This cell has been Rice’s temporary home since she arrived at the infamous prison last June as the chief nurse of the 344th Task Force — the Army medical unit assigned to provide health care for detainees in Iraq. A 58-year-old nurse practitioner who teaches nursing at The College of New Jersey, Rice’s job is to ensure detainees held at Abu Ghraib and at Camp Bucca (350 miles farther south) receive nursing care as good as that given to any U.S. soldier in this desert war zone.
“My mission is to make sure the nursing care that detainees receive in the hospitals and the camps is in accordance with Multinational Forces-Iraq [policies] and the Geneva Convention,” says Rice. “We are mindful that we must be careful. I must constantly be aware of and look for any violations.”
The 344th Task Force is an Army Reserve unit from Ft. Totten, New York, supplemented with some active duty personnel. After having trained for years, in some cases, decades to care for soldiers, the nurses, physicians, and medics of the 344th Task Force are performing an unusual wartime mission. They have learned to put aside whatever feelings they may have about treating men who may have injured or killed American service members and care for the detainees as they would their own comrades. Rice and several other nurses at Abu Ghraib and Camp Bucca were interviewed by Nursing Spectrum by e-mail and telephone over several weeks this winter.
Emotionally draining
It is, Rice says, “the most difficult mission in the Army Medical Department, and it is emotionally draining.” She calls her nurses heroes — they are doing a job few people would want to do, and they’re doing it in a difficult and dangerous environment. “We take care of the enemy like no other nation in the world,” says Rice. “One nurse told me, ‘I just can’t treat them as enemies.’ The care we provide here is better than that received by some uninsured Americans.”
In most cases, the staff does not know why individual detainees have been brought to the prison, says Capt. Scott Winters, RN, an ICU nurse at Abu Ghraib who is a nurse practitioner in a New York ED. ”We see human beings in the beds and provide quality care regardless. We provide care just as we would for our own soldiers.”
Army nurses say detainees still tremble when they learn they will be held at Abu Ghraib. Even before the war, the prison was known as one of Saddam Hussein’s torture chambers. It was built by the English when Britain occupied Iraq in the early 1900s. The structure is solid, consisting of several wings connected to a central hallway. The walls are thick to provide temperature control.
Coalition forces took control of the prison in August 2003 after toppling the Baghdad regime in the early weeks of the war. Since then, the military has used the prison to hold suspected insurgents. Late in 2003, a soldier leaked photographs from Abu Ghraib showing military police humiliating detainees; the photos created an international scandal, and investigations ensued. Thus far, two soldiers have been court-martialed while others reached plea agreements. More trials are pending.
No evidence of medical or nursing involvement
An assessment of policies, procedures, and doctrine regarding detainees’ medical care in Iraq, Afghanistan, and Guantanamo Bay, Cuba, was conducted by the Department of the Army and the Army Medical Department in 2005. The findings of the assessment, released last July by Army Surgeon Lt. Gen. Kevin C. Kiley, MD, found no evidence that military medical personnel were involved in the abuse.
“The overall quality of outpatient and inpatient detainee medical care is extremely high,” the report states.
However, the assessment did find a shortage of medical capabilities for detainee health and said policies and training regarding medical care for detainees were lacking.
“The team found no evidence of specific theater-level policies for detainee medical operations in OIF [Operation Iraqi Freedom] until 2004,” the report states.
At the time the abuse took place, the Army medical units located at Abu Ghraib were equipped to provide only combat medical care to U.S. soldiers, the assessment found. Also, there were shortages of supplies, equipment, and medication. Complicating matters further was the confusion about standards of care for detainees because of the different ways they were classified.
The first “detainee only” hospital built by the Army opened for inpatient occupancy March 18, 2004, and was staffed by the medical unit dubbed “Task Force Oasis,” according to the Army’s report.
The 115th Task Force replaced Task Force Oasis in August 2004 and further expanded the level of care that could be provided to detainees. The 344th Task Force replaced the 115th Task Force last summer.
The unit staffs a small tent hospital set in a warehouse on the prison grounds. The tent isn’t located in the open so personnel and patients can be protected from the frequent mortar attacks and small-arms fire that hit the base.
The hospital consists of a 20-bed general medical/surgical ward, an eight-bed ICU, an OR, a pharmacy, a lab, and x-ray. In addition, a mental health team works with detainees through interpreters. Medics hold daily sick call under physician supervision, and twice a day they go out to “the wire” — an area surrounded by barbed wire fencing — to dispense medication. Nurses go to the wire and manage the care of detainees with diabetes, oversee wound care, and give other treatments that might be necessary, such as IV antibiotics or warfarin (Coumadin).
The nurses interviewed say they have seen no evidence of abuse by U.S. soldiers since arriving at Abu Ghraib. Some say they have seen marks on detainees’ wrists that most likely occurred when the men were first detained by Iraqi soldiers or police. However, the staff is constantly reminded to report any evidence or suspicions of abuse up the chain of command. The care now provided to detainees is closely scrutinized by Task Force 344th medical leadership, as well as organizations like the International Committee of the Red Cross and the Iraqi Ministry of Human Resources.
Constant vigilance
“I constantly have to be vigilant,” says Rice. “I have to watch the nursing care. If there are mistakes made, I need to fix them immediately.” Rice’s area of responsibility includes nurses assigned to Abu Ghraib, as well as to the prison hospital and camps located at Camp Bucca. “When we’re asked how we can take care of these guys, we say we are doing a job our country has asked us to do and we do it without rancor or regret,” she says.
