Knife Edge: Life as a Special Forces Surgeon

by Villar, Richard

  ‘We have two examination rooms, sir, and a big medical store,’ he declared, his arms stretched wide and a sparkle in his eyes.

  ‘Any laboratory facilities?’ I inquired, knowing I would need to test blood and urine to help with diagnoses. Without some form of primitive testing facility, it would be impossible to make anything other than very basic decisions.

  ‘Oh no, sir,’ Ali replied, shaking his bowed head sorrowfully, his arms now by his side. ‘We have to send specimens to Lanurte, a village one day’s travel away. There they have a small medical centre, but the samples are usually destroyed by either the journey or the heat. We have to do the best we can.’

  I nodded my understanding. It did not surprise me. This same story could be repeated in a thousand other locations around the world. If I had ever harboured doubts as to whether joining the SAS had been right for my career, the Regiment had by now totally dispelled them. My ambition to become an orthopaedic surgeon, and assist the Third World, still remained. I was at the bottom of the ladder, but now well off its first rung. The experience I was now amassing in Third World conditions was enormous. I had a lot to thank the SAS for.

  Haruj, I decided, would be a good starting-point for our work in the Ramlaat Bawiti. Nothing was perfect, but with an existent dispensary, a crude water supply and Ali, things could be much worse. After ten minutes on the ground we clambered back into the Huey, shouting our promise to return, in incomprehensible Arabic, over the noisy, classical clatter of the helicopter’s rotors.

  It was a short flight from Haruj to Greboun, little more than thirty minutes. It was as we landed that the search and rescue call came through. A Scandinavian tanker, some distance offshore, had a sailor in trouble following a broken thigh bone. They needed help, and they needed it fast. I was the only doctor within easy access, so the helicopter pilot asked if I would assist. I had been given strict instructions not to become overtly involved in the local armed forces’ activities, before leaving the UK. Here I was, barely in the country twenty-four hours, being asked to disobey what I had been told. As a doctor, of course, there is no dilemma. If a patient is ill, whatever the cost to you, it is your task to deal with it. ‘How can I help?’ I inquired.

  The ship was 160 kilometres south of Greboun, at the very limit of range for a Huey helicopter with extended fuel tanks. It was already 4 p.m., which meant we would have to land on the tanker after dark. While the Huey was fitted with long-range tanks, a Strikemaster jet was sent to find the ship and circle overhead. Meanwhile, so that SAS personnel would not be seen working openly alongside local armed forces, I was given the uniform of a Flight Lieutenant for the event. I strutted round Greboun airfield as we waited to leave, feeling most important. I even received a salute from an airman at one stage, though failed to respond. I was caught by surprise, as saluting protocol was not rigidly enforced within the Regiment. It was my first salute for more than a year.

  Greboun airfield is an unremarkable place, but politically very sensitive. It was here the American Delta Force landed by C141 aircraft, before changing to their C130 Hercules during Operation Eagle Claw, their attempt to rescue the Teheran hostages. Many of us felt sorry for all parties involved in that Desert One tragedy. It appeared to me the event could be ascribed to the failure of several helicopters originating from the USS Nimitz. Rumour had it that those in the desert, despite the disaster unfolding, wanted to continue with the rescue attempt. The politicians in Washington, it was said, overruled them and cancelled. During the Iran/Iraq war, Greboun was also used as a base for disguised C130S in support of Iraq. Pressure from the UK’s Lord Carrington stopped this. Greboun was evidently a very sensitive place. Even as I strutted around in my Arab uniform I could see a massive American transport plane offloading men and supplies. With thirty-four US warships offshore at that time, albeit just beneath the skyline, the area was extremely active.

