Medical Mission

Be The Change

You know you are in a very strange city when you are awakened at 12:30 am by a loud boom, the house shakes, and you are glad it was just an earthquake and not a truck bomb. It is funny how time in Kabul will change your perspective on things.

My patients at Cure International Hospital continue to be a mixture of triumphs and tragedies. When the average Afghan can only expect to live to 45, a 94 year old man is truly rare. Surviving a myocardial infarction at that age is even rarer, yet this delightful fellow grows stronger every day. I admitted him from the ER and continue to monitor his progress in the ICU. Despite the language barrier and his near-total deafness, we seem to get by. His son Rafik and I have had some wonderful conversations of late, confirming my initial impression that the Afghans are a very warm and gracious people.

We took a wonderful day trip to Istalef today, a two-hour drive north of Kabul. Up in the mountains. It has clean air, beautiful fall colors and hiking. My Kenyan friend Richard found that when you climb a hillside and wander too close to a Tajik mountain house, the women throw rocks at you. Served him right.

Some beautiful young children herding sheep on the mountains near
Istalef, Afghanistan. Passed them on our hike.

I continue to be amazed at Jacki's dedication to the patients and staff at the hospital in her role as executive director at the hospital. Some people talk, others just do it. She is the embodiment of the saying, "Be the change you want to see in the world."

Day Two

I lectured on migraine diagnosis and treatment to the faculty and residents today. They had many good questions and all requested copies of my notes. Many of the best medications for migraine are not available here as of yet.

I also admitted three patients to hospital today: a young boy with possible cerebral malaria and two young girls with severe asthma. Asthma, always the asthma here. Oy vey! Sad case of a childless 30-year-old woman whose husband had just taken a second wife due to the fact that our patient now had a large malignant pelvic tumor. Not a real great day for her.

These guys below just had their cleft lip/palate repairs done at the hospital here. Man, are they ever showing off their new smiles! They follow me everywhere.

I must tell you that I love it here and am quite relaxed compared to my first trip. This is very hard work, but I am as happy as I can ever remember being. I saw a comment on the KPRC's news piece that "Dr Dickinson is probably just doing this for the publicity." They've got me on that one! My one goal is to raise awareness and funds to support the lifesaving work here in Kabul at Cure Hospital. I would be happy to show you all around Kabul and the hospital anytime. It will change your life.

The First Day

Internet service, like many things in Afghanistan, remains unpredictable. I am just back online after two days of no service in Kabul. I have met some wonderful people and, as always, have seen many interesting medical problems.

Today I was asked to consult on a 52-year-old woman who traveled for two days for evaluation of abdominal swelling. Her Cure doctor drained the fluid and found widespread cancer. She had been told correctly that this is not a treatable situation, but her son requested a second opinion from a "foreign" doctor (me). After reviewing the chart, it was clear that she was terminal. In Afghanistan patients are never told this directly, but are told it is in God's hands. As he heard this, his eyes welled up with tears. I told him that if she were my mother I would take her home and keep her comfortable with pain medication. Effective cancer treatment is unavailable here. It is hard to say if this comforted him, but he reached out to shake my hand and said "tashakur," which is Dari for thank you.

Grief is the same the world over. HIPAA patient privacy rules do not exist and random people often pop into the exam rooms just to listen or to offer the doctor advice - no one seems to object. Two widespread cases of tuberculosis, one brucellosis, an appendicitis and a delightful 94-year-old man with a heart attack. Security is very tight; lots of checkpoints, but so far there have been no incidents. Air pollution is horrific and we have the Kabul Cough. Chronic lung disease is one of the leading causes of death here due to air pollution.

More to come from Kabul.

Departure Day

As it gets down to departure time today, I am preoccupied with all the usual preparations for a long international flight. Passports, visas, luggage weight limitations, Cheese Nips, and noise-canceling headphones. These are a wonderful invention as they eliminate about 90% of ambient engine and cabin noise and are an effective defense against the overly-chatty adventurer in the next seat. You know the type... starts out innocently enough with a "Where are you headed?" Then quickly morphs into a somewhat unsettling story of their recent gallbladder surgery ("The doctor said he had never seen so many gallstones! I had them made into this beautiful necklace I am wearing. Do you like it?"). I assure my fellow traveler it is the most unusual piece of jewelry I have ever seen.

As I am on my own nickel for the trip, I am in steerage in seat 49C. Wasn't really aware they had seats this far back on airplanes. With any luck, 49C will be adjacent to the "water closet" and I will be witness to a 16 hour parade of restless, Ambien-addled sleep walkers and full bladders. No "lie-flat" seats back here like they have in Business Class, just a whole day of being wedged into a shoebox with a 23 inch "pitch." After 16 hours of this I usually feel like I am trapped in a time warp or some endlessly recurring loop of an old "Twilight Zone" episode.

I was interviewed this morning about the trip by Robert Arnold of KPRC , Channel 2 News. Watch for me tonight (Saturday) on TV or on their website.

I will be traveling for the next two days and will not arrive at my destination until early Monday. This is where it can be a bit of a grind, and I cannot say how reliable internet access will be in Afghanistan. Stay tuned, this is where it is going to get interesting.

Two Days Until Take-Off

I am now two days away from departing for Afghanistan to work at the Cure International Hospital in Kabul. This will be my second trip, and I approach it with a mixture of excitement and anxiety due to the turmoil gripping this beautiful country and her people. The chance to work side-by-side with the dedicated and hard-working Afghan physicians, nurses, and midwives was a very powerful experience for me during my first trip four months ago. With an average life expectancy of 45 and infant mortality rates approaching 25% in Afghanistan, the staff at Cure International Hospital provides hope and healing to those with little access to basic health care. I came away feeling somewhat overwhelmed by the severity and complexity of the patients I encountered, and I remember thinking I saw more serious illness in six hours at the Cure Clinic than I would see in six months at home.

A short version of my first day in Kabul last June: By 6 p.m., I had seen the following illnesses: Obstructive jaundice from a gallstone in a woman in need of surgery; a bad case of measles in a 32-year-old woman with delirium; an older man with pulmonary tuberculosis and respiratory failure (he died six hours later); a 1200-gram premature infant with jaundice on whom we did a total exchange transfusion; a 30-year-old man with acute kidney failure; two heart attack patients in pulmonary edema; a case of hyperthyroidism; and a man my age (58 years) with a three-month history of weight loss and fever (a probable lymphoma).

While I loved the professional challenge of diagnosing and treating these patients, the human suffering involved was often heartbreaking for me. It has become very apparent to me that people are very much the same the world over. We all want to be loved, to enjoy good health, and feel appreciated for what we contribute. Nine thousand miles doesn't change that.