MAJ JF Sucher, MD FACS USAR MC Surgeon, 909th FST

Salerno child, Paktya Province, Afghanistan - 2003 Photo Courtesy of SFC Dan Biesiadecki.

The 909th FST saw many children during their first deployment of 2002-2003 in Salerno, Afghanistan, Paktya province, but one beautiful child gripped their hearts. Anyone who saw her then, or sees her image now can’t help but feel driven to care for her, and the 909th did just that with all their heart. They waited on her hand and foot – A pattern that lead the FST to crown her “Princess Salerno”.

The young princess had a broken leg. The local treatment was to smear egg-whites all over her body and wrap her leg in what appeared to be something much like a tiny picket fence. Such is the level of medical treatment in the deep rural areas of Afghanistan.

There are cities in Afghanistan with at least a modicum of adequate facilities to take care of the population. However, getting to the hospital from a remote village is a challenging prospect. Notwithstanding the fact that getting to a hospital does not mean that there will be anyone there that has the ability to treat you.

Orgune father with baby girl - Paktika Province, Afghanistan 2010.

Fast forward 7 years. Fortunately for the people in and around Orgune, Afghanistan, the hospital is unable to treat the problem, then they can send the patient to FOB Orgun-E. At present time there is a consistent flow of injured children. Most injuries are not battle related.

The first day I arrived a young baby was brought in to see us after a week with colic and vomiting. The parents went to the local bazaar and collected at least 7 different medicines ranging from simethicone to antibiotics to extremely dangerous medicines like phenobarbitol. What the baby had was an incarcerated inguinal hernia and needed emergency surgery. Fortunately, the incarcerated bowel was not permanently damaged and the baby recovered quite well. Without our intervention, the baby would have likely died in a matter of days.

Orgune boy - Paktika Province, Afghanistan 2010.

“They don’t cry”, LTC Randy Hoeppner, noted from his previous deployment in Iraq. I see the same pattern continue with the children of Afghanistan. I don’t understand why it is that these young boys and girls don’t cry like American children would normally do. They seem to be too young for it to be a cultural influence. It is somewhat disturbing. This Orgune boy had a large cut to his left ankle, reportedly from a dog bite. It took him 5 days to make it to the hospital, who then sent him to us. I did not see any clear evidence consistent with a dog bite. There was a 4cm long laceration across his ankle. There is no way of telling what actually happened. We simply provided the best medical care that we could and hoped that they would return if there were any problems.

Medic from the 541st removes bandage from Orgune boy's ankle - Paktika Province, Afghanistan 2010.

There are many injuries these children are at risk for and it shows given that the average life expectancy for an Afghan is only 46 years. In the two weeks I spent at FOB Orgune-E, in addition to the above patients, we saw 2 children with femur fractures from reported falls, a child with a hand fracture, a baby with soft tissue infection and 2 children with burns. Burns are especially prominent in this population. The Afghans have bread ovens that are dug into the ground, and it is not uncommon for a child to fall into these pits.

Soviet PFM-1 antipersonnel mine.

Unfortunately, the children are also subject to injuries of war. There are still incidents of children being injured or killed due to mines. The Soviets had indiscriminately littered the Afghan countryside with a myriad of different mines. One of the most common is the PFM-1. This mine doesn’t even look like a weapon. It is small and meant to be picked up and played with. You can fold one of its wings, clicking it back and forth, all the while not realizing that you’re simply playing Russian roulette. Children are especially vulnerable to these mines and the FST at FOB Orgun-E has seen the impact they wreak on the children.

SSG Neumann, 909th FST comforts a young girl from local village, Logar Province, Afghanistan 2010.

It’s also easy to just be in the wrong place at the wrong time. The Taliban have no rules of engagement (ROE) and they certainly have no regard for life, no matter how young, innocent or precious. The young girl above (approximately 8 years old) and the young boy below (approximately 6 years old) were playing near coalition soldiers that were dismounted in a local village just outside FOB Shank, Logar Province. Someone in the village tossed a grenade over the mud wall sending grenade fragments into these young children. (note: no-one knows their age in rural Afghanistan – they guesstimate based on the crop cycles)

Young boy from local village, Logar Province, Afghanistan 2010.

Despite having been injured by a grenade, neither of these two children cried. The girl had a large grenade fragment embedded into her ankle. The boy had a fragment penetrate his abdomen, causing life-threatening injuries.

LTC Mike Bruce (L) and MAJ Joe Sucher (R) during operation on Afghan boy FOB Shank, Logar Province, Afghanistan 2010.

Both children required multiple operations due to their injuries. Dr. Bruce and I explored the abdomen of the young boy, repairing the damage done. Dr. Baier operated on the young girl, removing the grenade fragment and cleaning the fractured bone and soft tissues.

LTC James, LTC Hoeppner, SGT Anderson (background) and MAJ Aitchison provide postoperative ICU care for young boy - FOB Shank, Logar Province, Afghanistan 2010.

The children are recovering well as I type this post. The young boy will require at least 7-12 days of hospital care. He will recover fully and be playing in a matter of weeks. The young girl’s recovery will be longer, as the grenade fragments injured the bones of her ankle. She will be able to walk well, but will have permanent difficulty with running.

Afghan child recovering from grenade blast with older brother at her bedside FOB Shank, Logar Province, Afghanistan 2010.

The 909th FST, along with the “Charlie Med” team of the 173rd will hold on to these children until they have completely recovered. There is nowhere else for them to go and get this level of medical care. They are the now the Prince and Princess of Logar.

Princess Salerno - 2003Photo Courtesy of SFC Dan Biesiadecki.

Princess Salerno recovered from her broken leg and became a favorite memory of the 909th after their return home in 2003. There is no way of knowing what has become of her over the ensuing 7 years. The team would rather just simply think of her just as she remains in these photos. A beautiful, innocent, princess child.

This is the Afghanistan that we should focus upon. The children are growing up under generations of war. It is no wonder why it is so easy for them to be turned into radical Islamists. They are indoctrinated via the madrassas that had exploded in numbers during the 1980s through 1990s. This country has been manipulated into this radical culture from outside influences. In my humble opinion, if we are to win the battle against radical Islam and terrorism, then we will need to invest in multiple generations. This is a marathon, not a sprint. Anything less than this full, long-term effort will only result in what we have now. History will repeat itself.