Knife Edge: Life as a Special Forces Surgeon (17 page)

‘We’ve got to get her out,’ I said, turning towards John, the SAS signaller now beside me. ‘Can you call up HQ and get a casevac under way?’

‘Sure, Doc,’ came the confident reply. ‘Get on with what you have to do. I’ll see if we can get a Skyvan to take her out. Where to? Greboun?’

‘Greboun will do. Or Koussi if that’s easier. She needs a surgeon and operating theatre fast. I can’t open her up here. The place is too filthy. She’ll die under anaesthetic for sure if I do.’

John nodded and walked away through the dirty sand towards the patrol base. A ramshackle building, roofed with corrugated iron, it had been a bad choice. With desert temperatures often over 40 degrees Celsius it was like working in an oven for most of the time. One of the best with a radio, I was sure John would be able to raise Squadron Headquarters in Koussi’s Messouda Camp in no time. I turned back to the young girl. I would have to do what I could to save her.

‘Ergometrine,’ I muttered at the Pakistani dispenser who was also standing beside me. ‘Can you draw some up? It might just do the trick. And a drip. Haemaccel fluid, I think. Can you run one through?’

The dispenser nodded his understanding and strode purposefully towards his Portakabin dispensary, only twenty metres away. The girl was too sick to move, so I would have to use the back of the Toyota as my resuscitation room. Within minutes the dispenser had returned, syringe in one hand, drip in the other. It took no more than a minute for me to insert the small butterfly needle into the back of the girl’s forearm and start running the lifesaving fluid into her. Human blood would have been best, but I did not have access to any in the middle of the desert. A plasma expander was my only alternative.

With the Haemaccel running I tentatively lifted the coarse, black material of the girl’s dress. Not a dress by any Western standards, but a thick cloak-like affair covering her from neck to foot. Her veil had long been cast aside by the futile attempts of others to help her. Bedouin etiquette demanded that I did not expose her. So, with a degree of groping, I felt for the smooth flesh of her outer thigh, disinfecting it with the disposable alcohol swab before plunging in the needle. It was a big needle, long and broad, to ensure accurate placement into the muscles of the thigh. The attached syringe was small, ergometrine injection only being tiny in volume. Even so, it was a powerful drug, well able to force a womb to clamp down hard on the placenta, reducing any blood loss. The clear fluid emptied into the girl’s thigh rapidly, though I could see her wince as I pushed the plunger.

Removing the needle and syringe I placed my hand on the girl’s stomach, massaging her lower abdomen slowly. Gradually I could feel her womb beneath my hand contract tightly, becoming still harder as each second passed. Good! The ergometrine was doing its job. Then, with my bare hands, I reached up under her dress once more, fumbling now for the blackened umbilical cord. I felt it with the back of my hand, wrapping it around my fingers to get a good grip. Then, still massaging the belly with my other hand, I gently but persistently pulled. Nothing happened at first. Then, slowly, I felt the placenta give way, releasing its tight hold on the inside of the girl’s womb. There was a loud gurgle as it was finally expelled. Old, smelly, black, clotted blood followed it.

By now I was covered with blood. My fingers, forearms, even my legs and desert sandals. Blood goes a long way when it decides to spread. The girl was still breathing shallowly, her eyes closed. At least she was alive. I laid the placenta on the floor of the Landcruiser to examine it. Damn! It was not intact. At one corner I could see an irregular rent. That meant a piece was still stuck inside her. There was no way I could get that out without surgery. The girl was in desperate need of medical evacuation. In spite of my efforts she would die for sure if she stayed in Haruj much longer.

Two hours after her arrival we were still no nearer to arranging the evacuation. John had tried one frequency after another, but to no avail. We had been warned that Russian ships off the coast might try and jam our signals. This was obviously happening. John sat there continuously, doggedly hammering away at his Morse key, praying that Koussi would respond. There was no answer.

It took seven hours to get our message through to Squadron HQ. Some bastard off the coast was taking pleasure in imperilling the life of an innocent civilian. I was frantic with worry, likewise the women who had accompanied the girl. The combination of ergometrine, Haemaccel and my extraction had improved her visibly, but she was still not yet out of trouble. Three days is a long time to bleed, however resilient and youthful you may be at the start. She could still so easily die.

Eight hours later, a military helicopter arrived from Greboun, landing with a flurry of sand beside the dispensary. With its arrival, our problems were still not over. The girl’s husband, who had arrived late and had not witnessed the drama unfold, refused to allow her evacuation. This was deep, traditional, Bedouin country. What the husband decreed was gospel for his spouse, even in matters of life and death. It needed an armed SAS medic to force both patient and husband on to the helicopter at gunpoint. The soldier held an accurate aim at the man’s head, fortunately with the support of several Bedouin onlookers, until the aircraft left the ground. Bedside manner can take a variety of forms depending, of course, on circumstance. The girl reached hospital within an hour and was on the road to full recovery the following day.

