Knife Edge: Life as a Special Forces Surgeon

by Villar, Richard

  It is a feature of hearts and minds operations that, whatever it takes, you must do as they do. You must never inflict on local peoples an insistence that the English way is the only one. If they drink from a filthy well, ignore the use of toilet paper and routinely sleep for three hours after lunch, so must you. Never question their behaviour and way of life. It is reasonable to take precautions behind the scenes, but outwardly you should fit completely with their lifestyle and be as humble as you dare. Slowly this will give the opportunity to change the ways they use. In particular it will give them the confidence to speak to you and provide that valuable intelligence you seek.

  I had first come across this concept of total involvement in local culture thousands of miles from the jungles of Central America. I was in the North-West Frontier of Pakistan, on its border with Afghanistan. There was political chaos, with the Russians building up to their invasion of the land. Two of us had been asked to prepare a full report of the area’s medical facilities, in case of subsequent need. We found a small valley, south-west of Chitral, and arrived to announce our presence to the local Kalash tribespeople. Inexperienced at the art of working with such individuals, my own manner was perhaps too officious and condescending. I did not do well as a result. In the same valley, however, and preparing a thesis on local dialects, was Michael D. Michael and I had been at school together. To meet again in the Rumbur Valley of Pakistan was one of those coincidences that can only happen once in life. In contrast, he had thrust himself into local culture and customs. He spoke their language, ate their food, prayed to their idols, and lived their life to the full. He was an outstanding success and taught me a lot, though I doubt he realized it. His skills I have used worldwide, even to this day.

  As part of our attempt to be involved in all of Joaquín’s activities, I felt it would be a good idea if we went to church. Already Sister Helen had asked me to talk in the local school, watching bemusedly as I struggled through a lecture on good hygiene to an audience that barely understood English. But church? That was a different matter. Whatever one thinks of the SAS operative, however good or bad he may be, regular churchgoing is not a strong point. My companions looked horror-struck at the prospect but they, too, were as impressed by Sister Helen as I. So to church we went.

  On SAS patrol, attending church can raise problems. You are trained never, whatever the reason, to abandon your weapon. Irrespective of circumstance, it should never be more than one arm’s length away. Quietly, the four of us filed into the back of the chapel area once the service was under way. Sister Helen smiled, acknowledging our presence, though I could tell from her stern glance that our weaponry was not welcome. Taking the hint immediately, we leaned the M16 rifles against the rear wall and took our seats on the back row of wooden benches laid out for the congregation. At most, there were a dozen people present. The M16s were now at least five arms’ distant, but near enough to get at if trouble arose. You could never tell with Central America, particularly in border areas. The immigrant loggers we had been sent to investigate may well have been armed soldiers in disguise. Anything was possible and we were on our own. Jim would send out his twice daily signal to Tayola Camp, the sitrep, but it would have taken a long time to get help to us if we ran into trouble. Hereford had told us that Tony was now recovering well in hospital, so that was at least a relief. Beyond simple messages such as this, communication with our leaders was sparse.

  The service progressed as they always do. Mostly my mind was on other things - the clinics, loggers, jungle wildlife. For the religious sloth, church is an excellent time for reflection and thought. Then, suddenly, within my daydreams, I heard the command ‘Let us pray.’ Reflexly the SAS fell to its knees, facing forwards towards the cross. The remainder of the sparse congregation did the exact opposite, taking to its knees, but facing backwards. I have no idea why. As I looked up towards the cross I found myself staring directly into the eyes of a clean-shaven young missionary to my front. He looked horrified. I knew I was not a pretty sight and to the regular washer must have smelt terrible. I could see his eyes flicker nervously, as I had crept in behind him at the start, without his realizing I was there. He looked first at me, then at the others and then he saw the rifles. You could not miss them. There knelt the congregation, fingers clasped and palms together, praying to our four, tidily arranged M16 carbines. To their credit, no one mentioned it, but I was mortified. It was no surprise that Sister Helen took me aside after the service to say it would be better to hold our clinics outside Joaquín. It was her polite way of saying the SAS had outstayed its welcome.

