0:00

Welcome to your 2023 work recap. This

0:03

year, you've been to 127 sync meetings, you

0:06

spent 56 minutes searching for files and

0:08

almost missed eight deadlines. Yikes!

0:12

2024 can and should sound different. With

0:15

monday.com, you can work together easily, collaborate

0:17

and share data, files, and updates. So

0:19

all work happens in one place and

0:22

everyone's on the same page. Go to

0:24

monday.com or tap the banner to learn

0:26

more. MUSIC

0:34

All engine running. Excellent genius.

0:36

Get this. Welcome. Welcome. This

0:38

is the show where we bring you science. What

0:41

that potentially means is... Discovering is... ...the answers... ...research...

0:44

...technology... ...unbelievable. Without further

0:46

ado... This is The Naked Scientist. Hello.

0:50

Welcome to this week's Naked Scientist, the programme

0:52

where we bring you the latest breakthroughs in

0:54

science, technology and medicine. I'm Chris Smith. And

0:57

this week, we're going to look at the

0:59

role that medics play in war-torn regions of

1:01

the world. From Cambridge

1:03

University's Institute of Continuing Education,

1:06

this is The Naked Scientists.

1:09

MUSIC A

1:18

number of wars are currently raging

1:20

globally, most notably in Gaza, Ukraine

1:22

and Yemen. As many people

1:24

are forced to flee the fighting, teams of

1:26

medics often run towards unimaginable horrors to

1:29

help the injured. But what

1:31

role can and should the medical

1:33

profession play in conflict? To find out

1:35

when medics first started appearing on the battlefield, I

1:38

spoke to Michael Brown, who's a lecturer

1:40

in modern British history at Lancaster University

1:43

and also an expert on war

1:45

and surgery. Well, there had long

1:47

been medical practitioners attached to military

1:49

forces, you know, throughout human history.

1:51

You know, the Romans, Greeks had

1:54

physicians and surgeons in attendance. And throughout

1:57

the medieval and early modern periods,

2:00

We also see medical practitioners attending to

2:02

the wounded in war. Most

2:04

famously in terms of the history of

2:06

surgery, we had the French surgeon, Enboise

2:09

Paré, in the 16th century.

2:11

He was a pioneer of surgical techniques, including

2:13

things like tying off blood flow in cases

2:15

of amputation. But in terms

2:17

of the sustained provision of

2:20

medical care to personnel in war, I

2:22

think it's really the revolutionary Napoleonic wars

2:25

of the late 18th and early 19th centuries

2:27

that mark a significant change. Prior

2:30

to that, regimental surgeons had largely been

2:32

appointed by the commanders on an individual

2:34

basis. But in the latter part

2:37

of the 18th century, and going into the

2:39

early 19th century, we see increasing kind of

2:41

provision of production of medical services. A Frenchman,

2:43

Domélique Jean Lary, who served as Surgeon General

2:45

of the Imperial Guard, he

2:47

is responsible for a number of

2:49

innovations in the medical care of

2:51

wounded servicemen, including, for example, the

2:53

introduction of Ambiance Boulant or flying

2:55

ambulances, modeled on the example

2:57

of the horse artillery, as well as kind of

2:59

a train corps, a field litter bearers to kind

3:01

of collect the wounded. And this is where we

3:03

really start to see kind of innovation, I think,

3:05

in the field of medical care and war. Back

3:08

in history, the reason that surgeons pride themselves

3:10

on calling themselves Mr and Mrs is because

3:13

they were barbers back in the day and

3:15

they had sharp knives. So is that sort

3:17

of what started out as military

3:19

medical intervention and then it became

3:22

medicalised more professionally later? Or was

3:24

it different? As a historian

3:26

really of the early 19th century, I would argue

3:28

that the level of professionalism among late late 19th

3:30

century surgeons was actually exceptionally high. And

3:33

in many ways, actually war created

3:35

opportunities for education. In

3:37

a famous example, Charles Bell

3:39

celebrated early 19th century Scottish

3:42

Surgeon. Despite being a

3:44

civilian, he actually travelled to the battlefield

3:46

of Waterloo after the battle in 1815

3:48

to get experience really of working with

3:51

war wounds. And it was a formative

3:53

experience for him both intellectually and emotionally.

