Afghanistan - what we are leaving behind.

Should Britain be doing more to help civilian health authorities in Afghanistan?

  • No - we tried and its all too difficult

    Votes: 2 10.5%
  • No - not our responsibility. Our own NHS has enough problems.

    Votes: 13 68.4%
  • Yes - I would if I could. How ?

    Votes: 2 10.5%
  • Yes - we should support the Afghan people with whatever we can afford.

    Votes: 1 5.3%
  • Is Celebrity Big Brother on yet ?

    Votes: 1 5.3%

  • Total voters
    19
  • Poll closed .

Goatman

ADC
Book Reviewer
Although I've posted this in CA, I thought Ben Anderson's moving footage of the med fac in Lashkar Gar would be of interest to medical perss who had spent time in the Role 3 etc. Lot of clinical footage, moving,depressing. 28 minutes


" For a second I thought I must have misunderstood. I was looking at two children who were alive, conscious, and looking back at me. But I was also looking at their X-rays, which clearly showed that both of them had bullets in their heads.

In each case, the bullets had pierced the children's skulls, and were now floating inside — alongside or within their brains. The bullets were impossible to remove, at least in this hospital, so they would remain there for the rest of their lives, causing, at the very least, severe headaches.

I know a surprising number of people who have been shot in the head and are still alive, but they survived because they were wearing helmets. These two children didn't have such luxuries. No one in rural Afghanistan does.
there-is-nowhere-we-can-live-in-peace-visiting-an-afghan-hospital-overwhelmed-by-war-body-image-1415128618.jpg


Helmets, flak jackets, surveillance balloons, mine-resistant trucks — even simpler things like sunglasses, bottled water, and walking boots — all these modern accouterments that made life for foreign forces a little easier and safer are all gone. Visiting the southern province of Helmand today, it's hard to see any evidence that thousands of foreigners, with all their technology and promises, were here just a few months earlier. "


Full article here

( The BBC would have had issues with some of the imagery, not least in terms of NHS guidelines on patient consent, which may be why they have not carried this or any of Ben's report)

I think this is the facility in Bost(?) but you can undoubtedly tell me different.

Anybody who wants to criticise their clinical practices ,feel free. Anybody want to comment on how 'difficult' NGO's can be, ditto. And ask yourself whether they are doing the best job they can without the resources we can sometimes take for granted. I see no sign of either of the two CAT scanners we installed in the Role 3 so presumably they were shipped back to UK.


Edit: People who can, do. cf Dr Pauline Cutting . Link to the NGO page here
 
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Goatman

ADC
Book Reviewer
No worries. It struck a bit of a chord as I think it will with anyone who spent time in or around Bastion Role 3, given the inevitable conflicts between support to operations and

' not creating dependency in local civpop on military facilities'

I know this is a tricky issue. But it seems to me that a balance can and should be struck.

If you are the only remotely competent medical facility in an area the size of ( not Wales again FFS - Yorkshire!) then turning patients away is a tough line to maintain, especially when local medical coverage is scarce/non-existent. As it will probably be in any war-zone where British expeditionary forces are likely to operate....

The Italian NGO which operates the Lash facility can be contacted at
http://www.emergency.it/work-with-us/job-vacancies.html
for anyone who has an interest.( other flavours of Medical Emergency Charity are readily available, not least MSF (UK ) - LINKY )

MSF Press Release : Afghanistan - between rhetoric and reality is also worth a look. The attached report indicates that the picture across Afghanistan is as bleak as in Helmand.

Download pdf copy
 
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theoriginalphantom

MIA
Book Reviewer
The hospital in Lash' is a terrible shite hole with insufficient infrastructure, staff, training etc. During my time at LKG we ended up with a bit of an international incident due to Medicines sans Frontiers kicking off that we had 'kidnapped' a patient 'at gun point' from there.

We did manage to get some improvements there, by instigating a training course for the ambulance nursing staff. A course that was continued by the following tour, but that alone isn't enough. you could build them a massive new hospital and give them all the kit they'd ever need along with the training so they can use it all, but you need to change the way society runs out there for it to be successful. We knew that sending patients with drugs and dressings for their continued treatment just meant someone else would take them, at best the patient would sell them

the better hospital there was (is?) run by an NGO and nothing to do with MSF, IIRC they were Italians. however for a while that was shut down due to suicide vests being 'discovered' on the premises.

