Rem 2, the sonnet (part 1)

"Rossek Joweh Boweh Joweh" they say

The ritual plays out the same each day

Yellow suits shuffle here and there, then sit

As guards and detainees act out the script.

The docs roll in to start their day anew

As wounds are dressed by the daily crew.

Our nurses look for something to inspire

And medics give out Duwa at the wire.

Though difficult we try not to neglect,

Giving care with dignity & respect.

We strive to win over their hearts & minds

While evaluating balls and behinds.

Supporting each other we made it through

We band of brothers stationed at Rem II.

Iraq update #6: early July 2009

Another month is coming to an end, and we are definitely on the downward slope of this deployment. My education continues, but I’m looking forward to the end.

One of the highlights of June was attending one show of “Operation Iraqi Stephen”, being in the audience for the Stephen Colbert Show. He had a question & answer before the show for an opportunity to ask the “real” him questions before he assumed his alter ego. There were no insights, as all the questions were either funny or lame. It was a lot of fun, and he handed out WristStrong bracelets to everyone (well, his people did anyway) as well as a special Colbert Coin (heads we win, tails we win). While a few of the medics thought that Colbert’s trip was just grandstanding, he’s obviously not really running for anything; he said he just wanted to put a spotlight on the soldiers, who he thinks have been somewhat forgotten, Well, I wouldn’t know about that- I’ve not been forgotten. I’ve attached a couple of photos from our Colbert trip.

Snuffer, Sharkey and Edison walking to Al Faw palace to see Colbert

Edison, me , Sharkey waiting for the show (note WristStrong bracelet on Edison)

Me waiting for Colbert
Colbert during the Q&A session

A couple of days ago I went to my first Family Visitation. The detainees visitation program occurs 4 times per day, 6 days per week. Each detainee can have no more than one visit once per week. There are 15 slots per time, 4 times per day, so that’s 360 per week. And we have 3800 detainees right now. You can do the math. Anyway, the detainees and their families are bussed in to the visitation areas from opposite directions, briefed about what is going to happen. The detainees and families line up facing each other in a pleasant shaded area, about 15 feet apart from each other, the detainee behind a red line and the families behind blue. When visitation starts the families can walk across their blue line; the kids <16 yrs can cross the red line and get hugs, get picked up etc. The other visitors can hug, kiss embrace, but feet must remain on the respective side of the red line. A U.S. soldier watches over each detainee as they hug and kiss to make sure nothing gets passed back and forth. The army unit responsible for visitation will bring each family together for a photo, allowing the detainees to wear the white Iraqi man-dress instead of their detention yellow outfit, and copies of the photo are given to both the detainee and family. After 10 minutes, they are separated and they go inside to the phones. The phone stations look like your standard jail/prison phone things, separated by plexiglass. Each booth has semi-privacy. During that time while the detainees are talking to their visitors, the kids have to be amused, so I got to kick a soccer ball with some little boys age 4-12 or so, and then color with crayons with some little girls age 4, 7, 9, 11. One little girl was chattering away in Arabic to me while we were coloring. It was the first time I had even seen a child since I’ve been here- pretty amazing and uplifting, I can tell you. It was a fun thing to do, and I’m sure this program helps somewhat with the hearts & minds mission of detainee care.

Today is June 30, and the last day that the US military will have a presence in Iraqi cities. We are lucky to be about 10 miles west of Baghdad, so all the new activity that is bound to occur is less likely to affect us. We shall see what comes of it. I understand that some Baghdad residents were dancing in the streets, while I’m sure others were barricading themselves in against possible violence.

