A common request when working overseas is to perform a demonstration operation for local surgeons. I am always happy to oblige, provided I am not expected to do something too unusual. Hamsharry requested I demonstrate a hip replacement operation. As I do hundreds, if not thousands, of the things back home it seemed simple enough. Fresh in my mind, however, was the memory of a similar operation in Teheran, the previous year. There, with cameras in the operating theatre around me, a simple operation nearly turned to disaster when the thigh bone fractured in mid-surgery. Fortunately we spotted the problem at an early stage. We managed to salvage the situation, and complete the operation, without anyone else realizing what had taken place. It was not an easy task and certainly not a performance I wished to repeat in Hamsharry.
News of the demonstration spread like wildfire. One of the major orthopaedic manufacturers flew in a massive quantity of equipment from overseas for the occasion, accompanied by several support and marketing staff. It was to be the first replacement of its kind in Lebanon and they wanted to be sure they were there. The day arrived and the operating theatre was bursting with onlookers. When that happens, a major difficulty is to ensure surgery goes well, while still affording a good view to those who have travelled many miles to see you. The greatest risk is infection. Though it is an unpleasant thought, all people teem with bacteria.
The skin is covered in the little beasts, though they cannot be seen. The sites of maximum contamination are the nose and groin. Anyone who wears a skirt pours the things on to the floor. For this reason trousers are much preferred in operating theatres as they contain the bacteria inside the clothing until released into the changing room later. Those performing the operation wear special clothing throughout surgery to seal off their bacteria from the patient. Those watching do not. If the observers come too close to the patient during surgery it is easy for bacteria to infect the open wound.
As surgery began, all appeared to go well. The incision was made, bleeding controlled and the hip dislocated. There is always a wonderful graunching sound when that happens, enough to test the strongest stomach. The observers were fascinated. Someone was also using a video camera, its dangling lens cap swinging perilously close to the patient. At times it hovered only inches away. The observer would not have achieved a better view had he climbed into the wound itself. Behind me voices were arguing.
‘Out of my way.’
‘Give me room.’
‘Let me have a look.’
‘Come on, it’s my turn.’
People elbowed their way forward to see more. The only way those of us operating could prevent transfer of bacteria into the wound was by sticking out our bottoms to ward off the observers. We struck a strange sight doing so, but fortunately completed the procedure successfully within an hour. Never could one see a happier surgical team. When we inserted the final skin stitch to close the huge surgical wound I breathed an immense sigh of relief, only then removing my buttock crowd barrier. It was as I removed the restraint that the entire mass of observers almost collapsed on to the still sleeping patient. I had to smile, so close to the wind had we sailed. You can never tell when overseas. It will be a few years yet before I feel brave enough to try a demonstration operation again.
Maintaining sterility of the patient during operations is a skilled, difficult task for which surgeons and their teams train for years. Essentially, the moment you have scrubbed up and donned your gloves, mask and gown, you can touch nothing except the patient until surgery is complete. Should you develop an itchy nose, become desperate to have a pee or become uncontrollably overwhelmed to smoke a cigarette, it is tough luck. Touching anything other than the patient risks infection being transferred to the wound from elsewhere. You must stay at your post, whatever the consequences, until the task is complete. Imagine my discomfort on one occasion when I had to perform a single operation that was nine hours long. My bladder had by then distended upwards to my diaphragm and I could barely breathe without wetting myself. Imagine also Fred’s predicament when his trousers fell down in mid-operation. Surgeons’ clothing was at a premium in Hamsharry and he had been obliged to wear the only remaining pair that day. They were far too big for him and, predictably, ended up around his ankles during a particularly difficult operation. Baring your backside to unsuspecting theatre staff, male or female, is not a recommended act in Arab society, however unwitting the occasion. Fortunately, and judging by the laughter echoing round southern Lebanon that day, Fred’s involuntary display was taken in good spirit as theatre staff queued to pull up the offending items.
