- BAGHDAD, Iraq -- The patient
had tried to foil a kidnapping. He was a large man, with a black shadow
of a beard. Now he lay stretched out on a gurney in the spare emergency
room of Al Kindi Hospital, bleeding profusely from a chest wound.
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- The doctors wanted to transport him by ambulance to a
specialty hospital. But two of the Al Kindi ambulances were broken down;
a third was in use. So they gathered around to try to save a life.
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- "We don't have enough equipment here. We need more
of everything," says Dr. Ayad Taha, huddled over the patient. "But
the most important thing we need here is humanity."
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- For the emergency-room doctors of Al Kindi, the first
nine months of the U.S. occupation have been a dispiriting time. They thought
the American rule would bring them more medicines, new equipment and a
shot of hope to one of Baghdad's busiest hospitals.
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- Instead they try to make do as wave after wave of patients
- men, women and children swept up in the violence and mayhem - are delivered
to their front door.
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- They treat the victims of bombings. They tend to children
struck by the stray bullets from firefights. They try to save the lives
of policemen gunned down on the job and administer to the casualties from
robberies, kidnappings and other violence.
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- The bloodiest months immediately followed the political
toppling of Saddam Hussein. Then, as many as 70 to 80 injured people arrived
at the hospital a day, says Dr. Mustafa Al Jedda, another young and harried
emergency-room doctor. Now, on a bad day, 20 or more patients are brought
in, still substantially above the numbers under Saddam's rule, Al Jedda
says.
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- The doctors acknowledge that they did not see much of
the carnage under the old regime. Back then, the blood so often was spilled
out of sight, in the prisons and torture chambers of the former leader.
But in the first winter of American governance, they are frayed and increasingly
bitter.
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- "Before the war, things were better than now,"
Al Jedda says. "Americans made many promise, but these promises do
not come through."
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- The 300-bed hospital is one of more than 15 hospitals
scattered about this sprawling capital city.
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- It draws from a wide area, including several poor districts.
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- During the day, its long grimy hallways are jammed with
hundreds of people seeking outpatient treatment. At night, the hallways
are empty, but the courtyard and street outside often become a gathering
place for a smaller but more unruly crowd, including gangsters whose cohorts
have been taken in for treatment.
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- American soldiers used to guard the entryway to the hospital.
Now, Iraqi police have taken over.
-
- The doctors didn't much care for the soldiers but they
don't trust the police, either. And the hospital can be a rough place.
When a doctor can't save a life, he may be targeted with threats - or even
assaulted - by friends and relatives of the patient.
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- One emergency-room doctor last month was kicked in the
face by the relative of a traffic-accident victim. Bloodied and discouraged,
the doctor declared, "I will never work in this hospital again,"
says Al Jedda.
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- The doctor later changed his mind and returned to the
hospital.
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- Many of Al Kindi's doctors are in their 20s and 30s,
struggling to raise young families on a salary as low as $120 a month.
That's a lot higher than the prewar salary of less than $5 a month. But
they say spiraling inflation has eroded most of those gains. They are organizing
protests in hopes of improving their pay.
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- U.S. Agency for International Development officials say
a broad health initiative is helping to renovate more than 60 Iraqi health
clinics and secure new equipment for more than 600 others. And the U.S.
money is helping the Ministry of Health battle malnutrition and disease
in a variety of efforts, including vaccinations of 3 million young children
and supplemental food rations for more than 100,000 pregnant mothers.
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- At the Al Kindi emergency center, the biggest change
under way is the renovation of a new and larger receiving area for victims
of bombings or other mass-casualty events. The ER director, Bashir Mohammed,
proudly shows off the room as it receives a new coat of paint; he downplays
the problems the hospital faces.
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- The frontline doctors share a bleaker view.
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- They lack basics, such as a working phone to communicate
with other hospitals, and ambulances that work on a steady basis. The hospital
has a functioning generator to operate during frequent power outages. But
the doctor's quarters, used for sleeping, eating and relaxing during down
time, does not have a working generator. So the building is frequently
plunged into darkness.
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- Her name is Halla Ramdhan. She is one of about a half-dozen
children being treated at the hospital who were accidentally injured in
clashes between the U.S. military and insurgents since this summer.
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- She has always liked American soldiers. When she would
see them as she was coming home from school, Halla would wave and say hello.
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- But in early December, playing on her rooftop, she had
no time to wave. A wedding was under way next door, and the celebratory
shots brought an American patrol into the streets below. She thinks they
mistook her for a rooftop sniper. She says she ran to try to get out of
the way, but a bullet from an armored vehicle tore off her right leg and
struck her left leg.
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- "I think it was all a mistake," Halla says.
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- Today, the 12-year-old is an amputee patient in a ward
at the Al Kindi. Her mother, 40-year-old Ascha Karim, sleeps in a nearby
bed and helps tend to the bandages swathed around Halla's left thigh and
around the stump of her right leg.
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- Since arriving at the hospital, Halla has had several
operations and is still confined to bed. She has huge almond eyes and an
easy smile that has yet to dim.
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- She dreams of the time when she can return home. If she
sees American soldiers, she says, she will still say hello.