3:56

So now, I mean, I think in many ways, you

3:59

could say that war. was central

4:02

to the professionalization

4:04

of surgical training in this period.

4:07

And it's often been suggested that war is

4:09

a driver of change and I think there

4:11

have been arguments made that actually this

4:14

kind of structure of provision of medical

4:16

care for our first service personnel actually

4:18

made a big impact on surgical training

4:20

more generally. You mentioned

4:22

the Napoleonic Wars. What happened

4:25

then that marked

4:28

a step change and what drove

4:30

that step change? Two

4:32

things really. One is the scale of

4:34

the conflict. So this is a

4:36

conflict involving much

4:38

larger forces than have been seen in previous

4:41

conflicts. I mean notably the French for example,

4:43

basically introduced universal male conscription, the so-called les

4:45

d'en-masses as part of their war effort. So

4:47

there's a kind of growth of what we

4:49

right now think of as kind of total

4:51

war as a phenomenon idea that civilian

4:54

resources can be mobilized towards military and

4:56

strategic ends and I think that's what's

4:59

really going on. But also I think

5:01

the period is one in which the

5:03

state is taking an

5:06

increasingly structured approach to how

5:08

it organizes war, how

5:10

it organizes conflict and a much sort

5:12

of less decentralized approach to the fighting

5:15

of wars. So I think by

5:17

no means perfect, medical military services particularly in

5:19

Britain and other European countries are subject to

5:21

criticism throughout the 19th century. You're beginning to

5:24

see a kind of increasing interest in the

5:26

state in sort of providing

5:28

these services for soldiers and sailors. Would

5:30

they have put their practitioners right up

5:32

close to the front line so that

5:34

you can get your people out urgently

5:36

or did they just wait until everything

5:38

was done and dusted and then they

5:41

did what they could? L'Hari had

5:43

kind of pioneered a concept of

5:45

triage during the Napoleonic Wars and

5:47

that really developed in

5:49

the early 20th century. So

5:52

you determine who needs treatment most

5:54

immediately. It's really a

5:56

kind of product of 20th century developments, the much

5:59

more structured and a structured chain of treatment

6:01

that one begins to see, particularly around the

6:03

time of the first world war, where

6:05

you have first aid posts, you've got

6:07

regimental aid posts, advanced dressing stations, casualty

6:10

clearing stations, and finally you get to

6:12

a hospital. So you can basically

6:14

treat people at various stages in that process. And

6:16

that really is the product of a much more

6:18

structured intervention that you begin to see in the

6:20

early 20th century. Is

6:23

it fair to say then that pretty much

6:25

all facets of conflict these days are going

6:27

to have a massive medical component to them?

6:29

In more recent conflicts in the

6:31

early 21st century, particularly in the

6:33

West, you see this help for

6:35

heroes phenomenon that soldiers deserve all

6:37

possible medical care in return for

6:39

their sacrifice. And I think there's

6:41

been a great deal of both

6:43

popular and charitable interest in

6:46

wounded men coming back from Afghanistan and

6:48

Iraq. And of course, it's simply the

6:50

fact that because of medical and surgical

6:52

advances, wounds are far more survivable now

6:55

than they were in the past as

6:57

well. So that level of care has

6:59

to be provided in the way they

7:01

might not have done in the early

7:03

19th century or the 18th century, where

7:06

the state had relatively little

7:08

long term commitment to the care of

7:10

the wounded. Michael Brown there. We'll

7:13

hear more about the important work that charities

7:15

like Help for Heroes do a bit later

7:17

on. But before that, how exactly

7:19

do the 21st century's military

7:21

leaders plan for war casualties?

7:24

Here's General Sir Richard Chirif, who served

7:26

as NATO's Deputy Supreme Allied Commander Europe

7:28

between 2011 and 2014. War

7:33

is a dangerous business. And you have to

7:35

assume that if people are shooting at you

7:37

or trying to blow you up, that you're

7:39

going to take casualties. As commander, of course,

7:41

you do everything you can to minimise

7:44

the risk of casualties. But the reality

7:46

is that almost invariably there will be

7:48

people who are hurt, who are wounded,

7:51

or people who are killed. So

7:53

it's absolutely critical that The

7:56

medical side is thought through and

7:58

planned as a result of this.

8:00

part of the operation. Every operation

8:02

involves not only the movement of

8:04

troops and fair goals and formations

8:06

to get them into the right

8:08

place at the right time to

8:10

do the right thing. But.

