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November 2005

Release date: November 1, 2005

Physical Therapy Faculty Member Brings Iraq Experience Home

Angelo State University physical therapy faculty member Mark Pape has always been able to bolster his teaching with real-world experiences, but now he can offer insights that few professors anywhere can knowledge gained during a four-month deployment in Iraq.

Pape was stationed at an Iraq Air Force base in May and returned in September. It was the first overseas combat-zone deployment for Pape, a lieutenant colonel who has been in the Air Force Reserve since 1986. He was called to active duty during Operation Desert Storm in 1991 as well, but spent his time serving at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio.

Pape was the flight commander for a group whose mission was to provide physical and occupational therapy to U.S. troops, contractors, Iraqi civilians, military personnel and insurgents. The group consisted of Pape and one other physical therapist, another officer as the occupational therapist, and three enlisted rehab technicians, who assisted by doing procedures such as applying and removing casts.

"It's definitely something that's helped me grow," Pape said. "You never stop learning, improving, growing. Anytime I learn something, I bring it back to the classroom."

During his four months in Iraq, his ward saw about 5,000 patients. It's not uncommon for a physical therapy facility in the United States to see that many patients in that amount of time, but stateside facilities don't have to deal with the conditions in which Pape's field hospital was set up.

The hospital about 25 miles northeast of Baghdad was a complex of tents set up on concrete slabs. The air-conditioned tents tempered the desert heat that could reach into the 120s in the shade, but a few times the cooling system failed, bringing the temperature in the physical therapy clinic as high as 105 degrees.

Many of the facilities found in a stateside hospital -- such as CT scanners, a clinical lab, a pharmacy and an intensive-care unit -- were in the tent hospital, but the equipment was Spartan. Beds, for instance, weren't typical hospital beds, but essentially were cots with thin mattresses slung over the side poles.

The hospital saw patients from many walks of life.

U.S. troops -- mainly Army soldiers -- came to the hospital with injuries ranging from sprains to gunshot wounds to the head. Pape and his group's job was to help the troops rehabilitate as soon as possible to help them avoid a costly medical evacuation out of the country or numerous dangerous trips between their forward operating bases and the hospital.

"Ninety-nine point nine percent of the time, those guys didn't want to be in the hospital," Pape said. "Everybody wanted to get back to their units. I have absolutely the deepest respect for those people."

Pape also saw civilian contractors, Iraqi civilians, local police officers and insurgents.

"The insurgents, of course, were heavily guarded," Pape said.

One day a week usually was set aside for the Iraqi civilians to come in for treatment. They would come to the outskirts of the base, where they would be searched and driven to the hospital in an ambulance. They would fill out paperwork and receive a patient number, which the doctors and therapists used to identify them during the course of their treatment.

Pape and his group gave civilians a variety of treatments, including wound care and cast maintenance, and they also taught rehabilitative exercises. Sometimes the civilians would have extended stays in the hospital.

"Some of the Iraqis didnt have anywhere to go, so they stayed," Pape said. "They'd stay three or four weeks because there wasn't anyplace else to send them that could provide them with adequate care."

Pape also treated children who had birth defects.

"A young girl, about 6 or 7, came in and couldn't sit up," Pape said. "Her parents hadn't had any training in exercises that could strengthen her muscles. After a few weeks of treatment, you could just see amazing results, because she hadn't had any help before."

"It was very, very rewarding."

Interpreters helped Pape and other specialists communicate with the patients. However, many of the Iraqis were more expressive than Americans, and their gestures and cries left little doubt when they were in pain.

The medical workers also had phrase books that helped them communicate on a basic level. Words often used were the Arabic terms for "walk," "slow," "pain" and "medicine."

"Probably the most fun was working with the Iraqi patients," Pape said. "You learn just enough of the language so you can safely work with them. A lot of the patients that got out of bed for the first time or walked for the first time with their amputated limb or fractured leg -- getting those people out of bed and not knowing their language is really a challenge."

