200x magnification acinetobacter baumannii

In many ways, the Bush Administration's "War on Terror" has been able to accomplish things that the terrorists themselves could only dream of.  It has divided the American public against each other.  It has stretched our military so thin that we would be helpless in the face of a real national emergency.  And now, it has bred its own drug-resistant biological weapons, one of which is rapidly making its way through civilian hospitals from California to Canada, on to Germany and Anbar Province.  It's called acinetobacter baumannii and the US military not only created the conditions that led to its development, but the Pentagon has played an active role in exporting it to the world and in the suppression of information that could have led to its containment.

From Wired Magazine:

I VISITED WALTER REED in 2004 to write about anesthesia on the front lines. As I spoke with an Army sergeant who had survived a brutal attack in Najaf, US senator John McCain and talk-radio host Don Imus came into the room to thank him for his service. When we walked out, McCain's assistant whipped out a bottle of sanitizing gel and passed it around. A nurse explained to me, "It's this bug that grows in the soil over there and gets blown into their wounds by IEDs. These poor guys are covered with it. Around here we call it Iraqibacter." Rumors were circulating at the hospital that insurgents dosed their homemade bombs with the flesh of dead animals.

As nicely as that would fit into pre-existing Right-Wing narratives of Middle Easterners as filthy, disease-carrying foreigners who will stop at nothing to kill and maim Americans, it (like so much else we've been told about the Endless War on Terror) is in fact a big fat lie. 

It's true that many species of acinetobacter flourish widely in the environment. Thriving colonies have been recovered from soil, cell phones, frozen chicken, wastewater treatment plants, Formica countertops, and even irradiated food all over the world. But the particular species causing the military infections, baumannii, is almost always found in just one environment – hospitals.

Lenie Dijkshoorn, a senior researcher at Leiden University Medical Center in the Netherlands, has studied the bug since 1984. "My colleagues and I have been looking for Acinetobacter baumannii in soil samples for years, and we haven't found it," she says. "These organisms are quite rare outside of hospitals."

Hear that?  No acinetobacter baumannii in the soil of Iraq.  However, it is found at every stop along the military "evacuation chain" from Iraq back to the US and Europe.

Soon, however, the bug started popping up in other hospitals along the evacuation chain. More than 70 patients at Walter Reed eventually contracted acinetobacter infections of the blood. Other infected patients and carriers surfaced at Landstuhl, Bethesda, and Balad Air Base, the embarkation point for troops on their way out of Iraq. By early 2005, nearly one-third of the wounded soldiers admitted to the National Naval Medical Center had been colonized by the bacteria.

But where did this superbug come from and what exactly does it do?  All hospitals have nosocomial (secondary) bugs.  This version of acinetobacter  undoubtedly existed in a less virulent form in the medical facilities prior to the war, but the massive over-prescription of wide-spectrum antibiotics by American medical personnel is what gave it its ferocious drug-resistance. 

And as for what it does, this is what happened to 20-year-old Marine Jonathan Gadsden after he was severely injured by a road-side bomb and evacuated back to the US:

At first, he did quite well. By early September, Gadsden was weaned off his ventilator and breathing on his own. For weeks he gradually improved. His buddies took him to a Washington Redskins game in his wheelchair, and the next day he navigated 50 feet with a walker. Soon Gadsden was transferred to a veterans' hospital in Florida called the James A. Haley Medical Center, where he offered to serve as the eyes of a fellow marine blinded in an ambush. The doctors told Zeada that her son might be able to go home by the end of October.

But he still had mysterious symptoms that he couldn't shake, like headaches, rashes, and intermittent fevers. His doctors gave him CT scans, laxatives, methadone, beta-blockers, Xanax, more surgery, and more antibiotics. An accurate evaluation of his case was difficult, however, because portions of his medical records never arrived from Bethesda. If they had, they would have shown a positive test for a kind of bacteria called Acinetobacter baumannii.

Gadsden died on October 22nd.  His mother Zaeda Gadsden wanted to know why.