I was sad to leave Lebanon, most particularly its Palestinian people, who must be some of the bravest, most resilient, individuals alive. During our stay we had seen and treated several hundred patients who had borne their conditions valiantly, often for years, before corrective surgery was possible. It had been exhausting work, for both surgeons and patients. Perhaps I’ll go back one day, if they’ll have me. Who knows? They might even have a homeland by then. They certainly deserve it. By saying so, of course, I enter politics at my peril.
CHAPTER 11
The Forgotten People of Sarajevo
The Hercules was descending rapidly, its frame rattling and shaking with strain. ‘Hold on tight!’ I heard the loadmaster scream over the deafening noise of the throbbing engines. I glanced over the mound of freight lashed to the aircraft’s floor to see him grip the edge of his flimsy seat. Determination was written on his face. Surface-to-air missile attack was a genuine risk. Already one Hercules had failed to make it.
Sarajevo, this is where I meet my Maker I thought, as the angle of descent grew still steeper. One engine whined loudly as we picked up yet more speed. Through my mind flashed images of Serb snipers aiming their telescopic sights upwards, indiscriminately firing at whatever they could see. It was not unusual for United Nations aircraft to land peppered with bullet holes. The Germans were favoured targets. Sweating, I tucked the protective groin flap of my body armour still further between my legs, and perched myself on top of my Kevlar helmet. It would be my backside or privates the bullets would hit, if I was to be the chosen one.
‘Oi!’ yelled the loadmaster at the top of his lungs, addressing our motley group of eight terrified individuals. ‘Listen in you lot! When we hit the ground I want you out fast, and running! Grab any two bags, it doesn’t matter if they’re your own. We can sort that out later!’ Each of us nodded slowly, faces worried. The war beneath us was in full throttle. Every brokered ceasefire had failed, the land was alive with ruthless, gun happy militias. God help me, I thought. I had made it through a lot of things in the past. This? I had no way of knowing.
It had started with Irma, a young Sarajevan girl caught as an innocent victim of the Bosnian war. Stranded in Sarajevo’s State Hospital, doctors had felt she was dying due to lack of basic medical care. The world had thrown up its arms in horror as her plight touched millions of hearts. John Major, on the UK’s behalf, had stepped in to fill the breach. At the time, the conflict was a distant affair to me. Genocide was not something I really understood. Naturally, I had heard the news reports but putting figures and faces on the situation was impossible. It was another person’s problem, not mine.
The situation changed one damp Thursday afternoon when the letter arrived from a charity, World Orthopaedic Concern. It looked lonely, lying on my doormat, the envelope creased, stained and accompanied by a misspelt note from doctors in Sarajevo. A non-governmental organization, an NGO, was seeking surgical support for the beleaguered city and had approached WOC for advice. For some reason, they had recommended me. The NGO wanted surgeons on the ground, deep within the city, in a matter of days. Could I help? I should have known better. I was becoming accustomed to my relegated role of armchair warrior. Deep within me, however, still existed that voice of adventure. However old and crumbly I become, the voice speaks now. As I read the letter, struggling to understand it in places, I could feel the tiny spark become a blaze. Someone had to do it. Someo
ne had to show it was possible. It might as well be me.
Louise thought the idea crazy. ‘It’s not your war,’ she observed, her voice tense. She could see my distant expression the moment the envelope appeared.
‘I know that,’ I replied. ‘But can’t you imagine how awful it must be to live in Sarajevo? Think if it was Manchester, or Exeter, or Bristol. Those people are just like us.’
You cannot expect a mother with three children to support such things, whether or not she has undergone military training. Her whole being cries out for the security of her family. For two days I pounded the narrow corridors of our house, struggling to balance family duty with what I had been asked to do. It was an impossible decision to make. I knew if I did not move fast, the opportunity would be missed. As an SAS doctor I had resolved always to say ‘Yes’. So ‘Yes’ I said to Sarajevo.