When I worked IHA last week, there were 2 new captures that I did the intake physicals- one a 62 y/o man with scarred lungs, and a 20-something man, 120 lbs, with scars on his back that reminded me of Mel Gibson’s “Passion of the Christ”. Horrible scars. He said it was from when Al Qaeda captured him 2 years ago. I wondered, what did he do that we captured him? How could it be that this man who had been tortured so horribly by Al Qaeda was our enemy too? Actually, with how complex things are here in the Middle East, it’s easy to be everyone’s enemy. Today when I did IHA, they were all transfers from the Bucca TIF, including one convicted death-row prisoner. MSG Matz was there helping guard that guy when I did the exam. The prisoner was fine, respectful, as was I, just a pretty weird situation. There is a difference, somehow, between working with detainees (captured but not convicted), and convicted killers. I realized that I have come to appreciate the blessed ambiguity of not knowing which of my patients are really bad guys and which were just in the wrong place/wrong time.

It’s July 3 now, and we had a riot at the TIF last night. 2 of the Shia zones rioted, threw rocks & water bottles, burned mattresses, etc. The Wisconsin Guard is a little more forceful, and has better aim, than the New Jersey guard did. One detainee with a facial fracture, two needed stitches, and one US soldier needed stitches. The guards only use non-lethal means during a riot, but these methods are very good at dispersing crowds.

I’m attaching the July 1st photos of my walls. I count 135 postcards, including 23 from Shelly’s 3rd grade class in Milwaukee, and 23 from the 3rd grade class from Morgantown. The pressed flowers in the window are from Nicole Guppy’s English Garden in Dorset England. I will not be taking a photo on August 1st, as I’ll be out of my trailer by then. But thanks to all who’ve brightened my walls and my spirits.

Happy Independence Day! Somebody please have a beer and burger for me.

Pressed flowers from an English garden, on an Iraqi window

July 1 wall

... plus more post cards on wall and door ...
... and more decorations & postcards.

Iraq update #5- June 2009

Four months ago today Janet dropped me off at Reagan Nat'l. Four months- that means time is passing. Okay, it's not "just" passing- time here has been a joy, a drag, hilarious, maddening, an education, reflective, boring, sad, thought-provoking, and probably a few more things. It's not time yet to look back, so I'll just catch everyone up with what's going on.

This week and next week the last of the 90-day doctors go back home (2 to WV, 1 to CA, 1 to FL), & the Romanian doctors and nurses leave, so we will continue our mission while VERY short staffed. And our commander aka "the good idea fairy" is thinking up other missions to add. But hey, I've worked harder, and when you're working with people you enjoy, it's all good. Like in the "Golden Age of PGP" at WVU in the mid-90s. These past 2 weeks I didn't have day off, so my mood was getting dark and surly. Sometimes I think of Viktor Frankl and his concentration camp memoir "Man's Search for Meaning", and the darkness lifts, and I put my rosy glasses back on.

The Wisconsin Guard has arrived, and I'm getting my old accent back. Many of the guys that are in my work area are from the Kenosha and Stevens Point units. I've met one guy from Oshkosh- Steve Fritz, West High class of '74, but he works in Lomira. Never heard of the Weisses. He's a machinist in a shop back home, but is the Sergeant Major of the entire FOB here. I hear there's an Oshkosh cop here, but I haven't met him yet.

Predictably, the detainees have been acting up, testing the new guard. There have been "riots" in 2 of the compounds in the last 10 days. In the first one there was 1 detainee injured and 1 had chest pain, the other riot had no injuries. So happily, "riot" here is not what usually comes to mind. There was one really funny story from the first riot about one of the Guard officers acting like an idiot, accusing the medics of cowardice "is there no medic that wears the flag of the USA on his shoulder? Do we have no combat medics that are man enough to do his job?” As if this were the Battle of the Bulge or something. One of our docs (a rugby-playin’, West Virginia mountain man) jumped in his face told him they WERE doing their job, there were no injuries yet- it looked like a fistfight was going to start between the 2 officers, etc. Reminded me of the bad officer on "Band of Brothers". The Guard officer (not from Wisconsin) got a General Officer letter of reprimand, and our doctor became a folk hero.

