What does a deployed Pediatrician do?

[Perrotfish]

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When a general Pediatrician is deployed to Afghanistan as a pediatrician (not used as a GMO) where do they work and what kind of pathology do they see? I'm just curious if there is anything in particular I should be studying. Any experiences to share?

 

[pgg]

Well, the routine care of active duty Army and Marine Corps is about 90% adolescent medicine.


To be a little more serious, since we don't deploy kids, and US and TCN civilian contractors aren't kids, and we all leave our kids at home, every kid that gets seen while deployed is a local national. These fall into two broad groups - "elective" humanitarian work, and trauma.

Speaking only of my recent firsthand experience at a R3, we've done almost no humanitarian work. I'm sure the PRTs are doing lots of it.

Trauma care of civilians has dropped off tremendously over the last year as the medical ROE have changed. There's some regional variation in the ROE. The group prior to ours was swamped with local nationals. Now, we only care for civilians who are injured by ISAF forces. Short version - if we shoot them, run them over, drop something on them, we take care of them. Everyone else goes to the Afghan hospitals where they sink or swim. We don't shoot, squish, or bomb locals very often, despite what CNN says, so we don't see many civilians, and almost never any kids. Consequently, our pediatrician (actually a peds intensivist) doesn't see many. Maybe he's cared for five under the age of 10 in seven months? Perhaps five more under 16 - and most of those were probably Al-Queda-JROTC ... bad guys start young here.

Common themes? Malnutrition. Parasites. Standard 3rd world medicine.


Again though, there's so much variation in the medical missions and medical ROE across Afghanistan. Even just considering the R3s, there's a huge difference in the case load and patient profile comparing Bagram, Kandahar, and Bastion. If you know where you're going, the best thing to do is find out who's there and ask what they're doing.

 

[jabreal00]

When a general Pediatrician is deployed to Afghanistan as a pediatrician (not used as a GMO) where do they work and what kind of pathology do they see? I'm just curious if there is anything in particular I should be studying. Any experiences to share?

Seeing adult active duty service members in clinic. There may be some humanitarian work from Afghan nationals. The same goes for ob/gyn.

 

[J-Rad]

I deployed as a hospital pediatrician in charge of all the peds patients in the ward and ICU at a role III. I was quite a bit busier than PGG's colleague. The combat hospitals are surgical hospitals so most everything was skewed toward surgical-related care. I would also get the occasional outpatient. Some of these were follow ups on previously discharged patients. Others were "friends of friends" who were brought in for some evaluation (sometimes medical, sometimes surgical). As for the inpatients, I took care of (sort of divided by relevant surgical specialty):
NS-
myelomeningoceles
encephaloceles
head trauma (MVA, fall)
Undifferentiated mass invading the spine (turned out to be neuroblastoma)
Hydrocephalus due to AVM

Ortho
lots of broken bones
Hereditary exocytoses

ENT/OMFS
Cleft lip/palate repairs

Uro
ureteroceles and some other GU anomalies

Gen surg
Burns
Splenectomy
Staged repair of bowels in discontinuity (from prior trauma)
imperforate anus

Obviously the above is (mostly) the humanitarian stuff. Then there were the kids who were blowed up or shot, so mulitple surgical services were involved (ortho for fx/amputations, NS, surgery, etc).

I brought one kid to temporize sx of pulmonary hypertension and RV failure to get him home.

I actually saw quite a bit (I'm sure a few more than listed) and was, on occasion, the busiest doc in the ICU. Some of the admissions were prolonged and a lot were overnight stays (esp. ortho)

 

[Perrotfish]

I deployed as a hospital pediatrician in charge of all the peds patients in the ward and ICU at a role III. I was quite a bit busier than PGG's colleague. The combat hospitals are surgical hospitals so most everything was skewed toward surgical-related care. I would also get the occasional outpatient. Some of these were follow ups on previously discharged patients. Others were "friends of friends" who were brought in for some evaluation (sometimes medical, sometimes surgical). As for the inpatients, I took care of (sort of divided by relevant surgical specialty):
NS-
myelomeningoceles
encephaloceles
head trauma (MVA, fall)
Undifferentiated mass invading the spine (turned out to be neuroblastoma)
Hydrocephalus due to AVM

Ortho
lots of broken bones
Hereditary exocytoses

ENT/OMFS
Cleft lip/palate repairs

Uro
ureteroceles and some other GU anomalies

Gen surg
Burns
Splenectomy
Staged repair of bowels in discontinuity (from prior trauma)
imperforate anus

Obviously the above is (mostly) the humanitarian stuff. Then there were the kids who were blowed up or shot, so mulitple surgical services were involved (ortho for fx/amputations, NS, surgery, etc).

I brought one kid to temporize sx of pulmonary hypertension and RV failure to get him home.

I actually saw quite a bit (I'm sure a few more than listed) and was, on occasion, the busiest doc in the ICU. Some of the admissions were prolonged and a lot were overnight stays (esp. ortho)

Any electives you'd recommend to prepare? Do you think attaching to a Peds Ortho team at Children's for a month would have made you feel any more comfortable? Were there enough burns that a month in a burn unit would be worthwhile? Any procedures you recommend I master besides central lines and airway management?