It was an immense task, not something I could handle alone. Sarajevo’s orthopaedic surgeons were lacking large quantities of vital equipment. They were also short of people. Death, injury or evacuation had reduced their ranks to the few still able to work and survive. Within four days I had made contact with almost every orthopaedic consultant in the United Kingdom - there are more than a thousand - and had twelve volunteers able to drop everything at short notice. They were helping with an enterprise they, or I, knew little about. Suddenly, television news broadcasts assumed a most intense meaning. Every death or massacre filled me with dread. No longer were broken ceasefires other people’s problems. Now they were mine as well.
The NGO was small, though highly motivated. Its chief field worker was Simon, intelligent, well-used to conflict and an obvious adventurer at heart. Earlier work in Afghanistan had made him fairly war-wise. However, twelve surgeons, eager to help, were more than even he could handle. Within a few days I had whittled this number down to four, one nurse and a tough, capable operating theatre assistant. The pruning largely took place by natural selection. As the time to departure grew nearer, so I would receive more telephone calls and letters withdrawing initial enthusiasm. Wise folk, I secretly felt, sympathizing with the anxieties felt in orthopaedic households up and down the land. This was not to be a low-key charity task in some warehouse far removed from the fighting. We were being asked to work in central Sarajevo, only yards from a bloody front line. For myself, I was now thoroughly committed and could not opt out if I had tried.
Going to war as a civilian is totally different from conflict with the Services. The Government guards its intelligence jealously - such information is not for general consumption, certainly not for civilians. No satellite photographs, no detailed maps, no emergency evacuation routes, no briefings on the warring factions. The SAS would have told me all this. No such luck in the UK’s civvy street.
You must start from basics. Obtaining volunteers is just the start. Thinking as pessimistically as you can is the only way to survive. What happens if I die, I thought? I had to see what I would be worth if a Serbian sniper decided I was flavour of the day. Already I had upset Louise by volunteering for Sarajevo and had disrupted our planned family holiday by offering the same dates to the NGO. The last thing I wanted was to leave her penniless if I was killed. I contacted the handful of companies who have the misfortune to insure my life. ‘No problems,’ they proclaimed to a man, or a woman in one case. ‘We’ll pay the lot if you die. Good luck to you.’
I felt mightily relieved, until a colleague asked me one morning, as I sat in another terrified daydream, ‘What about injury, Richard? Say you get your hands shot off? What then?’
Confidently I replied I was sure there would be no problem. As I spoke, doubts were ringing noisy alarm bells in my mind. In peacetime I insure myself for such things. If I lose a hand, or my fingers drop off, I should be worth a fortune. In war, as I soon discovered, the situation is different. No one would insure me for injury, only for death. The risks were too great. Everything I had ever subscribed to protect against injury would be null and void if I returned, unable to work. War zones were major exclusions.
This was a problem. For a moment I considered aborting the project. I already knew that the chances of injury were far higher than the chances of death. Simon saved the day through contacts at Lloyd’s of London. They agreed, at enormous cost, to insure our team. My premium alone was ten thousand US dollars each week, the other team members being extra. The NGO was still in full support, so determined was it we would go ahead. Anything we required seemed fine.
By now Sarajevo was becoming even hotter. NATO jets were making bombing runs over Serb gun positions and the city wanted us there as fast as possible. Apart from Simon, only two of the group had previous war experience, an ex-Marine and me. The remainder had never seen such things before. It was colossal bravery on their part. Every news bulletin carried further evidence of death and destruction, with aid workers now appearing to be legitimate targets. I could see obvious worry in their eyes whenever we met to discuss our plans. Wills were written, relatives and parents telephoned and re-telephoned, personal equipment packed and unpacked a hundred times. I knew the feeling so well, having sat for days awaiting my certain death during the Falklands War. You daydream and ponder. You lie awake at night. Permanently you carry a pale, stressed expression.