I heard a briefing a couple of weeks ago about the calming influence of medical clinics within the TIFs. In the aftermath of Abu Ghuraib, there were frequents riots in the prisons at Bucca and here at Cropper, with injuries, etc. When the medical clinics were moved within the TIF walls, it was almost insta-calming. The catch-phrases used every day here are "hearts & minds", and "dignity & respect". It's a little difficult at times to live out these phrases, but I'd say we achieve it 95% of the time. While many of the detainees are respectful and grateful, a small percentage of them are surly, hateful and difficult. It's hard to practice H&M, D&R when faced with the latter. The first month or 2 that I was here I witnessed what I believed was "compassion fatigue" among the medics. A mantra that my predecessor Eddie Atwood repeated to the medics was "do the right thing for the right reason". A lot of them have to grit their teeth when they say it, but they try to live it.

On Tuesday, I and a few other docs and nurses are going to be at the "Colbert Report"! The one we will attend will be broadcast either Weds or Thurs, probably Weds. So Natalie and Mary, remember to wear your WristStrong bracelets those days! A week from today there is a powderpuff (women’s) football game- flag football- between the officers and enlisted. I am one of the 3 coaches for the officers. I am mostly helping out- Murph, one of our ICU nurses, played defense at Alabama, and Jim, our optometrist is the offensive guru. I just give tips on technique and get beat up by women. Hey, with a wife and 5 daughters I'm used to it. I'll let you know how the game turns out. I've been accused of coaching just so I won't have to be a cheerleader, but that's not true.

As you can see from the pictures, my wall is bursting with color from all the postcards and cards you all have sent. I received postcard #92 this week. I have received postcards from Ireland, England, Italy, Philippines, 20 states, and 23 from Mr. Steel's 3rd grade class at North Elementary in Morgantown. So thank you thank you thank you.

Postcards now extending out to another wall!

As I mentioned above, today is my first day off in 2 weeks, so I'm enjoying chilling in my trailer, writing to you all, gonna go to Mass, then have a steak BBQ with near-beer in honor of the departing WV docs. Good times.

The pictures were taken outside our TIF-clinic. One photo is of the providers (Doctors, PAs) and the other is the whole DMC staff. We are giving our "gang sign" for the 1-1-5. There’s a photo of the luau for Asian-Pacific heritage month.

The Wire Providers for that week- Tom Burklow, Jess Edison, Kendall Clark, Jerry Starr, Rob Snuffer, Cindy Lauer (making a guest appearance from surgery), Marty Weisse, Christine Sharkey

SGT Collins and SSG Baer preparing the luau pig
The DMC cast of characters- medics, nurses, doctors, ICOs (Iraqi Correctional Officers), translators. You can see why we say we're "at the wire" - barbed & concertina.

Iraq update #4- May 2009

May is here, and surprisingly it is still very pleasant. No 100 degree temps yet, even though some were predicted. The Wisconsin National Guard arrived on post 2 days ago, but I have not met any of them yet, I guess they are all in-processing, so maybe I'll see some tomorrow. A New Jersey Sergeant Major remarked that "Wisconsin is my new favorite state." He gets to go home in 2 weeks.

Just so you all know, there was a news report of 5 soldiers killed here on Liberty/Victory base. I am fine, as are all the people here that I work with.

Last week the International Committee of the Red Cross (ICRC) was here inspecting the prison. I went to the command briefing, it was very interesting. They had gone through the medical part when they were here in January, so they did not visit our clinic this time. I heard we got reviews again.

One of the detainees is on a hunger strike, hadn't eaten or drank anything for 3 days (the definition is refusing 9 consecutive meals). I got to do the evaluation, explain the consequences of his actions, and I even talked him into getting IV fluids, so that made me happy. He's crazy, thinks the bottled water is contaminated and therefore refuses to eat or drink. And he wants to be released. And have his tonsils out. He's in the SHU.

