Fieldset
On quick decisions and difficult questions.

Usually we receive no warning of the imminent arrival of bomb blast victims. They normally arrive in a cloud of panic; chaotic screaming ensues and staff members run to man their posts. This time we are prepared.

Usually we receive no warning of the imminent arrival of bomb blast victims. They normally arrive in a cloud of panic; chaotic screaming ensues and staff members run to man their posts. This time we are prepared. From the time of the phone call it should be twenty minutes before they arrive, not much time to ready the Emergency Room but I am surprised at how much gets done. We clear the resuscitation room and triage area, we prepare IV bags and bandages and then we prepare a queue of stretchers outside.

From what we hear it was a small IED, there should be six victims only. We should manage without problem, but there is still a sense of added urgency to everything we do. They arrive on cue in the back of police vans. There is still smoke rising from their smouldering uniforms when we offload the first two. Colleagues, from the in-patient and out-patient departments, temporarily leave their stations and within two minutes there is a small platoon of doctors and nurses tending the wounded.

A lifeless body with mangled limbs is quickly moved to a waiting area, it opens up space in the resuscitation area for another victim with severely injured legs. His profound blood loss is obvious but he is still breathing and despite his agony he manages to tell us his name. It seems like a ‘lose a limb and save a life’ situation for this officer. His relatives receive a phone call asking permission to amputate both legs; they have about one minute to make their decision.

Surprisingly, the most critically injured patients, the ones in most dire need, only arrive later. They were neither bombed nor shot – they were involved in a rickshaw accident. Between the two of them they have sustained two moderate head injuries and broken five different bones. Both have bled severely and require prompt resuscitation. They will also both require open reduction and internal fixation of their fractures. Only one hospital in the North-East of Afghanistan has the capacity to do this – it seems they have come to the right place. With a good team effort the Emergency Room is cleared and by lunch time there are only minor wounds left to suture and dress.

The point of the story is this: early in the short history of our hospital a decision was taken to open our doors to general trauma patients as well as those with conflict-related injuries. This must have been a difficult decision for two reasons: firstly it implies a greater demand on the hospital in terms of supplies and equipment. Secondly it deviates from the often romanticised idea of having a pure war hospital in Afghanistan.

The reality is that Afghanistan can be a perilous place. And the danger doesn’t always come from the barrel of a gun or the shrapnel of a bomb. Quite often it comes from a rickshaw, a donkey cart or a child falling from the roof because there is nowhere else to fly his kite. I, for one, am proud that the hospital treats all injuries with equal fervour. I am sure the two men from the rickshaw accident feel the same way.

The Resuscitation Room, MSF, Kunduz, Afghanistan

The resuscitation room © Stefan Kruger/MSF