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Sanjay Gupta MD

Special Edition: From Afghanistan; How One of the Largest Battlefield Hospitals Takes Care of Patients; Medevac Helicopters Rescue Patients; Malik's Story

Aired September 12, 2009 - 07:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

DR. SANJAY GUPTA, CNN HOST: Good morning, welcome to HOUSE CALL. I'm Dr. Sanjay Gupta. Welcome to a very special show from Afghanistan, specifically the Helmand Province.

We're going to take you inside some incredible places today: one of the largest battlefield hospitals in all of Afghanistan; we'll show you how they take care of patients here. And behind me, these tents over here, they take care of patients as soon as they come off the frontline. It is one of the most remarkable things that you'll see.

Back home, we're going to focus on President Obama's speech, as well his focus on health care affects everyone here as well. And finally, there's a boy out there named Malik (ph); he'll touch your heart. He was injured here in Afghanistan. You'll see how the doctors worked on him and what the lesson is for all of us.

You're watching HOUSE CALL.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Early morning, Kandahar.

(on camera): We've been here just a few minutes. We're already getting an idea of just how busy this hospital is. Out there's the busiest airstrip supposedly in the world, flights landing all the time, often get patients like this into the hospital. We're hearing this is a very urgent case, patient with lots of bleeding, possible double leg amputation.

UNIDENTIFIED MALE: OK, let's stay out of the box please. And then, the tourniquets were put on about 45 minutes ago. Bilateral tourniquets.

UNIDENTIFIED MALE: Dr. Hayes (ph) is communicating with the patient, translating, trying to figure out exactly what happened to him.

GUPTA (voice-over): We don't know much: middle aged, Afghan national. But here's something: only a quarter of the patients brought here are U.S. or coalition forces, the rest are locals.

(on camera): This is one of the keys here. You have no idea of the severity of injuries here. They got to roll the patient, check his back, check his spine and make sure there's nothing else that they've missed. UNIDENTIFIED MALE: Not soaking through, so you can see the tourniquets are still holding.

GUPTA: Yes. Putting big I.V.s in here. There;s just a couple of tourniquets that are really holding all that blood from coming pouring out of his legs. That's why they have to take him to the operating room.

(voice-over): 24/7, a battlefield hospital in the middle of a war zone like this. Surgeons working on a young soldier, IED, improvised explosive device attack. As you watch him wheeled out, his face is torn, his left arm terribly damaged and underneath that blanket, one of his legs is gone. Surgeons tell me his mother received the awful call just a short time ago.

UNIDENTIFIED MALE: No, don't move him yet.

GUPTA: It's all hard to watch and to process. They are brothers, friends, neighbors but here is where it gets worse. That sound you hear is a drill they used to remove the skull of a child, a two-year-old Afghan boy. He fell down a cliff while playing. His name is Malik and he has a massive brain injury, almost dead. Doctors here are trying to give him a fighting chance. He is one of the cutest boys you'll ever meet.

(on camera): It is night time now here in Kandahar. You can see what's going on behind me of a helicopter about to land. It's very windy. We don't have a lot of information, we just know there are patients on this particular chopper.

Look over there, look over there, two ambulances, all of the medics over here. They're starting to run out to the chopper. See what's going on. They just got the all clear signal. We're going to go with them.

(voice-over): Thirty seconds later, the patient is inside.

(on camera): As you can see, there's a lot of triage going on right now, they're placing IVs, they have the breathing tube checked. A couple of things I noticed right away, he's moving both of his legs and he's moving both of his arms. A very good sign. There's a concern about head injury, but it's probably not that severe if he's able to do what he's doing now.

And keep in mind, in the midst of all of this, a young boy, Malik, his life still hangs in the balance.

(END VIDEOTAPE)

GUPTA: And you know, we're going to check in on Malik later on in the show. So far, what you see is one of the largest hospitals in Afghanistan, a trauma hospital. What we know is that a lot of the care takes place in what are known as forward operating bases. This is very close to the frontline and it can be dangerous for the doctors who take care of patients there, but very important as well.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): One hour, that's it. Minutes began ticking down when word came that two men, both civilians about 40 miles from here were critically wounded. Without help, they could bleed out and die.

SGT. NATE DABNEY, COMBAT FLIGHT MEDIC, U.S. ARMY: If they're an urgent patient, we have timelines where we need to be moving extremely fast, I mean within minutes. We don't mess around. When that bell rings, we run, and we get out here, we get all geared up and we take off.

GUPTA (on camera): Right now, we're on a medevac blackhawk helicopter. We're traveling about as fast as I'd ever traveled in one of these, 1,200 feet off the ground. We know there are two patients who've been stabbed. That's all we know. We don't know how bad off they are or if (INAUDIBLE) ...

