Uncle

He arrived in the clinic on a NATO stretcher, a collapsible green mesh-and-metal contraption that rolls on bicycle wheels. The soft, grey-beard smile he offered with a hand over his heart didn’t match the bandages and splints on his legs. An AK-47 round, 7.62 caliber or “Seven-six-two” in military lingo, had entered his left leg a third of the way down his shin, pulverizing part of his tibia before exiting just below his knee. The damage, however, continued, as the bullet tore apart into the copper jacket and steel core, both penetrating his right thigh, where they lodged in the muscle. No major blood vessels were cut, so he did not bleed to death right away. Instead, the wound remained contaminated until he came to our clinic. Often in Afghanistan, the exposed, contaminated bone becomes infected, chronically draining pus, weakening, finally requiring an amputation.

Nobody, nowhere, wants a leg amputated. I guess I thought before coming here that amputation must be a part of life in Afghanistan, where the Soviets carpeted the countryside with air-dropped mines in an attempt to “depopulate,” and thus subjugate, the rural areas. I thought that a country that had been at war, on and off, for thirty years, would be more accepting of this sort of deformity and disability. I could not have been farther from the truth. I have regularly been told by patients, “I would rather die than have my leg cut off.”

So as we looked at this man we called “Uncle,” we made some plans to try to save his leg. His diabetes would not be our friend in this endeavor, making wound healing that much more difficult. But after some planning, several returns to the operating room for scheduled “washouts,” and cleaning away dead or contaminated tissue, we fixed his bone with a titanium rod and covered the hole in the bone with half of his calf muscle. Two weeks or so in the hospital, and he went home, his diabetes and congestive heart failure under some reasonable control. Was it worth it?

When any patient here is recovering from illness, hospitalization, or surgery, their friend and relatives come for a visit. They sip shin chai, green tea, and chat about their host’s recent illness. I think it is a universal that people love to talk about their bouts with illness. What’s more, spin-girai, or “grey-beards”, like Uncle are important men, wise men, tribal elders. A lot of people come to visit them. I mean, a WHOLE lot. By his estimate, around six hundred people came to visit the first day. The second day was expected to exceed a thousand visitors, to pay their respects to the elder. Every one of them got to hear his story and see his leg. So was it worth it? I’d say it was effort well-spent.

Motorcycle Man
One patient, who also had a bad leg fracture from a motorcycle crash, now well-healed, told us what he had thought of the Americans before his stay at our hospital. "They told me the Americans will cut off your arms and legs just for practice," he said. Again, the specter of amputation looms in the collective consciousness. There are no services for amputees, no rehabilitation, no handicapped ramps, no accomodations. Prosthetic limbs are few and precious. The prosthetic hospital in Kabul is very busy and overwhelmed, we are told by some patients. Furthermore, the trip can be dangerous.

TalibanCare
Another patient, from an area rife with the insurgency, related his story of seeking care at Salerno. "I asked my mullah [religious leader] if I could go to the American hospital." The mullah, a Taliban stooge, consulted his handlers. He returned to the patient with the news: "They said they would prefer that you go somewhere else, but if you can't get the treatment you need anywhere else, you can go to the Americans." We joked for a couple of weeks that we were now on the "Preferred Network Provider" list for TalibanCare.