Decision to go to Afghanistan was precipitated by a letter from Ken Foster, MD. He has worked in Afghanistan for many years. He described the Wazir Akbar Khan Hospital (WAKH) as the largest teaching hospital which serves patients from all over Afghanistan. He also sent a picture of a man in traction, which always been an emotional hook for us who recognize that SIGN system can be used to stabilize fractures and allow patients to return to their daily lives much faster than traction. “Many patients’ care is both prolonged and complicated by the non-availability of locking IM nails as they are treated with casting, traction, and plating, with the large exposures of open surgery.” –Ken Foster, MD

We also received an e-mail from Dr. Andrew Kim suggesting that we visit the Central ANA Hospital, which is run by the Afghan military. The descriptions of both of these hospitals indicated that they were many patients who would benefit from SIGN surgery. E-mails between Ken, Jerry Daly of Loma Linda University administrator of WAKH and Dr. Wardak of the military hospital brought resolution to our plans to travel to Afghanistan. David Templeman, MD, a professor at Hennepin Medical Center had also expressed interest in traveling to Afghanistan. We decided to meet in Atlanta and travel together to Afghanistan. Snowfall delayed plane connections and prevented our meeting so we traveled by different routes to Dubai and on to Afghanistan. Jeanne Dillner, CEO of SIGN, accompanied us.

Dave went to one hospital and Jeanne and I went to the other hospital each day. We then switched hospitals so one of us was at each hospital. Ken was correct. Each hospital had many patients that would benefit from SIGN. Many were treated with traction, external fixation or plate fixation. I counted 20 patients with fractured hips in one hospital. They were treated with traction for three weeks and then a body cast. I can only imagine how cold it is to be in a body cast in Afghanistan.

The surgeons at both hospitals were receptive and very competent. I only placed one interlocking screw at each hospital and host surgeons did the rest. The interlocking screw is the most difficult part of the procedure. SIGN technique and instruments are designed for this to be done without x-ray imaging in the operating room such as we have in the US. Soon they were doing SIGN surgery in adjacent operating rooms or on patients on the other operating room table within the same room. A total of 20 SIGN surgeries were done during our visit.

US military surgeons also visited the Afghan military hospital. They were part of an outreach program to evaluate and provide equipment. SIGN donated our instruments and implants for this hospital, but we hope we can get on their purchasing list. We will continue our donation regardless, because of the great need and the competence of the surgeons.

Dave is a very skilled pelvic fracture surgeon. He was presented a patient who had a fracture/dislocation of the hip. This was a difficult operation because the fracture/dislocation occurred six weeks prior. He brought along plates and benders and did an excellent job. I was asked to do a foot reconstruction on a patient who had fallen 60 feet into a well five weeks prior. He had fracture dislocations of both feet and had refused amputation. I agreed with him, so we devised a plan and then operated to reconstruct his foot deformity. Another patient had a complete anterior cruciate ligament rupture. This was very disabling so we operated on him as well.

There has been invasions and fighting in Afghanistan for over 30 years. The educational system has not been functioning so unemployment is very high. Ten percent of the people live in tents and 50% do not have enough to eat. They live in constant insecurity. The Rolling Stones song "You Can't Always Get What You Want" ran through my head. It seems so superficial, considering the needs of many Afghani people. I even thought of the Greek philosopher Epicuris who stated that "you are wealthy according to the number of things you can do without. I am sure he was not talking about food, shelter and security. The patients and their families responded to kindness and concern about their problems with gratitude. They did not complain about their fate. It was an honor for me to assist them in some small way. I have great admiration for the Afghani doctors who are innovative and excellent surgeons. Anesthesia was excellent. I was particularly impressed with the Afghan general who gave anesthesia. On the final day at the military hospital when I was leaving I asked to say goodbye to him. We could not find him. We had walked 200 yards from the hospital when I saw him coming out the hospital doors. It was snowing, windy and cold. He had a limp as do I. As we walked toward each other, I understood more about the brotherhood of man.

The chiefs of orthopedic surgery at both hospitals are good leaders. The WAKH administration is very dedicated to providing optimal medical care. Jerry Daly is filling in for an administrator that could not travel. He continues to do his job at Loma Linda. He requests that orthopedic surgeons, nurses and physical therapists who would like to fulfill an episode in their lives by working in Afghanistan to contact him. His e-mail is jdaly@llu.edu. It is a life-changing experience. Jeanne and I are also happy to answer questions.