(voice-over): It's what these guys do. I'm with an elite medical dustoff crew. The name goes back to Vietnam. It was the radio emergency call signal to chopper in the combat flight medics. They are a go team 24/7; they steal moments of time to save lives.

DABNEY: Our job is to get people up and out of here in that seconds, I mean because it's seconds count.

GUPTA: For Nate Dabney and his team, most missions are about rescuing American military.

DABNEY: They're leaving this gate every day on foot and on vehicles knowing what's out there. And if they can do that, then I'll do anything to make sure that they get out all right.

GUPTA: But today, the call came to save Afghan locals. It's a critical part of the U.S. strategy to win the hearts and minds of Afghan civilians. We are now into the golden hour. Most trauma patients who die of blood loss die within an hour unless we can stabilize them. So, we have 20 minutes to fly, 20 minutes to get the patient on the chopper, 20 minutes to get the patient to a hospital. It's one golden hour.

DABNEY: So, when I got on the aircraft, my mind set is airway, oxygen, stabilization of the chest. Finetuning this down to the very last second is the most important thing.

GUPTA: But with the dustoff teams, the challenge is not just getting to the patients, but about getting out of there safely.

DABNEY: It's probably the most dangerous place in Afghanistan. Couldn't see any security out yet and here we are coming into this area. You know, you can see it when we're going, there's six-foot high corn fields and water and mud everywhere. Not very many ways for us get out of there real quick if we had to. So, I was worried.

GUPTA: For so many reasons, that fear is always looming. Dabney surprised me when he pulled out this picture. These are his three boys.

DABNEY: I've discussed it with my wife, even written a letter for her to read to him, to them. When it comes to that kind of thing, you hope that they're proud of you. One of those things you try not to think about.

GUPTA (on camera): Oh man, it must have been a tough letter to write though?

DABNEY: It was. I was a real -- in fact, it probably took me about -- you know, being a dad is probably the most privileged and most important job you could ever have, no matter what you do. I mean, you know this. And but at the same time, showing them what being a man's really about. You know, fighting for your country, sacrificing for your country. Things that are more important than, you know, staying home and avoiding this kind of thing.

GUPTA (voice-over): As for today's mission, Dabney and his dustoff crew cheated the clock again. It's now clear the two men they flew in to save will survive their terrible wounds.

(END VIDEOTAPE)

GUPTA: Next, we go from a medevac mission straight into the operating room with Dr. Augustus Brown who I met when I was out here. It turns out he's from my same hometown which makes this all the more personal. We'll have his story after the break.

You're watching a special edition of HOUSE CALL from Afghanistan.

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE: One, two, three!

DR. AUGUSTUS BROWN, U.S. ARMY MAJOR, VASCULAR SURGEON: Oh, that's a mess, OK.

GUPTA (voice-over): U.S. Army Major Augustus Brown is the only vascular surgeon for the entire country of Afghanistan.

BROWN: Probably an anti-personnel mine that he stepped on, and basically, amputated his legs. His feet were gone and we completed the amputations.

GUPTA: Brown is 43-years-old and he's a long way from home, the same hometown as mine, which makes this all the more personal.

(on camera): This place has been attacked, risking your life to save others.

BROWN: The deal was when they need you, for whatever they need you, go. That's it.

GUPTA (voice-over): The go call came January 29th and there's been no rest for this battlefield surgeon.

(on camera): We're here in one of the trauma bays at the Cafe Royal Three (ph) hospital. It's an unusually quiet moment, but I wanted to give you an idea of the numbers here, which give you a reflection of what's happening here in Kandahar, what's happening in Afghanistan.

On average, they used to see about 80 patients a month, mainly traumatic patients. By April, it was 100 a month. And take a look at August -- roughly 230 patients a month. And I think by fall, the numbers will increase even more.

(voice-over): U.S. troops, coalition forces, locals, Dr. Brown treats them all.

BROWN: Oh, they asked me to help out. They needed four surgeons, they only had three. This is what happens when you have a hospital as busy as this one.

GUPTA (on camera): One of your children was born while you were deployed?

BROWN: That's true.

GUPTA: How do you deal with that?

BROWN: It is a sacrifice to my family, but it's a privilege. Even when I'm back in Atlanta and they ask what do I enjoy most about service? The most fun I ever have is in -- when I'm at war.

GUPTA: When you had to say good-bye to your wife and your many kids -- you have ...

BROWN: Yes.

GUPTA: ...lots of kids, just like I do. Tell me about that conversation.

BROWN: It was hardest for my son, and the oldest is six-years- old. That's always hard. There's no silver lining in that. He gave me a good luck charm, it's a little stuffed dog. It's in my uniform in the back. And I always go with it, and I -- the promise was as long as I keep it on me, I'll be safe.

