American medics help keep Afghans healthy

by Sgt. 1st Class Shannon Wright
82nd CAB PAO

	by Sgt. 1st Class Shannon Wright/82nd CAB PAO Capt. Erin Stibral, left, tries to talk to an Afghan boy at the field surgical clinic in Uruzgan Province, Afghanistan where she is currently deployed. Stibral is a physician assistant assigned to the 1st Battalion, 82nd Aviation Regiment (Task Force Wolfpack).

URUZGAN PROVINCE, Afghanistan — In southern Afghanistan, even the most basic healthcare can be inaccessible or too expensive for the average Afghan family.

“They don’t have adequate health facilities out here; certainly nothing like the West has to offer,” said Capt. Don Elshire, a Navy surgeon in charge of a Forward Surgical Team near Tarin Kowt. “Their mortality rates here are high; the infant mortality rate here is extremely high.”

The World Health Organization puts Afghanistan’s under-five mortality rate at over 25 percent; that percentage puts them second in the world. 

Elshire and his team at the FST treat local Afghan civilians twice a week at their small clinic; a significant shift from their regular customers — Soldiers suffering combat wounds. On an “as-need” basis, they see about 20 to 25 locals, typically small children and adult males sent on referral from the Afghan hospital in Tarin Kowt. According to Elshire, the hospital will sometimes ask the American Soldiers for help when they have a surgical patient they can’t take care of.
During these clinic days, physician assistants and medics from the 1st Battalion, 82nd Aviation Regiment, or Task Force Wolfpack, help out.

Capt. Erin Stibral, a PA assigned to Wolfpack, has been providing clinical support at the FST for a little over a month.

“We got tied in with the FST very early on,” said Stibral. “The FST PA told us about the clinic and asked if we could assist.”

Stibral said with only one primary care provider assigned to the FST, clinic days can be very demanding. She also recognized this as an opportunity for her medics to work things besides their routine sick call.

“We augment and help support the surgical team here,” Stibral said. “Primary care-wise, we see anywhere from three or four up to about 15 or 20; all ages, children and adult males usually.”
“We see stuff here that in the states, you wouldn’t see, “ said Navy Petty Officer 1st Class Crystal Edmonds, the noncommissioned officer in charge at the FST. “We had a little girl who had spina bifida, and you wouldn’t see that in the States. We had a little boy who had a five-pound abdominal tumor removed and we can’t send it to pathology to find out what kind it is because there’s no pathologist.”

Stibral said she primarily treats the Afghans for cold and flu symptoms and fungal skin irritations most likely caused by their close proximity to livestock and the poor water quality. 

It’s the more severe cases, like a young boy, who suffers from aplastic anemia and desperately needs a bone marrow transplant that can make the job a little tougher, she said.

“One instance is a girl with diabetes,” she began. “In the U.S., it would be fairly easy to monitor and control. Insulin pumps are very common and great for both monitoring and delivering insulin. They just don’t have that capability here,” Stibral said.

“I’ve been in this game now for a long time, many years, and I’ve been in humanitarian situations where you can only do what you can do,” said Elshire. “It’s frustrating. But, you do the best you can for them, and knowing that you’re doing the best you can, that’s better than nothing. It’s just kind of the way it is.”

The little boy with the bone marrow problem is running out of options. His uncle has sold livestock and spent all of his money on treatment at the Afghan hospital. The boy still needs a transplant.
In the meantime, the crew at the FST is doing the best it can by “putting a band-aid” on his condition by giving him regular transfusions of platelets and red blood cells.

“We have packed red-blood cells, what he needs is platelets,” said Edmonds. “And, there’s no way for us to get platelets here because they don’t last that long and have to be stored a specific way.

According to Stibral, when the demand for blood exceeds the supply on hand, surgical units rely on a “walking blood bank.” 

“So, the 82nd Airborne stepped up; they are the walking blood bank here. It’s not just for him; whenever we need blood, especially whole blood, they’re all more than happy to come over and donate for us.”

“When the FST is short on blood for a patient, they will call our aid station with the type of blood they are looking for and how many donors,” said Stibral. “We have had many TF Wolfpack Soldiers volunteer (to give blood) and thus saved lives.”