It is usually thoughts of breast cancer prevention and
treatment that occupy me most of the time, but for the last week or so I have
been distracted by the close of an interesting chapter. There is every likelihood that this will be
the last word on a time which is already fading into memory, and so far is it
removed from everyday life that if not properly shared or recorded I might
believe had never happened. Three
years ago I went to war in Afghanistan, ran surgery in a combat hospital,
survived missile attacks, and came home.
The official reason why we went was drummed into us through
numerous media training sessions. That
“Singapore wants to play a responsible role as part of the international
community to assist in the reconstruction of Afghanistan.” On a personal level, the best account I have
heard of why we went is by my colleague Mathew Cheng. “I had the skills, and I
was willing”. The need was clearly
there, and we went. On my part there was
also a certain amount of professional curiosity. I had seen and treated urban trauma on an
industrial scale after nine months in Johannesburg and I wanted to see how much
of that was relevant to the military. To
do that I needed to understand what the military needs are and the best way to
do that was to go.
There was a period of “Force prep” before leaving. The weapons and personal protection gear had
undergone significant changes compared to the time I was in a combat unit.
Everything seemed heavier. Most
noticeably the regulars we were with had no problems about motivation. Neither did the instructors from Guards
HQ. Unlike other training this one had a
clear objective in mind, not some nebulous possibility of defending the country
for some external threat. And as a
result of that at quiet moments you could see around you the quiet, unexpressed
hope that we would be good enough.
The truth is that we were not in constant danger, but danger
was a constant sudden possibility. It
came in the random times and places where poorly aimed missiles would land and
you took what precautions you could and got on with it. It did not really give much comfort that
these missiles were not aimed at you personally. Mathew and I were the only non career
soldiers in the NATO hospital where we were but we soon developed that common
trait of professional soldiers; a kind of quiet detachment and determination to
just get on with things.
We did see first hand the one constant of war: that young men die, and that doctors cannot save
all of them. there are some distinctions
between young men dying in a war and
those on a bike or from a fight in a bar.
Firstly there are a lot less dying in a war than on a bike or in a car. The action, while occasionally hectic was few
and far in between, which is the characteristic of this low intensity
deployment. Even in peaceful sterile
Singapore there are a lot more people being injured on the roads and
construction sites than in this kind of warzone. Secondly the energy transfers
were on a different scale. Bodies are broken
on a bike, they are blown up in a war.
The first major contact was typical:
two casualities from an IED ambush.
The gunshot chest was easily sorted with a chest drain. His squad mate came in in two different
vehicles four hours apart, one as charred bits in a sack. The first piece they could identify from
dental records, the second from DNA from
a lumbar vertebra I helped to pick out.
It is the challenging, potentially unsolvable problems that
remain in the memory. The young girl who
had been in the hospital for so long that she could speak Dutch, her fractured pelvis
with a temporary fixator that would be permanent unless we could improvise
something. A young boy with a fractured
femur that again had a temporary external fixator that we did not have the
equipment to sort out. The sad thing
about a combat hospital is that we are kitted out to treat soldiers, the
civilian load is just patch up and send up.
But Afghan kids have nowhere else to go. Matt sorted both out with great ingenuity and
skill. There are a few afghan kids now
with titanium implants improvised from used Apache helicopter parts.
For me the nutcracker was this 18 month old boy who looked
about the size of the average nine month Singapore baby with a stone in the
urethra. It was firmly stuck obstructing
the urine flow and as the dammed up urine got infected he had sepsis and renal
failure. We had a wonderful pediatric
trained intensivist in among our dutch colleagues who sorted this out within a
week but the stone remained. I remember
the uncle had brought the baby to us after an eight day walk and then had to
return to his farm, leaving a 14 year old brother to take care of the
child. I had only seen the operation
that was needed more than a decade ago in ideal conditions in NUH. That time it was performed by a gifted pediatric surgeon and even he
found it hard to avoid injuring vital structures in the penis, which would have
led to lifelong obstruction, recurrent infections and eventual kidney
failure. The more I read up the
operation, looked at the humungous size of our surgical instruments and most of all the sheer inadequacy of my skills, the more I dreaded doing anything. Every morning I would go to the ICU and see the baby get better and feel that stone still stuck in the urethra, the urine draining from a catheter through the lower abdomen improvised from a large intravenous line. There is a timing to surgical intervention and as colleagues watch me miss my cue day after day I say a quiet prayer about primum non nocere. After about 10 days with us the uncle comes
and expects to take the child back. We
put the kid under anesthesia and a miracle.
The stone shifts down to the tip of the penis and it’s removed without
difficulty. Delirious with relief it was
the time when I wished most of all that there was any kind of alcohol on post.
So last week marked the end of our involvement in Operations
Blue Ridge. Remarkably for an operation
involving hundreds of men over seven years, some doing extremely hazardous
duties, all SAF personnel returned safely.
Most other countries that have contributed have paid a far higher price
for being a responsible part of the international community, both in terms of
lives and especially in terms of limbs lost.
At the commemorative ceremony there was a sense of closure. It is highly unlikely that I ever put on
these desert number fours again, or at my age be part of any military op again.
It was also good seeing those people we served with for a last time – this time
with a noticeable difference from the way we were before we went. Serving in war always leaves a mark, some
more obvious than others. One thing in
common among those who went: there was
no longer that nagging doubt about whether we would be good enough. 
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