Cardiac Surgery Program

Upon his arrival in Afghanistan, Dr. Pigula worked with two other surgeons in makeshift military hospitals, first in Bagram, a city located an hour outside the capital of Kabul, then in Kandahar, the second largest city in the country.

"There is still a dangerous environment there," Dr. Pigula says. "You have some members of the Taliban who are still around, and they often set up these little rockets and shoot them off by remote control, aimed in the general direction of our base."

"I was watching a Cheers episode on my computer, and a system of loudspeakers all over the base - known as 'the giant voice' - went off. It was saying that the base was under direct fire. So I really didn't know what to do. I was in my shorts and a T-shirt. I knew I had protective gear, but I didn't know which bag it was in so I just started grabbing stuff," he says.

After running to an assigned bunker in the pitch dark, Dr. Pigula found that no one was there and that everyone had met for a head count in the hospital, which he described as "a big tent." To this day, he says, he doesn't understand this drill since the cement bunker seems safer.

"They have enough control that they can charge a toll to anybody carrying any kind of merchandise who goes across their area of control, including the United States government," he says.

Although his primary mission was to treat injured coalition troops, Dr. Pigula estimates that 90 percent of his patients were Afghan citizens who were injured badly enough to meet the criteria to be seen, which falls under "life, limb or eyesight."

"The great majority of what we saw was trauma... gunshot wounds, wounds from explosives and landmines or non-combat trauma - people who had been in car accidents or motorcycle accidents," he says.

"We couldn't deal with a chronic condition, such as high blood pressure. And unfortunately for these people, there aren't other sources of medical care. I was told the average life expectancy for a man there is 43 years."

Local hospitals, most of which do not have running water or electricity, are staffed by few, if any, real doctors or nurse. "Part of what Afghanistan is dealing with is that they don't have an educated middle class," he says. "In all the years of fighting, most of the educated people left the country."

The enormity of the problem hit home when he and his colleagues treated a badly burned 8-year-old girl who was transferred from the local hospital where she had been for weeks. "We skin-grafted her and gave her everything we could, but she didn't make it," he says. "It was very hard on everyone there who was watching this child go through this."

For a surgeon who normally fixes complex heart defects in children on a regular basis along with other highly trained clinicians and the most advanced medical equipment, realizing that that this child couldn't be saved was extremely frustrating for Dr. Pigula.

"We could not take care of burns," he says. "We did not have the personnel, the resources or the equipment." As a result, the medical team had to turn away anyone else who had a serious burn.

"Her father was so pleased that he took some of our intelligence guys out and showed them where the 'bad guys' (the Taliban) were," he says. "When the troops would get into a fight and there were survivors, they would write 'bad guy' in black marker on their foreheads because the person was considered dangerous and there were a lot of guns around the hospital, so that's how they would notify us."

His experience in Afghanistan, he says, has made him appreciative of the medical resources he calls "luxuries," which enable him to treat children here in the United States who have a host of ailments that could never be addressed in other parts of the world.