Pine-sol

"We merely want to live in peace with all the world, to trade with them, to commune with them, to learn from their culture as they may learn from ours, so that the products of our toil may be used for our schools and our roads and our churches and not for guns and planes and tanks and ships of war."
-Dwight D. Eisenhower34th president of US 1953-1961 (1890 - 1969)

I loaded about 300 new pictures in the Dr. Massaud photo album. He takes amazing pictures. Loading them onto picasa was like cooking a turkey. I started it last night and it was not finished uploading until middle of the day. I already mentioned it on a previous post, he won the camera from a BBC contest. He said that he wanted to document the effects of 30 years of war so when his country gets rebuilt people will not forget how terrible it is to go through war.

Today at clinic I walked into the ER to see an older man in his mid 60s lying on the exam table. The ER doctor told me that he was a judge and he was just attacked by 4 Taliban members on his way to work. They had just shot him in the head. The bullet went from the back of his head and out his upper brow. His wife, who wore a burqa, was by his side holding his hand. There is not a lot we could do for him. I helped get him an x-ray. We did a neurologic exam and it was normal. The judge was admitted to the hospital and, ironically enough, they placed him in a bed located right next to a criminal.

I was somewhat disheartened standing amongst all of the patients in the ward. I am fairly disappointed with the level of care the patients are receiving. In the states any one of the patients admitted would probably be followed by 5 different specialists- Internal Medicine, Physical Therapy, Infectious Disease, Orthopedics, General Surgery, Social Worker, etc. Instead, the patients have their family members take care of them. I spoke with a father who said that he has followed his son from a distant province so he can help to care for his son at our this new facility. He has almost spent all of his savings. His son was with a group of other soldiers when they were ambushed by the Taliban. Everyone died except his son. He had numerous gunshot wounds to his abdomen. A large verticle post-surgical scar is visible over his mid abdomen with a couple of drains protruding from it. His father has had to purchase all of his medications, and even the colostomy bag that he has to use, from a local bazaar. There were no sheets on the mattress. The sheets that were there were filthy.

The interpreter that was with me (Dr.Massaud) was visibly upset. He said to me, "It is not right. This is a very brave man here. He stood out in the cold snow with his AK fighting very bravely for his country and this is the treatment that he gets."

I went to speak with the housekeeper about the sheets. He said that it is not his job to collect the sheets he only cleans them. I went to speak with the head nurse and he said that there is no one on the payroll to collect the sheets so the sheets are not being washed.

It have found that it is very difficult to get across the do more with less concept. In our military we just get by with what we have. We say mission first. You check your pride at the door and just get the job done for the sake of the mission. I tried to convoy the importance of patients' first to the head nurse but I do not think that he was very receptive to it. Before I finish this deployment there will be sheets on every bed and they will be cleaned everyday. I will make sure of it.

Speaking of cleaning, it is so funny how the house keepers always want to impress you whenever you are there. Yesterday we were in a small circle talking in the lobby and one of the housekeepers literally took a long vacuum and started vacuuming in the middle of our little circle. Today in the ER a few of them were in the ER with a mop cleaning all the floors, stools, and walls. I looked at the solution that they were using and it was pine-sol. I spoke with the head housekeeper and I asked him why he does not use a diluted bleach solution because pine-sol is not a very good disinfectant. He said that pine-sol was very good at disinfecting. We debated back-and-forth for 5 minutes. I think next visit I will focus on mop water and bed sheet washing. In all honesty, I think that it is actually more important then teaching medicine. If you can disinfect and have a semi clean environment for the patients then that is half of the battle. The healing part is easy, most of it is done by the patient.

Take a look at the Goat House DFAC (chow hall). They made this impressive display all by hand. I saw them carving the figurines. It must have taken 3 weeks. I am sure that it is not written in their contract. They just do it because they enjoy doing it.

Adam and I went to evening mass at the Italian Embassy. It was really nice. It always amazes me how consistent Catholic mass is where ever you go. Here we are in Kabul, Afghanistan, with a priest that is from Italy, and they are singing all of the same songs, saying the same prayers, and doing the same routines that go with a Catholic mass. There is something very comforting about it. Take a look at some of these beautiful paintings in the church.

Take care.