By Tech. Sgt. Craig Lifton
332nd Air Expeditionary Wing Public Affairs
JOINT BASE BALAD, Iraq (12/18/08) - Hussein sits in a rocking chair with his young son, Hyder, who shivers from the pain of having more than 60 percent of his body burned, as doctors and nurses hustle around the Air Force Theater Hospital's intensive care unit here.
This ICU is in the largest military hospital in Iraq, and over the last few months, more than half of the patients admitted to the ICU were 12 or younger.
"Some people ask why we have pediatrics here," said Maj. (Dr.) Christopher Kieling, a pediatrics specialist with the 332nd Expeditionary Medical Operations Squadron. "This is a vibrant example of how we are using pediatrics in a deployed setting."
The Air Force Theater Hospital is not a humanitarian hospital, but it will not turn away anyone with injuries that threaten life, limb or eyesight.
"We get children here with gunshot wounds, victims of improvised explosive devices and some burn victims," said Kieling, a native of Anchorage, Alaska, and a faculty member from the Uniformed Services University of Health Services in Bethesda, Md. "They get burned from exploding kerosene heaters or boiling water because a lot of cooking here is done on open fires."
The children's family members bring them to a base gate. There, security forces or medical personnel determine if the children need to be transported to the hospital for treatment. Some are transferred here when Iraqi hospitals cannot provide the level of care they need.
Hyder's father had known the hospital's reputation, from family, friends and neighbors who had been treated or knew someone who had been helped there. Hussein was not disappointed, saying "The care my sons have received here is better than it would have been at home."
Currently, 332nd Expeditionary Medical Group Airmen are treating several children in the ICU. One was a victim of an IED blast. A piece of metal shrapnel the size of a nail was embedded inside of the young victim's brain.
"A neurosurgeon did a craniectomy and went into the skull to decompress the pressure on the brain," said Kieling, the only military pediatrician in Iraq. "The fact that he is alive and his mother could communicate with him -- even through appropriate head gestures -- is very significant."
Even with the advanced procedures and medical equipment at the hospital, some things are not in the inventory. In the expeditionary spirit, the staff at the hospital has found ways to adapt.
"Back in the United States, we would have a whirlpool bath to do daily dressing changes for burn victims," Kieling said, "but we don't have one here."
A search of an old linen closet in the hospital yielded a large plastic tub. Kieling and others washed it out, sanitized it and filled it with water to clean and change the children's bandages.
The language barrier also poses a challenge to the doctors when it comes to building a rapport with patients. Many times, the children don't understand what doctors are saying, and even some body language is not the same. Interpreters are employed at the hospital to help staff members communicate with the patients and families. Bilingual medical-cultural advisers also help alleviate these challenges.
After overcoming the language obstacle, the Airmen also have to find ways to make the patients more comfortable. According to Kieling the Iraqi children are noticeably different from American children. They still like cartoons, but the classics dubbed in Arabic are their favorites. When it comes to food they prefer hard boiled eggs, chicken and plain yogurt over the sweet foods Americans are used to.
"They do like sodas, chocolate and cream cheese," said Kieling. "This is fine because they need the protein."
Many people and charities from the United States have donated clothes and toys for the children to fulfill many of their wants and needs. Storage rooms are filled with toys, games and videos. Soccer balls are a favorite, along with painting and playing with clay.
One child, whose leg was amputated after an IED exploded near him, did not smile or laugh until a staff member gave him a special present, Kieling said. A nurse gave him a syringe filled with water, which he would squirt at passing medical personnel.
Caring for children requires a team of medical professionals. Orthopedic surgeons are involved with the children with limb injuries. Surgeons handle nerve reconstruction, bone fixations and amputations. Physical and occupational therapists go to work on rehabilitation. Kieling said that the nurses who don't normally work in pediatrics have also stepped in to take care of the children.
Kieling said he believes it is therapeutic for both the children and the servicemembers to spend time together.
"We've all kind of bonded tighter," Kieling said. "We are all taking care of these kids, and everybody has done a fantastic job."
"The families can't stay all the time," Kieling said, "but we have a seemingly endless supply of volunteers that just come and sit by these kids while they sleep, play with them while they are awake, feed them, and help bathe them."
Hussein comes nearly every day to sit with his son Hyder. He had two other children who were treated at the hospital and released. The three boys and their mother were burned when a kerosene and gasoline heater exploded. The two other boys are at home recovering with their mother.
"The way the nurses cared for my sons was very impressive," Hussein said. "Before doing anything like changing bandages, they got an interpreter to explain everything to me."
Hussein's sons have returned several times for follow-up treatments and said that they want to see their nurses and thank them for taking care of them.
"These children are pretty darn resilient," Kieling said. "They have a strong will to live and do pretty well healing up."