  We left Greboun at 5 p.m., heading south-west to the coastal settlement of Dilma. This was to be the Huey’s final landfall before heading over the sea to the tanker. As we flew I could tell by the pilot’s voice that all was not well. I have always hated flying and much prefer to jump out of aircraft than stay on board. It is, I suppose, a morbid fascination with air disasters. I always imagine the next crash will be the one to involve me. So when the pilot started talking over the intercom about fuel capacities, speeds, ranges and headwinds, I knew we had problems. His difficulty was the lack of room for error. The tanker was at the extreme limit of the Huey’s range. With a strong headwind and a full load of personnel and medical supplies, the helicopter would be struggling to reach the ship. More than a few degrees off with his navigation, or a few litres out with his fuel calculations, and we would have to ditch in the sea. I had already seen vast numbers of sharks from the air during our earlier trip to Haruj. I had no desire to go swimming at night in the Arabian Sea.

  As the sun was beginning to set, the pilot stationed the Huey on the very edge of the cliffs at Dilma, looking out over a vast expanse of ocean. I was beginning to feel helpless, being entirely in his hands. I knew I had to shut up and put up, whatever the decision he made. Anyway, I was damned if I was going to be the one to say yes or no. It was a beautiful view, I remember that as I write, but it did not detract from the terrible dilemma facing us.

  We backed down in the end, for the sake of safety to all concerned. Before making that decision the pilot radioed the tanker’s captain. By the time this conversation had finished I was not impressed. It transpired the thigh-bone fracture was already twenty-four hours old, and the ship’s medics had been able to rig up some form of traction. Traction is the medical term for pulling on something. With a broken leg or broken arm, pulling on it is an excellent way of reducing pain and blood loss. If in doubt, when faced with a fracture, try pulling on it. You are unlikely to do great harm, though there are some exceptions. The injured sailor was also receiving painkillers by injection, so it appeared everything was in control until the tanker could reach harbour. There was certainly nothing extra we could do. Crash landing a Huey on to their helicopter landing pad would do no good at all. We abandoned the rescue, somewhat annoyed that the ship’s captain had considered risking our lives for a casualty that was not an emergency. Scandinavia was not popular that night when we returned to Greboun to console ourselves in the bar.

  My reconnoitre of Haruj had shown me one vital point. I could not do my job without a woman. Bedouin culture was strictly sexist. In public there were two societies, one for women and one for men. Behind closed doors, as in the rest of the world, the situation was different. Girls frequently ruled the roost. As a man, even as a doctor, I would not be allowed to do much with female patients. They were frequently covered from head to toe, two tiny eyeholes in a hood-like arrangement allowing them to see. The response to my simple request ‘Can I examine your knee?’ would be to expose a few square inches of the area and nothing else. Without a woman to help me it would be worse than veterinary medicine if I was to deal with females.

  We were rescued by Rosie, a truly remarkable woman. Married to an ex-Royal Army Medical Corps officer, she was a London trained nurse. I think she was somewhat overwhelmed by the idea of going into the desert with an all-male SAS Squadron, but in the event volunteered her services wholeheartedly. At the start the SAS operatives were doubtful. Taking women on Squadron activities was not something the Regiment normally entertained. By the end of our tour she had reversed this opinion. Rosie was worth far more than her weight in gold.

  It is almost 300 kilometres from Koussi to Haruj. An easy journey by air, travelling overland is difficult. For most of the journey one is faced with endless miles of rolling sand dune. This is the land of Wilfred Thesiger who wandered the area with his camels and Arab friends. We did not have camels, but standard-issue Land Rovers. Dune driving, now a recognized adventure sport, was then almost unknown. The principle is to throw your vehicle forcibly at the things. Lowering the air pressure in your tyres to give improved grip, yo
u drive as fast as you can go down the side of a dune. The process is electrifying - and terrifying - with slopes being slanted often at sixty degrees or more. Once at the bottom you must not stop, but maintain a low-ratio four-wheel drive to the summit of the next dune. If you stop at the bottom you are stuck. The Ramlaat Bawiti is not a place to call out roadside assistance. Dunes can sometimes be 100 metres high.

  It took two days and several mechanical emergencies to reach Haruj. I realized then that desert navigation is a challenge. In Europe there is often a mountain peak, or a road junction, even a telephone box on which to base one’s compass bearings. The Empty Quarter of this barren land offers no such luxuries. Largely uncharted, your navigation points are being continually blown and moved by the wind. Salt marshes appear and disappear, tracks exist when they should not. The fact we reached Haruj at all, without the luxury of Global Positioning Satellites, was a credit to our Squadron navigation team.

