Thursday, July 22, 2010

In the palm of your hands

Abandoned as a baby, 12-year-old Haidar has never buttoned a shirt, held a pencil, combed his hair or played with a toy. Born with a twisted knot of bone, joints and fingers instead of normal hands, Haidar never been able to properly care for himself; he has only been able to use his wrists and forearms to pick up objects and manipulate his environment.

Haidar was brought to the National Military Hospital in Kabul in the hopes that the Afghan army doctors there would be able to help his situation, but they lacked the expertise to operate. When they learned an American reconstructive hand surgeon would be soon arrive as part of the new medical embedded training team rotation, the ANA doctors admitted Haidar.

One month later, U.S. Navy Capt. Jerone Landstrom, a surgeon specializing in hand and microsurgery, arrived and Haidar had his left hand operated on, giving him, for the first time, the ability to pick up objects. While Haidar’s hand will never look like a normal hand, it is functional.

Our office heard about the operation, and thought that it would make a great story. We cover anything related to training, but so often that focus is limited to developing the Afghan National Security Forces, even though our mission scope is much broader. We were invited to come out to the hospital to meet with Dr. Landstrom and the Afghan doctors who assisted him during the operation.

Working with Dr. Ab Ghafoor-Ateef, the Afghan orthopedic resident who admitted Haidar, Dr. Landstrom, who has been practicing for 27 years, taught the surgical staff the essentials for performing complex reconstructions. This type of surgery hadn’t been performed at the 400-bed military hospital before; Dr. (Gen.) Bahaudin, head of the surgery department, told us that the hospital typically treats major trauma injuries resulting from improvised explosive device attacks or vehicle accidents.

For a hospital used to dealing with trauma patients, Haidar’s case is a success story for both the Afghan physicians and U.S. mentors, especially as they work together to improve the supply and logistics systems and handle the nursing shortage. Based on their current tash-kil, or manning document, they don’t have enough nurses to fully support the ICU ward which international standards suggest having one nurse per bed, and there aren’t enough nurses to provide long-term care. The staff often relies on a patient’s family member to help feed and bathe patients.
More than anything, having the U.S. embedded medical team has given the Afghan physicians a chance to improve their technical skill base and improve the quality of care they’re able to offer patients. In addition to working directly with Dr. (Gen.) Bahaudin, who is responsible for nine departments including neurosurgery, urology and ear, nose and throat, Dr. Landstrom mentors the ICU staff as well as the plastic and orthopedics departments.

The center of the Afghan National Army healthcare system, the NMH mainly treats soldiers and their families, and Afghan National Police patients with injuries too severe for their own hospital to treat. So when I asked how Haidar was able to receive treatment, they told me a relative brought him, but no one seemed to know who he was or what relation he was to the boy. I’m guessing the relation, if he even exists, is a very distant one, but that just further demonstrates the Afghan capacity for compassion.

In terms of sterility, cleanliness, efficiency and capability, NMH is definitely not a typical Western hospital, but they are doing the best they can with what they have. Dr. Landstrom told me that the staff has far exceeded his expectations; he has worked at hospitals in other developing countries like the Philippines and in comparison the NMH has much higher standards.

Landstrom told us that the staff has far exceeded his expectations and have higher standards than some of the hospitals he’s worked at in other developing countries like the Philippines. Landstrom’s goal is to pass along some of his expertise to the surgeons during his year-long tour; already they are learning and taking over – Dr. Ghafoor assisted in Haidar’s first surgery and will be the lead surgeon on the second operation. I hope Haidar’s second operation is as successful as the first; I couldn’t image how difficult his life must have up this point and a simple thing like being able to pick something up can change a life.

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