A Whole New World

     Since arriving in Afghanistan I have been reminded over and over about the fact that I am not in Kansas anymore.  Having served a mission in South America I know that different cultures have different customs and beliefs.  However, I have never experienced the differences I have seen here.   Life in Afghanistan is about survival, about living day to day.  The majority of people here live in mud or adobe huts with no running water or electricity.  Personal hygiene is non-existent.  The Afghans toil for their daily survival. In general they have no concept of time.  No one knows how old they are, how tall they are or how much they weigh.  Birthdays are not celebrated.  All holidays are religious.  There are many things about the American way of living that the locals find totally crazy.  The fact that we run for exercise is something they have no concept of and don’t understand.

     We have to do physical assessments on the patients that come in to have surgery.  The first thing we ask is how old they are.  This question is always followed by a blank stare.  They usually associate their age to some local historical event.  Most people say they are a lot younger than they look.  Most children are extremely small for their age and are malnourished.  The infant and maternal death rate is very high.  Death is something that is ever present and the people tend to readily accept the death of loved ones as God’s will.   Often we will treat children with burns or cleft palates and get them to the point where they are ready to go home.  The families are usually overwhelmed by the requirements of special needs children and will typically allow them to starve to death or in many cases they will shoot them.  This is completely crazy for us to consider but to them it is about survival and anything that threatens their ability to survive is eliminated.  There are no social programs, no government assistance that will come to these families’s aid, they are on their own. 

     We ask people about their general health and about their exercise tolerance to get an idea of their cardiac status.  The stark majority of these people have never seen a doctor in their lives and as explained before they have no concept of exercise.  We have to adjust our questions to things that make sense to them.  Instead of asking about exercise we ask about how far they can walk.  We ask about where they have pain and what their diet is like.  Often they have underlying disease states that have gone untreated for years.  Just the other day we had a patient with horrible diabetic foot ulcers.  Our orthopedic surgeons scheduled him to have both of his legs amputated below the knee.  The patient looked at them and said that he would rather just go home and die.  As I said it is a whole new world.

     I may have mentioned in previous emails that the fighting season is supposed to end with the onset of the cold weather.  It has cooled down but winter has not yet arrived.  The fighting seems to be getting more intense not less.  This past week we had patients come in from two separate IED blasts and yesterday had a convoy that was ambushed and several soldiers had some non-lethal gunshot wounds.  When American soldiers are injured we stabilize them and then ship them to Germany and from there they go to my hospital in San Antonio.  When they are Afghan troops that are injured we treat them here until they are pretty recovered and then send them to the Afghan hospital.    

     So I wanted to end this week’s email by talking about dog tags.  Every soldier in the deployed setting is required to wear a set of aluminum identification tags referred to as dog tags.  If ever there is a situation where a soldier’s life is lost the tags identify the soldier.  There are also religious emblem tags that people wear.  The LDS church created a tag that you can see in the photos on the blog.  When I first received my dog tags I had a thought.  This little piece of metal identifies who I am.  The first line is my birth name.  It identifies me as a member of the Rush family.  This is the name given me at birth by my parents.  Interestingly enough the next line is my social security number.  This number is also assigned to me at birth.  It identifies me as a US citizen and is linked to my net worth.  It is a representation of my value to society, how much I contribute into the system.  The last line is my religious preference.  On my tags it says Mormon.  The religious emblem on my tags is the temple.  I also found this to be pretty significant.  The last line shows what I believe, who I am spiritually, whose I am.  We each come from an earthly family.  Those of us who work in the US have a social security number, however; nothing gives us more worth than recognizing that we are God’s own children.  This simple truth is more important than the family we were or were not born into or our net worth.  Being a child of God gives us infinite and eternal worth and the most important thing to realize is that every living soul has the same value to God.  I am grateful for life and liberty, for my family, for agency and the atonement.  Life is so simple, don’t be fooled by the easiness of the way (Alma 37:46).  Love you all.

These are my dog tags.  I covered up my social so that I could post ithem on the internet.

This is the religious emblem that the church gives LDS service members

My new boots.

They are super comfortable and no more foot pain.

I flew this flag in my operating room on Veteran's Day.

One of the most beautiful sights a deployed soldier can see.  A special thanks to all those who have taken the time to write and send care packages.  They are so appreciated!  Since my last post multiple people have offered to send me toilet paper from the states.  While I could probably make some good money selling it, it really isn't realistic as I have no where to store it and I would have to tote it around with me every where I go.  Besides, once I develop some callouses it will be a mute point.  Thanks for the concern!