Mark de Rond: Doctors at War: Life and Death in a Field Hospital

Abstract

These are the words of surgeons at the 50-bed Camp Bastion hospital near Helmand. Their patients include International Security Assistance Forces, Afghan fighters, noncombatants, and possible insurgents who, if they survive, could once again construct improvised explosive devices that maim. In 2011, ethnographer Mark de Rond was embedded with these surgeons for six weeks. His goal was ''to try to portray the lived experience of those whose lives, in spurts, revolve around damage-control resuscitation and early surgical management in a war zone'' (p. xvii). This meant that he witnessed work that involved severe limb injuries, amputations (''limbs in bins''), extreme transfusions (''he took 91 pints of blood. .. the normal human has 10 pints,'' p. 93), and dilemmas of pain relief (''should we give this Afghan more opiates than he'll get when he is transferred to the second-rate local healthcare system?''). This work was interspersed with efforts by everyone to cope with the surreality of it all. De Rond's compact ethnography is a tale from the field of senselessness and making do amidst conflicting professional, organizational, and institutional expectations. It is a pretext for deep reflection on the (in)significance of much academic work. And it is intermittently a tale of success. According to publicly available records compiled between April 2006 and July 2013, surgeons at Camp Bastion worked on 20,000 severely injured people, and 96 percent of those people survived their stay. What makes this remarkable is the sheer magnitude of the surgical challenge, namely, to control hemorrhaging and contamination from limbs that had been blown off, severe abdominal and head injuries, and unique combinations of damage in multiple body parts. The unexpected can happen at any time. For example, while a patient is being transferred to the hospital his tourniquet falls off, which leads to uncontrolled bleeding, which leaves the surgeons with fewer physiological reserves and less margin for error when they finally work on him (p. 63). The surgeons' objective in this form of trauma surgery is physiological restoration so that patients can be kept alive and transferred to other facilities for anatomical restoration. All of this is what the book develops in deeper, more emotional detail. The reader is