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KLMNO THE WORLD A military hospital’s all-encompassing mission


NATO facility in Kandahar takes care not only of troops, but also of Afghan civilians — including insurgents and children BY DAVID BROWN


AT KANDAHAR AIRFIELD, AFGHANISTAN M


ost of the time, this war-theater hospital crackles with danger and expertise, its staff members


working to keep alive people who would be dead if they ended up almost any- where else in the world. But some of the time, often in the morning, it’s quiet and almost empty, except for a few recuperating Afghans stoically watched over by family mem- bers and, today, a young girl in a pink robe exploring the corridor outside her room in a wheelchair. The hospital, which opened in May


and is owned by NATO, is an odd mix of urgency and relaxation. It features pa- tients whose stays inside its $40 million walls are both shorter and longer than any in contemporaryU.S. hospitals. American soldiers critically injured on


the battlefield spend only a day or two here, many unconscious and on ventila- tors, before being sent to Bagram air base, then to a hospital in Germany and on to theUnited States. At the other end of the continuum are


the Afghans who make up about half the patients. They also come aboard medevac heli-


copters. They get the same immediate treatmentasU.S. soldiers.Thenthey stay, often for weeks, until they are well enough to be transferred to a nearby Afghan hospital or discharged. Some are Afghan soldiers or members


of thenational police.Many,however, are civilians or Taliban insurgents. It’s often difficult to tell the latter twoapart, and to the workers at the hospital, which is run by theU.S.Navy, it’s largely irrelevant.


Pediatricians in war zone


About 15 percent of the patients are children. Most are here because of the consequences of war. But there’s also a steady trickle of patients who have cere- bral malaria, burns from kitchen fires, car accidents, snake bites and obstetrical calamities or have fallen from roofs, where families sleep in hot weather. “Those are probably the hardest cases,


when the kids come in,” said Cmdr. Eric Peterson, 40, an emergency nurse. “I don’t think people expect that when they come over here.” The Navy did expect it, and planned


for it. “This is the first time theNavy has sent


a pediatrician as part of a wartime role,” said Capt. Jon Woods, 45, a pediatric intensive care physician. “It is a recog- nized part of our mission.”


‘New paradigm’ in care Pediatrics isn’t the only addition to


what is considered possible and neces- sary in war-zone medicine. The hospital also has an interventional radiologist, who can snake catheters into bleeding sites that surgeons cannot reach. It has a 64-slice CAT scanner that would be the envy of any radiology department in the United States. It has a neurosurgeon. “This is a new paradigm, having a neurosurgeon in-theater. But I frankly can’t imagine not having this capability,” saidCmdr. StevenCobery, 44, a neurosur- geon who did 120 operations between April and mid-October. One of the consequences is that some


Afghans receive care here and at a sister hospital at Bagram that would be un- imaginable elsewhere in Afghanistan. In somecases, it would be rare in theUnited


At the hospital, orthopedic surgeons Sean Comstock, left, and ChristiaanMamczak amputate the foot of the man, who had stepped on an improvised explosive device.


States. For example,Woods recently flew to a


forward operating base where a newborn had been brought after a difficult deliv- ery. The baby, four hours old, had persis- tent pulmonary hypertension and meco- nium aspiration — both life-threatening lung conditions. On the flight back, Woods breathed for the child with a squeeze bag and an endotracheal tube and gave her drugs to keep her out of shock. It was ICU care in a helicopter, delivered by a pediatric intensivist. The child stayed in the hospital for six


days, recovered and went home. The alternative destination — if she had survived to get there—would have been Mirwais hospital in Kandahar City, which has a single ventilator for infants. Of course,many of the Afghan patients


wouldnotneedheroic medical treatment if not for theU.S.-ledwar,nowin its ninth year. And much of the time the circum- stances of a civilian’s wounding are un- known or ambiguous. To accommodate long-staying pa-


tients, the workers at the Kandahar hospital have set aside a room for pray-


ing. Relatives are permitted to spend the night in the patient’s room. Staff mem- bers often get food for the families from the dining hall (and hold it until after sunset during theMuslim holy month of Ramadan). When a patient dies, the face is turned towardMecca, the big toes are tied together with cloth as prescribed by Islamic law, and someone is called to say the proper prayers. “We try to be as culturally sensitive as


wecan, given the mission,” said Lt.Cmdr. Timothy Broderick, a nurse who heads the intermediate care ward.


