Published: 22 March 2010
MAJ JF Sucher, MD FACS USAR MC Surgeon, 909th FST

The 909th FST saw many children during their first deployment of 2002-2003 in Salerno, Afghanistan, Paktya province, but one beautiful child gripped their hearts. Anyone who saw her then, or sees her image now can't help but feel driven to care for her, and the 909th did just that with all their heart. They waited on her hand and foot - A pattern that lead the FST to crown her "Princess Salerno".

The young princess had a broken leg. The local treatment was to smear egg-whites all over her body and wrap her leg in what appeared to be something much like a tiny picket fence. Such is the level of medical treatment in the deep rural areas of Afghanistan.

There are cities in Afghanistan with at least a modicum of adequate facilities to take care of the population. However, getting to the hospital from a remote village is a challenging prospect. Notwithstanding the fact that getting to a hospital does not mean that there will be anyone there that has the ability to treat you.

Fast forward 7 years. Fortunately for the people in and around Orgune, Afghanistan, the hospital is unable to treat the problem, then they can send the patient to FOB Orgun-E. At present time there is a consistent flow of injured children. Most injuries are not battle related.

The first day I arrived a young baby was brought in to see us after a week with colic and vomiting. The parents went to the local bazaar and collected at least 7 different medicines ranging from simethicone to antibiotics to extremely dangerous medicines like phenobarbitol. What the baby had was an incarcerated inguinal hernia and needed emergency surgery. Fortunately, the incarcerated bowel was not permanently damaged and the baby recovered quite well. Without our intervention, the baby would have likely died in a matter of days.

"They don't cry", LTC Randy Hoeppner, noted from his previous deployment in Iraq.  I see the same pattern continue with the children of Afghanistan. I don't understand why it is that these young boys and girls don't cry like American children would normally do. They seem to be too young for it to be a cultural influence. It is somewhat disturbing. This Orgune boy had a large cut to his left ankle, reportedly from a dog bite. It took him 5 days to make it to the hospital, who then sent him to us. I did not see any clear evidence consistent with a dog bite. There was a 4cm long laceration across his ankle. There is no way of telling what actually happened. We simply provided the best medical care that we could and hoped that they would return if there were any problems.

There are many injuries these children are at risk for and it shows given that the average life expectancy for an Afghan is only 46 years. In the two weeks I spent at FOB Orgune-E, in addition to the above patients, we saw 2 children with femur fractures from reported falls, a child with a hand fracture, a baby with soft tissue infection and 2 children with burns. Burns are especially prominent in this population. The Afghans have bread ovens that are dug into the ground, and it is not uncommon for a child to fall into these pits.

Unfortunately, the children are also subject to injuries of war. There are still incidents of children being injured or killed due to mines. The Soviets had indiscriminately littered the Afghan countryside with a myriad of different mines. One of the most common is the PFM-1. This mine doesn't even look like a weapon. It is small and meant to be picked up and played with. You can fold one of its wings, clicking it back and forth, all the while not realizing that you're simply playing Russian roulette. Children are especially vulnerable to these mines and the FST at FOB Orgun-E has seen the impact they wreak on the children.