  My impression of Haruj, having reached it overland, was very different to the opinion I had developed by air. Surrounded by rolling sand dunes, the village consisted of no more than twenty ramshackle huts. Twigs, corrugated iron, blankets, wire fencing were leant, one on top of the other, to make a Bedouin house. Usually one-room, never more than two, these tiny dwellings would house an entire family. Animals, primarily goats, would be outside, their dry black droppings littering the sand. Our oven-like patrol base was in the centre of Haruj, though it was too hot to remain in for long. By nightfall, when the temperature declined to frequently chilly levels, it became more tolerable. We slept in small tents to one side of the base, away from prying Bedouin eyes. On patrol, in the surrounding desert, there was no need for tents at all. A standard Army sleeping bag, fondly called the ‘maggot’ due to its bulging, transverse, down ridges, was all that was needed. Lay it on the ground, head on your escape kit, rifle in hand and off to sleep you went.

  Sleeping at night under a desert sky is a magical experience. I wish I knew more about stars. They must have incredible stories to tell. You are not alone, of course. The sand can come alive. Once darkness falls, a host of God’s creatures set about their respective tasks and most love the feeling of a warm body nearby. Into your maggot will crawl all manner of beasts: scorpions, spiders, even the occasional snake. Like Jack in the Far Eastern jungle, it is important not to panic if this happens. You lie very still, breathe shallowly and regularly, and feel whatever crawls in crawl out again. Easier said than done, may I assure you.

  Despite many creepy-crawlies, malaria was not a risk in the Ramlaat Bawiti - it was too dry. Mosquitoes need moisture to survive and water was in short supply. Sandstorms would occasionally whip up, particularly in the evenings. Sand gets everywhere when this happens. Eyes, nose, mouth, ears and, tragically, a Land Rover engine. You undertake mechanized desert travel without a mechanic at your peril.

  Despite Haruj’s initial appearance of being wild and uncivilized, its barren outer impression covered a warm, caring society within. Bedouin communities are ruled by the waalee - the head man. He is their direct contact with Government in Koussi. It is he you must woo and coax, in order to win the cooperation of his people. Haruj’s waalee was a small man. Small in body perhaps, but huge in character. Outwardly quiet, a word from him and anything was possible. He was an important man to impress. I tried hard, perhaps too hard at one point, convinced my medical skills were all that was needed to ensure lifelong cooperation from the Bedouin of Haruj. We had been there barely forty-eight hours when the waalee himself paid me a visit. Shuffling slowly through the hot sand, he knelt down outside my tent and put his head inside.

  ‘Tabib [doctor],’ he said. ‘Tabib, I have a problem.’

  I was resting after a particularly chaotic clinic, though sat up immediately I heard his voice.

  ‘Yes, what is it?’ I asked. This conversation actually took place in awful Hereford Arabic.

  ‘My son. Please come. He is not well.’

  I sprang to my feet instantly. The waalee’s son was perhaps the most valuable member of the Bedouin community next to the man himself. If the boy was sick, Doc Villar had to be on his best behaviour.

  ‘I’ll come right away,’ I replied, grabbing my medical bag as I crawled from the tent. It was a very hot, stifling day.

  As appeared usual in the Ramlaat Bawiti, all sick individuals were wrapped in several layers of blankets. The waalee’s son was no exception. Beneath a massive pile of at least eight of them, I found the terrified boy. He had already been half suffocated. Removing the blankets gave me an opportunity to look at him more closely. Certainly his temperature was high, well over 40 degrees Celsius, the normal being only 37 degrees. There were two sore lumps in his neck and two slightly red eyes, but nothing to explain such a high temperature and illness. No skin rashes, no enlarged liver and spleen, no infection of his waterworks. What the hell was going on? Through my mind raced a thousand tropical possibilities - impossible names like tsutsugamushi fever, onchocerciasis, toxoplasmosis. Then I thought to look in the boy’s mouth, mainly to check his tonsils. The tonsils were normal, but on the inside of his cheeks I could see dozens of tiny white spots. No! Surely not? But yes, these were the so-called Koplik’s spots of measles. An everyday occurrence in Hereford, but not something you would expect to see in a Bedouin village. I was as likely to see measles in Haruj as malaria in Hereford, though when I thought about it, I had seen that too.

