By Air Force Senior Airman George Cloutier
Special to American Forces Press Service
Oct. 7, 2008 - For some, it's the opportunity to see for the first time in 10 years. For others, it could provide an artificial limb that will allow them to walk again after losing a leg to a land mine. Regardless of what they come for, and where they come from, they all come for the same primary reason -- because there's nowhere else to go.
There are other reasons Afghans come to the Egyptian Field Hospital at Bagram, Afghanistan. It's free, for one. But there's something else about it that hits home with the people who come looking for care.
Col. Ahmed Ashry has a very good idea of what that something else is, as well as the practical side of benefits he and his co-workers' services provide. He's the chief of doctors at the field hospital and holds a doctor of philosophy degree in ophthalmology, a branch of medicine that deals with visual pathways. When he's not coming up with new ways to make the hospital better, he's usually busy in surgery fixing someone's eyes, another of his specialties.
Ashry, like many of his co-workers, comes from Cairo, Egypt, where he practices. He's been deployed here since early June, along with much of his staff. Since he came to Bagram, he's been on a complex mission that started with some practical steps, and then evolved to something a little more extreme.
"When I came here, I told the commander I wanted to change everything," the colonel said.
The first thing the colonel did was to develop a system for tracking patients, based on the system used at the American hospital on Bagram Airfield. The second was expanding the hospital from 20 inpatient beds to 30 and building a new intensive-care unit and operating room.
The colonel said the opening of the ICU and operating room was good timing, because the second day after they opened, the hospital saw three trauma patients. The most extreme case was a mine explosion victim who had lost both legs above the knee. The doctor said by the time they received the patient he had lost so much blood he wasn't bleeding any more and wasn't expected to live. His blood pressure was 40/20; normal human blood pressure is about 120/80.
He lived, though, thanks to the new operating room and ICU and a large blood supply from the American hospital.
As if the improvements weren't enough, the colonel's next idea was a little more radical. Instead of seeing only the 100 or so patients he and his staff were seeing every day, the colonel decided to attempt to see every patient who came for one week.
"Why should we take only 100 patients?" the colonel said. "We should take all the patients. So I did an experiment; one week, we took all of the patients."
On the first day of the new policy, the colonel said they saw 520 patients. At first, the American hospital did not believe there was any way possible they could have seen that many patients in one day until some of their leadership came and saw the vast numbers who showed up the following morning.
The colonel said he can sleep easier now knowing that he's not turning anyone away. After all, the colonel said, if he doesn't do it, nobody's going to.
"You have to do it -- you have to do everything here," he said. "You can't tell the patient, 'Sorry, I can't do it.' I can sleep at night with a good conscience, because I don't say 'no' to the patients."
Lately, the colonel has turned his attention to another problem. It's not a physical disease, but something that runs deep into the minds of the people who come to the Egyptian hospital – cultural and religious considerations.
The colonel said one of the things that gives the Egyptians an advantage working in Afghanistan is that they share a similar culture and religion with the Afghan people. This makes it easier for people to come to them for medical help, where they may not come to Americans. The colonel said this stigma is due to a misunderstanding the Afghan people have with Americans and the other forces who have been here in the past.
"Some people don't have the idea that the Americans have come to give freedom to them," the colonel said. "When I speak to them I ask, 'OK, if you are correct, why did the Americans set up a hospital for you? We came here with the permission of the Americans, and they gave us equipment and drugs.'"
To clear up this misunderstanding, the colonel decided to try a new idea. He asked for volunteers from the American hospital to come once a week, not to see patients, but just to do simple things such as handing out food and water. It may not seem like much; however, the colonel said that before long he began seeing a change in the attitude of the Afghan patients toward the Americans.
"Day by day, the Afghans begin to think, these are the Americans," the colonel said. "Every day, they come here to give me food and water, they give me help, and they speak to me."
The colonel said since Americans started coming to the Egyptian hospital, patients have begun to specifically ask to be seen by American caregivers. In general, the patients now are willing to receive treatment from Americans, where before they would refuse.
The colonel and many of his staff still have four more months on their rotation. In the following months, he has a lot of ideas to further improve the hospital, such as new endoscopy department, dialysis machine, and an incubator for newborns.
The colonel said one idea that will be around for much longer than any of these and have a much more far-reaching impact is a new mentoring program the hospital started earlier this month. It gives Afghan doctors a chance to practice their skills and learn from Egyptian and American doctors.
"This hospital will not stay here forever -- not the American or the Egyptian -- and one day it will belong to the Afghans," the colonel said. "I suggest to every Afghan doctor here, 'Please come, don't waste a moment. Do everything and learn everything, because one day we will leave and this will be an Afghan hospital.'"
(Air Force Senior Airman George Cloutier serves with American Forces Network Afghanistan.)