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28 February 2002 Military Doctors Attend to Detainee Maladies at Camp X-ray, February 28, 2002 (Surgeons flown to Guantanamo perform sensitive medical operations) By Stephen Kaufman Guantanamo Naval Base, Cuba -- The initial medical evaluation upon arrival at Camp X-ray revealed that two of the detainees from Afghanistan had brought with them a disease no longer common to most Americans: tuberculosis (TB). But the two needed far more extensive medical care than treatment for TB. One had an abscess pressing upon his spinal cord that was causing him to lose the function of his lower back and legs. The other had a serious lung infection, and suffered from malaria, pneumonia, frostbite, and battle injuries sustained while fighting in Afghanistan. Tuberculosis, a highly contagious disease that targets the lungs, kills approximately 2 million people around the world every year. However, according to one health specialist at Guantanamo, in a place like Kandahar, Afghanistan, diseases such as TB are endemic. "The TB complicates things," said Commander Doug Wallace, a thoracic surgeon who operated on the detainee with the lung infection on February 23. "All the people who were working with him -- the guards who are guarding him, and everybody in the operating room -- have to wear TB masks, and they all have to be fitted for the masks so that he is not a risk to any of the health care workers or the guards." Commander Wallace was flown to Cuba from Bethesda, Maryland on February 22 to perform the lung surgery. "Whenever we have detainees who require a service that we do not possess on the island, we bring that service to the island to take care of the individuals who require it," explained Captain Alford, the commanding officer for Fleet Hospital 20 on the naval base. "We've told the world that we're going to take care of these people, and we are," he said. Alford said the policy of bringing in specialists was far less dangerous to an ill detainee than trying to medevac him to the United States. It is also "easier to transport a healthy doctor rapidly to a place like this than it is to transport a sick individual, regardless of their status someplace else," said Alford. Lieutenant Commander Edison McDaniel, a neurosurgeon from Portsmouth Naval Medical Center in Virginia, was brought in to operate on the detainee with the abscess in the spine. He met with the detainee prior to the surgery to discuss the procedure, and recounted that his patient was initially apprehensive about the operation. McDaniel said that through a translator, he was able to reassure the detainee of its necessity. "I made it very clear to him that this was an operation to help him and that without surgery he was going to be paralyzed at the very least and possibly dead before long. He seemed to understand that," said McDaniel. The three hour operation eased the pain caused by the abscess and allowed the patient to improve movement of his lower body, McDaniel said. "He feels much better overall and seems to be doing well," said McDaniel. McDaniel met with the detainee afterwards and recalled that, in broken English, his patient expressed his relief and appreciation. "He was quite happy that things went well, and expressed his gratitude probably as anybody else would," said McDaniel. The two detainees with TB are housed in an acute care unit within the main base hospital, recovering from their surgeries. "Both detainees are up and eating this morning, which is a very good sign in our book," reported Captain Alford on February 24. Other detainees with pre-existing injuries requiring medical care are kept in Fleet Hospital 20, which was rapidly constructed and supplied with staff and medical equipment during one week in January. Resembling a MASH (mobile army surgical_hospital) unit, the tent complex holds twenty beds, though it could be expanded to treat as many as 500 individuals at one time. The hospital is equipped with a fully functional lab, x-ray machine, pharmacy, anesthesia machines, intensive care unit (ICU) and operating room (OR). As of February 24, the fleet hospital had cared for 17 detainees and performed 27 surgical procedures. Currently, there are 14 detainees recuperating within the canvas medical structure. Alford explained that all 14 came to Camp X-ray needing "orthopedic surgical interventions." Many had gunshot wounds and blast injuries incurred while fighting coalition forces in Afghanistan. Due to the lengthy process of bone healing, Alford expected many of the detainees to remain in the facility for weeks. One detainee was seen in his bed reading the Qur'an, and the facility has a clock that alerts the recovering patients to the five daily prayer times prescribed by Islam. A psychiatrist is in residence, and is treating two detainees at Camp X-ray with medication for mental illnesses. Captain Alford said the most challenging aspect of the psychiatric work is making sure the detainees take their medication. "Normally we give you a bag of pills and say take one of these four times a day, and then we trust you to do that four times a day. In this case, we physically go there [Camp X-ray] four times a day and deliver it," said Alford. After determining the dosages, the times they should be administered, and the name of the patients who require it, the staff must take great care to verify that the each detainee is actually the person in need of the medication. The staff must locate each patient's individual cell among the 320-cell complex. Thus far, the fleet hospital staff have made about 1000 outpatient visits to Camp X-ray. They serve between 20 to 40 patients during the daily sick call, mostly changing bandages on the detainees who are recovering from battle injuries. Upon arrival from Kandahar, each detainee goes through a 45 minute in-processing routine, much of which is devoted to ascertaining the individual's health. The initial medical evaluation includes a chest x-ray to look for internal injuries and to screen for TB. Fingerprints and a digital photograph are taken, clothes and comfort items are issued, and then the detainee is taken to speak to the International Red Cross (ICRC) representatives at the camp. There, they are given the opportunity to fill out a short message to loved ones, which the ICRC will deliver. While in detention, the JTF provides a regular mail service. Also, any personal items the detainee had in his possession when captured are collected, identified and saved. "They are shipped here with the detainees and then we hold those here," said Major Steve Cox of JTF public affairs. Within Camp X-ray, there is a level-one first aid station equipped to handle up to 50 detainees at once and capable of responding to basic lifesaving steps and routine matters at the daily sick call such as changing bandages, treating wounds and dispensing medication. The various efforts being made by the JTF to provide health care to the detainees are closely monitored by the ICRC, which "continues to enjoy full access to Camp X-ray," according to General Lehnert. Chief Bill Austin, the Fleet Hospital's public affairs officer, said the detainees are given full-time medical care. "The lights don't go out and no one goes home," said Austin. "Yes they're detainees, but they're also patients, and they are going to receive the same type of quality care that military folks would receive." This is Part 3 of a 3-part series on the Guantanamo detainees.
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