SO let me tell you about another group of people I encounter every day in the DMC, the interpreters. The interpreters here at the DMC and hospital are mostly local nationals with contracts with the US government. They get paid well by Iraqi standards; I heard it’s about $1000 per month. Still and all, they are performing heroic work. Well, some of them are. Some of them may be gathering intelligence to pass on to others, or may be passing info to some of the detainees. Who knows?
Interpreter/ linguist/ speaker- these are the most common terms for them, and I’m not sure which one is most accurate. While we certainly could not do our job without them, there are several problems with working with our linguists in our situation.
1) Most doctors don’t know how to use interpreters. Luckily, I was trained by Teresa McG to speak to the patient, keeping eye contact, pausing to allow the interpreter to interpret. Most of the docs here address the speaker “ tell him that …”. “Ask him to …” I have noticed that the surgeons that address the patients directly with benefits, risks, etc have a higher consent rate than those that use the “Explain to them…” method.
2) The linguists don’t speak English well enough to be helpful. This is especially true with medical English, and most of our linguists have ZERO medical knowledge, which makes it tough to be a medical interpreter. But some just don’t even have a firm enough grasp of English to be helpful..
3) Different dialects, words, usage, accents. Most of the detainees are from greater Baghdad, but some of our linguists are from the Kurdish North, Jordan, Mosul, etc. And there are enough detainees from Syria, Lebanon, etc. that the Baghdad linguists have a tough time occasionally. It would be like someone from Arkansas interpreting for
someone from rural Scotland.
4) The linguists have their favorite doctors, who trained them to approach patients a certain way, which doesn’t work well with other doctors.
5) It may be an Arabic thing, but the concept of time is lost on patient and interpreter. For example, for a sore throat, “How long has it been a problem?” “Two years.” “No, your sore throat now, how long has it been bothering you? 2 days, 1 week, 10 days?” “Before 1 week.” “What does this mean, ‘before 1 week’?” “Before 1 week!” says the
interpreter. Oh just forget it. Drive on.
If the interpreters work for 1 year, they are eligible for a work visa in the US. This is obviously a big deal, a way out for them. Sara, from the Kurdish North, has had several family members killed by the Hussein government, and others have died since the war. She is 21 or so, has very good English, is a good interpreter. She is tough, brooks no BS from the detainees and tries to teach us docs a word or phrase of Arabic everyday we work with her. Most of the linguists wear large dark sunglasses, some wear bandanas over their face, they all have made-up names- Sara, Brian, Don, Michael, G9. There are some detainees that resent them for working for the Americans, and as more and more detainees are released, the linguists’ families, or their own lives, may be at stake. While most interpreters are young, Katari is a retired schoolteacher. He was an English teacher, and it is obvious he has very little medical knowledge, but he enjoys learning, but
unfortunately is shy (or something) about teaching us Arabic.

The interpreters that work in other venues- interrogation centers, for the commanders who meet with Iraqi leaders, etc.- these are American citizens. My favorite we’ll call “Nash”. Born in Baghdad about 60 years ago, he has been an American citizen for 35 years. What a difference, working with someone that is truly fluent in both languages! He understands idioms, context, the concept of time in both cultures, etc. He works as a contractor, is paid $100k per year, gets to go back home for two weeks of leave 3 times per year. If only all were like Nash.

Well that's all for this time. Just a picture or 2 this time.

More than half-way done! Woo-Hoo!!

My wall on May 1st
Me and Christine Sharkey, on a day-off together. A few of us wear the black Cropper T-shirt as a teflon-shield against bad vibes, to put us in a good mood. I guess I needed it that day.
Me and Christine Sharkey on a picnic at FOB Sather (this pic at Victory)
Me & SPC Zahn of Watertown WI. The Wisconsin state flag, with the Brewers' flag below.

The Watertown unit runs the Quick Reaction Force. State and UW flags fly over Camp Cropper, Iraq.

Iraq update #3- April 2009

11 April 2009

Thanks to all that have sent cards, letters and packages. Rest assured that I received them whether the address said the 155th, Camp Crocker, or whatever. I think I hit a few wrong key strokes from time-to-time when I sent my emails, so the address was written wrong. Think of where I work as the "Eleventy-fifth", and that will be a good reminder.

