Richard Villar - Disaster Medic

Full transcript: Richard Villar on London Real

9:41 This is London Real I am Brian Rose we are sponsored today and drinking bulletproof coffee which is a coffee that’s free of molds and toxins you mix it up with some grass-fed butter much to the surprise of many of my guests and we also put in some brain octane oil which is like the best of the coconut and you mix it all up and it’s kind of a brew kind of like a yak butter tea I was explained to Richard earlier he’s actually had yak butter tea? I have had yak butter tea. Is there any similarity? There’s a vague taste of yak perhaps in the background, but that’s about all. It’s very tasty indeed.

10:19 Okay, well you like that. It’s a great way to have some coffee. A lot of times I find that normal coffee has some molds and toxins. I feel lousy afterwards. This has some butters and oils in the morning and it’s kind of my breakfast replacement. It gets my brain working well. I just want to thank the guys at Bulletproof. They’re big into biohacking, which is like getting your body to perform better and questioning a lot of the things that we put in our body.

10:42 Like a peanut butter and jelly sandwich, I was thinking today, why do we eat those? Maybe because my mom gave me one, but it’s just different ways of eating things. So if you wanna check them out, their blog is bulletproofexec.com and you can go to upgradedself.com to pick up the coffee, MCT oil, et cetera. My guest today is Mr. Richard Villar, who is an ex-SAS surgeon and author of the book, Winged Scalpel, which describes the difficulties, dangers, and occasional impossibility of providing medical aid in disaster areas and war zones.

11:14 You have been to three major earthquakes. I believe it’s Casimir in 2005, Java in 06, Haiti, which you taught me how to pronounce correctly the last time you were here. In 2010, you were at the Libyan Civil War in 2011. You’ve just returned from the Philippines. I have indeed.

11:32 Where you were there to be on the ground after the typhoon. Richard, welcome back to London Real. Thank you very much indeed. It’s a pleasure having you here. You are only one of three people who has returned to the show.

11:44 You’re in fantastic company, Graham Hancock, the author of Fingerprints of the Gods has been one. We had the founder of Martial Arts, 10th Planet, Jiu Jitsu, Eddie Bravo, and now yourself. So thanks for being here. Your assistant, Rosie, texted me about a week and a half ago. She said, Richard just got back from the Philippines after the typhoon, would you like him back on the show?

12:04 And I had two words that I said. I said, hell’s yeah. So it was an immediate yes, so thanks so much to her, and thanks for coming back. My great pleasure. You know, I’m gonna cut right to the chase, and I’m just as excited as everyone else watching right now, because I don’t know anything that happened to you.

12:19 About a month ago, I think it was like, early part of November, I believe it was Typhoon Haiyan. Yes. It hit the Philippines. I wanted to know, when did you first hear the the typhoon when did you know that you might be going in and then what was the next week of your life like well it’s it was a very rapidly moving event I mean I think the world knew as did the Philippines that the typhoon Haiyan was going to arrive it’s actually locally called typhoon Yolanda and so in many respects there were certain agencies that already had personnel in place waiting to see what might be required unlike let’s say an earthquake which is totally unexpected right people knew the typhoon was going to happen like days before it happened?

13:00 Yes. It was short. A day before it was going. Okay, okay. But of course, you’re never prepared for the real thing when it happens.

13:06 You think you’re prepared, but you’re not. We were not stood by. In fact, I went to a meeting with Save the Children Fund, where we were talking about everything other than the typhoon, and that was about two days before the typhoon itself. So we had an inkling that might be something that might involve us, but no specific detail. But there were personnel actually in country waiting to see what would happen.

13:30 OK. When you were here last time, I was thinking that every time you watch the news, you must be thinking in the back of your mind, am I going to have to go there? Am I going to have to go there? So does this something you kind of saw creeping up, or you were saying you didn’t see it? Well, we knew there was a typhoon, but obviously not the…

13:45 It’s a strange way to live, by the way. It is. It may well be. But in fact, it’s never… It’s not always…

13:51 I’m not always as accurate as I might like to think. And I remember on one occasion, having just come back from one earthquake, and I can’t quite remember which one it was, looking at the television and seeing there was going to be a tidal wave off the coast of Japan, ringing up the NGO for which I was working and saying, look, we must put everyone on standby for tidal wave. When the tidal wave came in, it was only 18 inches high. And meanwhile, the entire UK disaster emergency response had been stood by.

