A dash of danger
I was Professor of Surgery at Sydney University and worked at Concord Hospital. I'd been in the Army Reserve for maybe about 10 years. In fact, a colleague of mine invited me to join the reserve, they were short of surgeons and they had an exercise, I think it was K89. And he said, "Would you mind?" And I thought, "Well, I'm pretty well established and I can probably get the time off, why not?" It forced me to take my first holiday from work because I'm a bit of a workaholic as many people in my field are and I enjoyed it.
I grew up in the post-war period. I was in the cadets at school. I mean it was a time when we could get on the train and go home with our 303 over our shoulder. I mean, you can't imagine that today. But I think I grew up with that idea that we should be doing something along those lines. I think it was inbred in our education and it was a natural thing. It wasn't a difficult decision…the process started with a very nice girl ringing me and asking me if I'd do it.
And I thought, "Well, that's interesting that they would choose someone of a very nice voice to..." And I was in my office at the time and I thought, "Well, I've been in the reserve. It's pointless just being in the reserve if you're not going to do anything and here's an opportunity to do something." I said, "Yes." And then I told my wife and kids and they accepted it. A dash of danger as my wife said. Yeah. So that was getting the family on side was okay.
A week of vasectomies
We did do some interesting exercises out at Liverpool where we would have sort of pretend casualties come in and clearing stations. And it was interesting really because you'd have a case station and someone would bring in something and we'd go through all the aspects of what you do to revive them and prepare them for theatre and maybe even take them to theatre. And it would be all over in 10, 20 minutes. Whereas in reality it's hours, which we learned. If you made your calculations based on how prep we would wear.
The Australian military hadn't been engaged really since Vietnam. So there's a big gap between experience and what we were then. We developed an operating theatre that was in a container. The concept being you could put it on a Herc and fly it anywhere. And it would open up and it could be used within 24 hours or so, it was an operating theatre. So I was involved in that to some extent and it had an anaesthetic theatre or preparation bay and a recovery. So three containers and you sort of had a little mini operating suite. To try it out they wanted to have some genuine patients.
So they took us down to Shepparton and there's a paddock there somewhere and set it up. And then they needed real patients. Now, where do you get real patients that come into a paddock? I think it was Dookie Agricultural College. Well, there were a lot of people in the army in Melbourne waiting for vasectomies. So we did a week of vasectomies to put it through all its paces. So it wasn't quite preparation for military wounds, but it was getting a feel for working for these people who many of whom actually turned up in Rwanda because we came from all sorts of backgrounds to Rwanda. It wasn't a unit per se or the medical side of it wasn't, it was put together by people with expertise from various states and various backgrounds, therefore it was Navy and Army really.
A rushed preparation
We had briefings and we had the legal aspects of what we were doing and what we could and couldn't do, which I think was very important. And it played out certainly while we were there when we were stopped in transit at one stage. It could have been a very threatening situation, but our protectors were very disciplined and didn't do anything silly and we got through it all.
Bob. But the legal aspect was important. The medical side, essentially they saw us as going to look after the UN troops. But in fact, we looked after the locals who were horribly injured by mines and other things. So the preparation for what we really needed, for instance, paediatric equipment and that it wasn't there. But Peter Tralaggan who was my anaesthetist, he's a cardiac anaesthetist at Prince Alfred had the foresight to think about what we might need. And he brought a lot of paediatric stuff as well. And a lot of the operations we did were on children.
I think if you read the history, it was a very rushed preparation for everyone. But what they were relying on the specialists, and there was myself as a surgeon, there was an orthopaedic surgeon, there was an intensivist and an anaesthetist. So they really wanted our expertise in the field that we practised. And because the Australian military isn't big enough to have full-time surgeons, et cetera, anaesthetists, they always had to rely on the reserve and it was a good thing because we had people who were operating in the belly and the chest and the legs every day of the week.
Whereas if you're a surgeon in the army, you're doing ankle injuries, and knee injuries, not to detract from them, but it's much lighter surgery. They're not so familiar with the belly as they found out actually in the first wave they sent a lovely fellow who was a full-time army surgeon. And he was clearly out of his depth.