  The waalee’s son represented the start of a massive measles epidemic throughout the region. In populations such as the Bedouin, who have no inbuilt resistance to the disease, measles can represent a medical disaster. Over the next two months I was to see dozens of measles cases, some patients almost dying from the disease. More than 80 per cent of the adult population acquired it and I imagine some perished, even though I was never told.

  There was little I could do for the waalee’s son, beyond reassuring his father that all would be fine. However, I felt that sedation would be reasonable, so produced my bottle of liquid sedative. It was marvellous stuff, perfect for quietening children and, I thought, ideal for the waalee’s son. I checked the instructions in my small reference book, administering the precise dosage to the child. The boy gulped it down enthusiastically. I then covered his tiny body with one blanket, not eight, and made sure he had enough air to breathe. The waalee was delighted with my treatment, producing his wife who lent support to his thanks. Happy with my administrations I returned to my tent, confident that I had secured the standing of the SAS in the Ramlaat Bawiti for the rest of time. Confident that was until the following morning. It must have been 4 a.m. Again, I was woken by the sound of a voice outside.

  ‘Tabib! Tabib! Please come! My son. He is not well.’ There was genuine terror in the waalee’s voice. I knew this was not the time to have a quiet discussion whether or not I should stay in my sleeping bag. You pick such things up very quickly as a doctor. I scrambled to my feet and walked briskly alongside the waalee to his house once more. There, reburied beneath the bottomless pile of blankets, was the little boy. He was stationary and barely breathing. His lips were a faint shade of blue and his pulse thready. He looked awful. I knew immediately what it was - the sedative. In my dose calculations I had not taken account of possible racial variation in response to the stuff. The quantities I had given were the same I would have prescribed an equivalent child at home. For the waalee’s son, never before exposed to the drug, the response had been extreme. It had flattened him out, making him unresponsive to anything his parents had tried. Effectively, I had overdosed him by at least three times. If I had known any Arabic swear words, I would have used them. The only way out now was to evacuate the child to Koussi, and evacuate him fast.

  The evacuation went well, without any radio jamming by the Russians, and all ended happily. By the time the child reached Koussi, the overdose was beginning to wear off and the boy starting to recover. By the time he reached his hospital bed he had returned to normal, without any long-term damage. I received
the credit for the cure, having created the problem in the first place, and the waalee had been shown to be of sufficient standing to merit an official Skyvan to fly out his family. It was a narrow escape that I never wish to repeat.

  Running a Bedouin clinic is an experience for which any amount of training in the United Kingdom cannot prepare you. The numbers are enormous. It was not unusual to find a hundred people waiting outside the surgery door each morning, sitting patiently in the sand. Rosie would take the girls and I the boys, and between us we would struggle through. Patient identification was a challenge. Firstly, the women were fully covered, making recognition impossible. Secondly, so many of the men had identical names. In one morning alone I treated eighteen called Hamed. I tried to solve the problem by asking a medical orderly to issue each new arrival with a left-luggage ticket. Instead of Abdullah, Ali or Ahmad, the patient simply became number 357 or whatever. This worked perfectly for several days, with patient records being kept by number rather than name. I then began to notice certain ticket numbers appearing more than once and not attached to the same patient. Apparently a thriving Black Market had developed outside the clinic, with luggage tickets being sold to see the foreign doctors. I abandoned the idea immediately.

  While Rosie and I ploughed our way through the morass of sickly Bedouin, SAS patrols throughout the area were doing the same. As well as treating patients they were doing their best to recruit young men to form a local firquat. They were doing well, with several tough young Bedouin signing up for duty almost daily. Generally the Ramlaat Bawiti was a safe region, but the presence of opposition dhows offshore, combined with occasional reports of border incursions, did give an air of unease to the situation - no more so than early one evening as I was returning to Haruj from an outlying village.