  The following day we made our way to the village of El Morinto, barely a kilometre from the opposition’s frontier. Word had now spread that the British soldiers were here and there was free medicine for all. Wherever we went we would be followed by long lines of sickly natives, some genuinely ill, others perfectly fit but wishing to see us nevertheless. Sister Helen, dressed in radiant white as always, came with us, helping Roger and me to run an overcrowded clinic in the village town hall - the cabildo. Meanwhile, Tom and Jim disappeared to see what information they could gather on border activity.

  The cabildo clinic was the worst of my life. I dream of it even now. Sister Helen, Roger and I stood at one end of the primitively constructed reed hut. It was no more than fifty feet long, its open door at the far end. No sooner had we taken up position than the entire population of El Morinto tried to join us, squashing and cramming themselves into the tiny space. Dogs, children, adults, more than 200 in all, crushed themselves in to be with us. Worse still, a gastroenteritis epidemic had struck the village. Everyone, young and old alike, was smitten. We could not cope. No space, insufficient medical supplies and appalling human suffering.

  One mother forced herself to the front of a non-existent queue, misery and distress etched on her face. In her arms she held a lovely little girl, no more than eighteen months old. Diarrhoea streamed down the child’s thighs and legs, dripping disgustingly on to the earthen floor. The girl’s sunken eyes, her wrinkled, desiccated skin meant that death from dehydration was not far away. I knew there was nothing we could do and turned to Sister Helen, if nothing else for moral and spiritual guidance. I could see the agony in her own eyes as she, too, realized the situation was hopeless. Then the most terrible thing happened. As the child died, so a pack of emaciated dogs began to sniff at the limp, frail legs, licking the diarrhoea from her thighs and from the puddle on the earthen floor. It was awful. A great wave of revulsion and nausea welled up inside me. I could sense Roger, to one side, being similarly overcome. Neither of us spoke, but together we forced our way through the crowd into the open air beyond, retching and vomiting on to the ground outside. That child died a horrible death, an end from which we were powerless to save her. The jungle can most certainly be a terrible place.

  The little girl’s death at the cabildo clinic ruined Central America for me. I was glad to leave, and as soon as Tom and Jim returned we exfiltrated to Celoni by boat along the Dabacho River. From there it was to Tayola Camp and, two days later, the UK and Hereford.

  True to form, the SAS barely gave me time to unpack. On this occasion it was Major Y who disturbed my peace, putting his smiling face around the door only thirty-six hours later.

  ‘Far East, Doc? What do you reckon? We could do with you out there.’

  I rolled my eyes Heavenwards but realized I could not refuse. I knew Major Y’s Squadron well. Scheduled to remain in deep jungle for several months, medical cover was a necessity. This time it would not be Central America, but a Far Eastern frontier. As was traditional with the SAS, it was only happy when poised beside a border somewhere. The more political and precarious the position, the more the Regiment appeared to thrive.

  We were inserted by Huey helicopter, of Vietnam war fame. Their rotors really do go ‘thump, thump, thump’, being audible for miles. It is an aviation classic and a joy to travel in. One might imagine that jungle insertion is a simple affair. It is not. The lush gr
een jungle canopy extends for miles. Clearings do not exist and any that are present may easily be compromised by the opposition. The Regiment has dreamt up many ways of infiltrating deep jungle, but abseiling from a helicopter is perhaps the easiest. Clip your figure of eight descender on to the rope and away you and your equipment go. Strangely, the process is fun. I remember feeling upset that, once down, I could not go back up and try again.

  At one time the SAS went through a phase of parachute jungle insertion - tree jumping. The principle was simple. You descended by parachute into the trees, crashing through the branches until your canopy snagged and broke the fall. You then either climbed down the tree or released your reserve parachute. The latter’s rigging lines made an excellent rope down which you could slide. This was simple in principle, but hazardous in practice. As the parachutist descended rapidly towards the trees, there was a real risk that upward pointing branches would skewer his private parts. Before leaving base a thriving Black Market in telephone directories or extra towels existed. Anything that could be stuffed down a pair of jungle trousers to ensure the SAS’s ability to procreate remained intact. Abseiling was safer.

  Getting out, or exfiltration, from the jungle was equally troublesome. An overflying helicopter would find it impossible to identify the exact location of troops on the ground. The Search and Rescue Beacon - the SARBE - was one choice but could again be identified by enemy signals personnel. An orange marker balloon, floated up through the jungle canopy was a silent way of identifying ground position. Operatives could then be winched upwards, assuming the winchman could steer the sling through the branches. If tactics allowed, plastic explosive could be used to fell sufficient trees and permit a well-controlled helicopter to land. This was a time consuming, dangerous and messy business.

