U.S. Air Force photo by/ Master Sgt. Jeromy K. Cross - , MPH ’99 , MPH ’99 O

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Heart-wrenching Role III regularly this unfold the at scenes NATO like Multinational Medical Unit Kandahar. in “The says we see trauma Navy U.S. here devastating,” is Michael Capt. McCarten, MPH DO, who ’99, spent a year “Sometimes unrecognizable.” is the anatomy thecommanding hospital 2010–11. in MPH MD, Benjamin, ’96, witnessed similarly grave (“Chris”) About Christian Air 300 U.S. Force Col. miles away, Jointinjuries Theater year leading during his the Hospital Craig Bagram at Air Field. Equipped with operating rooms, beds,ICU laboratories, and other state-of-the-art services, these centers trauma treat both coalition and forces soldiersAfghan and maimed civilians, children including explosives. by The hospitals boast 98 survival percent and rates, McCarten and Benjamin credit their resourceful and teams several public health strategies—such as reducing the lag time between injury and surgery—with helping save lives the in decade-long Afghanistan. war in e l Batt

i Sav edics roll a badly wounded soldier U.S. the military into Afghanistan. He lost has hospital both Kandahar, legs in to a roadside bomb, and abdomen, his head, and neck The torn are action up. international surgical snaps into team to clean exposed his specialists flesh; the bandagedyoung soldiercheck fewfor days A later, head is to flowntrauma. another military hospital more for then surgery, begins journey his home recover. to tary medicine most training, them of its in one-year MPH program. Their crew cuts stood have may out on the liberal- leaning campus, but the pair say their Harvard education helped has guide their leadership roles combat in hospitals, on military bases, and aboard aircraft carriers. Military medicine, they explain, typically involves caring healthy young for people serving hazardous in environments, as such noisy flight decks or enginehot rooms; it alsoinvolvesto tending families, retirees, and veterans. Benjamin and McCarten belong a cadre who to alumni of attended Harvard School Public of Health as part their of mili Harvard Public Health Review Health Public Harvard

lumni 36 A

Lasting lessons M Christian Benjamin, MD, MPH ’96 and Michael McCarten, MPH and Michael ’96 MD, D Benjamin, Christian are delivering evidence-based military medicine in Afghanistan. in medicine military evidence-based are delivering END

Captions ideas Benjamin: “I couldn’t prevent people from being injured,” says Col. Chris Benjamin. “But it was gratifying to know we gave each [patient] the best chance for survival anywhere on this planet today.”

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Chris Benjamin, MPH ’96, leads trauma centers in Afghanistan that treat both coalition forces and Afghan soldiers and civilians. continued

Fall 2011 37 Kent Dayton/HSPH - - arvard education has helped guide their leadership roles leadership their guide helped has education arvard arten say their H their arten say C c Harvard Public Health Review Health Public Harvard This attitude meshes with the self-analytical approach the of military U.S. medical system. our “We are own worst crit These and other evidence-based strategies hypo prevent from the lines, up temperature the to cranking front ER including from the front lines a from t 38 in combat hospitals, on military bases, and aboard aircraft carriers. carriers. aircraft aboard and bases, military on hospitals, combat in The research value of was one the of biggest takeaways from HSPH. “They teach ask you how questions, to analyze the data, recalls whoBenjamin, commands nowU.S. the and comeAir up withForce School answersin,” of fit that the situationyou’re Aerospace Medicine. Da fghanistan war. lives in the Afghanistan war. lag time between injury and surgery have saved Public health strategies such as reducing at the an Afghan child in an emergency room Michael McCarten, MPH ’99 (left) watches as a medical team resuscitates Role III trauma center in Kandahar. says McCarten,ics,” who was interviewed via Skype. “We understand the sacrifices In these men and womenmade.” have heAfghanistan, and Benjamin drewfrom statistics the Pentagon collected has from conflicts recent to identify best practices and tourniquets, example. for Used stop centuries to for outcomes.improve bleeding Take on the battlefield, these simple devices became controversial because they can the aggravate injury if applied incorrectly. But the timely use tourniquets of proved has essential during the wars Iraq in and where Afghanistan, homemade bombs explosive or “improvised led a (IEDs) devices” have to horrifying number amputations. of thermia, caught the have attention civilian of counterparts. Indeed, Benjamin hosted visits renowned from four civilian trauma surgeons Bagram. year in during his Their crew cuts may have stood out on the liberal-leaning campus, but Benjamin Benjamin campus, but liberal-leaning the on out stood have may cuts crew Their M and Infection control is a crucial public health weapon in military medicine, and hand hygiene is paramount on the Bagram and Kandahar bases. In hospitals, the routine use of antibiotics can quickly foster drug- resistant bacterial infections, a problem exacerbated in Afghanistan because many local patients are malnour- ished and show up with dirty, festering wounds—all factors that hinder healing and lead to longer hospital stays. Bugs such as Pseudomonas and Klebsiella are among the most stubborn and virulent antibiotic-resis- tant pathogens in these military hospitals—just as they are in the U.S.

Life Expectancy: 45 Years Amid rampant poverty, unsafe drinking water, limited access to care, and other challenges, Afghanistan has a dire health profile. The nation’s average life expectancy is 45 years and the maternal mortality rate is one of the Chris Benjamin walks with Afghan President Hamid Karzai highest in the world. during a visit to Bagram Airfield in 2010. Serving in Afghanistan reminded McCarten of courses given by Michael Reich, Taro Takemi Professor of International Health Policy, and Ichiro Kawachi, chair of the Department of Society, Human Development, and Health. These courses underscored the message that socioeconomic conditions shape health outcomes. “Looking at health systems around the world that I’ve observed in my Navy career, it’s clear that the rich get richer and the poor get poorer,” McCarten says. “My time O

pposite and lower right, courtesy of U.S. Navy Capt. Michael McCarten, D McCarten, Michael Capt. Navy U.S. of courtesy right, lower and pposite at Harvard, and those two courses in particular, changed my politics. They were absolutely life-changing for me.”

Supporting the Wounded As they evacuated patched-up soldiers to bigger facilities in Germany and the United States, McCarten and Benjamin knew that recovery would test their patients’ fortitude. But they say military and veterans’ hospitals have made impressive gains in providing for wounded warriors, especially those with the signature injuries from Afghanistan and Iraq: amputations, traumatic brain injury, and psy- chological scars. The two doctors envision a health care system that addresses the service members’ O , MPH ’99; top right, REUTERS right, top ’99; , MPH Michael McCarten with an Afghan girl and her father. The girl lost her physical, emotional, and spiritual needs and lower left arm in a bus accident and suffered other serious injuries. a society that supports them as they strive to McCarten’s team performed several surgeries to ensure her survival. rebuild their lives. As McCarten puts it, “They deserve nothing less.”

Note: At press time, Capt. Michael McCarten was scheduled to return to the Debra Bradley Ruder is a Boston-based Navy’s Bureau of Medicine and Surgery in Washington, DC, to oversee Naval freelance writer specializing in health care, medical operations. education, and end-of-life issues.

Fall 2011 39