The Squadron’s work in the Middle East added to a comprehensive history of SAS desert warfare. The Regiment was created in the deserts of North Africa during the Second World War and since then had spent much of its life in the desert. The Jebel Akhdar, the Musandam Peninsula and Operation Storm in Salalah were all major features of SAS life. This visit, Globe Trotter, was the Regiment’s first major trip to the Middle East after helping win the Dhofari war in 1976. Largely a training mission, behind it lurked several clearly defined tasks. Fish smuggling was one. It appeared that fish were being pulled from the Gulf of Greboun and illegally shipped across country to a welcoming neighbour. To help stop this, as well as reinforcing support for the Sultan in the rural areas of the land, local militias had to be strengthened. Basing our activities on a hearts and minds facility, we were to recruit Bedouin Arabs to work as a local militia - the
firquat
. Few recruits for the army came from the Ramlaat Bawiti, a trend the military hierarchy was keen to reverse. Border and internal security were, and are, significant issues in the Middle East. At the time of Globe Trotter there was a major border dispute in the north with a neighbouring power, while armoured dhows from an unfriendly Arab cousin were often being chased from oceans nearby. No one could accuse the land of being quiet and peaceful, however beautiful it might appear to the untrained eye.

Our task was to set up the hearts and minds facility. Unusually, we had time to prepare. It started, as always, with a casual approach from the Squadron commander, Major A. He was an unassuming man. Highly professional, extraordinarily nice, it took others to tell you of his medals for gallantry or of his command and control of the Iranian Embassy siege. He had no reason to boast and was highly respected as a result. ‘I want to do this one properly, Doc,’ I recall him saying. ‘You’ll have time to train the lads. We can really make it work.’

Train I did, both the operatives and me. The Squadron was well endowed with medics, most of whom needed simple updating.

For myself, it was veterinary training I sought. I felt I knew human beings pretty well, they were my trade, but animals I barely understood. We had only had a dog for eighteen months during my childhood. The dog, a hamster and a few goldfish were all I could muster. Even the goldfish I had managed to kill. I knew how much the Bedouin Arab relies on his animals. I was bound to be faced with veterinary problems at some point.

So off to Melton Mowbray I went, the home of the Army’s Veterinary Corps. They were very helpful, teaching me how to hold and shear sheep, deliver foals, clip the nails of rabbits and even shoe a horse. Unfortunately, camels and goats were not their forte, so though I left Melton Mowbray much enlightened, their instruction was not a great help for the Middle Eastern wastes. I was to run into trouble later as a result.

Then there was Arabic. French I can handle, even Latin or Greek. Arabic was a different matter. I have never understood how or why people read from right to left rather than left to right, nor use a script that to many is little more than a squiggle. That is, of course, a reflection of my own ignorance. However, if I was to communicate with my patients, Arabic it would have to be. The SAS Arabic course was fascinating, even if many of the phrases it teaches involve moving machine-gun positions, priming grenades and showing local soldiers how to stand to attention. None of these were the least use to a doctor attempting to establish the cause of a Bedouin’s abdominal pain. Nevertheless I enjoyed myself. What is more, I passed top of the class, an utter rarity for me. I loved the sequence of greetings and lengthy conversations required before business is ever discussed.

As-salaam alaykum
(peace be upon you)

Wa alaykum as-salaam
(peace be upon
you)

SabaaH al-khayr
(good morning)

SabaaH an-noor
(good morning to
you)

Kayf Haalak
(how are you?)

Zayn al-hamdu lillah
(well, thanks be to God)
wa anta
(and you?)

Zayn al-hamdu lillah
(well, thanks be to God)

And so it goes on, for as long as you wish, inquiring after the family, the in-laws, the goats, even the weather, until the essential topic is reached. Such an approach does create very lengthy meetings but ensures absolute tact and diplomacy at all times. By the time I had finished with the greetings I found it impossible to be argumentative when discussing the key subject. Thus, clutching my colloquial Arabic dictionary and a copy of
All Creatures Great and Small
as a veterinary textbook, I boarded the now beloved Hercules aircraft for our painfully slow flight to Koussi’s Tafasset Airport.

The country is now a thriving, high-profile, very prosperous land. In 1981, the year of Globe Trotter, it was still struggling. When I reconnoitred the village of Haruj, our area of operations, I was horrified. There was nothing. Little more than a few ramshackle houses, a contaminated water supply, and goats and camels as far as the eye could see. The locals greeted our arrival, in a noisy Huey helicopter, as a gift from Heaven. Immediately we were surrounded by chattering men and women, each offering us dates and tea. Each wanting his or her own moment of discussion with these strange beings who had miraculously appeared from nowhere. It made an assessment difficult but superficially it seemed a good location from which we could work.

As I leapt from the helicopter, determined to make a good impression on our impromptu reception committee, I sank up to my knees in sand. I understood immediately why the helicopter pilot kept his engine running, maintaining a theoretical hover millimetres above the ground. I fell forwards on to my hands, instead of effecting the professional exit I had planned. I laughed. I had to, as for those present I must have looked like His Holiness the Pope, kissing Mother Earth on arrival. It was so like the story of one of the RAMC’s model women doctors in Northern Ireland. Called in haste to the scene of a terrorist bombing, she had been landed by helicopter in a ploughed field. It was only as she stepped gracefully from the aircraft, medical pack in hand to rescue a mortally wounded comrade, that she realized her high-heeled shoes were still in place. Stranded in the field, skewered by her heels, her attempts at resuscitation had to be conducted barefoot. I had no high heels in the desert, but the sand’s softness was just as good.

In Haruj, a small Portakabin dispensary already existed, manned by Ali and his two medical assistants. Ali was from Pakistan and not overly happy to have been banished to the wilds of the Middle East as a dispenser. His skills were good, but he was not medically trained and there were obvious limits to what he could achieve. However, I detected immediately that his heart was in the right place. He cared for his patients and wanted the best for them. He greeted me with open arms, showing me around the dispensary with great pride.

‘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.