Saving lives, nomatter whose Although the hospital is important to


the “hearts and minds” campaign, the military realizes the openness of the doors could compromise the main mis- sion of saving troops’ lives. Consequently, if a certain number of beds are filled, the hospital will not take civilians unless they have been injured in combat. Except for the exceptions. “We always take neurosurgical cases,”


said Capt. Michael D. McCarten, 58, the commanding officer. “If there is a poten-


DIGEST BRITAIN


In Christmas message, queen encourages sports Speaking this year from her Hampton Court palace, Britain’s Queen Elizabeth II


used her annualChristmasDay broadcast to extol the benefit of sports and uttered not a word about Prince William’s recent engagement to KateMiddleton. Sports “teach vital social skills,” the queen said in her address, which is as much a


part of Britain’s holiday observances as pantomimes and mince pies. Meanwhile, footage was shown of William and his younger brother, Harry, playing soccer with orphans in Africa. “Nothing is more satisfying,” the queen concluded, “than the feeling of belonging to


a group who are dedicated to helping each other.” While it was not clear whether the 84-year-old monarch was deliberately weighing


in on the current political debate about state funding for school sports, the annual Christmas speech is one of the rare occasions when she speaks publicly without first consulting with the government. “It’s a great British institution,” Robert Lacey, a prominent royal biographer, said of


the tradition, which dates to 1932, adding that it’s “still significant beyond the sentimental.”He noted that in the cost-cutting era of former prime ministerMargaret Thatcher, the queen’s Christmas address was “thought to uphold values of humanity that Thatcher lost sight of.” Although not considered a natural public speaker, the queen writes her own speeches and reportedly records the address in one take.


—Karla Adam THEVATICAN


Pope urges courage for world’s Catholics Pope Benedict XVI urged Catholics in


China to have courage in the face of persecution and repression, while more than 100,000 pilgrims — the most in a decade—flocked to celebrate Christmas in Bethlehem. “May the birth of the savior strengthen


the spirit of faith,patienceandcourage of the faithful of the church in mainland China, that they may not lose heart through the limitations imposed on their freedom of religion and conscience but, persevering in fidelity to Christ and his church, may keep alive the flame of


hope,” the pope said in his traditional “Urbi et Orbi” holiday speech Saturday. In recent weeks, tensions have flared


anew between the Vatican and Beijing over the Chinese government’s defiance of the pope’s authority. Thepopealso urgedthe faithful to take


heart in Iraq, where hundreds of Chris- tians braved insurgent threats to gather at a Baghdad church where Islamist extremists killed 68 people in October. —Associated Press


IVORYCOAST


West African bloc threatens use of force West African leaders said they would


HERI JUANDA /ASSOCIATED PRESS


An Indonesia boy leaves a message of hope on a paper flower outside the Baiturrahman mosque in Banda Aceh to mark the sixth anniversary of the tsunami that killed 164,000 people in the province.


use “legitimate force” to remove Laurent Gbagbo from power in Ivory Coast if he does not agree to step down peacefully, a call that comes amid rising fears of violence. Gbagbo has refused to quit the presi-


dency despite calls for his ouster by the United Nations, the United States, for- mer colonizer France, the European Union and the African Union. The inter- nationalcommunity recognizes Alassane Ouattara as the winner of a recent elec- tion, though Gbagbo maintains control of the military.


James Gbeho, president of the region-


al bloc Ecowas—the Economic Commu- nity of West African States — said the group was making an “ultimate gesture” to Gbagbo to urgehimtomake a peaceful exit. The 15-nation bloc made the decision


after a six-hour emergency summit in Abuja, Nigeria, as worries mounted that Ivory Coast, which endured a 2002-03 civil war, could return to conflict. —Associated Press


Blasts mar Christmas in Nigeria, Philip- COMMEMORATINGTHETSUNAMI’STOLL


pines: At least 11 people were killed in multiple Christmas Eve blasts in the central Nigerian city of Jos, where ten- sions often boil over between Christians and Muslims. And a bomb exploded during Christmas Day Mass on Jolo Island, a stronghold of al-Qaeda-linked militants in the southern Philippines, wounding a priest and 10 churchgoers.


Iran bars foreign travel for opposition leaders: Iranian opposition leaders are barred from leaving the country, a promi- nent conservative lawmaker said. The comments byMousa Qorbani, a member of the parliamentary judicial committee, were the first official word of such a ban on the top opposition figures, Mir Hos- sein Mousavi and Mehdi Karroubi, who both ran in the disputed 2009 presiden- tial election, as well as former president Mohammad Khatami.


Ecuador recognizes Palestinian state: President Rafael Correa officially recog- nized the Palestinian territories on Fri- day as “free and independent, with its borders since 1967,” the ForeignMinistry said, making Ecuador the latest Latin America, after Argentina, Bolivia, Brazil, Cuba and Venezuela, to recognize a sov- ereign state of Palestine.