  Problems with jungle insertion and exfiltration highlight the one major feature of the environment. It is dense. Jungle can be primary or secondary. Primary jungle is as God designed it. Thick, mature trees, close to one another but without much smaller vegetation between them. Secondary jungle is what happens once man starts to remove the primary trees. A morass of thinner, tangled, smaller trees and bushes regrow. Making headway is nigh impossible. Then there is bamboo. If you wish to creep up on someone unheard, bamboo will let you down. It is frighteningly noisy. Step on a piece, or move it to one side, and you will hear a noise like rifle fire. The plant must have been responsible for more deaths in the world’s secret wars than any other. Soldiers struggling through bamboo are a giveaway.

  The Far Eastern jungle felt a friendlier place than its Central American equivalent. The jungle warrior’s bible, The Jungle Is Neutral by Spencer Chapman, was written in this part of the world. However welcoming and neutral the rainforest may be, it is still rich in wildlife, not all of which is friendly. I had barely detached myself from my abseiling rope when the first case came to me. It was Jock, a huge, massive Scotsman with hands like spades. He had formed part of the advance party, preparing the abseiling site prior to our arrival. He had killed the beast that had bitten him but was now suffering the effects, the insect’s venom already beginning to circulate round his body. It was a large centipede, as long as the palm of my hand. Despite being crushed by Jock’s jungle boot, a few of its legs still twitched. Jock was not well. Within thirty seconds of being bitten he had collapsed, his chest wheezing, his forehead sweaty and yet his skin clammy cold. Nowhere had my military medical training told me what to do with centipede bites. From an RAMC viewpoint, if you did not suffer from a standard NATO illness then they could not recommend a cure. Despite this, Jock was obviously in a bad way. Antivenom, if indicated or even available, was nowhere to be found. So steroids it would be. All I had was an injection called dexamethasone, mainly used in civilized societies for the treatment of severe head injuries. Nevertheless it worked wonders for Jock who, within forty-eight hours, was back to his usual massive self.

  The one beast dominating the jungle was the leech. Everywhere and anywhere the little horrors could be found. These were not the big, black bull leeches so favoured by Hollywood film producers, but their smaller, browner brethren. Stop for a matter of seconds on patrol in the Far Eastern jungles and the ground will come alive with these wriggly creatures. Purposefully they make their way towards you, determined that you, above all others, will be their meal. They get anywhere, often where you least think of looking. The first you know of them is after they have had their fill. Scratch your backside, or brush your neck, and you will feel the self-satisfied lump of a bloated beast, only too happy to be flicked to the ground and begin digesting your blood cells. They can sometimes be dangerous too.

  Mac, a new addition to the Squadron’s ranks, found it impossible to urinate one morning. He had never had such troubles before and was beginning to get anxious and distressed as his bladder enlarged. I was preparing to plunge a needle through his abdomen into the bladder to remove the urine when I thought to examine his penis. There, under the foreskin and very self-satisfied indeed, was an inflated leech blocking Mac’s urinary passage. Fortunately a small piece of tail still protruded, giving me something to grasp with my surgical forceps. Mac lived to pee another day.

  It is a lonely life in the jungle. You are about as stranded as you can get. Movement is slow, communications poor and claustrophobia common. For the married men it was particularly difficult, as any form of contact with home was impossible. You need a very understanding wife in the SAS. For the unmarried ones, like me, jungle trips represented a succession of broken relationships. Whenever I went I could be sure a girlfriend would shelve me. At the start I thought it was just me until I looked around at the gathering of sad faces after the infrequent mail delivery had, literally, been dropped in. Dozens of the single men, and a few of the married ones, had glum faces after reading their letters from home. On this occasion I had already received and read mine. Glancing around me I saw Trooper Mark S looking shocked. I went over to him.

  ‘What’s the matter, Mark?’ I asked.

  ‘It’s Tracy. She’s given me the elbow,’ he replied, his voice low.

  ‘I’m sorry. What are you going to do?’