Settling in
We went up to Darwin and then I think from Darwin we went to South Africa, to Johannesburg, I think. And then we flew in a Spanish Air Force flight to Rwanda, to Kigali. It was to our amazement that the Spanish Air Force was so big and it was big because it was engaged in UN work. It was much bigger than the Australian Air Force. And that was just a Herc that they flew us up in. Yeah. Yes. So that's how we got there and we were greeted by Wayne Ramsey, who was the Commander of the first round who we knew because he had been the Commander of the field hospital out at Ingleburn. He turned up with a couple of jeeps and an armed protection unit. That was the first time we realised we needed to be protected all the way. It was very nice to see him.
We were put into the Kigali General Hospital and we were billeted, if you could say that, in the bombed-out maternity wing. The whole place was shot up, the bullet wounds all over the building walls, all that sort of thing. All the glass had been blown out. I think the first night we slept in the boiler room, not that it was working. The place was a mess, but the engineers had been in there a few weeks or maybe six or eight weeks before and they'd cleaned out all the bodies and removed all the bloodstains from the operating theatre. There were big mass graves on the side. It was makeshift, but it was actually functional.
They'd, actually in a very short time, made it a functional area to work. And there were some wards with patients already because I was in, I think the third lot of specialists who went over. So it was about out of the second month, maybe into the third month of our experience there. We had a handover. Took into account what was there and they introduced me to a young boy of about 12 who was going to be on the operating list the next morning. And they said, "We've kept him for you." I said, "Well, that's very nice." The thing was that he had a shrapnel wound to his neck with a false aneurysm, a blow out of his carotid artery.
And in the real world, I was an international expert on carotid artery disease. But we didn't have x-rays or appropriate x-rays or anything else. We just went by clinical signs. But I was very pleased that the first case I did with theatre staff, that I wasn't all that familiar with, an environment I wasn't familiar with, but in an anatomical area that I was very familiar with, and it all went fairly smoothly. I think I relaxed after that, that I could work with these people, they could work with me. And of course that was easy-peasy compared to what we had to deal with subsequently with all the mine wounds. And there's always anxiety, I think when you're doing something for the first time. That was very good that it worked well.
A rifle under the pillow
I think I slept in what was the director of obstetrics office and there was a bed there. But we did sleep with a rifle under the pillow. And we had an escape route plan through the roof and down the side if we were attacked. I mean, it was all... Once a week we would practice with our Steyr rifles and a pillow slip over our heads, stripping it down and putting it back together again.
They were very keen on us being proficient with the weapons. And fortunately, we didn't have to use them. It was a different experience. And I was reflecting at the time that my colleagues were probably in the Hilton International in Hawaii or somewhere, and here I was in the border. Yeah.
Ingenuity required
We'd have breakfast and I can't stand long life milk or whatever. So I started eating my cereal with orange juice. I really didn't stop then. So, I'd have whatever it was corn flakes or something like that. And then we'd do ward rounds and we'd probably have theatre scheduled from maybe nine o'clock in the morning and we'd have a lunch break and then theatre in the afternoon again. But it was often interrupted by what came in through casualty.
The pace of the work varied. So some days you might get three or four really gross injuries coming through, and then you might spend a few days staging what you had to do for them. So you might've started off by cleaning up all the wounds and doing initial surgery. And then you might have to come back a day or two later and close some of those wounds or do some more revision and that sort of thing. Because blast wounds are so devastating, you have to use a bit of ingenuity is to what tissues you can keep and what you have to cut off and all that sort of stuff. So, it was variable and the pace was variable.
In competent hands
And the trauma. Look, it was very important to support the nursing staff and the theatre staff, because most of them had never seen anything. I mean, we hadn't seen anything like it either, but we had been involved in surgery for a long time. And so we were more familiar with some of the grosser aspects of it, but for the staff, it was new. And I know one or two of the nurses had difficulty.
One of the senior officers thought they could handle that by ordering them, that they should take orders. I can understand that approach, but that doesn't work. You really got to cope with their psychological issues, and it's not easy for some people to understand that most people were very professional. Actually I have to say how professional, not only the medical side of it, but the trained military were very professional. We felt safe and we felt we were in competent hands all the way.
An interpreter's story
We had an interpreter who was a local Rwandan. He spoke French and the local dialect. Even more so when you don't speak the language, you need to communicate with the family, and with the patient. To me, that was an essential part of what we did having good interpreters. And we had some time that we spent down at the local hospital, which was part of the whole complex. And there were some American NGOs there as well.
