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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.

A few months earlier, John tells me, the fighting was ferocious in Kandahar, but it always stalls in winter. The plain outside Kandahar in late January is dusty and, come midday, even warm. But in the mountain passes leading from Pakistan, the snow is deep, deep, deep. This makes for difficulty if one is crossing into Afghanistan, and comparatively gentle days in Kandahar.

Nevertheless, by the end of my first week, I scrub in on nerve and vascular grafting procedures, craniotomies, and all manner of thoracic surgery. If bones are involved, the orthopedists wade in; the oral surgeon does any procedure north of the collarbone. Otherwise, the general surgeons demonstrate just how general they can be. There are no plastic surgeons available for burn patients, no pediatric surgeons for the kids, no urologists, no vascular surgeons. It's clinical practice as it exists in places remote either in geography or time. But in medicine, as in love, there is Doctor Right, and there is Doctor Right Here.

About two-thirds of our patients are Afghans: Taliban and Afghan National Army (ana) personnel and civilians. The rest are coalition soldiers. The coalition folks generally do well; their body armor is very effective, and the amount of penetrating chest and abdominal trauma is limited. Not so with the Afghans. They often don't have body armor, and they aren't eligible for evacuation. When we received news that a mass casualty was en route with severe burns, we were told not to intubate Afghans with burns over more than 50 percent of their bodies—because in the absence of a burn unit, such a patient requiring life support rarely survives—but that we should do everything possible for coalition personnel because they would be evacuated to Germany or Dubai and then to places like Brooke Army Medical Center in San Antonio, where the burn care is the best in the world. Any temptation to protest the different valuation of life explicit in the order was stalled by the briefest survey of the country around us: What else is new?

ten thousand soldiers and civilians work and live at Kandahar Airfield. The civilians mostly work for kbr, the former Halliburton subsidiary that runs the dining facilities (dfacs) and maintains the miles of prefabricated, pressed-metal barracks. The contractors speak with Midwestern and Southern accents mostly, chatting merrily with soldiers like neighbors leaning over a fence. The few other civilians include a handful of physicians, some foreign-service personnel, and—judging from the haircuts and eyewear—some cia types. It becomes a game to spot Special Forces soldiers, who do not wear uniforms but are revealed by their shoulders, exuberant beards, and sun-wrinkled eyes.

In the dining halls, Australian, New Zealand, and Jordanian soldiers eat alongside soldiers from nato countries, one polyglot mass of blinking and farting martial vigor. Viewed from the entrance, the long rows of tables appear as a kind of fabric mosaic: The Americans and Canadians in their pixelated browns and grays, the Australians in their bunny-ear-patterned beige, the British streaked by sawgrass-colored fronds, and the Romanians in yellowish-brown uniforms and floppy hats—currently the trend in military millinery, the Canadians, Dutch, and British all sport variants—looking rather like lifeguards in mufti.

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