COL Martin Weisse
TF 115 MED
Camp Cropper
APO AE 09342

It's Holy Week, the weather's warming up, and there is a changing of the guard, sort of, going on. The last group of replacement doctors and nurses just arrived, and so a whole bunch of people that I've worked with for the last 6 weeks or so are leaving this week. God bless'em!
For the bulk of the 115th group that has been here the whole long time since last May, this marks a watershed. They won't have to see anyone else leave before they do.

******************************
17 April 2009

I’d like to say to say it’s the end of another week here at the “Eleventy-nickel”, but that’s too confusing, because weeks don’t begin or end here. Every day’s about the same, except I go to church on Sunday afternoon, or 8 a.m. East-coast time.

There was a rainbow today here in Iraq. I was inside the DMC, and heard a rat-a-tat-tat on the roof, looked out the door window and saw sunlight. I went out to investigate and it was rain. Looked up and saw a rainbow. Not a brilliant, Hawaii-type rainbow, but by God it was a rainbow. Now THAT will make you smile, I don’t care where y’are.

I have a new job here- when the last group of doctors came, and the people they replaced left, I became the medical director of “Wire Medicine”, which is all the medical care that goes on in the TIF. As you can imagine, it is an extremely glamorous job, pretty much what I have trained for my whole life. Not bad for a country pediatrician. Actually, I have a bunch of paperwork to do everyday, but the good part is that I have a much better idea of all that goes on inside the TIF. I got a tour of one of the compounds, and went inside one of the large, concrete structures where the detainees sleep- all their mats are on the ground, in three rows. Each detainee gets a thin mattress, 1 blanket, a prayer rug, a Koran, a hygiene kit (towel, tooth brush, etc), 1 change of clothes (yellow pants and shirt, white underwear) and that’s pretty much it. A small soccer field, volleyball, ping pong tables. Sounds like a picnic at the Weisse Farm, at least that last part. I’ll write more about the DMC and the TIF later.

The other benefit of my new position, is that I get to go to the weekly Chiefs' meeting. Thats when the chief of each compound meets with LTC Graul, the TIF commander and they can exchange info, requests, etc. Then Medical gets their turn, then Legal. It's all very interesting. I thought it was going to be boisterous today, because earlier in the week there was a disturbance at the "Pledge ceremony". Basically, before the detainees get released, they must pledge before an Iraqi judge to work together for the good of Iraq, etc. Well, the judge was late, and a fight broke out between the Takfiri and a Shia. The Takfiri all remind me of Simon Zealots. They don't like anybody. So much for the pledge. No one got released that day. Ever wonder what will happen after we leave?

I had a nice Easter- there was an ecumenical sunrise service, I went for a run outdoors (my first non-treadmill run since I’ve been here), then mass at 3 p.m. and a nice dinner. They even had Easter decorations, chocolate bunnies, and jelly beans. (See pictures) Janet had sent some Peeps, so I even had those! And I want to thank everyone who continue to shower me with their thoughts and prayers, postcards and packages. The pictures you see are my wall on March 1st, and then on April 1st. I have received more than a dozen postcards and pictures since then, so you’ll see what my wall looks like when I take a picture on May 1st.

I think of you all, and your thoughts keep me going strong. If I don’t write back, it’s not because I’m not thinking of you or don’t care, of that you can be sure.

The view from the end of my street/alley.

My room on March 1, 2009

Already more color on the wall- April 1, 2009

The Ba'ath Party HQ building- the first thing we bombed in 2003.

Directional sign on Camp Cropper.
My favorite street sign on Camp Striker.
Easter basket in Iraq- peeps, chocolate bunny and jelly beans.

Iraq update #2- March 2009

Flowering tree at a mosque on Camp Victory

As Salaam Alaakum!

Rachel, did I get that right? It seems there are numerous ways to spell it, and a few ways to pronounce it.

