Gene-expression profiling of peripheral blood mononuclear cells in sepsis.

To the Editor: Spinella et al (1) recently described the demographics of injured and critically ill children who continue to flock to U.S. Army hospitals in Iraq and Afghanistan. This report mirrors our experience in the 332nd Expeditionary Medical Group Air Force Theater Hospital (AFTH). Since the authors’ deployment in January 2007, the AFTH has received an average of 23 children per month with life-threatening injuries—more than the required number of admissions for level I pediatric trauma centers in the United States. Our care of these patients exceeds typical combat support doctrine, but out of a sense of moral obligation, we continue to admit, resuscitate, and operate on these children. Numerous case examples show that this approach has effectively won the hearts and minds of the Iraqi people in the community around the AFTH and the surrounding regions (Fig. 1). After a blast near her home, a 1-yearold girl was struck in the forehead by an 8-cm iron chunk. Her father brought her to us with this fragment protruding like a horn. Our neurosurgeon removed the jagged block from her frontal lobe, and she returned to her family in good health. Another 2-year-old girl was discharged after recovering from a blast to her right neck. We had to emergently ligate her vertebral artery and repair a large laceration in her trachea. A young man on whom we had operated for abdominal trauma brought his infant niece to our gate with a note from an Iraqi physician: “Baby vomiting. Barium study consistent with pyloric stenosis. Please treat. ” We corrected the child’s profound electrolyte derangements and then performed a routine pyloromyotomy. Another 10-monthold baby exposed to vaporized chlorine was intubated and transported to our hospital, where a bronchoscopy showed profound bronchial edema. After 5 days of bronchodilators and steroids, he extubated and was soon discharged. This list goes on, as both Iraqi families and military medics continue to bring children to our facility. As documented by Spinella et al (1), caring for these children requires a disproportionate investment of time and resources by our combat hospitals, but the Iraqis currently have no viable alternative. According to the Brookings Institute, more than half of Iraqi physicians have fled the country while 2000 have been murdered and another 250 kidnapped (2). A World Health Organization report cites a 70% mortality rate for critically injured patients cared for in the sparsely supplied and minimally staffed Iraqi hospitals (3). As a transitional solution, the relative security of our bases after the recent surge might be used to encourage nongovernmental organizations (NGOs) to return to Iraq. Allowing NGO healthcare workers to offer services for Iraqi civilians within the walls of our bases would require progressive thinking, representing a landmark in cooperation between the military and the NGOs, but it could serve as an important intermediate step as the Iraqi medical system rebuilds. But for now we must not grow weary of our care for these children. The future of this new democracy and our moral integrity as physicians demand nothing less. The views expressed are personal opinions of the authors and do not officially represent the U.S. Air Force.