastated hangar, where tendrils of aluminum roof sheeting hang down like crepe paper; Mars glows red between the largest of them. A company sergeant major approaches and asks who I am. "Well, why hasn't the hospital sent someone for you?" The foreign-service officer walks around in tight, quick circles asking pointed questions of her BlackBerry. "Greg" has slipped away quietly. Detecting little in my bewildered response to satisfy him, the sergeant major barks into a telephone. A few minutes later a medic arrives to drive me to the hospital. Nobody naps on his desk here.

past midnight, I'm deposited in my barracks and meet the other doctors: a mix of Dutch, British, and Canadian officers, as well as a Canadian civilian radiologist, and the icu doctor I'm replacing, John Ronald, with whom I work on Vancouver Island. After a burst of enthusiastic welcome, words run short. I've been flying for days. I crawl under my coarse woolen blanket. An instant later, I wake myself up with my own snoring.

The next morning, John shows me around the recesses of the jury-rigged hospital, part tent and mostly unpainted plywood. The toilets are in a prefab metal container. There are two operating rooms and the only ct scanner in the entire province. Within this construction-site ambience work two surgical teams: one Canadian, the other Danish or Dutch, which alternate every two to four months. Also present: British, Australian, and American doctors, nurses, and medical assistants; morning rounds have the sort of internationalist air that Madrid might have had in 1936. ncos don't bother saluting officers here—no one can figure out the myriad of rank insignia present on the base.

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