8:12

I've got to be proper. Support

8:14

it with fuel with food with

8:16

ammunition. And. Of course with

8:19

medical support and so medical support

8:21

comes under the heading of logistics

8:23

which is everything bad Allies and

8:26

army or military force to operate.

8:29

And. Presumably the kind of medical support

8:31

you can a very that according to

8:33

what kind of conflict or what sorts

8:35

of weapons will sort of engagement you

8:38

anticipate seeing. Every regiment or a battle

8:40

group has a doctor who set young

8:42

captain and at every level well be

8:44

a medical specialist. Sarah to brigade level

8:46

you might have a field and and

8:49

that's attached to it commanded by left

8:51

aren't gonna let a division which is

8:53

about twenty five thousand people. Don't

8:56

have quite a senior com or

8:58

who is the commander Medical? Who

9:00

does the medical plan? Who does

9:02

the medical estimate? A whole range

9:05

of factors are looked at in

9:07

real detail. deductions, the drawn and

9:09

out of that a range of

9:11

courses of action are considered. One

9:13

course of action is decided upon

9:16

that best meets the needs of

9:18

the plan on they commanders intent.

9:21

And. In which the disadvantages

9:23

are outweighed by the advantages.

9:25

And I must know what's caused by. Since

9:28

then you make a plan to to put

9:30

it in place. On that plan will bring

9:32

together the assets that are particularly needed for

9:34

a particular operation which approach might change. So

9:37

presumably your thinking about where to put things

9:39

in relation to where you see the action

9:41

going, How you see the action playing out

9:43

so that you can walk, evacuate people is

9:46

left is possible anticipate was source of injuries

9:48

you going to see in there. For what

9:50

salsa care people going to need in the

9:52

short term before you can evacuate them months

9:55

have been stabilized. To get them longer

9:57

term help. Yeah, I mean the principle is

9:59

that you. I'm treat of

10:01

close to the point of

10:03

winning as possible Every fighting

10:05

soldier, tank crews, infantryman dollars

10:07

that are all trained with

10:10

immediate battlefield first aid. And

10:12

then with intersection there might be one

10:14

soldier who's who's a battlefield medic. It's

10:16

a bit like being a sort of

10:18

paramedic and he can do a little

10:20

bit more that of course exactly that.

10:22

Further back you've got the regimental a

10:24

fast and this is the whole point

10:26

about trying to get people back as

10:28

quickly as possible to stabilize them up

10:30

and back through the system so they

10:32

can be three hours into. those who

10:34

studied the my surgeon help as quickly

10:36

as possible. What about the civilians Because

10:38

they're potentially also indeed Yoga sandwich your

10:41

operating and they might become. Victims States

10:43

is consideration given to them.

10:45

And do you ever find

10:47

that the military ends up

10:49

treating civilians because they become

10:51

casualties. Absolutely not. Clearly

10:53

the priority must be to treat

10:55

our military force because that's what

10:58

about for and it's all about

11:00

treating the military force in order

11:02

to ensure that of not in

11:04

our our soldiers. Are treated

11:06

as quick as possible and returned to

11:08

battles quick as possible. A but it's

11:10

it's essential for morale. But yes, civilians

11:12

are treated regularly and even to go

11:15

to look at what happened in Afghanistan

11:17

and and in Iraq and Afghanistan particularly.

11:19

Were. Afghan civilians were treated and and

11:21

military hospitals and a d to cause

11:23

it's not us civilians but it's enemy

11:25

soldiers as well will be treated the

11:27

military hospital. So. Wanted to

11:29

raise the. Russia Ukraine conflict.

11:32

There was some people including yourself

11:34

who said they were cecil that

11:36

an invasion might be imminent because

11:38

the Russian army had moved. blood

11:41

transfusion units lead to a certain

11:43

started field hospitals near the border

11:45

with Ukraine and people like myself

11:47

are arguing you only do something

11:50

like that if you getting serious.

11:52

Absolutely. And it's an obvious combat

11:55

indicator the some of level of

11:57

logistic support being deployed and support

11:59

about. The Military Force. And

12:01

when we saw the blood been brought

12:03

forward and and all the paraphernalia military

12:06

Hospital for might have been pretty clear

12:08

that this I'm not just our out

12:10

a demonstration or an exercise. General.

