Afghanistan: Doing whatever it takes to treat trauma in Kunduz

An unexpected case

One of our patients was a young boy. He was brought in to the ER by his father with a bandage already on his arm. He wasn’t crying and was just silently looking ahead. I was supervising the ER along with the Intensive Care Unit nurse. The boy looked comfortable and very much okay. There seemed to be no immediate urgency.

Because the fingers sticking out of the bandage looked well circulated and warm, I took my time in demonstrating to the staff how to do a proper investigation of the hand for nerve damage. Strangely enough the boy didn’t seem to feel anything on his whole hand, which suggested all three different nerves were cut.

I gently unwrapped the bandage and saw a gaping hole in his forearm. There was more hole than actual tissue! The father told me that a stray bullet had hit the child while he was playing.

Their expressions on the staff’s faces said: Well, I didn’t expect that! Nor had I. So, we packed up the wound again and tried to stabilize the hand. The only salvaged part was the artery going all the way to the fingers, but the nerves were all damaged.

Medically, we all agreed that amputation was probably the best option. The father didn’t agree with this. He wanted to give it a chance. We did our best to clean the wound and keep the tissue alive. We attached an external fixator, a metal bracket to hold the bones in place while mending, to try and let it heal for as long as possible. Up until today, the boy’s hand is still there. He will never have a good hand again, that’s for sure. But the hand is still there and we didn’t expect that.

The father has been very friendly, but the little boy knows that if a doctor is coming close, that means there is going to be pain. He hasn’t smiled at any of us, but we see him smiling at his father.

Doing all we can

After the fighting lessened, we began to see more patients coming in. Many of them had already received some sort of emergency treatment. When they got injured, they went to the nearest hospital they could to be taken care of and the staff there did what they could.

We are seeing an increase of patients being referred to us from provincial hospitals, where patients had multiple surgeries. Quite often we go into surgery and realize that we don’t have too many options—there is not much more we can do to try to save the person. We still try though; try to stabilize; try to get things in order with some surgery.

Moving to the new hospital

Here in Kunduz, the rebuilding of our hospital has been going on for quite a while. The community has been waiting for the hospital to open. Two weeks ago, we transferred the patients from our temporary clinic to the hospital for the first time. It is a huge step to open the new hospital, although it is not completely finished yet.

We’re seeing a shift from the very active gunshot and bomb blast injuries to complications with the war-wounded who need follow-up from previous treatments. We’re also seeing more road traffic accidents, which are increasing sharply as society opens up again. Everyone here drives on their motorcycles without a helmet; when they fall, they suffer head traumas, which is not the best thing for us to treat as we don’t have neurosurgeons, so sometimes there is little we can do.

Making it work

In the Kunduz Trauma Center we’re doing our medical work while construction is still going on. But the speed at which all the construction teams and others are fixing things is quite amazing. They have a real approach to solving problems.

We saw a stretcher bearer going to get a patient and having problems passing the stretcher over the uneven ground because there was too much rubble. In no time, there were people putting concrete over the rubble. It’s incredible how the crew is working so hard to fix all the problems the medical staff encounter.

We have the same support from the team that is responsible for the hospital compound. One of them is always on a bicycle, cycling from one department to the other, fixing things rapidly. Same for supply fixes—you see medical items and supplies suddenly appear at the front step of the departments, followed by other packages for us to treat our patients.

We’re also increasing our recruitment efforts. We have ongoing exams for staff, and we’re hoping to start recruiting mental health officers, which is something that we badly need.

That’s how it feels for the moment—all the teams are helping each other, together, trying to just make it work.