In many ways, it was like practicing in a Third World refugee camp, where you have no choice but to adapt quickly to countless shortcomings.
As the skids on my Blackhawk gently touched down on the tarmac, Kentucky suddenly felt very far away. The contrast was stark from the verdant, rolling hills of my home state to this desiccated piece of desert in southern Iraq.
Back home, my urban private practice operates at high speed and with brutal efficiency; here, limited resources were the norm. In many ways, it was like practicing in a Third World refugee camp, where you have no choice but to adapt quickly to countless shortcomings.
Another aspect of life on the base also took some getting used to: This was truly an armed camp. Apart from chaplains, all military personnel carried a weapon of some type-even the medics. In this conflict, unfortunately, our opponents do not recognize the Geneva Conventions, and medical personnel, who typically have not carried arms in other conflicts, are a favorite target. But rules on weapon use were strictly enforced, and in my three months there, I never heard a shot fired in anger.
HUMANS TREATING HUMANS
The detainees were a mixed bag physically, culturally, emotionally, and physiologically, and they represented a broad swath of Iraqi society. They were every bit as human as the next lot, our commonality of DNA providing far more similarities than differences.
Physiologically, the men were far more aged than their years would have suggested. Life is hard in this environment, where trauma seems ever-present. Psychological ill effects are equally common, though the average Iraqi seems to deal with these challenges far better than the typical coddled American would.
Each society has its saints and sinners, and the detainees certainly had a blend of both, but treat these men with dignity and respect, and they typically responded in kind. One of my proudest days came when Isaac, the most exacting of my contract interpreters, told me, "The men respect you and pray for your safety." No medal or accolade could mean more to me; it is a campaign ribbon I can't wear, but is the figurative distinction from this deployment that I will treasure most.
SHIITE VS. SUNNI
Rakman is Arabic for "number," and my patients were all numbers here. The rationale of assigning an identification security number is based primarily on the need to maintain anonymity. Shia vs. Sunni strife is still endemic, and not only was it necessary to physically separate the groups, but the absence of formal names helped to avoid reprisals against other tribal or family members within the facility and across Iraq.
It was disconcerting, however, to abandon the simple doctor-patient introductions I've been so accustomed to in my career. It was also suggested that medical providers not use their last names, to help protect our families back home. Paranoia, perhaps, but this is a very different world. I was known only as "Doctor C."
Living conditions were primitive for all concerned, but especially for detainees. Everything they did happened communally, from shared meals to sleeping, from toilets to showers. As a result, low-level communicable diseases associated with overcrowding were rampant: scabies and lower-respiratory infections, as well as environmental diseases including refractory asthma. Fortunately, high-risk communicable diseases, such as tuberculosis and bacterial enteritis, were uncommon. But whatever the disease, they were far more difficult to eradicate than in the U.S., exacerbated as they were by the poor conditions and limited resources. (In fairness to the U.S. Government, conditions in this camp were far better than what would have been available in an Iraqi-run facility.)