Interpreting | 2009.12.26
UK medics keep wounded troops alive in Afghanistan's Desert of Death
More and more British troops are being saved at Camp Bastion in Afghanistan as Taliban steps up its assaults
They are known by the medics at Camp Bastion as "Holy Shit Sundays", the darkest day of the week when the Taliban are most likely to strike. A popular theory going round the British forces\' headquarters in Afghanistan holds that the Taliban stop for Friday prayers, plan their attacks on Saturday and carry them out the following day. And they are doing so with increasing regularity.
Traditionally at this time of year, there is a lull in the fighting as temperatures fall well below zero at night and the tree-lined "green zone" that runs like a spinal cord through Helmand province is replaced by mud, stripping the Taliban of cover. But despite the onset of winter recent Sundays have seen an increase in attacks on British forces in Afghanistan\'s most notorious province.
As winter rain turns the dust coating Camp Bastion into a treacly yellow sludge, festive cheer is in short supply. The best Christmas gift the medical teams can hope for is a lack of work.
"Any day we\'re sitting on our arses getting bored stiff is a good one," said Captain Simon Cook, who works with the resuscitation team at the camp. Sipping tea in a storage room-turned-canteen in the surgery unit, he adds: "It means our guys aren\'t getting hurt."
But these days are rare. More than 1,300 British troops have been killed or wounded in Afghanistan since operations began in 2001, with 104 fatalities and more than 430 injured so far this year. "The enemy is breaking new ground with their improvised explosive devices, but so are we with our treatment," says Colonel Peter Gilbert, commanding officer of Camp Bastion\'s Territorial Army unit, 256 Field Hospital.
"We see injuries that soldiers would definitely have died from a few years ago. Men who step on IEDs [improvised explosive devices] are losing one or both of their legs or arms and suffering major chest and abdomen injuries. The IEDs are getting worse, but I\'m deeply proud of how many soldiers the team is saving."
Gilbert, who normally works as a GP in Kent, oversees 90 NHS medics. Supported by 60 US Navy medics, the 256 unit treats all seriously wounded British troops, the international coalition and the Afghan National Army, in state-of-the-art surgery and trauma units.
The hospital is one of few permanent structures erected at this vast camp of tents, barbed wire and blast blocks, constructed in the scrubland of what local people call the Desert of Death.
The need for medical care in the war zone arrives in flurries, sometimes several casualties at a time. The reservists staffing the field hospital are proud of their achievements in the face of the devastation.
With an affability belying his responsibilities, Gilbert, 51, a married father of two aspiring medics, heaps praise on the dedication and skill of the volunteers. He says they have made many "remarkable saves" due to the speed of the treatment "passageway" that starts on the battlefield, continues on the specialist medical evacuation helicopter and field hospital, and ends in the patient being evacuated to Selly Oak hospital in Birmingham.
The process takes between 12 and 48 hours; a soldier wounded in the morning in Kajaki, the most remote area of operations in the province, can wake up in a hospital on British soil by the evening.
Medical advances along the chain mean those who are not instantly killed or fatally wounded have a fighting chance of survival.
"We\'re doing things rarely seen in a hospital, sometimes several times a day," says Captain Raj Nathwani, an anaesthetist for the NHS who doubles as a surgery medic in the battle zone. "There\'s no other hospital in the world that handles this level of trauma injuries so frequently."
Every soldier operating from the isolated, mud-walled forward bases in rural Helmand carries tourniquets that can stem blood loss immediately. These are vital as it can take as little as 40 seconds to "bleed out" from an amputated limb. When the worst happens, a Chinook rescue helicopter is dispatched carrying the emergency response team, including a consultant who can, if necessary, start surgical treatment in the air. The effect is to bring the emergency department to the front line, often under heavy fire.
Once at Bastion all emergency care is routinely led by highly experienced consultants, a standard of care beyond the capacity of most NHS hospitals.
