Healing beyond the battlefield: When care extends past soldiers

Capt. Jack Smith, MD, a U.S. Army reservist in Afghanistan, said people come from miles away when they hear through village leaders that the Americans -- and their doctors -- are coming. One Afghan brought his father seven miles in a wheelbarrow so an American physician could treat him.

Dr. Smith's main job is to treat U.S. troops and coalition forces in Afghanistan. But he also volunteers to provide medical care in local villages. He travels in an armored convoy with fellow soldiers on the humanitarian missions, then sets up a makeshift doctor's office in a heavily guarded area.

Sometimes, the swarm of people is overwhelming as physicians use translators to bridge the language gap and patients try to explain their problems.

"We may see 500 people a day between eight of us. We try to see as many as we can, but as many as we see, there are just as many we don't see," said Dr. Smith, an internist from Bayonne, N.J.

When they complete their responsibilities of treating U.S. troops, active military and reservist physicians give medical care to people in Iraq and Afghanistan who are caught in the cross fire of war.

In villages, they provide basic aid to people who otherwise would go without it. They transport the most seriously wounded to military camp hospitals, conducting surgeries and following patients through recovery.

The military uses the humanitarian trips to distribute donated food and clothing and to give medical care through physicians and other personnel. It's a goodwill gesture that the military hopes will build strong relations with Iraqis and Afghans.

The doctors volunteer for the missions, sometimes referred to as "adopt-a-village" visits. The trips are carefully planned. Village leaders coordinate with military officials to ensure the safety of the troops. No convoy is sent if the area is not safe.

Lt. Col. Joseph Dore, MD, volunteers for weekly community missions to Iraqi towns and villages. Dr. Dore and other soldiers caravan in armored vehicles through the streets of Baghdad, traveling the same areas where civilians and troops have perished from car bombs and other attacks. He lugs a backpack loaded with bandages, antibiotics, cough syrups, anything he thinks will tend to the ills and wounds of the villagers he sees. He also carries an M-16 and a 9 mm Beretta.

"I wouldn't do it unless I felt I was changing the hearts and the minds of these people. Maybe they won't shoot at us the next time. Maybe we're saving a soldier down the line [from attack]," said Dr. Dore, an emergency doctor from Charlotte, N.C., and a National Guard member deployed in Iraq as a brigade surgeon. "It's worth it. Absolutely."

Healing in their spare time

Military physicians say they have the blessings of military commanders to visit villages. Approval is needed before physicians are allowed to operate on civilians brought to military camp hospitals.

"Obviously, our primary mission here is to take care of the soldiers. [For civilians,] you have to tread carefully and get permission from the command. Sometimes, you have to get permission from the Iraqis, too," said Army Lt. Col. Jeff Poffenbarger, MD, a neurosurgeon from San Antonio. "As we do more and more, it gets easier."

Maj. Ron Hugate, MD, an Army reservist, said the Army was good at providing the resources he needed to conduct surgeries such as the one he did on an Iraqi boy injured by a roadside bomb.

"If you could offer someone a chance at saving a limb, I ran into no friction at all. The amount of good going on there is outweighing the bad," said Dr. Hugate, who served in Iraq for four months in 2003 and is now senior orthopedic oncology fellow at the Mayo Clinic in Rochester, Minn.

But if doctors tie up a medical facility too long with a civilian case, it can cause tension. Dr. Poffenbarger has to be true to his word when he tells Army brass that a surgery at the camp hospital in Iraq will take two hours, followed by five days of patient recovery. Using an operating room for too long may lessen the chances of getting approval the next time.

He also must make sure his surgical team is willing to take on the extra work. Then he selects a time when military intelligence says casualties will be low, so he won't be forced to juggle a civilian case while handling incoming injured troops.

"The bad guys tend to make a lot of work for us on a Saturday or a Sunday. They tend not to strike really late at night," he said.

Many civilian patients are children. One 4-year-old girl was paralyzed after an insurgent's bullet struck her spine. Dr. Poffenbarger and his team did surgery. "Twenty-four hours after surgery, she was able to move her legs again," he said. The girl now moves with the aid of a walker, and Dr. Poffenbarger sees her every six to eight weeks when she comes for therapy.

