The Tiger's Bite

Published on July 10, 2013
In the austere environs of an Afghan military base, infections can turn vicious in an instant.

Nothing is more frightening then the growl of a tiger while moving through the bush. It is a primal fear that makes one stagger in the path. Tending to a tiger in a cage can be just as frightening. Cornered, it is unpredictable. If you survive an attack the mauling wound is horrendous, permanent, and disfiguring. In Afghanistan, the conditions are such that every wound will become infect- ed. While Tigers are not indigenous, they are present nonetheless.

On Military Bases in Helmand Province, maintaining health and hygiene requires constant vigilance. Most toilet facilities are outhouses, and bathing may require a one kilometer walk through the desert in the dark in the early morning. In Kandahar, the UN ISAF troops took over an old Russian Base, and expanded it until a Human Waste Pool and Treatment Plant that was once on the outside of the Base, now is a lake in the middle of the base. As a result the inhabitants live in a cloud of E. coli mixed with unpaved road dust. So it is little wonder that a scrape festers, and a laceration requires oral antibiotics.

In this environment, good diet and exercise are essential to boost immunity against a myriad of virus and bacteria. This keeps not only the fighting man or woman on duty, but also the contractor on station and mission enabled. Hitting the gym is essential to maintain both physical and mental health, relieving stress but also straining muscles. When those muscles get sore self-care is encouraged and a healing Balm has fewer side effects than Ibuprofen. When the patient presents to the clinic for such complaints, they are usually given Blue Ice Gel or Tiger Balm as first aid.

One day, I received a call from a Paramedic at a Forward Operating Base concerning a rapidly expanding ulcer on a young man’s thigh. Two days previously, the patient applied Tiger Balm to a sore vastus medialis after a workout at the gym. He then applied an occlusive dressing over the site where he placed the Tiger Balm. As a result he developed a chemical burn. Initial treatment with topical and oral antibiotics per the Paramedic was ineffective, and I was contacted the next day. On seeing the wound, I switched treatment to a burn protocol but over the next day his condition worsened. It was clear that on the initial presentation the chemicals had been either removed or metabolized, but the burn process continued. Once the underlying muscle was exposed, the following day, I ordered a medical evacuation to a burn center. The patient required wide debridement and skin grafts, and his job was forfeit due to the long period of recovery.

This article originally appeared in issue 10 of Emergency Physicians International

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