She discovered that an autopsy was performed shortly after her son's death. The coroner recorded the "manner of death" as "homicide (explosion during war operation)" but determined the actual cause of death to be a bacterial infection. The organism that killed Gadsden, called Nocardia, had clogged the blood vessels leading to his brain. But the acinetobacter had been steadily draining his vital resources when he could least afford it. For weeks, it had been flourishing in his body, undetected by the doctors at Haley, resisting a constant assault by the most potent antibiotics in the medical arsenal.

"No one said that my son had anything like that," Zeada says. "I never had to wear gloves or a mask, and none of the nurses did either. No one had any information."

Now, don't you think that if the doctors at Bethesda knew that Gadsden had been colonized by this organism that they should have maybe told the personnel at Haley Medical in Florida?  Curiously, no one saw fit to inform the veterans' hospital what Gadsden was bringing with him.

But this is part and parcel with the government's strategy for "fighting terror" with speeches and photo-ops and letting the underfunded, ill-equipped military cope with the unintended consequences of their disastrously mis-planned war(s).  The whole reason we have this bug is because the combat hospitals in Iraq have never been adequately supplied, sterilized, or maintained:

Known as combat support hospitals or CSHs, these facilities had been hastily erected in tents and other temporary structures, in keeping with the Pentagon's goal of a lean and mobile fighting force. Maintaining sterile conditions in the desert required creative efforts. Sand blew through every available opening in the walls, and the 130-degree days took their toll on drugs, power supplies, and diagnostic equipment. To move trauma care closer to the action, the DOD deployed modified shipping containers called ISO boxes as portable operating rooms. It was standard procedure to have a dozen nurses, surgeons, and anesthesiologists in each box crowded around two patients undergoing surgery simultaneously – an infection risk in any hospital.

At the 28th CSH near Camp Dogwood – home to more than 4,000 US and British soldiers – there was only one washer and dryer to launder all of the linen, including the surgical scrubs. Army nurses reported to the DOD that "sheets were more often than not soaked with blood and other body fluids – linen that covered the patients who were transferred back to Germany was not replaced." When hospital-grade disinfectants ran low, which was often, the supply crew stocked up on bleach from a local bazaar.

The derelict infrastructure of the Ibn Sina, where Jonathan Gadsden was treated during his evacuation, bedeviled the staff's best infection-control efforts. Rainwater dripped into operating rooms and supply closets, and pigeons roosted in the ventilation system, wafting the smell of droppings into the surgical suites. (A request was filed to the Iraqi Ministry of Health in September 2003 to "eliminate bird feces" from the air ducts.) Clean sheets and scrubs were scarce at the Ibn Sina as well, because the civilian laundry contractor was apparently selling them on the black market.

Ah, yes.  Mr. Rumsfeld's "lean and mobile" army.  What a smashing little war this is!

The wounded soldiers were not smuggling bacteria from the desert into military hospitals after all. Instead, they were picking it up there. The evacuation chain itself had become the primary source of infection. By creating the most heroic and efficient means of saving lives in the history of warfare, the Pentagon had accidentally invented a machine for accelerating bacterial evolution and was airlifting the pathogens halfway around the world.

But of course, once it figured out what was happening, the military took immediate measures to inform everyone at risk for infection and make sure that this menace never spread beyond its initial disease vectors, right?

Wrong:

As the bacteria spread through hospitals in the US and Europe, the DOD worked overtime to keep a lid on the rumors. In a PowerPoint presentation about acinetobacter and pneumonia delivered at the US Air Force School of Aerospace Medicine, a slide labeled "How to handle the press" read: "Don't lie. Don't obfuscate. Don't tell them any more than you absolutely have to." (emphasis mine)

Yes, like every other problem that has arisen in our nation's prosecution of the Bush Administration's "Great War on Terror", rather than deal with the issue in a frank, open, and effective manner, the government has chosen instead to lie, obfuscate, and cover up, thereby placing more and more lives at risk.

This is what happens, however, when your flagging superpower decides to launch a voluntary (but inadequately funded) war based on cooked intelligence from a perspective of deep and abiding political and historic ignorance.  You end up with a cascading set of errors that will be haunting you for generations, not just diplomatically and militarily, but economically, socially, and apparently epidemiologically.

How much longer will this catastrophe be allowed to continue?