Mending Lives Shattered by War

U.S. Army Staff Sgt. Christopher Cummings was deployed to Iraq in February 2004 as a military liaison to aid in rebuilding the country. He closed his Ft. Lauderdale, Fla. central fabrication facility — Artisan Braceworks — where he served as both owner and sole technician, to go on active duty. The prosthetic care he was providing in Florida would soon be needed overseas.

The growing number of amputees in Iraq, consisting of both Iraqi civilians and military personnel is overwhelming. Recognizing the need for advanced training and immediate assistance to treat this population, Cummings reached out not only to help rebuild a country, but also literally a people.

Creating a clinic

The military did not plan for Cummings to work toward opening an amputee treatment clinic in Baghdad, Iraq, but seeing the devastation within the ravaged country caused him to act. Along with U.S. Army Capt. Steven Lindsley, Cummings was determined to find a way to reach the injured population and make a difference.

At first, Cummings set up a lab and saw patients in his spare time. The palace basement of Uday Hussein, oldest son of former Iraqi dictator Saddam Hussein, was the first location of the lab.

“At the time, this was the headquarters for a brigade combat team of the 1st Calvary Division,” Cummings explained. “Part of the building was bombed out but the rest of the structure was sound. The kitchen was in the basement and had a great pizza oven that I put to use right away making polypropylene sockets.”

Working together, Cummings and Lindsley saw between 40 and 50 patients over the first 3 months of operation, which Cummings said is more than he had seen in any other clinic. This large patient population also triggered fund contributions on the part of the U.S. military to expand the clinic and Cummings took on clinic leadership full time until his term of duty ended in October 2005.

After an 18-month stay in the United States, Cummings returned to Baghdad on the request of the military to continue working in and expanding the clinic. Additionally, he was asked to train Iraqi military personnel on prosthetic techniques and devices so they could ultimately take control of the clinic successfully without his guidance.

Patient loads

Cummings (center) during opening ceremonies of the new clinic. BG Samir (left) is the surgeon general of the Iraqi army and Col. Bassim (right) is head of logistics for his office.
Cummings (center) during opening ceremonies of the new clinic. BG Samir (left) is the surgeon general of the Iraqi army and Col. Bassim (right) is head of logistics for his office.
All images reprinted with permission of Christopher Cummings.

The initial 3-month figures from 2004 seemed like simpler times, given the new figures collected within the first 7 months since Cummings’ return.

“In the last 7 months, I have seen about 200 amputee patients,” Cummings said.

He estimated that 50% of his patients are army personnel, 20% police personnel and 30% civilian.

“I see a lot more double amputees than I see anywhere else and I suppose that is a credit to the lifesavers, the first responders, the people picking them up off the battlefield, or [from the site of] a mass casualty event like a car bombing, and getting them to the hospital,” Cummings said.

He said that he is currently working with seven bilateral transfemoral amputees and another 10 transfemoral/transtibial double amputees. Most of the amputations are trauma-related, although he does see two patients with amputations resulting from diabetes.

The patient loads are quite different from those he was accustomed to serving in Ft. Lauderdale, where the majority of amputations are conducted on diabetic patients.

“Because of [the amount of] trauma, we are getting a lot of young people who are fit, which is good for a prosthetist because they have another level of capability,” Cummings said.

Training tools

Cummings is working with eight Iraqi army trainees who have undergone previous prosthetic training at a 2-year technical college in Baghdad.

It is a “pretty good prosthetic program academically but they do not have the materials,” Cummings said. “Within a 2-year program they can make and fit one leg or arm.”

To adequately treat the patients coming for treatment he is teaching the trainees to work with thermoplastics and the Biosculptor CAD/CAM system.

“It is a much quicker system … and we can turn around [transtibial prostheses] in the same day,” Cummings explained. “So a patient comes in and we can scan them, mill it and put the plastic on it. The patient can leave with the device.”

Transfemoral patients have a lengthier process because Cummings uses the same system he would in the United States — a suction socket that requires the composition of a test socket before completion of the device.

“It has taken the guys a little longer to catch on because they did not learn how to modify the quad brim,” Cummings said. “They learned how to cast over a brim so the [transfemoral] concept is a little tough for them.”

Challenges in training

Ali, a 19-year-old transfemoral/transtibial patient, is fit with a test socket injected distally with alginate
Ali, a 19-year-old transfemoral/transtibial patient, is fit with a test socket injected distally with alginate.

Training the eight members of the Iraqi army while also seeing a massive influx of patients is difficult. Add a language barrier and it becomes almost impossible.

“The first 2 months I was here I worked completely without a translator,” Cummings said, likening the communications between him and the trainees to a form of charades.

To add more complexity, there was no appointment schedule for seeing patients and he “had to hit the ground running.”

“Whatever patients showed up, that is who they would bring into the clinic. I was supposed to conduct training to people who didn’t speak English and have never used a computer before and see 10 or 12 patients in a day,” Cummings said.

He admits it was frustrating at first and that he was, and remains, tough on those he is training, but with good reason.

“I want to make sure when I am done that this was a big accomplishment on their part,” Cummings said.

He is confident that when he does return to the United States the trainees will be able to take over control of the facility.

Future of the clinic

Cummings said threats, including rocket attacks, on the clinic grounds are occasional, adding that his military experience made him a good candidate to return and continue the clinic.

“It would be very difficult for someone who has never served in the military to take this job because I am not really freaked out by rocket or mortar attacks, or everyone around me carrying guns, or hearing gunfire,” Cummings told O&P Business News. “I am more accustomed to it. I have been in a couple of wars and I have spent 11 years in the Army.”

A new location for the clinic was erected at the Old Muthana Iraqi army base, about three miles outside of Baghdad. The move is scheduled to take place in July and will be the last act Cummings will attend to, rounding out his 1- year return to Iraq. After that, the Iraqi army will control the clinic, and Cummings can come home.

Jennifer Hoydicz is a staff writer for O&P Business News.

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