At the height of fighting in the Iraq War, before U.S. forces entered Baghdad, Navy Fleet Hospital Three was filled mostly with Iraqis. But only two members of the hospital staff spoke the patients' language.
With field hospitals closer to the front lines in this war than ever before, Iraqi prisoners of war and civilians took up three-quarters of the hospital's 116 beds, says Navy Capt. Charles Reese, M.D., director of surgical services at the hospital.
"It's been a challenge to communicate with them," concedes Reese, speaking from a satellite phone at the hospital after the fighting had subsided. The facility is attached to the First Marine Expeditionary Force and located somewhere in the southern Iraqi desert.
With so few interpreters, Reese says physicians and other caregivers had to rely on the few scraps of English the Iraqis knew. They also had prepared flash cards with phrases in Arabic, such as "Are you having pain?" and "Are you hungry?"
But Reese asserts the limited communications have not affected medical care and provide many lighthearted moments.
"You see a great deal of animation, a lot of gesturing," Reese says. "It's been a lot of fun communicating."
Even Iraqi prisoners of war have been grateful for their care, and one of the few English phrases they know is, "Thank you, doctor," he says.
Reese says the Iraqi patients took some serious wounds in the torso and head, while U.S. soldiers, protected by armored vests and helmets, had more manageable wounds mainly in the extremities.
Many of the Iraqis sustained "big blast injuries, with big chunks of bone missing," Reese says, adding that three-quarters of all patients have been orthopedic cases.
The serious cases are transferred to the next echelon of care aboard the USNS Comfort in the Persian Gulf, he says.
Reese reports that the hospitals are smaller than those used 12 years ago in the first Gulf War, but colleagues who served in that war tell him the military hospitals have been "dramatically busier" this time.
Reese says he is one of 25 career military doctors at the hospital, 11 of whom are surgeons. An otolaryngologist used to performing "bread-and-butter ENT stuff" such as tonsillectomies back at the base, Reese says he has been getting a great deal of surgical experience in Iraq.
Even nonsurgeons help out. Reese says a dentist has been working as a scrub nurse for an orthopedic surgeon. "This sure is a wonderful opportunity to be able to treat the whole spectrum of surgical care," he says.
Interviewed on Easter Sunday, Reese had endured a sandstorm the day before. The storm blew very fine silt into everything, penetrating even the tent's three-layer walls, but an air-conditioning system kept the sand out of the hospital's two operating rooms.
Fleet Hospital Three, based in Pensacola, Fla., put up tents for the expeditionary hospital in three days. It opened on April 1, three weeks after staff left Pensacola.
The ORs are expandable units brought in on a flatbed truck. As the tents went up, Reese says doctors and others on the hospital staff of more than 100 worked long shifts to assemble sterile surgical instruments, calibrate equipment and set up a blood bank refrigerator.
"Mail call is always a big morale booster here," says Capt. Peter O'Connor, the hospital's commanding officer. But he doesn't think there is much homesickness. "We're pretty focused on our mission," he says, adding that the staff left back in Pensacola wish they could have come, too.
Levels of careU.S. military echelons of medical care in the Iraq War:
Echelon 1: Dressing the wounded at "battalion aid stations" staffed by nonphysician medics within each platoon.
Echelon2: Initial stabilization by "surgical companies" using physicians in small, tent-based ORs and ICUs near the front lines.
Echelon 3: Some surgeries and tests at an "expeditionary medical facility," a tent hospital with 116 beds, two ORs and 25 doctors, mostly surgeons.
Echelon 4: Complex surgery aboard the hospital ship USNS Comfort in the Persian Gulf for most Iraqi wounded, or in military hospitals in Europe or the United States for severely wounded U.S. soldiers.
Source: Navy Capt. Charles Reese, M.D.