12:12

Sir Richard Serious. Will. Get

12:15

here Now from Steve Just Me who

12:17

is a Burns surgeon emphasis of Wound

12:19

Studies of Birmingham City University State spent

12:21

two weeks and twenty twenty treating dozens

12:24

of Armenian combat soldiers who were injured

12:26

in a war there with neighboring. As

12:28

a by yawned I began by asking

12:31

him about the special piece of kit

12:33

he took with him. When my suitcase

12:35

with me I brought a number of

12:38

items my mom thought was some Siskin

12:40

with any from previous experience would be

12:42

particularly handy in a sitting with. You

12:45

have probably more patience and he know

12:47

how to deal with and when they

12:49

will be some challenging wounds. When.

12:51

You say suskind? You literally mean the

12:53

skin of fish. Yes it has

12:55

been processed a bit but not a

12:57

lot which is some. The beauty of

12:59

this is Skyn. It's a byproduct of

13:02

the to see into see there's a

13:04

sexy in northwest Iceland and isa feel

13:06

that were am the used to throw

13:08

this his skin away. And. Then

13:10

somebody has a light moment saying, we're

13:12

all, can we Do this It's distilled.

13:15

And then it is as theorized, And.

13:17

That is freeze dried from that moment

13:19

on you can see pits. At

13:22

room temperature on the shelf and what to

13:24

do with it? How is it used? You

13:26

rehydrate it with water. Seeley know what of

13:28

you've got for about a minutes and then

13:30

that makes it nice and pliable and then

13:32

you put it on to your wounds that

13:34

that you will have. The. Bride it

13:36

and what debridement means is when

13:39

you get a a wounds. Combat

13:41

wounds particularly are often very dirty

13:43

and contaminated with. Lots.

13:46

Of horrible bad bits and pieces from the

13:48

battlefield and them when you to bride a

13:50

wound. What we mean is that we take

13:52

away all the dead and the dying tissue

13:55

and leave a nice healthy bed. and then

13:57

we have to put something on as a

13:59

temporary com. and the fish skin

14:01

works very well in that role. Do

14:03

you have to change that rather like a wound

14:06

dressing or do you put that down in there

14:08

and then leave it for the duration of the

14:10

healing? Well what will happen,

14:12

it'll start to degrade, the body doesn't like

14:14

having anything next to it, but also at

14:16

the same time it encourages blood vessels to

14:18

grow through it and so it's very

14:21

good at encouraging the growth of granulation

14:23

tissue as well as being an antimicrobial

14:25

there. If you think about the life

14:27

of a fish, the ocean is full

14:29

of bacteria and they are

14:31

constantly swimming through bacteria so there

14:33

are proteins in the structure of

14:35

the skin which are innately antimicrobial.

14:38

And a person doesn't become sensitized like develop

14:40

an allergy to it because they're in close

14:42

contact with it, could you keep on using

14:44

this? The

14:47

only people that can't use this are

14:49

people who are allergic to fish as

14:51

you can imagine, but even those people,

14:53

when you are actually truly allergic to

14:55

fish, it's actually a protein within the

14:59

muscle of the fish that you are usually allergic

15:01

to, not the skin. So

15:03

no, the vast majority of people will

15:06

not develop a kind of allergy to

15:08

this that was used subsequently. And

15:10

what sort of a difference does this make? Have

15:12

you done head to head trials where you've done,

15:14

I know it's very hard to take an equivalent

15:16

injury and do a direct comparison, but have you

15:18

got data before and after doing this

15:20

to show that this really makes a difference? Data

15:23

in combat injuries is hard to get off, so

15:25

you have to sort of extrapolate. It's been used

15:27

in burns, sort of head

15:30

to head against allograft, which is

15:32

where you take skin from another

15:35

dead human. So it's the

15:37

same species, but the problem

15:40

with taking skin from another

15:42

human is it has

15:44

to be very, very highly processed in

15:47

order to make sure there's

15:49

zero risk, that there's any viruses or

15:51

prions or anything that we might not

15:53

yet Understand can

15:55

be transmitted. Now It

15:57

turns out that... This.