Maj. Linda Zajicek, RN, who works in the emergency treatment room, says as a civilian nurse, she did a clinical rotation as a student nurse practitioner in a county jail.
“I find the basic premise is the same,” says Zajicek, a civilian nurse at the University Medical Center in Stony Brook, N.Y. “Treat the prisoners respectfully, but be cautious and aware of your surroundings.“
While military physicians are assigned to Abu Ghraib for only three months, most nurses and medics serve a one-year tour of duty. The continuity of the nursing staff helps set the tone and tempo of the hospital and the day-to-day operation of the nursing and medical care, Rice says.
“The care here rivals anything I’ve seen in a big city hospital in the States,” she says. “We may not have all the equipment we want, and it may not be the newest, but we improvise and do what needs to be done. We have saved lives that most people would not even have attempted to save. So the medical care that detainees receive is exceptional.”
Still, providing nursing and medical care for detainees is cumbersome and dangerous. Two MPs are stationed in each ward, and the prisoners wear two-point restraints at all times, usually on one arm and one leg. Many detainees are missing limbs, making it difficult to place the two restraints. The staff must be aware at all times that any one of the detainees would harm or kill them given the opportunity.
“The hair on the back of my neck goes up when [the detainess] are behind me,” Rice says. “It is difficult because we want to treat everyone equally, yet we cannot get too close because they can turn on you very quickly.” Some nurses have been hit, kicked, or punched by patients who were out of control. Yet the patients were not specifically looking to harm the nurses because of their American status, Rice says.
She frequently goes into the camps to give flu shots — surrounded by MPs. Although her fear of danger is real, Rice says she still sees the humanity in her patients.
“I am one-on-one with them and their responses,” Rice says. For example, she explains, some detainee-patients are fearful of injections and will turn their heads, don’t want to stop smoking, will not drink enough fluids because they do not want to urinate as frequently, and think a pill can cure everything.
“One detainee wanted a pill so he would not miss his family so much,” says Rice. “We have all been touched one way or another by various detainees. We have laughed and joked with some detainees. Initially it seems that we are wrong to do that; but when you see the humanness in everyone, you cannot help it.”
Thorny issues
One of the most common ethical issues faced by the medical staff at Abu Ghraib is the question of when to cease life-sustaining treatment. “Again, because of the people we treat, we must be extraordinarily careful,” says Rice. “All the physicians we have had here have been extremely compassionate. They work and work to keep these guys alive. People who should have died haven’t” because of the care the patients received.
When it appears that nothing more can be done to help a detainee, his case is brought before an ethics committee to determine if treatment should be discontinued. “We do have a functioning ethics committee that works,” says Winters, the nurse practitioner from New York. “It is multidisciplined and meticulous.”
The unit commander, Col. William F. Martin, makes the final decision and informs his superiors at higher command levels about the detainee’s situation. The body of any detainee who dies at Abu Ghraib or Camp Bucca is sent to the U.S. for an autopsy to verify the cause of death.
The hospital at Abu Ghraib receives a large number of trauma victims from the violence occurring in and around Baghdad. The victims usually are detainees who were injured by improvised explosive devices, mortars, or suicide bombs.
Rice points out that detainees are not the same as enemy prisoners of war. Detainees are not fighting as soldiers of Saddam Hussein’s former regime. Instead, they’re suspected of being insurgents or terrorists. Some detainees are common criminals, and some may be from the countries surrounding Iraq — Syria, Jordan, or Iran — who have come to make some money by participating in the insurgency. Many of them may simply have been in the wrong place at the wrong time.
Detainees requiring rehabilitation or long-term care are sent to Camp Bucca in southern Iraq, not far from the Kuwaiti border. Located in the middle of the desert, this prefab hospital was built specifically for the care of detainees. Long-term rehab is provided to detainees who have lost limbs, are paraplegic or quadriplegic, or have serious burns, among other conditions.
Hard, hard work
Members of the 344th will do more than what’s expected of them. Rice recalls a detainee who was dying from lymphoma. The staff was able to track down some of his family, a mother and two brothers, one of whom was at Camp Bucca. “We told him to keep breathing until his family arrived,” Rice says.
Tearing through the red tape, the staff was able to bring the family to the Abu Ghraib hospital, even though this is not ordinarily permitted. The mother and one brother stayed with the patient only briefly, but one brother remained until the detainee died. “It was hard, hard, hard,” says Rice.
Nurses of the 344th Task Force will be returning to the U.S. in late spring or early summer. Their military nursing experiences with detainees are unique — not only to those of civilian nurses, but to other military nurses, as well.
Says Rice of the experience, “The message we send by treating detainees well may change their minds forever about Americans. It is our own little war against terrorism that we fight daily. Nursing kindness and caring may change a potential terrorist or insurgent into a law-abiding citizen.”
Rice recounts the story of a patient she saw in the clinic: “When we were finished, I asked him, via a translator, if he had any questions. He spoke for a few seconds and then covered his heart with his right hand, which is a sign of respect and gratefulness. Through the translator, he said he wanted me to know that throughout Iraq, our hospital and staff were known as angels of mercy. This statement was unprovoked — and surprising.” |