  ‘I can’t do much from here, Doc,’ came the sorrowful reply. ‘I’ll just have to make a new start when we get back. She says she’s got a new bloke. Doesn’t ever want to see me again.’

  I put my hand on his shoulder, as reassurance. It seemed the right thing to do. This large, powerful operative was completely shattered by what had happened. The frustration of being able to do nothing in response, stranded deep within humid jungle, was naturally immense.

  As I stood beside him, uncertain what I should say next, I saw Mark’s saddened form slowly begin to change. He was well known to be a very determined soldier. I could almost sense his renewed strength course through my hand. I withdrew my arm as he stood up, his jaw now set. ‘Bloody hell, Doc. It’s ****ing ridiculous. What the **** can I do about it anyway? Come with me. I’ve got an idea.’

  I followed him through the jungle to a spot fifty metres from our base, in jungle terms a very long way. He stopped by a large, knurled tree stump, perhaps four feet high. It was black, half-rotten and stood beside its decaying trunk, the result of a deadfall months or years earlier. This was the area of our jungle range. I stood behind him, fascinated, silent and completely motionless. I watched Mark slide the long combat knife from its webbing pouch, hold the now sodden letter from Tracy against the stump, and plunge the knife through the paper into the rotten wood behind. Then he took six steps backwards, flicked his M16 safety to automatic and fired. It was frustrated fire, not aggressive. Gunfire in tight jungle surroundings is explosive. I winced with the agony of the noise, thanking Heaven that the nearest non-SAS person was reported as many miles away. I tried to remain impassive as I watched Mark empty several rounds into the letter, softened bark, sharp wood splinters and pieces of paper flying everywhere. Then, as rapidly as the noise had started, it stopped. Total silence once more. The letter hung in tatters fro
m the trunk, though still held secure by the ugly combat knife. Mark turned, his face now smiling, contentment in his eyes as he looked directly at me. ‘Doc,’ he said, removing a full magazine from his ammunition pouch, ‘here are some rounds. Let’s have the letter. Now it’s your turn.’

  I have to admit a sense of warped satisfaction, returning my ‘Dear John’ letter to its sender full of bullet holes. It was a wonderful therapy. I did it twice, on two successive jungle trips. When upset, the Dear John tree saved the day.

  Much of a jungle doctor’s work is to do with worms. These tiny creatures, frequently invisible to the human eye, show no mercy. SAS operatives are certainly not exempt. Nor am I, I am ashamed to say. Worms form a very diverse family - tapeworms, hookworms, guinea worms, threadworms. The list is long. You get them either from infested food or by walking through contaminated water. Take Brian, for example. His small stature belied an enormous, hidden strength. On patrol he could keep going for days while others might stop and rest. One morning he came to me. Overnight he had developed several large, red, linear streaks on his legs. I looked at them. Almost like marker pen lines on the skin, I was sure they were getting longer as I watched. They were also very itchy. Great weals and skin flakes littered the area where Brian had scratched furiously in his sleep. I was annoyed with him for that. Break an intact skin surface in the jungle, by whatever means, and you are assured an infection. High humidity and filth are a wonderful breeding ground for bacteria.

  ‘Creeping eruption,’ I explained. ‘That’s what it is.’

  ‘Creeping what?’ he asked, somewhat unconvinced.

  ‘Creeping eruption. It’s a type of hookworm.’ I went on to explain the problem. Certain types of animal hookworm do not have the power or strength to penetrate the human body. A normal human hookworm can get anywhere — lungs, guts, everywhere. Animal hookworm, particularly from cats and dogs, penetrates the skin from infested water and stays just under the surface. It wanders anywhere it wants, leaving long red weals wherever it goes - the creeping eruption. The difficulty is in establishing the direction the worm is headed. At which end of the red line is the beast to be found? The best way, and the one I used for Brian, is to mark each end with a black, indelible pen. Then send the patient away and ask him to return the following day. The direction of travel is then obvious, remembering the red line follows the worm and does not go ahead of it. Brian was easily cured. Once I had found the worms, they were quickly killed when I injected local anaesthetic into the skin around it. The process was painless and over within minutes. I think Brian was somewhat disappointed when I eventually killed his uninvited companions. By the time he had marked the red streaks and followed their movements, he was beginning to become quite fond of the little horrors.