Bored, brave and brilliant: the UK medics in the Afghan war zone

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Kim Sengupta reports on a remarkable study of Camp Bastion hospital

A day job teaching at a business school might not be ideal combat-zone training – especially for a Cambridge academic whose previous fieldwork involved studying university rowers. But Mark de Rond's six-week stint at the military hospital in Camp Bastion, the main UK base in Helmand, has produced a remarkable study into the ways medics treating terrible injuries cope with their working conditions.

Dr de Rond found that the doctors and nurses were dedicated and professional but also, at times, highly competitive.

"At Bastion, you see the best teamwork you will ever see. But these are driven people, and some of the qualities that make them brilliant also make them difficult. The surgeons will occasionally compete for interesting work, and interfere with the work of others when they have none of their own.

"Unable to cope with boredom, they will hope for new work to come in but then feel guilty about this – because these are people, often civilians. But the acceptance of such paradoxes is vital to the psychological safety of the surgical teams, allowing them to perform more effectively."

The need for best medical practices had led to a relaxation of the rules of hierarchy, he noted.

"The 'de-ranking' meant that people were able to speak more openly, admit mistakes, offer suggestions, or even criticism without worrying about that going on their records, upsetting the chain of command. It worked."

During his time at Camp Bastion, where medical staff treat both service personnel and civilians, Dr de Rond took photographs, which have been put on display online by Cambridge University, where he works.

The medical centre at Bastion has grown in six years from a row of tents to the most advanced of its kind, with treatments pioneered there, especially for trauma, being adopted in civilian hospitals across the world. But many of the staff, experienced in dealing with accidents and emergencies back home, find the experience emotionally and physically draining.

Dr de Rond, a Reader in Strategy and Organisation at Cambridge Judge Business School, had never been in a conflict situation before and knew that an induction course he had taken back in the UK would only prepare him so much for what he would experience. His past research had involved spending prolonged periods with the Cambridge rowing team and comedians.

The 44-year-old academic is a specialist on ethnography, which he describes as an "old fashioned attempt at trying to understand teams by living with them under similar conditions".

He said: "I wanted to see how the staff at Bastion coped with what was going on all around them, how the team functioned under all that pressure. I was there just to observe and record what was going on, but, of course, I could not help being affected myself. It is very difficult seeing a child missing a leg, or a teenage soldier who is a double amputee."

The Bastion hospital, he believes, was "a safer place than many psychologically" because of the safety valves in place. There was humour from a "dark heart" needed to balance the constant suffering and death. Somewhat surreal situations such as when a nurse taking a pair of amputated legs to an incinerator bumped into a man in a Santa Claus costume, on his way to a mid-summer party, eased tension.

Dr de Rond left Bastion, unsurprisingly perhaps, feeling changed. "When I was done, I left almost all my clothes behind, except the clothes I was travelling in, because I felt they were all tainted. I wanted to try and shed all that stuff. Maybe it's an overreaction, but how do you cope with all this stuff? I did not dream once during the six weeks I was there, but now I am beginning to have these dreams."

It has been hard for him to talk to his wife, Roxanne, friends and colleagues about the things he has seen, what he felt. He finds himself wondering whether some of the things he does in his professional life are meaningful.

"The academic work we do can often feel like a game of our own devising that doesn't make much of a practical difference to the world. There is an inability to effectively communicate what we do – I think photography can play a key role in improving this. And I hope these photographs help in understanding a truly remarkable place."

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