And we used to do a clinic down there and it was largely burns and that sort of thing. Burns are very common in third world countries, babies roll into fires in the middle of the night and all that sort of stuff. And the nurse who ran that was a lovely lady. She was a local Rwanda. She had paid the Tutsis. No, she'd paid... Let me just think. Well, she'd paid whatever the group were that came, knocked on a door to shoot her parents rather than hack them to death.
And I think actually she was a Tutsi, so it would have been a Hutu. And then she managed with her kids to escape, but she told us this story of how she had to pay, rather than have her parents hacked to death. And that was the other type of injury, of course, the machete injuries were, if they survive were often quite a lot of challenging work.
Escaping the hospital
What we did, we'd get up in the morning and we'd actually go for a jog in the cool the morning and the mist. And we only went a couple of K's down the road and back. Down to the Hotel Rwanda and back. And it was not only were we jogging, we were talking because we were discussing what we'd done or what was on the agenda that day. That was one way. The other thing we did on Sundays to escape the hospital, we'd go to church.
This was an amazing thing that they had. They're very tough people and you go to church and there was virtually no sign of emotion, until the prayers for the dead and then it was very limited. Which amazed me because I thought there'd be much more emotional out pouring, but it wasn't there. And the other amazing thing is you'd see women going to the markets or downtown who were living in mud huts and they'd come up, out, dressed immaculately in white clothing, I mean, how they did it was beyond us. And just kept up their spirit.
A lesson from the Gurkhas
So one of the things we did, the Gurkhas arrived and they were in force really to look after us. We were invited around to dinner with the commanding officer for one night in his mess, which was a very interesting experience. He was telling us that they brought all their unit silver, the regimental silver, and they were there for, I think, two years. And he said most of the troops that came with him, that would be their income for retirement forever.
The money went back home. It's a way of making money. Then he said to us, "Do you know how many folds there are in Australian Army puggaree and slouch hat, and the history of it?" Well, first of all, we're medical, so totally ignorant. He said, "Well, there's one fold for every State of Australia." Which is something I didn't know. And I noticed that the New Zealanders only have three and a half folds, whereas I think we've got seven or whatever it is. Yeah. So, we got a little lesson on our own uniform from the commander of the Gurkhas.
Detached from reality
I think we slipped through the net there, because we were more or less individuals going back to our individual situations. We weren't part of a group or... And maybe they thought being doctors we could self-cure or something. I don't know. No, there wasn't. No. No. But the one thing I do remember, we went into town, Mary and I went into town, went into DJs for some reason or other. I think I wanted to go down to their food hall and enjoy a bit of nice food. But I remember feeling like I was floating, detached from the reality of the city. And it was an unusual feeling, it didn't last long when I was back in reality. No, that's the one thing I do remember is feeling I was different and detached.
Family support
I think my family, that was very important for them to support, we had planted, believe it nor not, several hundred olive trees on our farm just before I was called up. And it was a drought in the Hunter. On the weekends, they'd load up a trailer with water from our home in Sydney and they'd take it up and then water all those trees.
We had plastic bags that we had around it and dripped the water out over the week. We didn't lose another tree in the two or three months that I was out of action from preparation and getting there and all that sort of stuff. So I was very proud of them for doing that. They thought it was a duty to keep the olive trees going when I was over in Rwanda.
Worthwhile service
It was something I was very pleased that I did. It meant that my time in the reserve was worthwhile and I think it gave me purpose. And afterwards I actually did give quite a number of talks about it. We actually recruited people, young doctors who'd come along and see the talks, listen to the talks, would join the Army Reserve or sometimes we lost them to the Navy or Air Force, but they joined the military as a result. So I thought that was positive. I now chair the National Centre for Veterans Health Care, which is an initiative of Central Sydney or Sydney Area Health.
And we have set up a one stop shop for veterans with post-traumatic stress disorder and other issues, including we're just about to open some residence for their families to come and stay in. It's actually given me a pathway to do things and a rationale for being on these committees and on this board because I've got the link. My professorial career kept going, but I had this additional... And I worked at Concord which had this long tradition with the military. So I've been involved in lots of para events. And with the tag that I served in Rwanda sort of helps, I think. Yeah