Protest turns deadly in Tunisia: Police opened fire on demonstrators who set police cars and buildings ablaze in a protest over unemployment in the cen- tral Tunisian town ofMenzel Bouzayane, killing one person. Several others were wounded, including two policemen who were left in comas, authorities said. Tunisia, a popular tourist destination, rarely sees such open clashes. —From news services


PHOTOS BY LINDA DAVIDSON/THE WASHINGTON POST RichHillsden and his trauma staff move an injured Afghan man onto a CAT scan table at the hospital at the Kandahar air base.


tial for a life-saving intervention, we’ll take them.” In the spring, an Afghan man arrived


with his 14-year-old son, who had fallen from a tree.Themanhadtaken the boy to one forward operating base, been turned away and taken him to another. (“Just like in theUnited States, parents here are very persistent,” Woods said as an aside, as Cobery, the neurosurgeon, told the story.) The boy had a skull fracture. Cobery removed a section of the skull to decom- press the swollen brain. He put the skull fragment under the skin of the boy’s abdomen, where it would survive until the brain had fully healed. Three months later, the father returned with the child. Cobery put the piece of skull back where it came from. Case closed. The care and solicitousness extends to


Taliban fighters, as well. The only differ- ence is that they are under armed guard until they are handed over to other authorities. Cobery said, “Not one time has it come


into my medical decision-making not to do something for someone because he’s a bad guy. To someone, he’s a good guy.” Several months ago, the hospital treat-


ed a man in his 20s, reportedly a Taliban fighter, who had had one leg amputated very close to the hip joint.The stump had become infected, and the infection had begun invading his pelvic cavity, an ominous development. The doctors told him that they were not sure they could save him. “He started to cry,” Woods recalled.


“He said he just wanted to see his wife and kids again.” The orthopedic surgeons mixed bone


cement with two antibiotics and fash- ioned the concoction into small beads. “In the States, this stuff is manufactured. We were our own manufacturing plant here,” Woods said. The doctors packed the wound and the pelvic outlet with the beads, then put the patient on extra- high-dose intravenous antibiotics. He survived.


browndm@washpost.com


Blast kills 42 at food aid center in Pakistan


SEVERAL CHILDREN AMONG VICTIMS


Witnesses say suicide bomber was clad in women’s robe


BY HAQ NAWAZ KHAN AND KARIN BRULLIARD


peshawar, pakistan — A suicide bomber, possibly a woman, struck a food distribution center in Pakistan’s restive tribal belt Saturday morning, killing at least 42 people and injuring dozens. The attack occurred in the main city in


the Bajaur area as hundreds of members of the Salarzai tribe, which had been displaced by fighting between militants and the Pakistani army, lined up to collectWorld Food Program rations at a government center, a local official said. The dead and injured included several children, according to the official, who was not authorized to speak to the media. A day earlier, 150 militants launched a coordinated attack on military check- points in the neighboring Mohmand agency, leading to a battle that left 11 Pakistani soldiers and 24 militants dead. Both attacks underscored insurgents’ continued ability to strike state targets despite various Pakistani army offen- sives. The army declared victory over militants in Bajaur last year, but the insurgents have reorganized. Witnesses said the bomber who struck


Saturday was dressed in a head-to-toe robe known as a burqa, leading to speculation that a woman staged the attack. Officials said they could not confirm the bomber’s sex. Islamist insur- gents in Pakistan, based in the semiauto- nomous tribal areas bordering Afghani- stan, have rarely deployed female bomb- ers. Such a tactic would indicate a shift in strategy. No group asserted responsibility for


the attack. But insurgents have de- nounced the presence of all foreign relief organizations in Pakistan, and they have targeted aid distribution centers and refugee camps. Last year, the Pakistani Taliban bombed a World Food Program office in Islamabad, the nation’s capital. Militants have also focused attacks on


pro-government tribes, which include the Salarzai. The tribe was the first in Bajaur to organize a pro-government militia to combat the Taliban. Zahid Ali, a tribesman who witnessed


the Saturday attack, said it occurred at a spot where security forces were search- ing people who wanted to enter the government compound to collect aid. “A suicide bomber stormed into the


gathering and detonated himself,” said the local official, who works for the Bajaur political administration. Zakir Hussain,whoheads the civilian adminis- tration in the area, could not be reached. brulliardk@washpost.com


Brulliard reported from Islamabad.


SUNDAY, DECEMBER 26, 2010


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