Greg Laffitte
April 29, 2008 12:20 pm
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The boy standing before me in the clinic couldn’t have been more than eleven years old. He came in with a friend.
Their story: He had been playing with 50-caliber ammunition when the bullet he was hitting with a rock went-off striking him just below the knee. He wasn’t crying. He wasn’t upset. Stoic, is the description that seems best to describe his affect.
The wound was amazingly nondescript. A small entrance wound, no exit wound, and virtually no bleeding. How in the world this child calmly walked into my aid station I still don’t understand.
The X-rays clearly revealed a small caliber bullet lodged deep in his lower leg. Throughout his exam my young patient never took his eyes off me. It was as if he were a middle-aged man trapped in a boy’s body.
My interpreter asked all of the usual questions surrounding the nature of the accident, while I proceeded to implement my plan of care. In the back of my mind I hoped that the round was going to be found anatomically in a superficial location permitting an easy extraction.
The boy never flinched as I injected an anesthetic into the wound site, not even the slightest whimper. I’ve seen grown men display more emotion with the same procedure. No parents were present to provide moral support or to ask questions regarding his diagnosis or treatment plan.
The very thought of caring for a minor child without parental consent would be absolutely absurd back in the states not to mention the legal ramifications surrounding a suspected gun-shot wound and the law enforcement response. I never cease to be amazed at how strong these children are even in the face of extreme pain due to their injuries.
My attempt to extract the bullet proved unsuccessful. The clinic was not set-up to perform complex procedures and I was particularly cautious to avoid inflicting further damage to an existing wound site. Wound cleansing, tetanus booster and antibiotic therapy was the limit of my care and a request to return for a follow-up visit in 24 hours.
My interpreter caught me by surprise when he explained what he thought actually happened to the boy. He explained that the Taliban will use children to act as lookouts and carry weapons and ammunition during their operations against coalition forces. It seems very likely that my patient may have in fact been an unwilling participant in a recent insurgent firefight resulting in a ricochet round striking him in the leg. Fear of reprisal against one’s family by the Taliban for not cooperating typically results in death. Whatever the case this little patient never returned to the clinic for his follow-up visit. I can only hope that his condition will improve on its own.
Many local nationals live in extremely primitive conditions. The province where I am deployed is said to be the poorest in the nation. I have a storage shed in my back yard at home that would be the equivalent of a country club here in the province.
Poor people living a lifestyle reminiscent of life on the Great Plains back in the 1800’s. Families of nomadic sheep herders still roam the vast desert countryside often isolated from the hamlets and villages until it’s time to trade their wares at the community bazaar.
The rugged country- side is populated with jackals that prey on the sheep so the families use large dogs to prevent their herds from being attacked. Unfortunately, there was a recent event when one of these dogs attacked a small child. A family of nine carving out a living herding sheep high on a mountainous plateau far removed from any form of civilization had a dog inflict a vicious attack on their 10-year-old daughter.
The dog’s massive size contributed to a bite sufficient enough to break both the bones in this child’s forearm. Access to Afghan medical care is extremely limited particularly with regard to emergency surgery so her father was forced to trudge several miles to a coalition forward operating base where she was then airlifted to our clinic. Imagine Laura Ingalls of “Little House On The Prairie” fame suddenly seeing a helicopter for the first time then riding to a hospital fully-equipped with the trappings of modern day medicine and Western culture!
The child was quickly placed on an exam gurney. She was surrounded by our team of medical personnel standing ready to examine her wounds and provide the necessary care she required. This was a case bound for the operating room as soon as the requisite preliminary exams were conducted. Amazingly enough this was a rare event in that her father was present during the entire intake process.
A weather beaten middle-aged man who appeared much older than his chronological age, wearing a long robe and a turban, sat waiting patiently beside his daughter. I couldn’t help but notice the bewildered look on this child’s face as she surveyed the environment she was now a part of. No smiles, no obvious emotion were visible even though my efforts to comfort her were sincere.
Her surgery was a resounding success. She was discharged the following day with guidance to return for follow-up dressing changes. On her return visit I once again attempted to establish rapport with this little girl while she was undergoing a painful dressing change. Standing next to her during this stressful ordeal I patted her head as it was obvious that she was hurting. To my complete surprise she reached out and grasped my hand and wouldn’t take her eyes off mine until the process was complete. Finally, I detected a smile.
A smile is worth a thousand words. Take Care.
Holler back at greg.laffitte@gmail.com
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