Tuesday, June 7, 2011

Canadian Surgeon in Afghanistan

Below I link to a few articles about Dr Patterson. And then I highlight what captures the essence of the article. One thing I did not highlight which is of great interest is the non use of insulin for all of critically ill patients in Afghanistan. It was just never required, while in Western countries it is standard medical care. Read the full article to get the full explanation, I find it most informative.

This is a from an article by Dr Kevin Patterson

Recently I WORKED as an internist-intensivist at the Canadian Combat Surgical Hospital in Kandahar. Most of our casualties were Afghans: National Army soldiers, National Police and civilians caught in crossfire. They were diminutive men, almost always less than a hundred and forty pounds. I cannot comment on the body masses of the Taliban—they were never brought to us. But they are not likely larger than those of the soldiers and the police. And because, in war, soldiers are fed first—prospering right up to the moment they are pierced—the civilians were even thinner.

For someone used to the life and the pathologies of the rich and settled, much about practicing medicine in Afghanistan felt unfamiliar. One of the striking differences was the way gunshot victims’ abdomens looked in CT scans. Back home, I was used to seeing organs stand out with some prominence from the abdominal fat. In fact, in Canadians, the state of the kidneys can be partly assessed by the degree of inflammation in the perinephric fat that envelops them. It’s the same with the pancreas, and the liver often looks like it belonged to a French goose fattened for foie gras. Indeed, the idea of “normal” in a Canadian body proceeds from the assumption that it might be normal to spend one’s days tied to a grain spout, beak pried open, being filled with cracked corn.

Not the Afghans. The surgeons, in fact, often commented on how the abdominal contents spilled out once the abdominal wall was opened; every loop of bowel immediately visible, unobscured by mesenteric fat, which, in Canadians, would cling to every organ like yellow oily cake. Excessive fattiness is precisely why, when caring for the critically ill in North America, glucose levels are tightly controlled with insulin—a procedure necessary even for those not thought to be diabetic. Stressed by the infection, or the operation that has brought us to the intensive care unit, our sugar levels rise, paralyzing our white blood cells and nourishing the bacteria chewing upon them. But it was never necessary to give the Afghans insulin, no matter how shattered they were.

This from an interview:


Dr Patterson dons his mukluks for a stroll on the ice
Photo courtesy Dr Kevin Patterson

Kevin Patterson's writing is vivid, emotionally acute and bracingly smart. His first work, the sailing memoir The Water in Between, was a New York Times "notable book," and his short-story collection,Country of Cold, won the Rogers Writers' Trust Fiction Prize. But it's not just his literary craftsmanship that stokes the envy of his fellow writers. More maddening is that he is this good and he has a day job.

Dr Patterson, who lives on Saltspring Island, is an internal medicine specialist at Nanaimo General Hospital. He put himself through medical school by joining the Canadian Army. He's currently doing a tour of duty — as a civilian physician — in Afghanistan treating civilians at a hospital in Kandahar to provide relief to overstretched Canadian Forces healthcare personnel. Before he left, he managed to persuade 11 of his physician and nursing colleagues to pitch in too.

His latest book, Consumption, was inspired by his experiences as a doctor in the Arctic, where he's spent part of every year since 1994. Consumption began as a non-fiction account of the abrupt transformation of Inuit communities. In a short period of time, the Inuit have changed from suffering the diseases of deprivation — particularly starvation — to the diseases of affluence, such as cancer, cardiovascular disease and diabetes. But as Dr Patterson wrote about the medical and psychological impact of acculturation, he kept returning to the underlying issues of loneliness, fear and social dislocation. These, he realized, would be better probed using fictional characters, and so Consumption became his first novel (click here to read an excerpt).

Consumption begins in 1962, when Victoria, an Inuit girl, is diagnosed with tuberculosis and evacuated to the south. When she rejoins her family six years later, she is healthy but culturally estranged. In her new home of Rankin Inlet no one really fits in, however. The community is in the midst of wrenching change as the latest technologies, diamond fever and new patterns of consumption all arrive from the south.

"This novel is not about the problems of the Inuit, it's about our problems examined partly through the lens of the Inuit," Dr Patterson told me when we met for breakfast at the Sylvia Hotel. He's a trim man in his 40s but looks younger — except for the wrinkles at the corners of his eyes, a consequence of weeks spent squinting into the distance at the helm of his ketch.

Here's what else Dr Patterson had to say...

On the North:

"The closest thing I've ever encountered to the tundra is the open ocean 1,000 miles offshore, on a particularly bad day. Part of what stirs me about the Inuit and the north is the sense of wonder I feel that people survived there, in that climate and with no wood.

Think about the bowhead whale hunt, for example. It's just amazing. I mean, you are in a kayak made from sealskin, and you have a piece of driftwood with a sharpened rock tied to it, and you are hunting these 50-tonne animals!

But when you pulled the whale ashore your whole band ate well for weeks. You just set up a camp beside the carcass. Each morning you got up and chopped off another square foot of frozen blubber and skin and took it into the igloo. Your biggest job then was to fend off the dogs and polar bears."

On why narwhale blubber is better than Cheez Doodles:

"When I first went up north in 1994 there was no diabetes. As late as the 1960s, people were travelling to Cree villages in the northern boreal forests to find out why they are immune to diabetes. Now, in a place like Norway House (a Cree community in northern Manitoba), the prevalence of diabetes in adults is 40%. That's just amazing!



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