快猫短视频

Jonathan Kaplan was born in South Africa and studied medicine in Cape Town. He did his first work as a surgeon surrounded by the violence of apartheid. When he was called up by the army for the war in Angola, he left for England and the US. After 10 years of research and surgery, he became a battlefield surgeon, working in trouble-spots such as Kurdistan, Mozambique, Burma, Eritrea and Iraq. He also makes documentaries and works as a photographer. His accounts of life on the front line form the basis of his bestselling book, The Dressing Station (Picador 2001).

What was it like working in Iraq?

I thought I would be working as a surgeon in Baghdad, but the condition of the hospitals was so dreadful that it was almost impossible to do any organised, safe surgery. The operating theatres had been used intensively during the bombing and had received casualties throughout the looting, so their floors were many inches deep in caked blood, clothing cut from the bodies of the wounded, discarded surgeons鈥� gloves and suture packs. There was no light and no water so no one could do any cleaning. I did less surgery than I had anticipated, apart from patch-up emergency stuff.

Who do you work for?

I get called in for crises where there are wounded, often conflicts or wars. The organisations I have worked with are usually involved in acute intervention and different from the ones involved in long-term development, restructuring and rebuilding. Emergency intervention is always a bit frustrating because you know that you haven鈥檛 really changed the underlying circumstances that caused the crisis.

The 鈥渁id industry鈥� is competitive because there are large numbers of organisations working in the same areas, especially 鈥渇ashionable鈥� wars and disasters such as Bosnia, Rwanda, Mozambique and recently Iraq. These were all places where the press had raised the profile of events to such an extent that any self-respecting aid organisation had to be there. And they had to be there in a way that showed up on the media radar so they could be seen to be active and productive, attract the attention of donors and get funds to perpetuate their existence.

There are CNN wars and non-CNN wars: it really depends to what extent western interests are going to be served or disrupted by what is happening. It took very many years for anyone to intervene in Liberia.

What makes you keep going back into these dangerous environments?

There鈥檚 a sense of professional and personal fulfilment in working to the limit of one鈥檚 abilities 鈥� and even beyond, when one has to improvise all the time. It seems bizarre, possibly even unhealthy, that one should seek out places where people are suffering. Yet it is in those places, working as a doctor, that I find a heightened sense of my own humanity, in circumstances where other people are being deprived of theirs. The motivation for this sort of work is complex. I do not think it is completely altruistic or purely morally positive.

Is this how your colleagues in the field feel?

Oddly enough I have never worked with the same people twice, so I cannot answer for them. There is a relatively small group of doctors, nurses and health workers who do this emergency intervention work.

I tend to do acute interventions, which means that my involvement is often short, intense and exhausting. When I leave I may not have made a substantial long-term difference to anybody apart from those who have passed under my hands. Not all of them will have benefited because many of the people I see are badly injured. My resources are limited and there may not be proper nursing facilities or an evacuation route. Quite a lot of them may die, but I have to accept that what I do under these circumstances is the best I can.

Something I may share with other people who do this kind of work is a feeling of heightened awareness, of intense vitality. It transcends the daily drudgery of normal life, of careers, pensions and property 鈥� all this falls away. You are alive in places like this in a way that is hard to find in an ordered society.

Soldiers also report a heightened sense of awareness. As a surgeon working with people harmed by soldiers, are there any similarities in what you experience?

There are marked similarities between the way humanitarian workers and soldiers live in these precarious circumstances. Of course, our goals are diametrically opposed. I have known soldiers who have killed people, and I have treated people who have died under my hands. Nobody who has killed someone is unscathed by that experience. On some level or another, they will suffer the consequences of that act forever. In being a surgeon and having my patients die, while I haven鈥檛 been the person who pulled the trigger, I have nevertheless been involved in those people鈥檚 lives at a level of intensity and intimacy that means I too remember them forever.

How advanced is battlefield surgery?