14:16 So one has to be slightly careful about what one does. So nothing came of that. This was many years ago. This was what? Must have been about five or six years ago, I think.

14:23 Okay. Before the big one that had the earthquakes. Exactly. But no, on this occasion, I was actually climbing in the Lake District. I’d been off for a weekend and I was enjoying myself and then my mobile telephone went and the request was, and here we are, I think, 36 hours after the typhoon, could I be on 12-hour standby to move?

14:43 So I instantly responded yes. Can you say no to that? You can say no. But you wouldn’t. But I mean, you’re not on the disaster team if you are the sort of person that says that sort of thing.

14:54 I mean, in practice, a disaster means you’ve got to move quickly, and absolutely everything goes by the board. The difficulty, I think, for most UK doctors has been getting the time away or getting their UK job covered while they had been away, because obviously, in my case, I have a full operating session for two, three weeks, however long it may be, I shall be away for. And all of that has to be cancelled. And at the last minute, all your poor patients have done all their arrangements.

15:23 So they have to be sorted out. And so we have in place a facility, a system to cater for that. Within the National Health Service, you’ve now got locum appointments, locum doctors who can come in. And so the chief executives of many of the UK hospitals are now happy for their staff to go because they know that their places will be covered when they’re away. OK.

15:44 So you have people that are getting replacement hips, hips are your specialty? Do you do knees as well? I do hips and knees. Hips and knees. Mainly hips, but hips and knees.

15:52 And when they come in to see you, do they, is there a disclaimer saying, I might have to go? Do they already know about you? Because if I was getting my hip replaced and I knew you were going to do it, I would want you to do it. Oh, no. You’re absolutely right.

16:03 No, they know about me and they know before they even come that the practice with which I form part of, which I form part, the personnel may have to go to a disaster zone on occasion. In reality, going away doesn’t happen that much. You’re stood by very frequently, but probably once a year or so, you will have to go to a big one. Okay, all right, so you got the text. You were in the Lake District.

16:25 You went back and said, I’ll be ready, which means within 12 hours, you might have to be on a plane. Yes, exactly. Now, at that point, you have no idea if you’re gonna go for sure, but you’ve got a pretty good inkling, you will be. You’re not quite certain who the team is. You’re not quite certain which airport you’ll have to be going to or how you’ll be flying.

16:43 You simply get yourself ready, mostly you are ready. Your bag is largely packed, there are a few things that will need to be changed. I suddenly, for example, remembered I’d forgotten to have my typhoid and cholera vaccination and so suddenly you have to get that at the last minute. But generally speaking, you’re on a roll, the system is in place and you will turn up to meet the others wherever you’re told to meet and turn up to meet them as it were. Okay, now for you, does that mean leaving the Lake Gesturing and coming back to central London?

17:11 Oh yeah. No more whiskey for that evening. I mean there are certain behaviors you have to change right away Well, I know it’s a sadly. I’m not a whiskey drink. I wish I was but the no it means for example that particular week I’ve got a course I’m running running in York the following week I’m in Copenhagen so all of that has to be cancelled or people have to be stood by now I say to my secretaries back at the practice Just cancel the next week You may think I’m going to be away for two weeks three weeks four weeks who knows but just cancel the next week because you never really know how long you’re going to be away from.

17:43 They can sometimes be longer than you think, sometimes be shorter than you think. Right, because the last time you were here, you talked about how your deployment, it’s all about the very, very initial phases. You call yourself a medical fixer. Yeah, surgical fixer. Surgical fixer.

17:55 Yes, that’s all. Because you almost get on the scene and you have to make things happen, like you have to build the hospital sometimes, or like triage in the ultimate sense of what is going on here, triage, as opposed to individual patient triage. But now I’m answering for you. No, no, no, no, no, no, no, no, no. So oftentimes your deployments are very short?