During his time in Iraq, Pape was not allowed off the base. Even on the base, life wasnt perfectly safe. Mortar attacks were common, with shells falling on the sprawling base about 60 or 70 times during Papes stint.

"Out of those 60 or 70 times, I felt impacts and the ground shook maybe 10 times," Pape said. "Parts of the base could get hit, and we wouldnt even feel it or hear it. All we hear is a siren going off, we put our gear on, and we'd wait, or go to a bunker, depending on what the situation was -- sometimes we had to take our patients to the bunkers -- and just wait it out. And usually, within 30 or 40 minutes, the 'all-clear' would sound and we could go back to work.

The trailers in which the troops lived were surrounded by sandbags to deflect blasts. This usually gave Pape a sense of relative security, except for one night when the mortar shells landed nearby.

"I was never really scared except one night when they came closer -- the trailer rocked a bit," Pape said. "We could stay in the trailers as long as we were below the level where the sandbags came up. The way the beds were set up, I was about two sandbags below the level. As the mortars got a little closer, I thought, 'I'm going to sleep on the floor.'

"And then they got a little closer, I thought, 'Well, maybe I'll be under the bed a little bit.' And by the time the attack was over, I was all the way under the bed wishing I had my helmet and flak vest with me instead of over in the clinic."

Pape joined the Air Force Reserve in 1986 at the age of 34. He had earned his master's degree in physical therapy in 1981 and received a direct commission into the reserves.

Pape had entered Angelo State University in 1970 thinking he would either enlist or be drafted upon graduating. By the time he earned a bachelor's degree in biology in 1974, the United States was completing its withdrawal from Vietnam and the draft had been suspended.

"My dad was in World War II and was recalled for Korea, and I grew up at the edge of being able to go to Vietnam or not," Pape said. "I fully intended after four years in college to be drafted or join, serve my country."

After talking to another physical therapist who was in the Air Force -- the service in which Pape's father served -- Pape learned that he could join the reserves without having previously served. After filling out the appropriate paperwork and going through an officers' course, Pape received his commission as a 1st lieutenant.

His career in the reserves has generally had a tremendous impact on his professional and personal life, but had not required any substantial time commitment. He usually had one weekend a month and two weeks a year of training. He lived on base in San Antonio during his Desert Storm deployment in 1991, and he hadn't been in a combat zone until this year.

During his recent deployment, he missed his daughter's graduation from college. ASU physical therapy faculty picked up his workload to minimize the external pressures on Pape so he could focus on his mission in Iraq.

"Without the University's full support, I would not be in a position to answer the countrys call for help," Pape said.

"My wife was very supportive. I know she hated it, but she was very, very supportive. It was probably harder on her than it was on me. I really missed her a lot."

"I think my daughter was proud of me. I think she was a little afraid something might happen to me, but I felt nothing but support from everyone around."

"The university told me, 'good luck', and said my job would be here when I got back. Some of the faculty called my family to make sure they were OK while I was gone and I got e-mails from them as well -- that means a lot."

If it weren't for his commitments back home, Pape said he would want to return to Iraq.

"It was a very rewarding experience for me," Pape said. "I was working with absolutely the best people. The surgeons, the nurses, the doctors -- they are some of the best-trained people in the world."

In the military, Pape is able to do more than a civilian physical therapist is allowed to because of either professional conventions or licensing restrictions. In Iraq, he was allowed to suture wounds, pull drains, prescribe medications, remove internal fixators and order X-rays.

"Combat medicine blurs those lines a little bit," Pape said. "It's something you do automatically because its going to help the physician out. If you've got an orthopedic surgeon taking out staples, that means he can't be in surgery doing what he does best."

Now that Pape is back in the classroom, his students are reaping the benefits of his varied experiences.

"By practicing, I'm keeping my skills up to date," Pape said. "That really enhances education. The students are learning by hearing a story about how this therapy worked for this patient. I'm definitely a better therapist and a better person because I went."