INTERVIEW: Dr. Rakesh Patel

Dr. Rakesh Patel works in the ICU at the Ottawa General Hospital where he is the Director of Adult Critical Care Medicine. He’s also an Assistant Professor with the Fellowship Training Program at the University of Ottawa. He spent the month of January 2008 at the Role 3 hospital in Kandahar.

Watch the interview online.

Dr. Rakesh Patel: When I walked into the hospital, looking around it was like wow, this kind of looks bare bones, but all the things that I would want in ICU, I could pick out, yeah so, except for the you know the plywood walls and instead of it having bricks and mortar, it's like ok well, here's a ventilator, the I.V. pole, here are the drugs and it felt home. I didn't feel like I was out of my element if you will, because that was one of the concerns I guess I had was coming to a war zone.

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Gillian Findlay: Do you feel thought that you at least initially, did you feel like you know I've got to prove myself to these people? They're going to be watching me?.

Dr. Rakesh Patel: For sure, absolutely and as I said, I mean I had to prove to myself that I could walk the walk here.

Gillian Findlay: You weren't sure.

Dr. Rakesh Patel: I wasn't sure and I think the same thing I had to do here, but I think again, I think I was lucky because we had two very sick patients in the ICU right from the get go. People saw what I did, because I just did what I knew how to do. I wasn't thinking about where I was, because it didn't really make a difference, it was very individual with one person in this bed and one person in another bed and I think through my actions, people probably recognized that yeah I think he knows what he's doing and maybe we actually can trust him. So I think that was helpful. I think knowing somebody and being thrown into the fire right from the get go, was the way to go for me at least.

Gillian Findlay: Why did you think you had to prove it to yourself that you could walk the walk?

Dr. Rakesh Patel: Because I was outside a comfort zone, you know. I mean I work in a teaching hospital that's got all kinds of equipment, people, consultants, etc., etc., etc. Here, it's just me essentially. I mean I'm managing the ventilator here, whereas there might be a respiratory therapist working with me and handing all the knobs and buttons and all that kind of stuff, whereas I'm doing it here. It was those little things that you don't really think about in a day-to-day situation in a tertiary care hospital where you have a lot of people looking after any individual patient, as it should be. I think you do need an ICU team to look after complex patients.

Here the degree of complexity is there, but it's much younger patients who don't have high blood pressure and cholesterol problems and all the rest of the work. By in large dealing with young people who are injured on the battlefield and so their scope of injury is limited. So you may not need the same team, but at the same time all the little things that all those guys that I rely on back home, I was it. So I think that was part of proving, is could I, do I actually really know what I'm talking about back home?

Gillian Findlay: And it turns out you did.

Dr. Rakesh Patel: You know the people here are going to have to decide whether it turns out I do. At the very least, I can say I haven't created any illness and I probably haven't gotten in anybody's way so far and I think that's a good thing. I think I'll start there, because my job is to manage illness, not create any. I'm happy to say I haven't done that yet.

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Gillian Findlay: But there's no question if you're a Canadian soldier and you've come in here badly injured, you know pretty quickly you're going to be on a flight to Germany and the finest medical care the western world can offer. If you an Afghan, whether military or civilian, that's not available to you.

Dr. Rakesh Patel: No. No it's not.

Gillian Findlay: How do you reconcile that or do you?

Dr. Rakesh Patel: I can't actually, particularly because I don't know specifically what's beyond the wire as they call it here. So there's no sense making grandiose plans for medical care when you're pretty sure that they're not going to get it. In fact probably the most important medical care that they can receive is good meals. Many of the Afghan people that we have seen so far, at least I have, are undernourished and I think that's probably more of a danger to their health then any of the injuries that they've sustained, because despite that they seem to be fairly resilient. The dilemma is once we fix them if you will, or correct a life-threatening or limb threatening injury, what about all the other follow-up kind of care that they need.

I think what's in place right now and I'm actually going to go and teach some of these guys next week is, physicians here in Afghanistan training them to provide the care that the population needs, because it doesn't matter how long we're here, one day we'll probably go home to some other place or we'll go back to Canada for good and that means we're going to have to help them develop an infrastructure to look after that. It will be up to the Afghan people as to what degree of infrastructure they need or can afford for that matter to do that, but if we can help some of the people outside the wire if you will to look after it.

I think that would be one way of resolving at least, in a small way, the dilemma in my mind as to what they're going to get after they leave the ICU. So to that end, you know many of us participate in teaching at Camp Hero the generation if you will, of Afghan medics, PA, doctors and nurses about things to….how to become the deliverer of health care that we've had the opportunity to learn back home, so I think that's one way.

It's not complete by any means, but you have to start somewhere and if we can at least start with education, I think it will build good will. It will build, ideally some trust with us. Ideally more rapport then we may have already and allow us to build bridges that may not be built right now, but are in the process of doing so. That could easily mean someone who has come back five years from now, sort of in a (French) type way, or some other organization, Red Cross what have you, and to see exactly what the legacy is like that we've left. That certainly could work out.

Gillian Findlay: Would you come back on another tour here?

Dr. Rakesh Patel: I think I would actually. I've actually enjoyed it, it's an experience. It's a life changing experience, it's a life building experience so I certainly would think about coming back.