 

[J-Rad]

Any electives you'd recommend to prepare? Do you think attaching to a Peds Ortho team at Children's for a month would have made you feel any more comfortable? Were there enough burns that a month in a burn unit would be worthwhile? Any procedures you recommend I master besides central lines and airway management?

The surgeons were very good at guiding the appopriate care. I provided the pediatric expertise. As for central lines, I think I would focus on femorals as they are fairly easy and safe, but becoming facile with others won't hurt. One of my more interesting cases revolved around preoperative management of severe malnutrition. The military humanitarian course (don't remember the name) and recall from GI were helpful. As for other procedures: get good at IVs, especially in smaller, harder to stick kids. The nutritional status of most of the kids is poor and they are small.

 

[Droopy Snoopy]

Depending on rank there's also the possibility of being sent up in some leadership position with minimal clinical activity, regardless of specialty (i.e. chief of medical staff or group command).

 

[Perrotfish]

Do newly minted pediatricians still deploy? I know the intensivists still go, but is there a role for a generalist?

 

[Gastrapathy]

Lol. Yes they do my young friend. Where's that caveman?

 

[J-Rad]

Do newly minted pediatricians still deploy? I know the intensivists still go, but is there a role for a generalist?

As you can tell, the answer to this question (especially if you add "and in what role" to the question) depends on the respective service of the member.

Army deploys pediatricians and pediatric subspecialists all the time. They're just not deploying them as pediatricians. They go over as brigade surgeons i.e. GMOs. They occasionally go in other specialty related roles as well. For example, when I was there, the theater neurology consultant was a child neurologist.

The AF deploys practicing* pediatricians and pediatric subspecialists as well. They are going as pediatricians, in the role I described above.

Yes, the Navy is deploying peds intensivists. I don't know if they are deploying generalists and other subs; you are probably in a better position to get the gouge on that than I am. Tangentially, if they are only sending intensivists over, I wonder if Navy Medicine is mulling over whether it is wise to continue to do so. To solely task such a small community when there is a relatively paltry number of patients (at least during PGG's experience) and that a generalist/other sub could do the job as well seems a poor idea.

*Added to exclude the flight surgeons, admin types, and commanders who were pediatric trained but not really practicing the specialty.

 

[Homunculus]

Lol. Yes they do my young friend. Where's that caveman?

i sensed a disturbance in the force. . .

As you can tell, the answer to this question (especially if you add "and in what role" to the question) depends on the respective service of the member.

Army deploys pediatricians and pediatric subspecialists all the time. They're just not deploying them as pediatricians. They go over as brigade surgeons i.e. GMOs. They occasionally go in other specialty related roles as well. For example, when I was there, the theater neurology consultant was a child neurologist.

The AF deploys practicing* pediatricians and pediatric subspecialists as well. They are going as pediatricians, in the role I described above.

Yes, the Navy is deploying peds intensivists. I don't know if they are deploying generalists and other subs; you are probably in a better position to get the gouge on that than I am. Tangentially, if they are only sending intensivists over, I wonder if Navy Medicine is mulling over whether it is wise to continue to do so. To solely task such a small community when there is a relatively paltry number of patients (at least during PGG's experience) and that a generalist/other sub could do the job as well seems a poor idea.

*Added to exclude the flight surgeons, admin types, and commanders who were pediatric trained but not really practicing the specialty.

this.

you have to remember that pediatricians are not viewed as such by the line commanders. if a medical asset needs a "pediatrician" you will likely go to a billet requiring peds skills. otherwise, you are viewed a notch above a PA. until you get there and show them we aren't all stickers and jokes and having experience with stressful resuscitations in delivery rooms and PICU's sets us up well for the (from a resuscitation/stabilization perspective) mostly straightforward traumas that may come in. other than FP's, no one else is as suited for a level 1 aid station (as much as it pains me to say). yes, it is overkill and a PA can do most of it, but having a healthy appreciation for scary things is ingrained into pediatricians i think.

deployed-- your actual job, other than the occasional admin briefing, is sick call, sick call, and more sick call. it is adolescent medicine, first and foremost, for most of your population. the old farts you occasionally see will likely know more about their chronic condition than you will, and with the rare exception unlike kids you can try a round or two of different approaches and see what sticks. and if it doesn't, hey, "i'm evacing this guy up to you, i did this/that and think he may have xxx but 'm JUST A PEDIATRICIAN and have done all i can" is a legit excuse. sometimes claiming a little ignorance is ok.

anyway, there is nothing sexy or exciting about GMO work. to be honest, the medicine really is straightforward and can be done mostly with clinical exam skills. i enjoyed more training my medics, helping them along (if interested in medical careers-- you will run across some really smart medics/corpsman-- some kids this is their only way out) and in general being a bigger and more important cog in the system.

experience vary widely from garrison to deployed to flight surgeon to brigade and from service to service. the best general advice is to be flexible and don't get too cowboy, and, as i think the rock used to say. "know your damn role."

honestly though, as much as the line guys get boners for killing people and blowing **** up, OEF is winding down, and in the next 3-5 years it will be all of us oldsters telling ghost stories to the new interns about how we nation builded a country about as well as a 4 year old would build the lego star destroyer.

-- your friendly neighborhood lego my legos caveman

 

[BigNavyPedsGuy]

I really missed the Caveman