I had Sunday morning off this week, so another one of the docs and I hopped a bus and went to another FOB, where Saddam had built a number of palaces for the Baath Party (we stayed inside the wires of US protection, of course). And Kringle will be proud to know that we went fishin'!! Of course, as usual, the other guy caught some fish and I didn't. But as they say, the worst day fishin' is better than the best day workin'. I've attached some pictures.

I've been writing this for a couple of days, and finished this morning so I can send it.

Sunday, March 22, 2009

The weather is still nice here between the Tigris and Euphrates, 50 degrees when I got up at 0450, and the high is supposed to be 75. I had thought it would have been warmer by now, but who can complain about this?

I worked in the IHA yesterday, so I thought I would explain about that. The Internee Holding Area is the transition point for new captures, detainees going from one place to another, and for release of detainees back to their “normal” life (if such a thing really
exists here). After someone is captured by the Iraqis or us (raids on suspected cells, aftermath of an IED, etc), they can be released immediately, kept for questioning, turned over to the Iraqi police if there is a warrant out for them- but a disposition must be made by 21 days after capture. By the 21st day they have either been released, turned over to the Iraqi justice system (whatever that means, I’m not sure) or they come to the IHA.
At the IHA, they get processed, their personal effects are catalogued and stored, they can let their families know where they are if that hasn’t happened yet, they get fingerprinted, retina scans, their yellow detainee clothes, and get assigned a number, their “rockma”.
(As in, “What is your Rockma?”) When they get a number/rockma, that is when they become a detainee, and become our responsibility.
That’s where the medical evaluation comes in. All the newcomers get a CXR to look for TB; we take their medical history (diabetes, high blood pressure, heart disease, epilepsy, previous surgery, etc); an exam to look for tattoos, birthmarks and bruises, and anything else a medical exam would turn up (from amputations and heart murmurs to poor
dentition and hernias). We offer tetanus shots (TdaP), flu shots (in season) and pneumonia shots for the elderly.
The outgoing evaluations are more fun for everyone. Each detainee can choose a new set of clothes to wear home. The goodbye evaluation consists of 3 questions- something like this: (1)Since the time of your capture, is your health better, the same or worse? (2) If you
take medicines, do you have a 7 day supply with you? (and if not we give them their meds), and (3) Do you have any more health problems that you want us to evaluate before your release? Then they sign the form, and a doctor signs the form. That day, the will get on the “Happy Bus” (yes, that is really what everyone calls it). The Happy
Bus takes them to various locations, where they will be picked up by the unit that originally captured them, and that unit will drop them off in the neighborhood/ town/ location where they were originally captured. Some detainees do NOT want to be taken to that spot, as the people in that area may not like them for what they did (participated
in an IED explosion that killed local people, etc). Some detainees are taken onto the Happy Bus kicking and fighting, but, as the M.P.s say, “they WILL be on the Happy Bus”.
As part of the new treaty signed January 1st, all detainees will be out US TIFs by the end of the next year- they must be charged or released. Of the 2000-3000 or so released in the last couple of months, only 100-200 have been charged and transferred to Iraqi prisons. For those detainees, the Happy Bus isn’t so happy. I understand that the most dangerous ones in our TIFs will not be released until as late as possible, so that as strong a case can be made for their continued internment in an Iraqi facility.

That’s all for now, I want to get this sent off. Thanks for the thoughts, prayers, cards, emails and packages!

Jason Roth walking to the fishing spot behind the mosque.

Me fishing at the mosque, Camp Victory.


Jason caught one- we call them bass because the way their mouths look.

Camp Cropper, Iraq- Feb-March 2009

10 March 2009
There was a big windstorm, or asifa turabia, yesterday and then it rained hard last night, making our FOB a big gravel-and-mud ball. It cooled from 91 yesterday to 57 right now, so that's good.

I've been working in Iraq for about 2 weeks now, and have enough perspective to write a few things. A friend suggested I start a blog, but I'm not disciplined enough for that! One thing that you'll notice as I write, is that the Army has a language all its own- not just all the abbreviations, but the names, and little catch-phrases that I'll sprinkle in from time to time.

