Knife Edge: Life as a Special Forces Surgeon (20 page)

Lighting for dentistry - achieving illumination of the little nooks and crannies at the back of the mouth — was a problem. Without good lighting much of dentistry is impossible. My solution was to hold a pen torch in my own mouth so I could direct the light accurately into the patient’s. This worked well unless the treatment was particularly lengthy. With the pen torch between my lips I was unable to swallow, which meant my own dribble ran down the pen torch into the patient. It was unpleasant for both of us, though fortunately not too many patients noticed.

Tooth extractions were great fun. If I had removed every rotten tooth I would have been clearing almost all Bedouin mouths of anything within them. It was important to be selective as I had no way of making false teeth. The only extractions therefore I undertook were for the most decayed. The average tooth is locked in tight and special instruments are needed to remove it. Each type of tooth, be it canine, molar or whatever, has a specific design of grasper dedicated to its removal. The principle is to push rather than pull at first. By pushing
in
you break its tight connections to the bone. If you pull before the connections are broken there is a chance you will chip off a piece of root. With a root left behind, the patient is likely to develop an abscess around it. By the time I had finished in Haruj I had nevertheless performed more than 400 extractions. A few, I confess, had shattered roots, not a fact of which I am proud.

With the SAS hard at work in the Ramlaat Bawiti, there was intense interest within the country’s Government as to what we were doing. No more so than from the Minister of Health. He was a pleasant, ambitious man, with whom I had liaised before leaving Koussi. When I had first asked him what the Government expected of us, he had replied that so little was known of the Ramlaat Bawiti that anything we could do would be fine. Once we had looked at fish smuggling and recruited a local
firquat,
of course. He did promise to visit us.

The day he arrived at Haruj we were four weeks into the job. I had gone totally Bedouin, with a lightweight cotton pyjama suit,
shimaagh
Arab headdress, and moderately respectable beard. I would walk either barefoot, or in sandals. The SAS operatives were looking similarly tribal, although the occasional vestige of military uniform still remained, such as khaki shorts or battered suede desert boots. The latter, fondly called ‘desert wellies’ were favoured items in the Regiment and always in short supply. When worn in Hereford, in combination with civilian clothes, they represented a type of badge of action. A label that said ‘I’ve been there and you haven’t’. Anyone wearing desert wellies in Hereford, bearing in mind the strong desert associations of the Regiment, was definitely the bee’s knees.

That morning it was, as usual, bright baking sunshine. The clinic had been uncontrollable and I was exhausted. Suddenly, at about 11 a.m., I heard the sound of a helicopter approaching. It was not a Huey, but was certainly white and spotlessly clean. I could see that, even as it descended from around two thousand feet. It was sparkling. Transfixed to the spot and wondering who this could be, I waited in the sand to greet the newcomers, hand to my forehead as I squinted into the sun. I had not noticed that my SAS operative colleagues had, to a man, disappeared.

It took another two minutes for the helicopter to land, by which time I could clearly see the Royal crest emblazoned on its side. As the Minister of Health stepped from the machine, closely followed by several aides, I began to feel exposed. I was filthy. So keen had I been to integrate myself completely into Bedouin life that, to an outsider, I must have looked disgusting. Having not had a bath since we arrived, I also smelt revolting. As the Minister crossed the fifty metres of sand between me and the helicopter I could see confusion in his expression. Where were those famous soldiers about whom he had heard so much? At one stage I saw his gaze strike me and then move on. He even started to turn back. Then, after a brief hesitation, his expression brightened as he turned in my direction once more. This was associated with an obvious shuffling in the sand either side of me - my SAS colleagues. Each had dashed back to his tent, quickly donned a spotless uniform and was now standing in even rank to my left and right. Rigidly to attention and looking every bit the perfect British soldier, it had been like an actor’s quick change at a Christmas pantomime. Of the entire base team, eight of us in all, I was the only one to look dishevelled, unkempt and dirty. The smartness of those beside me made my own appearance even worse. To the credit of the Health Minister, he ignored the insult, though what he would have told his masters in Koussi I do not know. With a brief handshake he looked me firmly in the eyes and asked, ‘Would you kindly take me round?’