16:00

Is. They. Also get me

16:02

and viruses, etc. Like all

16:04

animals the do but we

16:06

are so distantly related to

16:09

fish that there's this new

16:11

viruses that affect face but

16:13

can also affect humans. So

16:16

you don't have to do all

16:18

that mega processing of the skin

16:20

that you would if you're taking

16:22

allograph from another human or the

16:25

alternative is you're taking another type

16:27

of z know graft. Zito means

16:29

foreign species. so. For. Example

16:31

from a pig, but then it

16:34

would also have to be highly

16:36

processed because Sam and of those

16:38

oversee risk of viral transmission from.

16:40

From. Picks to humans. And. Just

16:42

came back to my point which was have you

16:45

evidence this is actually better to do this because

16:47

some of his his one thing to do it

16:49

that if if you don't know it's better we

16:51

don't know we're improving outcome to this so what's

16:53

the of it yet his words as oh yes

16:55

oh the for example in the band's world with

16:58

you which is. Kind. Of similar

17:00

you to burn excision so you do

17:02

in excision and then you will often

17:04

put our grasp on his be shown

17:06

to be as as good as if

17:08

not better than Cat of Eric allograft

17:10

in that situation and also in other.

17:13

Moons in the not combat related woods

17:15

for syphilis up a lake, wounds like

17:17

Elses etc is been shown to be

17:19

very efficacious and the company of the

17:21

makes it a selling an awful lot

17:23

of a around the world still. Jeffrey

17:25

and Steve was awarded the prestigious middle

17:27

of the Prime Minister of Armenia for

17:29

his work with the skin. Well.

17:32

Deserved I say. The

17:34

Naked Signed His podcast is

17:36

produced in association with Spit

17:38

Cost Effective Voice, Internet and

17:40

I Engineering Services League Uk

17:42

Business A sign of has.

17:46

York asked Fire Not. Music.

17:53

In the program is sponsored by Epidemic

17:55

Sound Doesn't Music for audio and Video.

17:57

Productions This is the Naked Son.

18:00

With me Chris Smith and with considering

18:02

the role the medics play in the

18:04

military. This week. So. While many

18:06

people are left with physical scars

18:09

or killed in conflict, others have

18:11

less visible wounds. My trauma. And.

18:13

Mental health conditions are not. Be Speaking

18:15

to Trees Mitchell who is the head

18:17

of the Hidden Wounds Surface of the

18:19

Help for Heroes Charity. I

18:21

think a lotta people will resonate with

18:23

the idea of shall Shop for the

18:26

First World War probably since Afghanistan and

18:28

Iraq and those more recent was this

18:30

idea of a hidden wound and and

18:32

he just a has become more in

18:35

the public domain, but unfortunately pretty much

18:37

as a kind of a depiction in.

18:39

Movies and it shows people being map

18:41

out in fact which is very untrained.

18:44

Innocence than it's always been there,

18:46

but we haven't always talked about

18:48

it. Exactly that. So it's.

18:50

Been many men were

18:53

coming home and were

18:55

either uncommunicative, old had

18:57

physical sensations. With Ptsd presents itself

18:59

not just in the mind off of in

19:01

the body, but they didn't have a name

19:04

for it. They just knew that people would

19:06

change or the experiences that they had undergone.

19:09

When did we realize that we needed

19:11

to do something about it? When did

19:13

we sort of transition away from the

19:15

stiff upper lip mindset? I think. They.

19:18

Took it seriously even in the Us level

19:20

because I think that what they needed they

19:22

needed people back at the front. They needed

19:24

people to a battle worthy if you like

19:26

and battle ready made with. The way in

19:28

which it was treated with was quite brutal.

19:31

The to begin with it was about rest,

19:33

relaxation and bring people that the fence they

19:35

decided that probably have an organic. Origin

19:37

and what they did was I use of

19:39

it to at the latest medication or they

19:42

probably didn't have a little really brutal treatment

19:44

like brain surgery that you people have heard.

19:46

Of the bottom is I guess I

19:48

sort of thing it'll.stiff upper lip that

19:50

still exists. But Moto a soldier on

19:53

and get on with it And. Be

19:55

the best Saudis and day. All

19:57

the different traditions of exposure.

20:01

If someone say something awful.