GUPTA (voice-over): In talking to Major Augustus Brown, I realize there is a fear of death but he never let's it steal his thoughts. He finds though there are some images he can't shut, some that haunt him, like this burned child, her only pain relief a package of candy.

BROWN: You just don't ever see yourself after all those years of education sitting in the middle of a desert trying to scrape dead tissue off a child. That was probably the worst day. And they all lived, all of them and they all got better. But I think maybe 20 years down the road, when everything settles down and I can come back and see one of them alive, grown up and you feel like it was worth it. (END VIDEOTAPE)

GUPTA: And there's one thing out there that's going to affect Dr. Brown and just about every other health care professional from the United States, and that's the focus on health care reform, which is what President Obama talked about before Congress this week. We're paying attention to it, even here from Afghanistan.

We'll talk about it after the break.

(COMMERCIAL BREAK)

GUPTA: And we're back with a very special edition of HOUSE CALL. I'm Dr. Sanjay Gupta reporting to you from Afghanistan.

Of course, we're trying to keep up with the news happening back in the United States as well. There's a new vaccine recommendation for men up to age 26. An FDA panel says that Gardasil, which protects against a sexually transmitted Human Papilloma Virus is safe for males age nine to 26. Now, we know that Human Papilloma Virus can cause cervical cancer in some women and raise the cancer risk as well in some men. Now, the FDA is not required to follow the panel's advisory, but oftentimes they do.

Also, President Obama making big news, of course surrounding health care reform. He gave a major speech to Congress, he also met with a lot of resistant Democrats at the White House. The head of the Senate Finance Committee Max Baucus also making news, saying he's going to push forward with legislation, with or without Republican support.

We also know that there's a growing number of people who are paying either all or a big chunk of their medical bills. So, Elizabeth Cohen has a column on this week's CNN.com/empoweredpatient talking about how to comparison shop for everything from hip replacements to appendectomies.

Also, an odd thing happened to me while I was out here in Afghanistan. I ran into an old friend, a doctor, a commander with whom I was embedded when I was here in Iraq back in 2003. He shared some remarkable stories over the last six years and he also told me what's different about what's happening here medically in Afghanistan versus six years ago Iraq.

You won't want to miss it. Stay tuned to much more HOUSE CALL after the break.

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

GUPTA: Since I've been here in Afghanistan, I couldn't help but remember some of the time that I spent in Iraq and some of the people with whom I spent time with. And one of those guys was Commander Rob Hinks, Dr. Hinks and I happened to run into you here. It's an amazing thing. DR. ROB HINKS, U.S. NAVY COMMANDER: Great to see you again, Sanjay.

GUPTA: I see the FRSS, the Ford Resuscitative Surgical Suites where you and I spent a lot of time in Iraq, they're up again. How are they different?

HINKS: Well, as you recall last time, basically it was expeditionary maneuver warfare. We were charging up towards Baghdad together, taking down the tents every couple of days, packing up all of our gear in about an hour's time, putting in the back of trucks and moving ahead with the forward edge of the battle area.

This particular period of time, the medical facility at least is static. So, we want to have a more robust capability. We've set it up in multiple tents. We have hard platforms, we have air conditioning.

GUPTA: You know, it's amazing to think about a dusty desert -- a dusty tent in the desert here. Do you feel like you have everything you need at a place like this now?

HINKS: I do. We're well equipped for the mission that we intend to do here, which again is to revive those that won't make it further up the line.

GUPTA: You know, you mentioned the operation that you and I performed together. I still remember this, it was a two-year-old Iraqi. Do you remember that?

HINKS: I remember it very well. What happened was that a two- year-old was unfortunately hit by a bullet, probably several and had severe injuries to the arm and leg as well as a bullet wound to the head. And at that point in time, this would have been our first and at that time our only brain surgery. Sanjay was present. I said, Sanjay, welcome to the corps. And he suited up and graciously scrubbed in and did the case.

GUPTA: We actually had to sterilize the bit off the drill that was being used to put up the tents.

HINKS: Yes.

GUPTA: That's what we used to so the craniotomy. Right after the operation, the child was doing well, but then I think lost her airway for a while or something happened.

HINKS: Yes, unfortunately the child didn't survive.

GUPTA: The child did not survive.

I do wish you the best of luck. You know, I think about our time in Iraq a lot ...

HINKS: I do too.

GUPTA: ...together. So, it's just really -- it's nostalgic and fortuitous that I ran into you.

HINKS: That's when you became an official Devil Dog.

GUPTA: I felt like it.

HINKS: Yes, sir.

GUPTA: Appreciate it, thank you so much.

