24 NOV No easy fix

24 NOV 2007 No quick fix
Today I felt about as useless as an anus on my elbow. After duties, around 1400, I returned to my hooch and just passed out cold. I have been fighting a little fever and haven’t been able to get a solid chunk of sleep. Last night I tried several times to rest, but alternated between kicking the sheets off for feeling too hot and sweaty, and shivering in long johns even with the covers pulled up and the combination air conditioning/heating unit blowing like a hair dryer. Eventually I gave up and read Marine Mike Hodgins account of his reconnaissance work in Viet Nam.

After climbing into bed this afternoon, apparently I slept through an Alarm Red for an indirect fire attack. I missed the klaxon and the All Clear. When I didn’t report in for accountability, the command section sent someone looking for me. The female sergeant and airman who knocked on the door of my hooch had a chuckle when I staggered out in my boxer shorts and mumbled my name as I squinted in the afternoon sun.

I’m feeling a lot better now after being comatose for the evening. Having a cold over here showed me one of the brief shining moments when it is so easy to be deployed. When I wanted a decongestant and pain reliever, I stopped by the pharmacy. There were no forms, no fees, and no wait. Pharmacist P. just tossed me a pack of Sudafed and a bottle of ibuprofen. It’s in the spirit of “three hots and a cot” where the military just provides anything you might need while you are stuck over here. In my case it’s sometimes four hots since I’ve been known to draw midnight chow.

The hospital has seeing business like a big city ER back home. Last night, we had more patients injured in car crashes than from battle injuries. As has been the trend, most of the patients were Iraqis, one a child who sustained a head injury in a fall. It is good to provide this much needed and appreciated help, but someday, the Iraqi healthcare system is going to have to suffice. Doubtless, they are struggling with shortfalls in personnel, supplies, electricity, water, and security. As long as our hospitals are here, they provide a crutch on which the domestic system is willing to lean. At some point we have to let the Iraqi system stand on its own. Back in the United States, if we had a free alternative hospital that would take care of our sickest patients, even we would take advantage of that option. Since that outlet doesn’t exist for us back home, we do our best to take care of patients with the resources we have.

I have been able to find out a little about the system of healthcare financing in Iraq from an Iraqi soldier who works in the hospital. He is a liaison to the hospital who helps get Iraqi soldiers back where they belong after they have been treated here, as well as directing their pay in the proper direction. He explained to me that the Ministry of Health, like other governmental bodies in Iraq, has a central office in Baghdad, then a branch for each of the provinces in Iraq. There are no taxes levied against citizens in Iraq. The money to run the government comes from oil sales, but mostly from foreign financial aid, the majority of which comes from the US. Each Ministry gets its budget, and then the ministry is responsible for supplying the provincial offices. The Ministry of Health in Baghdad electronically transmits money to the bank accounts of each of the provincial offices. The provincial minister of health is responsible for running and supplying healthcare needs in their region with that budget.

It’s not surprising that there can be problems with this system. I remember the last time I was here, in 2005, the local hospital in Balad had depleted their supply budget in March. They could no longer buy bandages. Each week, Iraqi Doctor O. would visit our hospital and drive off base with a big box of donated bandages. I have seen Iraqi patients come to us wearing soiled towels around their colostomies because there were no colostomy bags available. Emergency medical needs can overwhelm the hospitals quickly. Elective care is often only available to those who can afford to pay for it up front. Security is also a problem. I read in the Brookings Report that of the 34,000 doctors in Iraq before 2003, approximately 17,000 had fled the country and 2,000 had been killed. That chilling statistic certainly tells me that I have very little to complain about when I consider the challenges that Iraqi doctors face every day. It is so good and rewarding to care for Iraqis in our hospital every day. But I have sinking feeling that we are only seeing a tiny fraction of the many who fall through the cracks in Iraqi healthcare. It reminds me that lawmakers have the potential to save far more lives than doctors.

I did do one operation today. Laparoscopic surgeon S. and I used a laparoscope to evacuate a collection of pus from the belly of a US troop. About a week ago, I took out his appendix. He never felt quite right after surgery and didn’t regain his appetite. Day by day, he felt worse and then he developed a high fever. We did a CT scan on him and found the liquid collection of pus in his belly was interfering with his intestines. After removing the pus, we left a soft rubber tube hanging out of his skin to allow any further infection to escape. He will be evacuated from the country to continue his recovery. I hope that things turn around for him now. We do so many appendectomies in which people recovery nearly immediately, that it is easy to take it for granted as a mild illness. Before the advent of surgery, appendicitis was considered a death sentence in nearly every patient who suffered from it. Every once in a while, a challenging case comes along that reminds us what a potentially serious illness it can be.

Well I’ve heard a bunch of helicopters land as I’ve written, so it is probably worth checking to see if I can be any use to my partners, especially since I was so useless today! I am going to try and get a little more rest before morning because tomorrow I start a 24-hour on-call shift.

I miss you and I can’t wait to get home.
Chris