18:11 Oh, I say it depends what you mean by short, but I mean, they’re probably about two weeks. I mean, for example, this was a two week trip. How long was Haiti? Haiti was just under three weeks. Okay, and this trip was?

18:22 This is two weeks, roughly two weeks. Okay, two weeks, all right. No, because you see, you have a disaster. You don’t quite know what you will be expected to do. Now on this particular occasion, I wasn’t quite the surgical fixer.

18:34 I formed part of a surgical team. That is, we already had in place individuals who had spotted likely locations, but even those locations they hadn’t been to, because there was no way of getting in there. So as it were, we had to position ourselves very near to the action, and that’s the point at which you have to make it up slightly as you go along. You know what your skills are, you know what are needed, you may not know precisely where they are needed.

18:57 You’ve got a pretty good idea, but not precise enough to send everyone there instantly. And do you give Merlin feedback? Merlin’s the organization you work for, is that right? Well, yes, on this occasion, I worked for Merlin and for Save the Children, and in reality, in-country, because Save the Children has now purchased Merlin, and so they now form one large organization. So this was my first ever mission with Save the Children Fund.

19:18 Okay. And is it a discussion? Do you talk to them about what you think should be done, or are they kind of very top down there, like, we really need you here, and you’re going to be working with these kind of people? And there’s a lot of discussion. I mean, remember, 12 of us turn up to this.

19:31 So we all arrive at Heathrow, and there are 12 individuals, and all of them have got experience of this. Have you met them before? Typically not. Some of them have. Some of them haven’t.

19:40 And so there’s some fairly rapid bonding going on. Sounds like a Hollywood movie. Like that hangover, but like the, I don’t know, whatever, the disaster series. But all right. Go ahead.

19:48 No, no, no. It probably is. So see you arrive, and then you’re then told of your route. Get hold of some money, some cash is given to you, your equipment is given to you. You take your personal belongings, but the Department of International Development who have also helped fund this, they provided some extra equipment like sleeping bags, sleeping bag liners, a knife, fork and spoon, water bottles and so on.

20:10 So you get given your kit or the extra kit literally at the airport. So you’re busy packing everything you possibly can and then away you go. Now literally in Costa Coffee in Heathrow, you are given your first briefing and that first briefing was given by one of the senior members of Save the Children Fund. It was, I have to say, a textbook briefing. If I’d wanted to give a briefing or explain to people how to give one, that was how I would give it.

20:32 And so you really felt motivated. I want to get out there. Now, at that point in Heathrow, you’re still 20 hours away from the location. There’s a lot of traveling to do. But you’ve got an inkling at that point, what is likely to be expected of you, but even then, not where it is to be expected of you.

20:48 What makes a good briefing if you had to just kind of summarize what that was like? Is it short? Is it sweet? Is it motivational? Is it provide details?

20:56 Detail and basically this individual has had the skill of making you feel he was talking to the person when in fact there were 12-15 people there you know and so every individual felt they were being addressed in a way that most people find it very difficult to do no notes nothing at all looks you in the eye when he wants to look you in the eye and no you feel very motivated I felt very motivated after this is coming from an essay a soldier I’m sure you’ve had And you’ve heard some people talk to you. I’ve had countless briefings. And he’s up there with the best of them.

21:27 And he works for Save the Children. He does. He does. OK. All right.

21:32 So you’re given the mission. You’re flying off to Manila via something? Yes. Well, we knew we were flying to Manila. That was via Kuala Lumpur.

21:37 And at that particular point, you then sat in your economy class seat and away you go. You changed in Kuala Lumpur. We ended up in Manila. And then in Manila, you’re met in country by one or two individuals who’ve been there for a few more days. They have just put out feelers, and they begin to give you a feel of the sorts of things you might be thinking about.

21:58 I, this location, there’s unlikely to be many casualties, in that location there’s likely to be a lot, these areas have been missed out, these areas haven’t, and so on. So you’re beginning to get a feel at this stage of what is expected of you. Okay, talk to me about typhoons. How big was this, and it’s such a different kind of damage than, say, an earthquake, I’m guessing, or a civil war, but what did you learn right away about the typhoon in its severity compared to previous ones in the Philippines.