20:03

On. It causes Ptsd. The someone get twice

20:06

as bad Ptsd if they see something

20:08

twice awful or is it very much

20:10

down to the individual. I think

20:12

tank which isn't a straightforward. Answer is it

20:14

you expect from the top. An acute stress

20:16

response. From they witnessed something or for whether

20:18

that the car. Accident: A billionaire Worth

20:20

the urban combat that people with other

20:23

from. That's what happens with Ptsd

20:25

is that becomes enduring and is. Eminently

20:27

to allow people to hear that. I think

20:29

that maybe what you're talking about is something

20:31

that will pull moral injury whereby is something

20:34

that we would call an act of the

20:36

mission or commission. Said there was something I

20:38

did same or I thought I should have

20:40

done and I didn't vaccinate. That. The

20:43

teacher see more. difficult to treat. Ptsd

20:45

is very much see a base that's

20:47

not the ascent, the pauses. The difficulty

20:49

is your belief about the offense, what

20:51

you thought was going to happen. They

20:54

didn't It's a hearing timeline. With Ptsd,

20:56

it's not like a memory. Is

20:58

fragmented. If your belief

21:00

is that you did something awful, or

21:03

you didn't prevent something awful happening. That

21:05

makes it difficult to treat. To. Give

21:07

an example, Say that young man who

21:09

held a child is been mortally wounded

21:11

in it's attack and he help a

21:14

child for a period of time. And

21:17

what happened was that he had a child

21:19

himself at the same age at home and

21:21

the really struggled So much was he felt

21:23

that it was his duty to protect that

21:26

child. And he had failed. and not

21:28

a juicy. So. Therefore, once event

21:30

itself was really. Really

21:32

awful. To. Witness. That.

21:35

Was a deeper sense around it was

21:37

a the least he had about it

21:39

and the belief that created the difficulty

21:41

for him. Or we can sing

21:43

better. Treating it. because i've seen

21:45

over the years the number of people

21:47

with different viewpoints about how we should

21:50

or shouldn't go about talking people down

21:52

from the aftermath of particularly harrowing events

21:54

and experiences and so on and what's

21:56

good to do what's not good to

21:58

do in the seems sometimes be at

22:00

odds with previous guidance. So do we know

22:02

the best way of managing this now? I

22:05

feel that this idea that I don't

22:07

want to talk about it, events were

22:09

so traumatic and so dreadful at the

22:11

time and so chaotic that you didn't

22:13

actually manage to process what was happening

22:15

in a coherent way and

22:18

therefore by revisiting those events in a

22:20

way that means you can tolerate it.

22:23

I think that the gold standard treatments

22:25

which are EMDR which

22:27

is eye movement, desensitization

22:30

and reprocessing and trauma

22:32

focus CBT which is the model

22:34

I practice in. I

22:36

think those models they're

22:39

evidence-based and actually have been proved

22:41

to be really, really effective in allowing people

22:43

to process the trauma that they

22:45

live with. It's perfectly normal when

22:47

you've been through an event that's

22:49

left you with a wound like

22:51

this, is to want to avoid thinking about

22:54

it, wanting to avoid things that remind you

22:56

of it, but what they do is they

22:58

maintain and perpetuate the difficulty. Having

23:00

the courage to look at the difficulty that you

23:02

have will be the best thing that will help

23:04

you through it. Theresa Mitchell from

23:07

Help for Heroes. So we're going

23:09

to conclude the programme this week by

23:11

hearing about some of the operational challenges

23:13

faced by doctors who go to work

23:15

in some of the world's most dangerous

23:17

active war zones. I've been speaking

23:20

to Natalie Roberts who is the

23:22

Executive Director of Médecins Sans Frontiers,

23:24

UK, also known as

23:26

Doctors Without Borders. The first

23:28

stage of emergency response is really trying to get

23:31

into somewhere and try and work out what's

23:33

going on. So we do that through a

23:35

sort of specially trained group of people. We

23:37

send them in to try and first of all just spend a

23:40

day or two really understanding what's going on, talk

23:42

to the people who are there and try and work

23:44

out the first steps of what we should start doing

23:46

and how we could be most helpful. So it can

23:48

be a little bit chaotic because you

23:50

go into places where maybe you don't already

23:52

have any team members, maybe never been there

23:54

before, you might not speak the language, you

23:56

have to first of all start by finding

23:59

maybe... translators, finding somewhere to stay,

24:01

finding some cars to drive around in and

24:03

then working out who you need to talk

24:06

to to understand what's going on.