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- Her doctor, Al Jedda, cannot forgive so easily.
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- For a woman without a leg, life in Iraq can be cruel,
he says.
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- "When she will become an adult woman, she will understand
more. I think she will never say hello to any American man."
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- No one has a precise count of how many men, women and
children are the accidental victims of the warfare that continues in Iraq.
They may be struck by the stray bullets of insurgents, or victims of American
firepower.
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- The seriously wounded are supposed to be able to get
treatment at U.S. Army hospitals. In Baghdad, that is the 28th Combat Support
Hospital, located on former palace grounds in the Green Zone, a verdant,
heavily guarded area along the banks of the Tigris River.
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- Many casualties gathered up by U.S. medics do make it
to the military hospitals. They include severely injured enemy combatants
who often require extensive and prolonged medical treatment that saps limited
U.S. medical resources.
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- Others do not.
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- Instead, they trickle into hospitals such as Al Kindi.
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- The hospital reports combat injuries to the Iraq Ministry
of Health, says Al Jedda. But he says he lacks a way to phone U.S. military
officials to inform them of the war-wounded patients.
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- This fall, Al Jedda says, U.S. officials did visit one
boy who claimed to have been shot in the leg after he made a thumbs-down
sign to a soldier. The U.S. military launched an investigation and offered
the child's family compensation, Al Jedda says.
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- But the hospital receives no routine visits from U.S.
military officials, he says.
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- Doctors and staff members at the Combat Support Hospital
say that U.S. personnel do circulate among some hospitals and bring some
wounded patients into the U.S. military health-care system. But they do
not have scheduled visits with all the hospitals or reliable telephone
communications.
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- The Combat Support Hospital is in the marble-floored
building Saddam once used as a kind of private treatment center. The hospital
has a heavy - and acute - patient load. In the United States, only about
5 percent to 15 percent of the patients entering an average hospital have
what are considered acute injuries. At the Combat Support Hospital, that
figure is almost 40 percent. The patient load sometimes strains the hospital's
supply of blood and some types of drugs.
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- Al Jedda acknowledges the limitations of the U.S. military
health-care system. But he would like to see more U.S. dollars invested
in his hospital to help compensate it for treating war victims and to improve
its staffing and service.
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- Ahmed Aziz is a frail farm boy from outside of Baghdad.
Wounded in an explosion, he has undergone numerous operations and bone
grafts on his damaged legs and feet. but his recovery is still a long way
off.
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- At 9, he has lost his smile.
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- He has been in the hospital since August.
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- His father, Hussain Aziz, says a U.S. helicopter fired
and detonated a weapons cache that was stored in the fields. The explosion
killed Ahmed's 10-year-old brother and severely damaged both of Ahmed's
legs, the father says. Ahmed was allowed to temporarily leave the hospital,
but he expects to return soon for another operation.
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- His prolonged recovery is an emotional and financial
burden on his father, who has spent months at the hospital, praying his
son will heal.
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- Back home on the farm, his wife cares for their third
son, who is just 5.
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- To survive, Aziz says, he has had to borrow money from
friends. There is no time to leave his son's side to seek help from the
U.S. military, he says.
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- Moreover, he says, he does not even know how to reach
the Americans.
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- When the sun sets, the emergency-room doctors brace for
a surge of gunshot victims. On a recent Saturday, the rush begins early.
In midafternoon, three gunshot victims are brought to the hospital.
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- They are dead on arrival.
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- The pace in the emergency room slows until about 9 p.m.,
when a police siren marks the arrival of the shooting victims from the
kidnap plot.
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- According to police, kidnappers tried to hold a young
boy for ransom. The police and the boy's relatives set out to ambush the
kidnappers. The scene ended in a gunfight.
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- One policeman was shot in the head. A relative of the
boy's was shot in the chest.
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- Taha performs a quick triage on both men. The policeman
is gravely wounded, so he dispatches the operating ambulance to take the
officer to a neurological hospital.
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- Ideally, Taha says, he would like to send the man with
the chest wound to another hospital that specializes in thoracic surgery.
But he is still hopeful that the man can be saved at Al Kindi. He brings
the patient into a small operating room meant for one or two people. On
this night, it is holding four, including a teenage boy shot in the arm
who unleashes a piercing wail.
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- Taha inserts a tube down the man's throat to help him
breathe and inserts another tube into the chest to drain blood. But after
the man is shifted over into a holding room, he goes into cardiac arrest.
A crowd gathers around, a mix of medical personnel and relatives of other
patients.
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- Taha administers drugs. He leans into the man's chest,
pumping down with clasped hands to perform cardiac massage. He puts on
cups to administer electrocardiac shock. But the patient fades fast.
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- Afterward, Taha is agitated.
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- He smokes a cigarette and ponders what else he could
have done.
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- "This is a small story," he says. "There
is a huge number of these stories here. Poetry stories, no. When I saw
this patient, he was alive.
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- "We did the best we could."
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- - Hal Bernton: 206-464-2581 or hbernton@seattletimes.com
-
- Copyright © 2003 Seattle Times Company, All Rights
Reserved.
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