There have been enormous advances in western warfare. As battlefields have become more specialised and wars have become scientific endeavours, the investment involved in training a specialist tank driver or a specialist battlefield ordnance officer is so great that these people cannot be allowed to just die of a preventable haemorrhage. Computer-assisted diagnostic methods and remote-operated medical intervention systems are being developed for western armies. And the use of things like synthetic blood 鈥� an area in which I assisted in some research in the US 鈥� is likely to save lives because it removes the complex procedures involved in cross-matching and blood storage.

But this advanced technology is not going to become available everywhere. There is no financial imperative in helping the local people wounded in some miserable war somewhere. Ultimately it will always come down to the doctor on the ground to try to do the best they can with available resources, using techniques like making a one-way valve to reinflate a collapsed lung with the finger of a surgical glove and a large bore cannula 鈥� a trick I was taught by a special forces medic I met in Iraq.

Does it make you a better surgeon if you are emotionally open to your patients?

Studying medicine and learning to be a surgeon involve learning the tools of dissociation, of clinical detachment. These are necessary because it is impossible to make clear clinical decisions if you are feeling the pain of the person in front of you, because that pain is overwhelming. But you also have to be aware that that is an artificial wall, and to question all the time whether it is interfering with your ability to be human. I don鈥檛 think of myself as a specially skilled, dextrous surgeon. I believe I can do procedures with an acceptable level of ability and I hope that in the situations where it counts my judgement is clear. Perhaps that is the best that any of us can ever hope for.

Is it a problem working in places where people have a different medical tradition?

The importance of traditional medicine in traditional societies is incalculable. But it is most effective in societies that haven鈥檛 been completely disrupted by war or humanitarian catastrophe. In most of the places I work people are bereft, disrupted, shaken from their identifiable roots. It is hard to imagine where traditional healing techniques could be applied there, though they become important again during the reconstruction phase.

I was in the US last year, talking in various cities about the work I do. I would be challenged from the audience on why I didn鈥檛 use Ayurvedic medicine or reflexology or some other form of alternative medicine. In some social contexts traditional or alternative medicine is appropriate. But the bottom line is that a fragmentation grenade doesn鈥檛 give a rat鈥檚 arse for alternative medicine.

What do you do when you鈥檙e not in the field?

At the moment I am working a day or two a week as a surgeon in the National Health Service in the UK and a day-and-a-half a week as an occupational health doctor and general practitioner. These are ways of maintaining an income because pretty much all the emergency medical work I do in the field is voluntary and unpaid. A couple of organisations have approached me about going back to Baghdad to work as a surgeon or a medical coordinator for three or four months. Another organisation that has a hospital in a particularly troubled part of the Congo needs a surgeon who has experience in trauma surgery. All these offers are there like insidious demons on my shoulder saying, 鈥淵es, when things get tough here, when you are weighed down with having to put together a tax return, why not go?鈥� That is both self-affirming and destabilising.

How long will you go on working in war zones?

I will have to stop at some point because I will lose the reflexes and physical fitness. I will find it harder to get over illness or be unable to hit the floor fast enough if there鈥檚 shell-fire coming in. I will need to stop then so that I don鈥檛 become a liability to my colleagues.

Was there a day when you thought what you were doing was absolutely right, or a day when you thought you could not carry on?

The most memorable days probably combine both those extremes. Nothing is a straightforward victory. There are times when you find that someone you treated is still alive a couple of days later, and you realise that is extraordinary because you did not expect them to survive. Or you might wonder about the patient who was doing so well and greeted you in such a friendly fashion two days ago, then discover they died with no explanation.

Does it get depressing?

A lot of it is extremely depressing. But huge amounts of it are exhilarating or downright hilarious, because of the levels of human absurdity that you encounter in desperate situations. You see incredibly inspiring things: people who for no conceivable reason will show the most extraordinary generosity, the most extraordinary kindness, the most extraordinary humanity, when it is against their interests to do so. I am always struck by how people in the worst situations transcend the limitations of humankind and become god-like in their abilities to do inspirational and extraordinary things 鈥� and as an atheist that makes me even more sure that there is no need for a superior being.