Page last updated at 14:52 GMT, Thursday, 30 July 2009 15:52 UK

Saving lives in Afghanistan's A&E

By Marie Jackson
BBC News

Lt Col Nigel Tai
Lt Col Tai has seen the horrors of war, but has no nightmares

For six weeks, surgeon Lieutenant Colonel Nigel Tai was on call 24 hours a day, treating wounded and dying British troops in Afghanistan on some of the bloodiest days the country has seen.

In that time, more than 100 British servicemen and women were wounded in action, some from gunshot wounds, others blown apart by roadside bombs.

The most critical of those were seen, alongside Afghan civilians and insurgents, at Camp Bastion hospital in Helmand province by 41-year-old Lt Col Tai and his team.

"We have seen a surge in casualties and it's certainly been challenging," he says.

"A significant portion have been blasts from IEDs [improvised explosive devices].

"These cause multi-cavity, multi-limb injuries which require multiple surgeons. So you are doing things concurrently - blood, critical care, intensive care," he explains.

The aim in a war hospital, he says, is to "always have a back door open" so patients are flown back to the UK as early as possible, often within 24 hours.

Matter-of-fact

Lt Col Tai, who was working in London during the 2005 bomb attacks, speaks in the matter-of-fact manner of most medics about his experiences.

"I don't have nightmares. Operating on injured people is my job. I would not be very good at it, if I did."

British Soldiers firing on Taliban positions in February
Humour as a coping mechanism works as well in hospital as on the battlefield

Just as on the battlefield, banter, humour and the odd quiet supportive word are the preferred strategy in the hospital for coping in the worst of times.

"Aspects of the job will be very stressful but I can't say I see lots of people upset all the time," he says.

He concedes that it was a "very challenging" tour with intense experiences, but adds it has been a privilege, too, to have worked with such professional teams.

This was not Lt Col Tai's first experience of a war hospital - he worked in Afghanistan in 2006 and Baghdad last year - and relishes the improvements that have been made since.

"We've got a proper building. Not like in 2006, when we were in tents," he says.

They also work in multinational teams with US and Danish medics, and have far more resources.

Over the past 18 months the hospital has acquired a CT scanner and sophisticated blood transfusion technology, as well as a plastic surgeon and radiologists.

It's easier than working in the NHS
Lt Col Nigel Tai

Such advances appear to have enabled doctors to save more lives.

Surgeon Rear Admiral Lionel Jarvis, assistant chief of defence staff (health), says recent data has revealed that the number of unexpected survivals is increasing all the time.

But while more lives are saved, questions are raised about the quality of life that can be enjoyed by the most seriously injured soldiers.

"As professionals we detach ourselves from thinking too much about the individual," says Lt Col Tai.

"To think too much about the possible consequences, we would be impeded.

British army Paratrooper Sergeant Stuart Pearson
Service personnel are rehabilitated at Surrey's Headley Court

"Young, fit guys may have to have multiple amputations, so we try to salvage limbs, at the same time we have to preserve life."

He takes reassurance from Headley Court - "the best example of a trauma rehabilitation centre" - where 114 patients from Afghanistan were being treated last month.

After returning to the UK on Monday, Lt Col Tai will go back to his job at the Royal London Hospital in Whitechapel, east London, but he admits Afghanistan has its advantages.

"It's easier than working in the NHS.

"I'm not saying the clinical problems are not challenging, but there's no bureaucracy in Afghanistan. Someone else looks after all that for you.

"So all of my energies are directed towards treating patients."

The assumption that long days and constantly being on call mean little sleep did not prove a reality.

"I've had seven to eight hours a night. It's better than here. I don't want to sound trite but you don't have to commute or go to Sainsbury's."



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