The U.S. military's main combat hospital in Iraq has increasingly switched to helping Iraqis. As the numbers of wounded American soldiers have fallen, the hospital is now saving the lives of a remarkable 93 percent of Iraqis who come with devastating injuries.
It's another sign of the radical improvements in health care made at combat trauma care units in war time — especially because unlike U.S. soldiers, most Iraqi patients at the Air Force Theater Hospital don't wear body armor and helmets or drive in vehicles designed to withstand roadside bombs.
"There are people with injuries that are brought here, and I say this with confidence, if they went anywhere else in the world, they would not survive," said Col. Mark Mavity, the commander of the hospital.
On one recent day, 5-year-old Sajad Lafta lay in his bed crying for his father while his older half brother, Abdul Wahid, tried to comfort him by holding up a picture of a puppy that Sajad colored while recovering at the hospital.
The boy didn't know yet that Wahid, 25, came to visit him because his father was attending the funerals for two of his other young sons. They were killed by a car bomb that blew off Sajad's lower left leg and left tiny pieces of metal scattered over his body.
"Thank God, we are positive he is going to live," said Wahid, who planned to bring the puppy picture home to their mother as proof that Sajad was alive.
Trauma victims
Over the years, the hospital on Balad Air Base has become synonymous with combat trauma care. It is best known for saving countless U.S. soldiers with catastrophic battle injuries — more than 96 percent on average over the six-month period ending in August.
But even more astonishing, during that same time, about 93 percent of Iraqis left the hospital alive — up from an average of 89.7 percent during the previous six months.
Their injuries are devastating — shredded limbs, penetrating shrapnel fragments, massive internal bleeding and gaping head wounds.
The car bomb that wounded Sajad exploded during the evening of Sept. 12 in the town of Dujail, killing at least 32 people including his 7- and 6-year-old brothers as the three walked home after buying a few pieces of candy.
When Sajad's father heard the explosion, he raced over to his sons. Sajad was the only one still breathing. After the local hospital turned the boy away because his wounds were too severe, Sajad was taken on a U.S. helicopter to the military hospital on Balad Air Base, about 50 miles north of Baghdad.
Of the 11 Iraqis wounded in the blast who were taken to the hospital, 10 survived. The 11th was declared dead on arrival, doctors said.
As soon as the Iraqis arrived at the hospital, a team of doctors and nurses began operating — up to eight patients at a time. Nine hours later at 4 a.m., they called it a night.
"The magnitude of injury is something that's unlike what we typically experience in the civilian world. ... We had a gentleman (from the blast) with an arm blown off, a leg blown off, a kidney that was destroyed, huge soft tissue injuries, a head injury and he's alive today," said trauma chief Maj. Gary Vercruysse, an Air Force reservist who is an assistant professor of surgery at Emory University and works at Grady Memorial Hospital in Atlanta.
'Head-to-toe injuries'
The injured were rolled back into operating rooms again the next day. Much of the effort was placed on cleaning wounds to prevent infection. Sajad had his leg amputation wound closed and shrapnel painstakingly picked out of his body.
Trauma surgeon Lt. Col. Debra Malone spent four hours on Day Two with one man alone, closing up his amputated finger, reconnecting pieces of his shredded bowel and washing out severe leg and groin wounds.
"This man is a poster child for what we see here — head-to-toe injuries. He would have possibly not survived if he didn't come here," said Malone, a practicing physician at the University of Maryland Medical Center and chief of the medical research branch at Air Force headquarters.
Malone predicted that the man would stay at least a week in the hospital — something unheard of just a year ago.
Fewer U.S. patients
Iraqi patients are surviving at higher rates partly because of bed space. As violence declines and fewer Americans are brought to the hospital daily, Iraqis are able to stay longer and receive more thorough care.
In August 2007, Iraqi patients stayed an average of about four days, but last month the average jumped to nearly a week, according to hospital data. The time coincides with a drop in admissions. The hospital admitted 140 trauma patients — including Americans and Iraqis — last month, less than half the number of August 2007.
"We now have the luxury of time and bed space to keep them here a little bit longer. That is a big reason why our numbers have gone up," Mavity said.
Relying on America
Over the past four years since the Air Force took control of the hospital, experience is paying off. Though doctors rotate every four months, the lessons and techniques are passed on not just to incoming surgeons but to doctors and medical staff back home.
"We are learning firsthand the physiology of blunt versus full body trauma," Malone said. "These are invaluable lessons because we just don't see this back home."
The place is physically cleaner as well, leading to fewer infections. Until July 2007, the hospital consisted of a series of large tents, similar to the combat hospital of the "M.A.S.H" television fame. Now the 107,000-square-foot hospital has walls, a roof overhead and pumps dispensing hand sanitizing lotion every few feet.
There's also more follow through.
American soldiers who are admitted to the hospital are usually evacuated on flights to the U.S. military's Landstuhl Regional Medical Center in Germany within two days after arrival. A similar system has now been put in place for Iraqis who need more longer-term treatment.
If Iraqis are discharged to go home, they are given follow up appointments to come back to the base to make sure their recovery is on track. And if they need further hospital care, they are flown to facilities in Baghdad and elsewhere in Iraq.
Although there are other U.S. combat hospitals in Iraq, the Balad facility is the largest and employs the only neurosurgeons. That makes the hospital a key destination in cases of severe head wounds.
While 70 Iraqis were admitted at Balad for trauma wounds in August, many more were treated solely at Iraqi hospitals.
But even as Iraq gets better at handling its own security, it is miles away from providing the level of medical care and other type of assistance provided now by U.S. military facilities. Any large-scale U.S. military pullout by 2011 will have to be matched by a major boost in Iraq health care and sanitation to fill the gap.
For now, many Iraqis must rely on the United States to treat their blast wounds.
Less than a week after the Dujail car bomb tore long, jagged gashes in Yassir Mustafa Majid's head, arm and legs, the 32-year-old third-grade teacher met his father at one of the Balad Air Base's gates.
He was going home, but said he would return in a couple weeks to get his thick stitches removed.
"If I wasn't brought here," Majid said, "I would have died."