"You come here and these people have absolutely no option other than you. If you don't do it, they're going to die," he said. "They bring you chickens and rugs, and it's like the old days before Blue Cross and Blue Shield. They reaffirm your whole faith in humanity. With a sick kid, there are no politics."

Some treatment is done in crude surroundings, often with outdated equipment.

"You're probably practicing 1940s and 1950s medicine," said Capt. Donny Reeves, MD, an ophthalmologist and Army reservist in Afghanistan.

He said one machine for cataract surgery is about 15 years old, limiting the procedures he can do. He treated one infant with cancer so advanced, he had to remove an eye. She may still die. In the United States, chemotherapy and other treatments probably would keep her alive.

"Psychologically, it's very tough to deal with. You have to remind yourself you're doing the best that you can," said Dr. Reeves, who was scheduled to return home this month to Kingsport, Tenn.

Treating Iraqis and Afghans can be stressful. Doctors say they have not been shot at nor fired their weapons. But safety is always a concern.

"When I was handing out candy to the children, I was just happy that there was a sergeant with an M-16 behind me for security purposes," said Maj. Thomas Beaver, MD, an Army reservist who was deployed to Iraq and Afghanistan and is back as cardiothoracic surgeon at the University of Florida College of Medicine.

Lt. Cmdr. Darnell Blackmon, MD, a Navy reservist, was on a mission in Afghanistan when two tires on the truck blew out. The soldiers sat in a valley for an hour. Locals came by and observed the Americans.

"You could tell they were kind of planning something. Fortunately, we got out of there," said Dr. Blackmon, an orthopedic surgeon from Tulsa, Okla. The next day, four soldiers were killed in the same area.

Sometimes, the volunteer efforts occur in chaotic atmospheres.

Every few weeks when his unit arranges a visit to an Afghan town, Army Lt. Col. John Smyrski, MD, is among the volunteers. "You're in the middle of a mob and everybody is tugging and pulling at you, saying what hurts," said flight surgeon Dr. Smyrski, a family physician from Waipahu, Hawaii. Once, people continued tugging on him as he prepared to leave.

An authority figure in the village says who is the sickest and who needs to be seen first. An interpreter tells the doctors what the patients say. One time Dr. Smyrski came upon a boy named Asedullah, who couldn't walk more than several feet without collapsing. He listened to the boy's heart and diagnosed a heart condition. Asedullah was sent to an Army camp for a full exam, and physicians arranged for him to be flown to California for surgery. "If nothing else, that one encounter makes my experience in Afghanistan a success," Dr. Smyrski said.

Physicians mostly practice basic medicine when they journey to towns and villages.

Army Maj. Alex Rosin, MD, said he usually sets up in a school or home when visiting Iraqi villages. He carries a trauma bag and several bags of supplies. He treats hypertension, diabetes and cuts for groups that can number 200 or more.

"You have crowd control and language barriers, things we don't usually think about as physicians," said Dr. Rosin, an emergency physician from Fort Hood, Texas.

Maj. Philip Lundy, DO, an Air Force reservist, has volunteered in the "adopt-a-village" operation in Afghanistan. Since the climate is dry and dusty, he sees a lot of upper respiratory problems and skin conditions. He also hands out medications. "It's gratifying because they seem to have so little. It doesn't take much to brighten their day," said Dr. Lundy, an internist from New Orleans.

Besides treating people, the physicians teach patients and fellow doctors.

Army Capt. Lori Sweeney, MD, got insulin and syringes for a diabetic Iraqi boy. Dr. Sweeney and other soldiers stayed with the family for several hours, teaching them what to do when the boy's blood glucose level gets low.

"They don't even have refrigerators there for insulin. We taught the family to bury it in the ground to keep it cool," said Dr. Sweeney, an internist who returned to Fort Bragg, N.C., this month after a year's deployment in Iraq.

In Kandahar, Afghanistan, Maj. Lance Smith, MD, and other doctors teach Afghan medical students and others surgical techniques, wound care and physical exams. Many Afghan doctors fled the country for fear of the Taliban. But others stayed and are learning from U.S. military physicians who eventually will return home.

"Our mission also is to help rebuild their medical system," said Dr. Smith, of Galveston, Texas, an Army reservist and general surgeon. "The next phase is to teach them to take care of their own people."