22:22 Right. Well, I mean, in terms of meteorology, I know very little. But in terms of the strength of winds, I mean, basically, you don’t want to be a strength five. And this was a strength five. This was as strong as they get.

22:34 And as far as we were told, it was the strongest typhoon ever to have made landfall. We knew that it had made landfall not once, not twice, but actually six times. Now we found on the ground, in fact, that yes, a typhoon is enormously destructive, But actually destructive in its route of passage, as it were. So it’s not destructive throughout the country, but if you sort of take its main track and then you go, let’s say, north and south, I’d say, what, 60 miles, then it’s created extensive damage, get beyond that, and then there’s much, much less damage and get further away and there’s no damage at all.

23:06 So what you’re doing is trying to spot the areas where it has made landfall, and those are the areas that you target. Was this completely unique compared to your other experiences in Casimir, in Haiti, as far as the geography and the actual disaster itself? Yeah, because I mean, it was unique for me, yes, because I’m used to buildings collapsing on people. Now they collapsed on people in the typhoon, but actually I think the thing that did most of the damage was actually the storm surge afterwards.

23:33 And so you’re looking at a storm surge like a mini tidal wave, but you’re many, many meters high taking out all this low-lying coastal, rather ramshackle wooden accommodation. So that’s really what did for people. And so it was more like, I suppose, the 2004 tsunami, where you find there’s a lot of fatalities very near to the sea, and then you get a bit further inland and suddenly everybody’s alive. And so yes, you do have injuries, but a lot of fatalities.

24:02 Okay, and logistically, can it be more helpful since a lot of the country is still working as opposed to on an earthquake when it must take out like all of Haiti and everything is dysfunctional. I mean, were there still parts of Philippines that could supply you with? Oh yeah, so the parts of the Philippines which were perfectly okay, but you remember we’ve got to get to where the action is and that was totally destroyed. So for example, in the era we eventually chose, there was one runway, that runway was blocked anyway with debris, even when the debris was closed, the runway was so small, you could only park four aircraft there.

24:33 And so you’ve only got room for four aircraft at any one time. So you’re flying day and night to try and get aid in. Wow, all right, so take us to Manila, you’re in Manila, you land, You’re getting briefings on where you’re going to go, well, what happens next? Well, you get to Manila and you think, actually, what’s all the fuss about? Because Manila is a fantastically fantastic city and you look out the window and you think, surely there’s no disaster.

24:55 But so now some agencies went no further than Manila and that’s where they did their planning from. From our viewpoint, we wanted to get as near to the action as possible. So our decision was to get as near as you could safely get and that would be when we would make the assessment we required. And so we went from Manila to a place called Cebu, C-E-B-U. And that was ours.

25:16 It was a center of operations from which we made our definitive plans. Now, you said safe. Are you worried about more natural disasters coming your way, as in more of those waves coming through or more typhoons? Or are you worried about safety? You’re worried about safety.

25:30 Of course, you are. In Manila, not at all. Not at all. Manila is a lovely place, lovely people. Down to Cebu, we went, again, lovely place, lovely people.

25:37 But you’re beginning to feel slightly edgy. You’re beginning to trust the weather a bit less. You know, even in Cebu, there are one or two fallen trees, even though Cebu itself wasn’t on the main typhoon track, but you’re just beginning to pick up a sense that things are not as they ought to be. And so you’ve got your wits about you at that point. Is there a sense of anarchy?

25:59 And do people, do you sense danger when there’s a bit of disorder going on? Well, in Cebu, there was no sense of that at all. Once you went from Cebu onwards, yes, you began to get that feeling for sure. And so what we basically decided in Cebu was, there would then be, we divide into two, and one party would, as it were, Rekki, Rekoniter, the local area, let’s go, say, go 60 or 70 miles away and see what was there, and another party would work out, were there any other ways in which we could maximize the aid we’d come to provide.

26:32 Okay. Now what do people need from you, you know, when you get there? I mean, what are the injuries and what are the things happening? Well, if you take, I mean, let’s, there we are in Cebu and we’re deciding do we locate in Cebu, do we go elsewhere, and we decide there will be certain key areas which were lacking aid. Some of the organizations were already going into a location called Takloban.