HINKS: Great to see you, Sanjay.

(END VIDEOTAPE)

GUPTA: Again, just a remarkable story of someone risking his own life to save the lives of others.

As you watch the show today, you may be curious how do these soldiers, how do these medics sustain themselves in a war zone setting like this. A lot of it has to do with what they eat. And you may have heard of something known as Meals Ready to Eat. This is what they look like. How exactly do they work, what do they provide for people as well?

We'll have it after the break.

(COMMERCIAL BREAK)

GUPTA: And we're back with a very special edition of HOUSE CALL. This is our tent incidentally. This is what I've been sleeping on the last week, sleeping bag, cot, tent.

You know, one of the big issues as you might imagine in a war zone is nutrition, how do we get all these infantry soldiers fed? You may have heard of something known as MREs, that stands for Meals Ready to Eat. This is what it looks like. You got a bunch of things in here, including this, which is very critical. This is a bag with old heating filament inside of it. You put some water, and it heats up your food. So, you get warm food as well.

As you might imagine, these types of packages are very resilient -- they can withstand air drops, they can actually have a shelf life of about three years at 80 degrees, about six months at 100 degrees. And for the big question, you might be wondering how many calories. Well, they can be up to 3,400 calories in one of these for a winter MRE and 1,500 calories for a summer MRE.

So, that's a little bit of how it works. It's scientifically tested to make sure they get the right amount of carbohydrates and protein to be able to do the work they do.

Now, coming up on the show, sometimes there are happy endings in war zones. The story of Malik and what happened to him next. Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Now, we're back with HOUSE CALL.

You know, we have a lot more details about what exactly happened to this little boy Malik, and how all the events unfolded. One of the startling details is that his parents walked over 50 kilometers by foot to bring their son to a hospital to get him care.

Here's what happened.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): This was going to end well, but when we met Malik, he looked like this, bandaged and broken and desperate, a toddler from a remote high mountain village. Malik had fallen down a cliff like this when a U.S. special forces unit found him.

UNIDENTIFIED MALE: He ended up falling off the roof and landing on his head, causing a fracture and he started to get a hematoma, which was causing the problems he was seriously having.

GUPTA: Army Special Forces, this is them at work. These guys are the elite, the invisible warriors and this exclusive video shows how they got Malik out of the mountains. By cover of night, they would chopper him to a military surgical hospital. It was the boy's only hope. These guys are special forces, hard core. They've never been filmed before. They wouldn't even tell me their real names. But they made saving Malik part of their mission.

UNIDENTIFIED MALE: Didn't appear to see anything, he wouldn't track with his eyes, couldn't get much of a response from his pupils. So, it was a pretty simple case when we first came on, it was obviously ...

GUPTA (on camera): Special Forces brought Malik here several days ago. He was brain injured, he was paralyzed on the left side of his body. he was in dire straits. We have seen him improve over the last couple of days. But now the mission is to get him home. These Special Forces have invited us along their special mission.

(voice-over): Here at this Kandahar military surgical hospital, a nuerosurgeon and his team operated to relieve pressure on the boy's injured brain. In time, they knew the swelling would go down and his senses could return. I visited every day as he slowly recovered. He was paralyzed on his left side, but he was gradually coming back. And finally, with a little aid from his father, he was on his feet again. Now, after a week of treatment, he is well enough for the journey back to his village.

(on camera): Malik is now in the back of a camp (ph) helicopter. This is the way patients are transported in the middle of a war zone. And his father has wrapped him in this blanket, he's headed home.

(voice-over): I had expected a real homecoming. But Afghanistan is too dangerous and his village too high and isolated to fly him all the way. Instead, we brought him here to a primitive clinic. We were greeted by Afghan police, who kept a close eye on us the entire time. As for the toddler, Malik slept most of the way. My first impression, we're a long way from that clean army hospital. Here, water pumps instead of faucets, dirty floors, no bedsheets. But Malik is on his way home.

(on camera): One final exam. Malik has got his candy, but still no smile, though. Can you push? Push. Kick the leg. Can you kick it? Kick.

(voice-over): He still needs months to fully recover. His prognosis is bright. Here's the thing. Malik's village is high up there, no place to land a helicopter. So, his father and their new friends, the Special Forces, will walk through these mountains to carry the boy home.

(END VIDEOTAPE)

GUPTA: I never did get that smile from Malik that I was hoping to see, but he's doing well nonetheless. From this hospital, eventually he's going to be transferred back to his home where he's going to continue to get checked in by those medics you just met.

That's our show for today. If you missed any part of our show, check out CNN.com/podcasting. Remember, this is the place for the answers to all of your medical questions.

I'm Dr. Sanjay Gupta. More news on CNN starts right now.