I could rant for a while and spent ages typing up the 'kidnap' story, but nobody would believe it.
 
' not creating dependency in local civpop on military facilities'
I know this is a tricky issue. But it seems to me that a balance can and should be struck.
Some years ago I attended a conference at the Royal Society of Medicine about the provision of healthcare in conflict zones, and the overwhelming view of the NGOs was that they felt that the military providing healthcare was treading on their rather precious toes.

The eligibility matrix for civpop using the R3 was robust, and should have provided the balance but prone to being ignored by PEDRO and DUSTOFF as well as the ANA at Shorabak, all of whom regularly delivered non-entitled patients and patients who could have gone elsewhere.

As I recall the Italian hospital in LKG was often reluctant to take patients from Bastion R3, especially those that were ventilated. The lack of anything like proper intensive care (both equipment and clinical expertise) outside military facilities highlighted the huge gap in provision in Afghanistan generally.

I think it's also worth considering what awaits civpop patients after treatment by the military. When we admit our soldiers, we know that the R3 is just the first step (or third if you take buddy care and MERT as the first and second) on the patient's recovery pathway. After resuscitation and emergency surgery, we can transport the patient by CCAST to R4 facilities, then world class rehab, with ongoing welfare support for them and their family.

The local patient gets the first part, and that's it. We may be able to save them from would, outside military facilities, be unsurvivable injuries, but ultimately they won't get the ongoing care we take for granted - though I do not know if there has been any research following up civpop patients, and how well they do after Bastion.
 

theoriginalphantom

MIA
Book Reviewer
we had a good relationship with both hospitals, the only drama being MSF ( I really have no love for them at all, they were not neutral at all, but vehemently anti military) - the italians had strict guidelines on what they would accept and refuse. they didn't want to be a clearing ward, so taking stuff from LKG was generally OK. They did take a couple of our ventilated patients, however we generally sent anyone that bad to Bastion.

I can't remember them ever refusing anyone we had for them - they even took on a couple of abandoned children (6 months and couple of years old - dumped by the side of the road and found by a British patrol) who were not injured at all, but we needed to keep them out of the local orphan system while other family were being searched for, the Italians took them for 24 hours and thankfully a confirmed relative was found only minutes before they were due to hand the kids over to local authorities.
 

Goatman

ADC
Book Reviewer
Thanks for those first hand responses gents....the credit belongs to those in the ' blood and sweat of the arena ' not the armchaired bystander.

I appreciate that this is difficult area and will garner views on all sides. Hopefully you took the time to watch Ben's report in full rather than just my simplistic take.

OriginalPhantom said:
the better hospital there was (is?) run by an NGO and nothing to do with MSF, IIRC they were Italians. however for a while that was shut down due to suicide vests being 'discovered' on the premises.

cf the first post.

I'm sure Service grown-ups have bothered their highly paid heads over this issue for years - and feel they have got it as right as anyone can.

I don't know where that leaves the two children with free floating rounds in their skulls.
 
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Goatman

ADC
Book Reviewer
Then it is good to know that 'other flavours of medical charity are widely available'
 
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theoriginalphantom

MIA
Book Reviewer
The military aren't singled out by MSF; when I was in Bosnia working for an NGO, they had an uncooperative attitude to everyone else.

That doesn't surprise me at all, the MSF reps seemed to be there as some kind of personal power trip as they didn't appear to actually do anything.
 

Goatman

ADC
Book Reviewer
Then you will be happy to hear that the clinic referred to in Ben Anderson's film is operated by an Italian NGO called 'Emergency'
They have a UK presence here

EMERGENCY’s involvement in Afghanistan began in 1999 when EMERGENCY built a Surgical Centre for War Victims in Anabah, a village in the Panjshir Valley, at the time under the control of Commander Massud, the leader of the Northern Alliance.

In 2001, EMERGENCY opened a second Surgical Centre in Kabul, which was under Taliban rule.

In 2003 EMERGENCY built a third Surgical Centre in Lashkar-gah, in Helmand province, where there was a total lack of specialized surgical facilities.

EMERGENCY has created a network of 36 First Aid Posts and Public Health Centres throughout the country, to guarantee the rapid treatment of patients and, if necessary, their transfer to hospital.

Since December 1999 to December 2013 EMERGENCY has treated over 3,9 million people in Afghanistan.


 
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