Guantanamo Tube Feedings Humane, Within Medical Care Standards
By Kathleen T. Rhem
American Forces Press Service
U.S. NAVAL STATION GUANTANAMO BAY,
Thirty to 33 enemy combatant detainees here are currently on a hunger strike -- which officials here call "voluntary fasting" -- to protest their continued detention. Of those, 22 are receiving liquid nutrition through a tube inserted through the nose and into the stomach.
"We have an ultimate responsibility that every detainee on our watch is taken care of," Joint Task Force Guantanamo Deputy Commander Brig. Gen. John Gong said in an interview. "We have a great desire to ensure they are healthy."
Gong and other officials said widely reported allegations that the tubes are the width of a finger, are forcefully inserted without anesthesia or lubricant, and are reused on different detainees are patently false.
Navy Capt. (Dr.) John Edmonson, the senior medical officer at Guantanamo Bay, said the "enteral" feeding -- meaning directly into the stomach -- is done with a nasogastric "Dobhoff" tube. The tube is flexible and 4 millimeters in diameter, Edmonson said.
He stressed that only doctors and nurses insert the tubes and always use lubricant. They also always offer anesthetics and suggest stronger pain medication if a detainee appears to be uncomfortable. He described the Dobhoff tube as "very soft and non-irritating."
Medical staff members never reuse the tubes, Edmonson said.
"I can assure you that the doctors are doing everything within the character of the standard of their profession," Gong said.
For the most part, the feedings are not involuntary. Both men said the vast majority of detainees voluntarily participate in the feedings. In fact, Edmonson noted, some even insert their own feeding tubes. "They are generally cooperative with the medical staff in that effort," he said.
Detainees are considered to be on a hunger strike after they miss nine consecutive meals, and medical specialists begin monitoring their health status. Body mass index, weight loss and physical condition are monitored. Edmonson said a patient can survive for about three weeks without eating as long as he is drinking water, which the detainees are.
When a detainee's weight drops too much and his health begins to deteriorate, doctors speak to the individual and offer supplemental nutrition, first intravenously and then through a nasogastric tube. Detainees receive Ensure, a commercial nutritional supplement, through the tube. Most agree to the procedure, Gong said.
He explained that as long as detainees maintain a certain level of health, they get to choose how much liquid nutrition to take. "The doctors try to be respectful of what the detainees want to do," he said.
Most take 1,500 calories a day. In contrast, most U.S. dietary recommendations are based on a 2,000-calorie diet.
In rare cases, detainees have received tube feedings involuntarily. "Some, because of their character and temperament, they would be less than cooperative and would need to be restrained," Gong said. Officials said restraints are always applied with the least amount of force possible. Both he and Edmonson said this is the rare exception and only used when a detainee's health is seriously in jeopardy.
The number of hunger-striking detainees peaked at 131 around the most recent anniversary of the Sept. 11 attacks, Gong said. Since then the number has steadily declined and has remained around the current number for the past several weeks.
"One has to really kind of scratch their head and ask why would they pick the anniversary of 9/11 (to protest their detention)," Gong said.
"It's their little contribution to their cause," Army Lt. Col. John Lonergan, commander of 1st Battalion, 18th Cavalry Regiment, said. Lonergan's unit provides security at the detention facility.
Edmonson, who has been at Guantanamo for two and a half years, said it's important to note that no detainees have died at Guantanamo Bay, while several of these men probably would have died if they weren't here. Task force doctors have treated cancer, battle wounds and other serious injuries and illnesses in a population that generally has limited access to medical care.
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