Medics are Stand-ins for Town Docs in Afghanistan

KHOST PROVINCE, Afghanistan — Even if he hasn’t seen combat, Spc. Joe Kunsch, an Army medic, had seen plenty in his first five months in Afghanistan.

On daily patrols with Battery A, 2nd Battalion, 377th Parachute Field Artillery Regiment, it’s almost a sure thing that Afghan civilians will ask him to attend to their injuries and ailments, everything from simple scrapes to cancer.

So, like many medics who came to Afghanistan to treat wounded Americans, Kunsch often finds himself filling in as town doctor for people either too poor or too wary of Afghan physicians to seek local help.

“A lot of times now, if we go to towns south of [Forward Operating Base Salerno], they follow me everywhere we go,” Kunsch said of the civilians near his unit’s headquarters on the edge of Khost city.

Typically, villagers show him small wounds, such as a cut or smashed finger, that he can easily patch up. But with frustrating frequency, he’s approached to fix old injuries beyond his help — broken bones set at odd angles, or scrapes that have become infected. In one case, a boy developed tetanus from an untreated cut on his foot.

“This country’s, like, in the Stone Age, pretty much,” said Sgt. Ramon Cortez, 38, a forward observer from El Paso, Texas, who sees many of the cases brought to Kunsch. “Somebody gets injured, they let him heal on his own, since they don’t have the medical facilities available.”

At one stop on a recent patrol outside Khost city, five men and boys sought Kunsch’s aid.

One man’s crookedly set pinky was covered in faded, rusty dye. He’d broken it a month earlier, and used henna dye rather than a splint to fix the break.

A boy of about six was worst off. His badly burned right foot was dyed a deep purple and grimy from walking without shoes.

His left foot was also burned, but less seriously. An Afghan adult in the mob around Kunsch said the burn was a cooking accident, an assertion the medic disregarded.

He simply pulled out a razor, bandages and antiseptic, and went to work. The wide-eyed boy barely flinched.

“This is the worst one I’ve seen,” said Cortez, who found the child hobbling toward the patrol, carried him about 100 yards to Kunsch and cradled him while the medic dressed his wound. “Normally I just see little scratches. But this one is pretty bad.”

It’s not the worst Kunsch has seen, though. Afghans treat him as if he were a doctor — an American medic’s skills probably exceed those of the average Afghan doctor, many soldiers say — and occasionally invite him into homes to address more serious maladies.

In one case, he entered to find a group of 15 to 20 women chatting in a room. Aware that Afghan culture generally forbids outside men from viewing women, Kunsch stopped in the doorway, asking, “Can I be in there?”

“Not a problem,” a male elder assured him. “You are a doctor. You’re fine.”

One of the women had a large goiter on her neck — a swelling of the thyroid that is usually the result of an iodine deficiency. Another, older than the rest, had what Kunsch thought was laryngeal cancer.

“She was a super-sweet, super-nice lady, and it was just hard not to be able to do anything,” he said.

He gave her some vitamins, hoping the placebo would do something to dull her pain.

“We can’t monitor them all the time, so we can’t do a lot for them” in serious cases, he said. “You don’t want to give them something strong and have it have an adverse reaction.”

Spc. Victor Cornejo, 34, a medic with Company D, 1st Battalion, 501st Infantry Regiment, based southwest of Salerno at Combat Outpost Narizah, has faced a similar dilemma.

On a recent patrol to visit nomadic Kuchi tribesmen in Tani district, Cornejo was asked to help a woman whose scalp was covered in painful cysts. According to her husband, a doctor in Khost city’s bazaar had prescribed antibiotics, a fact that drew a slight smirk from Cornejo.

“Yeah, that’s not going to do anything,” he told the man, an elder with a full gray and white beard and a deeply lined face. “They need to be cut open.”

“If she doesn’t get treated, yeah, it could take her out,” he told his platoon leader as they discussed treatment options outside the family’s patchwork tent. “But if I came and I did it and they wouldn’t allow us to come back ... or she wouldn’t come [to our base], that would take her out, too, because that could cause an infection.”

He gave the old man the only thing he felt comfortable with: advice. Take her to the doctor, he said, have him remove the lumps and put her on antibiotics to prevent infection.

It’s a long, rugged trip from the Kuchi camp, far from any real road, to Khost city. The nomads didn’t have cars, just tractors, horses and donkeys. The old man said he’d wait a week, and if the cysts didn’t clear, he’d take her then. Cornejo was sure they wouldn’t clear on their own.

Even on the suburban fringes of Khost’s provincial capital, less than 10 miles from a government hospital, the approach to medical care is tragically primitive. Injuries that would warrant a trip to the emergency room in developed countries are treated with far fewer resources, and far less know-how.

“Just about every injury I see has dye on it of some sort,” and that’s it, Kunsch, 34, from Prescott, Ariz., said. “I don’t know if it’s worse [than no dye], but it definitely doesn’t do anything for them.”

The Army doctors back at FOB Salerno told him they aren’t aware of the dye having any medical significance, though some said they’d seen the same thing in Iraq.

“It’s not necessarily their injuries that surprise me,” Kunsch said, “it’s how they try to take care of them. There’s no knowledge of real basic first aid.”

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Afghanistan Army