Protection was vital, both physical and political. The physical side was well catered for with body armour. Theoretically you can cover yourself from head to toe with armour, like a personal tank, but the weight makes walking impossible. Protection is a compromise between safety and mobility. Both suffer to a degree.
Once you start choosing designs it is impossible to know where you should stop. There are blue ones and red ones, even white ones and purple ones. Some go under your clothes and some go over them. Some have high-velocity protection plates front and back, others do not. The choice is mind-boggling. Kate Adie, the UK’s renowned BBC television journalist, came to our rescue, though she never knew it. I had always been impressed by her. When all hell broke loose around, she had that uncanny ability to appear relaxed and controlled. She is like that, too, when you meet her. On this occasion it was her body armour we loved. It appeared perfectly tailored, ready for anything war could throw at it. At every broadcast we scrutinized her form, not for the content of its journalism, I must confess, but for her design of body armour. ‘That is what we want,’ we universally agreed, if it’s good enough for Kate, surely it will be good enough for us?’
If you are male, the most important part of body armour is the groin flap - psychologically at least. Being shot is one thing, but being shot in the balls is another. When I go to my grave, however God chooses, my manhood goes with me. The groin flap is your salvation. Normally concealed within the body armour it can be pulled out any time you wish. If you genuinely think a Serb is about to take a pot shot, pull it down. It won’t alter his aim, but it will certainly make you feel safer. I look at male war correspondents with renewed interest now. If their groin flaps are down I know they are really worried.
Political protection was also essential. What, I asked, would happen if the Serbs overran Sarajevo while we were there? When the project was first suggested, no contingency existed for our rescue whatsoever. We would be on our own. Operation Irma saved the day. The young girl, perilously injured, had been evacuated to London’s Great Ormond Street Hospital. The politicians wanted Britain to appear fully involved as soon as possible. Our group was poised to move, which suited the UK’s Overseas Development Administration well. Suddenly, after a mere handful of telephone calls, we changed from an independent charity to a team under ODA control. Having ODA backing would not force a sniper from his target, but was a major layer of protection for the team. If the SAS had taught me nothing else, it showed successful survival is based on precise organization and anticipation of impending disasters.
First stop, via a tiny Fokker aircraft chartered specially for the team, was Ancona in Italy. Its airport was a hive of activity, Hercules transports from a variety of countries coming and going
regularly. It was the home of Maybe Airlines - maybe you’ll make it, maybe you won’t - the unofficial name of the massive United Nations airlift needed to keep Sarajevo alive. Ancona also highlighted one of the tragedies of war-relief work. In the pouring rain stood tons of flour being ruined by damp. Damaged medical equipment lay scattered in puddles of water to one side of the runway, in company with several discarded containers of military rations. Service life trains you to be a magpie, so within minutes I had encouraged the others to take what they could carry from the pile. If it was no use for us, we could certainly leave it behind in Sarajevo. Looking at the mound of damaged goods and equipment made me doubt how coordinated such massive relief projects can ever be. Public funds, and individual donations, had probably been used to bring the items together. I would be horrified if my hard-earned charitable donation lay in a puddle of water somewhere in the world. The fantasy of aid to an area of conflict is a sharp contrast to reality on the ground.
War zones are not pleasant places and Sarajevo was no exception. The first thing to strike you, surprisingly, is the silence. Much of the time there is eerie quiet interspersed with the occasional thump of a mortar round, or crack as a bullet flies by. That day, Sarajevo airport was deathly silent. All around lay evidence of the intense shelling that had gone before. Shattered glass fragments, earthen craters, surrounded by the hulks of burned-out personnel carriers and aircraft. The soldiers were similarly silent. No smiles, no warm welcomes. Just a lifeless stare as you walk by. Many had seen friends killed or maimed by the conflict.
Knife Edge: Life as a Special Forces Surgeon Page 32