26:55 And Takloban, I think it was the second point where the typhoon had made landfall and it was completely destroyed. Now, clearly, we decided that half of us at least would go there. Originally, we just thought, well, actually, the islands. Remember, the Philippines I think have got something like 7,107 islands, 2,000 of them are inhabited. And so, how do you get to those? And so, actually, it so happened the Royal Navy had HMS Daring there, and so it was a very good link to be made.

27:21 What is 80 most daring? HMS, Her Majesty’s shape. Oh, okay. So there was a Royal Naval vessel in the area. It had been diverted by the government to go there. And so it seemed ideal. Originally, all 12 of us were going to go on HMS Daring.

27:33 We were going to provide aid to the islands because they would not have had aid there. Anywhere you could land an aeroplane, fine. But these places, these islands had no airstrip at all. And so they simply needed a ship to get there. HMS Daring was a gift from heaven.

27:46 And so we thought, let’s all go and let’s put 12 of us on HMS Daring. And we all arrived, as it were, with our sea-going kit. And then literally three hours before we were due to board HMS Daring, we had a message from Tacloban that there was a field hospital there that had just started work and that was desperately short of orthopedic, that’s bones and joints, assistants. So half of us instantly diverted from HMS Daring and we went to this location called Tacloban. So the team is sufficiently flexible. We have a register called the UK IETR, the United Kingdom International Emergency Trauma Register. And that comprises a lot of individuals who are trained up to go to disasters.

28:25 And so they should be able to multitask, OK, I am an orthopedic surgeon, but I guess if you want me to dig a latrine, I will do so. But in practice, you need to be able to divert into different corners of your specialist activity. And so we have a team, suddenly we can divide into two. One half can provide the islands with support, and the other half, that was the half I belonged to, can go to Takloban, which is what I did. Were you disappointed not to go on the boat ride a little bit?

28:52 Well, I mean, you know, did I ride with my bucket and spade almost the I suppose actually Yes I mean there’s obviously you’re there to provide aid it is a critical situation and you are actually really feeling it for the local people In a big way and remember that there’s a huge link between the Philippines and the United Kingdom And there’s a lot of Filipino people over here who are doing a power of good for health care in the UK So actually you don’t feel you owe it to them, but actually friendship is there you just it seems the right thing to do But yes, I would love to go on to HMS Daring. I didn’t go on to HMS Daring and we got slightly envious of our colleagues who did because they had nice food and they sat down, they had nice beds. We didn’t have any of that.

29:29 Okay. So it was a bit of a refuge, a bit of a hotel on water. No, I would never for one moment say that, but there were comforts where they had, we didn’t know. And the Royal Navy is volunteering that kind of a vessel? I mean, that’s quite a, that’s some serious aid.

29:42 No, I mean, the UK government has been big on aid. I mean, you know, I mean, I’m the world’s most hopeless politician, but you can hear they are prime minister from time to time being criticized for the amount of money that’s being diverted into overseas aid. I disagree totally. I think it’s a really good thing to do. You know, I guess you’d expect me to say that I’ve done a lot of that, but it’s good for the UK to provide aid to these overseas countries because a whole heap of other countries simply do not.

30:07 Okay. Were there any American naval vessels being volunteered for this? Oh, yes. I’m pleased to say there were. There were.

30:13 We’re not involved with those, but no, of course, of course there were. There were? Yes, there were. OK, all right, just checking there. So you get diverted at the last minute.

30:19 They need you because of your orthopedic specialty. That’s right, yes. And it’s a nearby hospital. Are you all going on trucks and vehicles? No, no.

30:27 I mean, we’re in Cebu. OK. Cebu is another, it is distant from Tacloban. It’s about, I think, about 45 minutes flight from there. And so suddenly, my half of the 12-man team, we’re now down to six, is tasked to go to to Tacloban rather than to go on the ship.

