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 The degree to which specialists are needed in treating emergently ill unstable patients is relative, though their contribution to definitive care is indisputable. It is my personal opinion that no services should be withheld if they benefit the immediate situation; that is as long as the doctor in attending has the competence to deliver.
After morning duties, I took the early part of the afternoon and visited the 'receiving' department of another local hospital. Their claim to fame is the triage of greater than 300 patients per day through this department. After going through the typical bounce through different offices, the 'communication director' personally escorted me to meet the Chair of the department. The department was relatively well lit and clean; it was a long hallway with individual rooms holding patients on single cots--most rooms without any other equipment in the room. There was a crowd of people around a room; most staring quietly; a few screaming, crying. The Chair walked out and greeted us, follow by a tray carrying all the requisite materials for intubation, and a few (reusable) needles. They had been waiting for anesthesia to intubate, but they never showed up. I didn't ask any further questions, but it was obvious an important step in this patient's management wasn't completed. On another note check out Kabul early at sunrise from my balcony. It is amazingly green--the entire city. Apparently the local government underwent a massive tree planting campaign to replenish all that's been lost over decades of war. They pretty much made it a law to plant a tree, which was given to them. Aside from what you may read or hear on foreign news channels, I don't feel like I'm in a war zone. A not to distant blog is going to focus on the Wedding Halls of Kabul... reminds me of Vegas. kinda. - Edris Afzali  This was our second day in Kabul, but our first day working exclusively on our project. The bureaucracy here can be debilitating if you don't have the right contacts. Everyone is the boss; everyone is trying to push their weight around. We started out the morning chasing bureaucratic channels at the "400-bed" military hospital in the heart of Kabul. This hospital was built 3 decades ago and is relatively well-funded. It has an 'emergency department' that is divided into two sections: the trauma unit and the general medicine unit. These two departments provide relatively basic services and generally rely on in-house specialists for treatment (i.e. Anesthesia for intubation.) Patients that are deemed more "acutely ill" are transferred straight to the 3rd floor ICU department that is staffed by surgeons.
With our 14-page survey in hand, we were ping-ponged through various secretarial offices so we can be referred to the appropriate department head that can allow us access to physicians that staff the 'ED'. We were told more than once to come back tomorrow, but luckily found the office of the ED chief. His attitude was the exact opposite: He sat in his office with us and discussed extensively our project, its implementation, and we arranged for a return visit to spend the day with his staff physicians and to observed the department. He had called for tea but... We were already en route to the Ministry of Public Health. Dr. Sadruddin Sahar, the Deputy Ministry pictured second from left, was very amicable and will surely prove to be quite instrumental in the coming days. He had his own deputy from the Foreign Relations office draft a letter, addressed to the directors of each hospital we plan to visit, giving his own full support for our work and requesting their full cooperation. Then we had tea. I'm hoping we'll be spending more time drinking tea and less time chasing bureaucrats. - Edris Afzali
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