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Rx: Two Bricks, a Turban

Many Afghan civilians hurt by bombs seek care in Pakistan, where poor hospitals make do with ingenuity and whatever medicine patients can buy themselves.


QUETTA, Pakistan — Once in a while, Sath Mohammed smiles. On this day it happens as the 11-year-old describes his beloved sport, Afghan wrestling.

The thought of it brings a look of delight to his face. He reaches an arm into the air as if to grab an opponent. Then he moves a leg--or what is left of it--and his face goes blank.

For a moment, he had forgotten that he lies in bed No. 9 under a crudely lettered sign that reads "Bomb Blast Victim" and will never wrestle again.

His left foot was blown off in late October when an errant U.S. bomb hit the road where he and his sister were walking in Afghanistan's remote Oruzgan province.

By the time Sath reached Sandeman Civil Hospital here in Quetta, a two-day journey, the Pakistani doctors felt there was no choice but to take off the leg at the knee. Even then, they were not sure how he would fare. He has no money for a prosthesis, and infection was still a concern.

"He needs antibiotics, he needs painkillers, and we don't have them," said Mohammed Ramzan, an orthopedic surgeon. "Maybe his family can buy them in the bazaar."

This is the human face of "collateral damage." It is hard enough for families to deal with the tragedy of war's mistakes. But for Pakistan, whose health system is impoverished, and for Afghanistan, whose legion of destitute citizens Sath will soon rejoin, it is a Sisyphean task.

Conditions at Sandeman, the largest Pakistani government hospital in the area, illustrate the two countries' poverty as well as the perseverance and limits of their medical staffs. Hospitals like this are so poor that patients routinely are asked to buy medicine, bandages and the orthopedic plates, pins and screws needed to set broken bones. Or they go without.

The dismal state of health care suggests that the international community will face a mammoth effort as it tries to move the region into the 21st century.

"The real difficulty is that the Pakistani health system was struggling anyway," said Anna Pont, health project manager here in Baluchistan province for Mercy Corps International, an aid organization. "There's been a lack of resources for years, the hospitals are running at their limits, and there were a lot of Afghan refugees long before Sept 11.

"It's very important to remember that while the people coming across the border need help," Pont said, "the host country system needs a lot of help to deal with the situation."

The civilian victims of the U.S. bombing campaign are few, relative to the number of Afghans sickened by diseases related to hunger and poverty. International organizations that track such unintended casualties have yet to complete their official estimates. But they say the number is likely to be somewhat higher than the 1999 toll from allied airstrikes in Yugoslavia, which human rights groups put at between 500 and 600 people.

In Afghanistan, it appears that the bombing became more accurate, with some exceptions, as the war went on and military planners received better intelligence. Nonetheless, with so many injured in this and previous Afghan wars, vast resources will be needed for patient rehabilitation as well as basic medical care.

To walk into Sandeman Civil Hospital is to enter a medical time warp. There are no CT scans, no MRI machines, no centrifuges, no computers, no electronic equipment. There is no monitoring equipment at the nurses' stations, just dented plastic chairs.

In the orthopedics wing, whose doctors' skills are widely recognized in the region, there are no traction machines. Abdul Wasey, 10, who was injured when a wall collapsed after a bombing in the Afghan city of Kandahar, would be a natural candidate for traction, the application of weights to hold bones in alignment.

The bomb blast dislocated Abdul's hip, causing painful swelling and making it impossible to walk. Such injuries are generally treated with bandaging and traction.

It's a relatively simple matter in the West. Not here. Doctors, after searching for some way to rig weights, settled on two bricks, each a little more than 2 pounds.

But how to attach them to the boy? The doctors used a turban--contributed by a patient with a head injury--to hold one brick. A gauze bandage was rigged to hold the other. Abdul's father bought the gauze at a shop because there was none to spare at Sandeman.

For another patient, the doctors employed a full box of hard toffee. The candy hung forlornly off the end of the bed, tied with a gauze bow like a misplaced present.

Few Doctors, Many Mistakes

On one day last month, Sath and Abdul were among 77 civilians injured by the U.S. bombing who had made their way to Sandeman, according to logbooks kept by the emergency room. A few died soon after arriving. For the vast majority, the treatment they get at the hospital will determine how they spend the rest of their lives.

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