30:44 We arrive at Cebu Airport, and there’s a pile of people trying to get there, a lot of aid agencies trying to get there. I had a wonderful experience when I had a tap on my shoulder, I totally unexpectedly checked in, and there was my son who had been tasked by Reuters TV to go and report in Tacloban. So there was a most unexpected father-son reunion in an airport. So off we go, he’s on a different flight, I should hasten to add. And we arrive in Tacloban, And when you fly over the Philippines, there you are, let’s say at 15,000, 20,000 feet, they look wonderful.

31:14 And you couldn’t tell from the sky what the damage was at all, unless you were trained, and I certainly couldn’t tell. As you come down lower and lower and lower, you really begin to see the enormity of what happened. And you want to imagine total destruction. I mean, I don’t mean just a few houses down. The only properties I saw intact were two churches made of stone, okay?

31:34 The rest were completely trashed. Imagine everything destroyed from the shore inwards for a fair distance. And does that bother you when you see that, or are you conditioned to expect that? Or does part of you, does it get you down, or does it kind of get you excited to go and go to work? No, I remember that feeling right now.

31:52 I mean, you can never get used to that. You can never accept it as normal. It’s never something which you can relax when you see. I remember as I hit that tarmac, having seen all that from the air, you really wanted to go do something there and then. You’ve been in Manila and you’d thought, what was all the fuss about?

32:10 That had changed just like a light switch. The moment you got into Tacloban, everything, but everything was destroyed. Right, and that’s not the question I wanna ask you. How do you control like the adrenaline dump because you’re in Heathrow getting a briefing, but now you have to wait 20 hours and then you’re in Manila and everything looks fine and then you have to go here and then you have to go here and I’m sure you see it in your colleagues who may have less experience than you or maybe more, doubtful.

32:32 But how do you control your emotions? Is there anything you use or do you meditate or how do you do that? No, well, I mean, it can be emotional, mind you, I have to say when you’ve traveled for 20 hours, actually it’ll flatten most emotions out. Now I’ve been used to that in the services. We used to call it the services hurry up and wait or on the bus, off the bus, on the bus, off the bus.

32:52 Things change a lot. You just have to get used. I mean, I suppose in my UK practice, I think I’m fairly positive about the way I exist and practice. I think I try and direct my practice in a fairly positive way. You can’t really be the same sort of character in a disaster because you are slightly governed by events.

33:12 You may think you’re going to be in a particular location at, say, 9 o’clock in the morning and you suddenly find you’re somewhere completely different in its midday. So that’s the way you have to be in a disaster. You have to know when it’s right to turn that switch and act suddenly. In the act of travelling, generally you don’t. You just go with it and when you get there, you rest as much as you can.

33:32 I’ve taken a lot of photographs of the team going out there, there’s a lot of sleeping going on, everyone’s just relaxing, just getting themselves ready for the task they know they’re going to have to do. Okay, you land on the airport, what do you see right away and what do you think to yourself the first thing you need to do? Well, show me a patient, I guess is what you say, which is totally logical because of course you don’t have equipment with you in your hands at that moment.

33:56 The airport is destroyed, the airport terminal building is destroyed. Inside the airport terminal building, there’s a whole pile of aid which has been flown in, I believe, by the Americans. And so there is aid already coming in. There are Hercules is there with engines running, they’re taking aid off, the refugees going back home. Hercules are planes?

34:15 Yeah, Hercules, the C-130, sort of the workhorse of the sky. So people going on and aid coming out in crates and? Yes, exactly that. There are Ospreys, these sort of two-engined aircraft. aircraft, there’s special forces soldiers on four-wheel, all-terrain vehicles, all sorts of things are going on and you are forming part of that. So you really feel you’re part of a big machine. Now actually as you get in there you begin to realise there may be a big machine in the airport but very little of it has actually made it inland. Now we were actually quite fortunate because in fact the people who had requested our assistance were the Australians and so we formed part of the team belonging to what’s called OSMAT which is Australian medical assistance team. Now, this was their first real-life operational deployment, and they were wonderful to work with. The only point of disagreement was the test match, everything else we agreed about, and they ran it in a very, very good way. So it was an excellent place to work. Okay, and your first 24 hours there, what happened? Complete mayhem. Firstly, you’re getting acclimatized, but at the same time, you can’t really get acclimatized because you’ve just got to get in there. So the first thing we did, we’re met at the airport were taken to a tented Australian field hospital, because all the other hospitals have been destroyed, all the other within Tacloban, and they’re gradually being swept out and