I arrived at BIAP (formerly Saddam Hussein Int'l Airport) early in the morning of 19 Feb 2009, did some quick in-processing by 0400 and slept for 6 or 7 hours. Welcome to Iraq.

The Place. Because of OpSec (operational security), I can't tell you exactly where I am, but I am in Baghdad, more or less. Because I work at the TIF (Theater Internment Facility, = prison), everyone is EXTRA paranoid of letting people know the exact location. So those of you with Google Earth, sorry. As you can tell from my address,

COL Martin Weisse
TF 115 MED
Camp Cropper
APO AE 09342

I am at a FOB (forward operating base) called Camp Cropper. It is a fairly small place; I can walk from one end to another in about 10 minutes. It only includes the TIF, the Military Police HQs, an Iraqi Special Forces training post, a small chapel, our small hospital, housing for most of the people who work here, the DFAC (mess hall), a gym (the most popular place on the FOB), a semi trailer that is our shoppette, a "Green Bean Coffee" kiosk, and the local MWR (Morale, Welfare, Recreation) building, where I watched the WVU-Louisville game this morning at 0500, and where I make phone calls. Most of the buildings are temporary, or trailers, like the one where I will live for 6 months.

The Work. I work almost exclusively inside the walls and wires of the TIF. So I am practicing 'Wire Medicine". I work in 3 locations within the TIF- the DMC, IHA, and the SHU.

I'll talk about the Detainee Medical Clinic (DMC) first. Mornings start at 0730 with various clinics- wound clinic, TB clinic, type 1 Diabetes clinic, type 2 Diabetes clinic, Hypertension clinic, coumadin clinic. While we are doing this, the medics go out to the "wire" (which in this context means to the compounds where the detainees are) twice a day, and any of the detainees can come up to them with any medical complaint. The medics do what they can with OTC meds, then come and check out any questions with one of us doctors, arrange for a sick call appt, etc.

At 12:30, Sick Call starts, and the 2-4 providers will see anywhere from 20 to 40 patients (the high has been 33 since I've been here). It is extra challenging because of
(1) the difficulties with obtaining a medical history through a translator who isn't necessarily medical;
(2) patients who many times want attention more than have a medical problem so the medical history doesn't make sense (since I think they're making it up);
(3) an imprecise idea of time (in answer to "how long has this been going on?" the story changes every moment);
(4) the unfamiliarity that a pediatrician has with adult male problems that are mostly focused above the knees and below the waist; and
(5) other issues that I'm sure I'm skipping.

After sick call, we talk to the medics about the detainee-visits they have made in the afternoon, and any insulin questions that came up on Finger-stick and insulin rounds they make in the compounds. There also may be urgent visits to the DMC, usually chest pain, which we'll take care of until about 7 pm when it reverts to the ER. From 5-7 p.m. nightly we do physicals on detainees, screening them for communicable diseases (TB, scabies, etc). Every patient visit- by the medics or by us- has to be documented in the military's electronic medical record, which in Iraq cannot be read by anyone anywhere else, is unbelievably slow due to all the security on the computers, and is archaic in its "usefulness". It can take literally twice as long to document a visit as it does to see the patient.

In the mornings, one of the docs will make a visit to the SHU, or Segregated Housing Unit. These are solitary cells approximately 8x8 ft, that detainees are put in for medical isolation (24 hours while their scabies get treated, or 3 days to rule out TB), or more commonly, for violating rules out in the compound (fighting, throwing body waste at guards or medics, etc). I was the SHU doc yesterday- before I go, a medic & translator stop at every cell and ask if there are medical problems. I (and a translator) will only stop at the cells where there are issues, and otherwise will co-sign the medics note.
There had been a "rumble" in one of the compounds the night before so about half of the 70 SHU rooms were occupied.

That's enough for now. For those that didn't receive it already, here is an internet article I found about where I work. The commentary is from a certain perspective, but the information seems accurate to me.