The visit lasted little more than ten minutes. I could tell he was in a hurry, so concentrated on showing him priority problems. In particular, the communal water well that was littered with camel droppings. A young Bedouin girl also obliged by squatting in the sand to one side of the Ministerial party and opening her bowels, right in the centre of the tiny village. I could not have had a better display of poor hygiene if I had tried to set one up. Cat sanitation, defecating in the sand, was the only thing available to the Bedouin.

In hot sunshine the fresh motion would sterilize and dehydrate quickly, but the flies loved it. They would hop from there to your food. It was a perfect way of transmitting disease.

During that short tour, every point I made was absorbed silently by the Minister, who then turned to his aides behind and snapped his fingers. As if using some hidden code, one of them would write furiously on a tiny clipboard. I realized rapidly that the Minister was actioning everything I asked. Within those ten minutes, the village had been promised a new well, proper sanitation, a new dispensary and a measles vaccination campaign. How I wish I had such direct Ministerial connections in my current employment in the UK. It would normally take years to negotiate such things.

With the Minister gone, life returned to its usual cycle of clinic and village visits. Slowly we built up the confidence of the Ramlaat Bawiti Bedouin. It was a lonely job, though I had become accustomed to such feelings working full time with the SAS. However friendly one’s military colleagues, as a doctor it is useful to have medical people available with whom you can discuss cases and treatments. Otherwise it is easy to make the same mistake repeatedly. Moreover, when working alone, no one can tell you whether or not you are doing a good job. I began to feel very lonely in Haruj, despite Rosie and my SAS colleagues. I started to find it difficult to get out of my sleeping bag in the morning or to go to the clinic, and noticed it was taking me longer to make medical decisions. I decided the only way out was to add an extra dimension to my life - marathon running. I cannot explain why as it is a singularly mad idea to dream up in the middle of a desert. Each day, however, and for sanity’s sake alone, I would put on a pair of trainers and running shorts. Off I would go into the desert, up sand dunes and along gravelly tracks, training for the first marathon race I could find once I returned to the UK. It was my salvation. Every man needs his escape in life, whatever that may be. Marathon running was mine.

Physical prowess is important to a man, no more so than his abilities in bed with the opposite sex. The Bedouin are a tough lot - sexual prowess is important to them, particularly as the men get older. In one clinic, towards the end of an interminable patient queue, I came to an elderly Bedouin. His face was as weatherbeaten as they come, his hands knurled and wrinkled, his walking unsteady. Sitting on a stool facing me, his legs apart and his body supported by an irregular walking stick, he claimed his love life was at an all time low. Now, at the age of seventy-three years he was unable to satisfy any of his five women. Was there anything I could do?

I did not have the heart to explain that this was perhaps part of Nature’s ageing process, or that a man fifty years his junior would have trouble satisfying so many women simultaneously. It seemed fairer to let him work it out for himself. However, he looked undernourished, so I gave him a multivitamin injection, a treatment I was sure would do no harm. Unfortunately, I had not reckoned on Bedouin resilience.

The moment I injected him, surrounded by twenty onlookers, his face perked up, his stature broadened and the walking stick was left to gather dust in a dispensary corner. Out he strode, much to the delight of the surrounding throng, shoulders drawn back, an even pace to his walk.

For three weeks he barely emerged from his dwelling except to say, ‘That injection was marvellous,
Tabib
.’ Then, early one morning I saw him at the front of the queue, no longer his rejuvenated self. Back in his hand was the walking stick, his stature stooped, his head bowed. I took him to one side.

‘What’s the matter?’ I asked, after the usual sequence of mumbled greetings.

‘My wives,
Tabib
,’ he said. ‘Now they want your injection too.’

The old man and his impotence was an excellent example of maintaining the confidence of one’s patients. The injection worked wonders and was something for which the patient will be for prospect of dozens of rampant Bedouin males, each trying out my new wonderdrug, that I called a halt to the idea immediately.

