E-Mails (With Pics Attached) From The Front Line

In

military telemedicine, a digital camera, a laptop and good contacts are vital, as these extracts from Lieut. Colonel David Vassallo's e-mail log show. His first contact with Richard Loukota, consultant maxillofacial surgeon at Leeds General Infirmary, led to the involvement of other doctors who helped Kadriu: Jim Ryan, professor of post-conflict recovery at University College Hospital, London; Brian Leatherbarrow, consultant ophthalmic and oculoplastic surgeon at Manchester Royal Eye Hospital; and Bob Woodwards, consultant maxillofacial surgeon at North Manchester General Hospital. Dan Clay is the physician who first found Kadriu.

20 JULY '99 TO: Richard Loukota
By coincidence I have been approached by two doctors with the International Medical Corps who...would greatly appreciate your opinion and advice as to whether you could get involved in the management of a 21-year-old civilian who was shot on 29 April. The bullet entered the right fronto-temporal region, destroying his right eye and orbital wall, right maxilla, and exited through the nose. He has had no treatment since the injury other than wound dressings... I am attaching various images and X rays.

[27 JULY '99] The patient with the gunshot wound to the right maxilla is Besim Kadriu, age 21. My Commander Medical is pursuing the possibility of getting the Army HQ to fly out this unfortunate man to your care.

27 JULY. '99 TO: Jim Ryan
In the immediate aftermath of war, we came prepared for, and are coping alright with the acute trauma, but we are not so prepared...for the less acute but disabling injuries... We are repeatedly having to work on an ad hoc basis to try and find out how to organize medevacs for civilians, and we use our telemedicine satellite telephone to contact specialists in the U.K.... It is not a matter of just leaving it to the NGOs [nongovernmental organizations] or the government... I have yet to meet one NGO that can show such a chain in action. As an example, I am attaching a photo... On seeing it you will understand my wish to help him, and his desire to seek help. [Mr. Loukota] has been galvanized by these images and the accompanying clinical details into offering to help this patient.

30 JULY '99 TO: Richard Loukota
I reviewed Besim Kadriu yesterday... Coincidentally, it was Besim's 22nd birthday, and three months to the day since he was shot. Besim brought with him a small photo of himself and his wife, taken some two months before the shooting, which I have photographed, and which I have attached to this e-mail. Quite a handsome guy. Besim and his wife Valbona have only been married eight months--she is providing tremendous psychological support to him now, sticking with him through thick and thin. I hope we shall hear before too long about progress in getting him to the U.K.

6 SEP. '99 TO: Brian Leatherbarrow
Unfortunately, there seem to have been further delays in getting the patient out of Kosovo, and Mr. Loukota has heard nothing more these last three weeks. The poor patient (one of his photos is attached so that you can see exactly why I strove so hard, and shall continue to strive, on his behalf). I feel distressed that nothing seems to have happened...

27 OCT. '99 TO: Bob Woodwards
The photos I have of Besim are so striking (though I dare say you have seen many such) that they bring home the point of such humanitarian need in the most emphatic way... Ever since I met Besim, I have been promoting the need for a planned aeromedical evacuation chain for people such as him... I need to focus more on this though if this is to have lasting results for future conflicts.

18 NOV. '99 TO: Dan Clay
See attached photo of Valbona and Besim which I took yesterday. Besim underwent a 15-hour operation and I was able to visit him yesterday for the first time since he came to the U.K. All went well at op. He will need some minor refashioning of his nose in due course, but the major work is done. The visit was a wonderful, and very moving, experience. Valbona is expecting their firstborn in two weeks. Thought you'd like to know. God bless, David

22 NOV. '99 TO: Brian Leatherbarrow
Well done for your tremendous work last Monday re Besim. I had the wonderful opportunity to visit him just two days post-op. Delighted. You might like the attached photo. "A picture says a thousand words."