24:08

So those first stages of an emergency response

24:10

is really about trying to understand the situation

24:12

as best as you can. There must be some

24:14

things which are commonalities. It doesn't matter where

24:16

you go to a conflict or a war

24:18

zone, you're always going to expect the same

24:20

sort of things generally. What

24:23

are they? The first worry you

24:25

have whenever you go anywhere is this is

24:27

a war zone, it's very dangerous. You're going

24:29

into a dangerous place. You're usually going to

24:31

a place where people are leaving or trying to

24:33

leave. First of all, you have to start

24:35

thinking about, well, how can I make sure that I'm as

24:38

safe as possible? Maybe I need to

24:40

not go straight into the heart of the conflict. Maybe

24:42

I need to start off a little bit further away.

24:44

But you're trying to balance that with

24:46

the fact that you know that there's a conflict, there's

24:48

a war going on that people need you to be

24:50

there and you don't want to take too long getting

24:53

there to help them because every day that you're delayed

24:55

and choosing where to go and what to do,

24:57

that's a day that maybe you could have

24:59

spent saving people's lives or at least trying

25:01

to help them in some way. So

25:04

really it's about balancing those considerations about

25:06

well, this is uncomfortable and this is

25:08

dangerous and what risks am I taking

25:10

versus well, how can I do this

25:12

as quickly as possible to be useful

25:14

on the ground? What sorts

25:16

of medical problems do you end up trying

25:19

to solve? They can really vary from place

25:21

to place. So for example, I

25:23

went into Ukraine with this idea that really

25:25

I needed to be setting up surgical units

25:27

to treat people with war injuries. And

25:30

what you always find anywhere is that

25:32

you're never alone. You're not alone with

25:34

just a bunch of people around you.

25:36

There are always other doctors or there

25:38

are always other healthcare workers who are

25:40

already working there. And in Ukraine, it

25:42

actually wasn't the war injuries that are

25:44

most important. It's actually the elderly people

25:46

who, you know, it was cold, it

25:48

was winter. Suddenly their electricity had been

25:50

cut off. They couldn't move around anymore

25:52

because of the war going on around them.

25:54

A lot of the people that

25:56

would normally look after them had fled. And so

25:58

they were sort of, you know, left. behind. And

26:01

so in some places you have to change your opinion

26:03

immediately of who you're trying to help.

26:05

The other extreme is somewhere like Northeast

26:07

Nigeria, which is also active war zone,

26:10

where again it's not necessarily about treating

26:12

wounded people. It's more about the children

26:14

that are in that space who maybe

26:17

are struggling to access the right type of

26:19

food and the right type of health care. And

26:21

you have to immediately start thinking, who are the

26:23

people I'm here to try and help? It is

26:25

very challenging to even understand that in the first

26:27

place. Do you find yourself worrying about

26:29

yourself when you're there? Or do you put

26:31

all that to one side? Or do you

26:33

continuously think, how am I going to get

26:35

out of this? How do I get home?

26:38

Am I going to get stuck here? Anyone

26:40

going to that situation needs to worry about

26:42

themselves. If you're not worrying about yourself, nobody's

26:44

worrying about you. And you know, it's something

26:46

we have to learn is if we're not there

26:48

to sacrifice ourselves, we're there to try and

26:50

be useful. But there's no, you can't be useful

26:53

if you can't work, you know, and you can't be

26:55

useful if you get injured, if you fall sick, you

26:57

need to look after yourself and you need to worry

27:00

about yourself. There's a moment when you're in that

27:02

situation, you start thinking, I feel fine now I'm used

27:04

to this, this is normal. At the

27:06

moment, you should start thinking about taking a break and

27:08

seeing if somebody else should come in and replace you.