The hospital is also pushing the science. It stores hundreds of units of blood, several times more than a British surgical centre, pumping them at a hitherto unseen speed and volume into patients who have lost limbs.
"I have seen a patient with a double amputation have 150 units [pints] of blood and a similar amount of plasma and other clotting agents pumped in," Nathwani says. "That simply does not happen within the NHS. I am learning new clinical skills to bring home."
Under the Geneva Convention, the hospital is obliged to give emergency medical care to anyone injured as a result of conflict. Last week a heavily sedated Taliban fighter in his 20s could be seen occupying a bed in the corner of the hospital\'s intensive treatment unit. Tufts of jet-black beard curled free from beneath a large blindfold which reached down his cheeks. Sitting bolt upright, he muttered sporadically before being wheeled into surgery.
Bastion\'s wards are also open to Afghan civilians, among them many children caught up in blasts or crossfire. Major Sue Snaith, who in civilian life is a paediatric expert at London\'s Great Ormond Street hospital, keeps a keen eye on the young admissions. Standing beside a seriously ill four- or five-year-old boy in the intensive treatment unit ward, she describes her efforts to ensure that the boy\'s father – it is always men who accompany the child – is kept abreast of his son\'s condition.
"I\'ve been telling the interpreter what\'s going on at each step and making sure he passes the message on to the father," she says, greeting the father who is sitting cross-legged in the adjacent bed. "The language barrier is difficult, but I\'ll show him with my hands, acting out the surgery. It\'s not easy, but we\'re building up a relationship."
She laments that children are handed to Afghan medical care after they have received the "life and limb" treatment provided by the hospital. The lucky ones may receive help from an NGO, such as a basic prosthesis if needed, but there is scant record of their fate.
Captain Andrea Blay, second-in-command of the intensive treatment unit, shares her worries, but recognises medical outreach teams cannot reach all of the sick while security remains dire.
While the trauma patients dominate the work of the hospital teams, announced with grim regularity by loudspeaker, it is the mundane, nagging daily gripes that need attention if the army is to stay on its feet. Back pain, skin infections, dental problems, colds and diarrhoea are the staple of the hospital\'s primary healthcare team (PHT), all issues that can debilitate a soldier if left untreated.
A hundred soldiers pass through the doors of Colonel Angus Menzies\'s PHT unit each day. "Things like foot hygiene, ingrowing toenails and serious blisters can be a bit of a show stopper for guys on the ground," he says. "So we have medics doing rounds of the forward observation bases to make sure everyone gets treatment they need. Back pain is a major issue, especially for the guys spending all day carrying the 30lb of Osprey body armour alone."
The biggest fear is a camp-wide outbreak of swine flu or diarrhoea and vomiting which, left unchecked, could affect operations. All British soldiers have been offered the swine flu vaccine.
As the night temperature heads below freezing, soldiers become increasingly vulnerable to exposure illness. "A huge part of the job is education on how to stay fit and well," says Major Nicky Frew, a GP based at the regional headquarters in Lashkar Gah. "But the message is getting through. Their winter kit is also much better".
Mental scars have also been left by the fighting. Stress has stopped some soldiers who have been involved in blasts, or "contacts" with the Taliban, from going back out on patrol. To help them overcome their anxieties, the hospital provides a mental health worker alongside the army\'s well-regarded support systems.
"These are incredibly robust people and many deal with the things they are seeing best by being with their unit and talking it through with their mates," says reservist Captain Nick Parry.
"But coming under attack and facing IEDs every day has a huge psychological impact. The stress can be unbearable on those with incredible responsibilities, like the guys detecting the IEDs. I\'ve had instances where someone has missed a device which has then killed their mate. The guilt is unimaginable."
Duties back at Bastion are offered to those suffering acute stress, but the priorities of combat mean frontline troops are of little use behind the wire.
For more information, please visit
http://www.guardian.co.uk/world/2009/dec[...]medics-save-troops-afghanistan
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