You can find yourself up against formidable local, medical opposition. Cupping, or branding, even bloodletting, were all practised by unqualified Bedouin practitioners. Branding was the commonest. The principle is to take a hot stone, or glowing ember, and apply it to the painful area. Wherever there is pain, that is where you brand. I have seen it done. The smell of burning flesh is foul. If you have abdominal pain, then your belly is branded. If you have leg pain, so your legs are branded, and so on. Branding does sometimes appear to work, perhaps because the patient is so terrified of what is going to happen if he claims persistent discomfort that he tells lies to avoid further treatment.

Unfortunately branding may do little for what is called
referred
pain. For example, it is common to feel the pain of a heart attack in the left hand, or that from gallstones in the right shoulder. Sciatica, the pain from a slipped disc in the low back, is classically felt in one or other leg. Branding for these conditions is worthless. Nevertheless, irrespective of one’s own feelings about such treatments, it is important not to belittle the local practitioners in the eyes of their own people. Wherever I go in the world I always put them on a medical pedestal, and keep them there. You gain their support and do everyone more good in the end.

As a Squadron we felt it was important to win over the locals. To do so meant entering into every aspect of their lives and showing respect for their customs and traditions. So we ate with our right hands, not our left, and always took time off to have tea and sickly dates before discussing business. We would never show the soles of our feet to anyone and would not look at their women, which was the most heinous crime. The result was that we became gradually accepted by the Bedouin of the Ramlaat Bawiti, and were occasionally given presents. I remember one well - a huge, shark-like fish. We were very excited by this, having survived for weeks on military rations. Anything fresh was a Godsend. We cooked it immediately, spending most of that night around a fire telling each other stories as we digested the meal.

It was at 3 a.m. that it hit me. Acute, colicky, central abdominal pain. Not only was I smitten, but many of the others were as well.

One by one we succumbed to the most florid gut rot I have ever known. Within hours our supply of lavatory paper had been exhausted, the only paper left being paperback novels. By the time we had recovered there was barely any reading matter left in Haruj. Mixing with the locals had certainly taken its toll. We subsequently discovered that this particular fishmeat carried a high concentration of a chemical called ammonium. In our haste to celebrate the gift, we had not checked how it should be cooked. After we had recovered, the locals told us the meat should normally be buried in the sand for at least twenty-four hours before cooking, to allow ammonium to escape. The episode did not do my local reputation any good. In Bedouin society, if a doctor is any use at his job he will not become sick himself.

One major reason for our base in Haruj was to prepare what the Army calls a ‘medical appreciation’. This is a detailed medical report that allows a complete view of an environment and its medical problems. The SAS may be excellent at looking after itself for weeks on end in a disease-ridden land, but if larger numbers of more routine troops are to follow, particularly those without desert experience, the Army will need to be fully informed about possible medical risks beforehand.

In war, illness is the greatest cause of casualties. The second commonest cause is being shot by one’s own side. The least common is being shot by the enemy. If you are shot by enemy action the chances of death are even smaller. Contrary to belief, the majority of soldiers are fairly safe in a war zone. Preparing an appreciation is a time-consuming task. It goes on for pages. The document, typed finger by finger on a manual typewriter, took seemingly for ever to complete. My only consolation was the knowledge that I was bound to be handsomely rewarded before I left. Everyone was. I was certain I would not be an exception.

The standard gift, for those who had pleased the local system, was a gold Rolex watch. All those at Hereford who had served in the Middle East sported a magnificent, sparkling timepiece. That, I thought, is unquestionably for me. Unfortunately I already owned a Rolex, though of stainless steel design, given to me by my parents on qualification as a doctor. Because of family loyalties I had no intention of displacing my stainless steel one, but having
two,
that would be wonderful. I knew my best chance of receiving the gift would be through the Minister of Health.

It came to my last day in the Middle East. The Squadron had been extracted from its various locations and I had completed my laborious medical appreciation. When he had visited Haruj, the Minister had insisted I report to him on my journey back through Koussi. On this occasion I did just that, sprucing myself up with an immaculately pressed uniform, clean shaven and desert boots as smart as they come. I looked the immaculate British soldier. I did not wear my winged dagger beret as this was felt to be politically unwise. Consequently, I dusted off my little used Medical Corps hat and presented myself to his staff and secretaries, appreciation tucked under my arm. I was, of course, bare wristed, my stainless steel Rolex hidden firmly away in my trouser pocket.