27:11

How do you prepare for all that kind of thing,

27:13

though? Is that something that MSF

27:15

trains you for? Or is it literally a

27:17

case of being mentored by someone on the

27:19

ground? I'm really finding out the hard way

27:21

how to do this, do this safely, protect

27:23

yourself, look out for your own interest, but

27:25

also look after the people that

27:27

are there the best way you can. You don't

27:29

always know how you're going to react in

27:32

that situation. But MSF and other

27:34

organizations do prepare you to start thinking about where

27:36

you're going to be, how you're going to cope with

27:38

that. They also do quite

27:41

a careful selection procedure, recruitment procedure

27:43

to decide who will work with the

27:45

organization. You go on a special training, I

27:47

did mine for about 10 days in the

27:49

German forest, which is sort of, you

27:51

know, a scenario where you're supposed to kind of think

27:53

what this is like in reality. So they

27:56

do test you a little bit, so you're aware of the

27:58

realities, but there's only so much they can test. before

28:00

you go. What I found quite useful actually

28:02

was working in the National Health Service in

28:04

the UK because if you think

28:06

about working in the emergency department, if

28:09

anyone's ever been to A&E, you

28:11

get all these different patients coming in all

28:13

the time. You're constantly having to think about

28:15

what you're doing and what's going on. And

28:17

while you can't equate that to a war

28:19

zone, if you've learned to deal with that

28:21

and the stress that comes with that, that

28:23

gives you this idea that you probably can

28:25

cope with some elements of stress. Then

28:27

I think that idea of mentoring is going

28:29

with somebody who's maybe experienced something similar before

28:31

when you're going for the first time to

28:33

someone like that. So you can just talk

28:36

to them and just cross check. Not

28:38

necessarily what you're doing in terms of your work,

28:40

but more about how you're feeling and how

28:42

to cope with the situation that's around you.

28:45

Do you find though that it's tricky sometimes

28:47

because there are things that you think if

28:50

I were in my well-funded,

28:53

relatively speaking, NHS job,

28:55

I could solve this in the blink of

28:57

an eye and I don't have access to

29:00

this piece of equipment, this drug, this

29:02

course of therapy which could rescue this

29:04

person and I'm going to have to

29:06

give them less good care. Do

29:08

you end up with that conflict? Absolutely.

29:10

It can be really, in times really

29:12

frustrating, really tricky. You have to think

29:14

on your feet the whole time, you

29:17

know, you go somewhere and you're maybe

29:19

seeing diseases you've never seen before. I've

29:21

never seen diphtheria or Ebola in

29:23

the National Health Service. And so

29:25

not only you're trying to think, I don't even know what

29:27

I'm doing here, I've never seen these types of

29:30

diseases or injuries before but I'm also not

29:32

sure I'm well equipped to deal with them. You've

29:35

got those two uncertainties of seeing something

29:37

you're not familiar with and not having

29:39

all the equipment that you would have

29:41

normally at home and it can be

29:43

really uncomfortable. In some ways

29:45

the way to deal with that is think if everything's

29:47

a challenge, think about how you can be creative,

29:49

think about how you can maybe innovate, you

29:52

know, try different things out. And particularly if

29:54

you're working with local staff with doctors and

29:56

nurses and other health care workers who are from

29:58

there who have to work in that situation

30:00

all the time, they've often got

30:03

really good ideas about things you could do

30:05

when you're kind of more used to having your

30:07

laboratory tests or your x-ray machines and they kind of

30:09

saying, well, this is trick and I can teach you

30:11

this. And you actually learn an awful lot that

30:13

way. Very illuminating. Natalie Roberts

30:15

from Métis-Somme Frontière. That's where we leave

30:18

it for this week. Do join us

30:20

on Friday for our news roundup, of

30:22

course. And then the week after, we'll

30:25

be finding out all about plastic, not

30:27

so fantastic, as researchers show that there

30:29

are hundreds of thousands of plastic particles

30:31

in the average plastic bottle of mineral

30:34

water. We're going to explore what

30:36

health effects they might be having, both for us

30:38

personally and the planet, and how

30:40

they're teaming up with what we're dubbing

30:42

forever chemicals to unleash a toxic cocktail

30:44

on the world and what we can do about

30:47

it. The Naked Scientist comes

30:49

to you from the University of Cambridge's

30:51

Institute of Continuing Education. It's supported by

30:53

Rolls-Royce. I'm Chris Smith. Thank you for

30:55

listening. And until next time, goodbye. Thinking

31:18

about your next career move in research

31:20

and development? Then it's time

31:22

to make your move to the UK. The

31:25

nation that's investing £20 billion in

31:27

R&D over the next two years.

31:30

The nation that's home to four of

31:32

the world's top research universities. The

31:36

nation where great talent comes

31:38

together. Visit gov.uk/great

31:40

talent to see how you

31:42

can work, live and move

31:44

to the UK.