35:34 They’re trying to get them back to life. But imagine a series of tents over a space, an area maybe of three acres, four acres, a couple of hectares, that sort of thing. The whole area is concrete. The first action was to put our tents up, and the tents were single tents. You had a tent to yourself on concrete, which didn’t drain. And say you’re sleeping in your own accommodation, you’ve erected yourself, you’re washing for yourself, you’re cleaning for yourself, you’re cooking for yourself. So a lot of it is setting up your own personal survival system before you treat the patients. You probably got 35, 40 minutes to do that. Get yourself sorted. And then we were in theater, the operating theater, within 45 minutes of arriving. 45 minutes. We were operating. Yes, we were. And imagine a long, tent I guess, imagine a tent let’s say 30 meters long by 15 meters wide in that it’s air conditioned you’ve got two operating tables in that and in that area and patients are coming in about I would say 200 250 a day are coming through this particular typhoon it lasted 16 hours now firstly your house collapses okay so if you’re in the house you’ve been hit by some falling debris you then get a storm surge and with that a lot of debris comes through so a lot Part of it was, let’s say, corrugated iron, debris, corrugated iron lacerations we’ve had.

36:55 Comes flying through the air after your house has been destroyed. That’s right. Or even through the water. And so a lot of corrugated iron lacerations. And of course, the water is contaminated.

37:05 And so you can’t just close up or sew up, suture up a wound when you have that contamination because you know if you do, you’re going to harbor an infection. So you leave it open. You clean it. the patient back to their bed, you then bring them back two days later, and you look again. You keep on cleaning and cleaning and cleaning, and when you’re happy the wound is totally clean, that is when you close it. So that patient may require four or five different operations at two-day intervals before they eventually end up with a closed wound. Which is different than what would happen in Haiti. That wouldn’t happen to be the case as far as that infection by humidity and by moisture.

37:38 Well, no, infection by debris and dirt in Haiti, of course. So infection is the big victim. And And one of the problems, I think, of a lot of teams that go into these places, they may be in for a short period of time, and so they try and suture wounds up on day one, which is generally the wrong thing to do. Of all the patients I saw, of all the patients we operated on, I only sowed up one wound primarily, every other wound we left open and sutured up secondarily.

38:04 This one wound, and I have no idea why it was unaffected, this was an elderly man, and he came to see me I think about 11 days after the typhoon, and he had a corrugated our laceration to his thigh, and somehow he kept it clean. I have no idea how. I looked at it. It was perfectly keen. He was sitting there in the accident emergency tent with his dirty hand in the wound. He had every reason to be infected, but it wasn’t. So we closed it up.

38:28 Are you talking to these people? Are they only speak Spanish? What kind of communication do you have? We have local… English is spoken to a limited extent by the more educated people, but We had local interpreters with us, and so there was a wonderful interpreter called Manny who could, I think he was so good at interpreting, he almost became an honorary doctor by the time we’d finished.

38:49 Okay. So 250 patients a day. Yes. That’s quite a lot. Are you going out and triaging them, or are you staying in an operating theater, are there other people doing those things?

38:57 No. What happens is, I mean, you have a presence called triage, okay? And so any patient comes in and they go to a triage tent, first of all. They will see, not me, they’ll see a very senior nurse or a midwife, someone who’s got a lot of experience in life and in surgery and in medicine. And at that point they’ll be given a categorisation. They then get brought in and they see a doctor and that doctor will commence treatment if it can be treated conservatively or at that particular point he can make a decision about surgery or if he’s still struggling he’ll come put his head round the door of the operating tent and say look will you come out between the cases and look at this case I’ve got for you. So it’s a combination of being fed by others and making final decisions for yourself, because yes, for example, I’m a hip and knee surgeon in the UK. So let’s say I’ll give you one example. An elderly man comes in and he has broken his hip bone.

39:44 Okay. Now he hasn’t actually broken his hip bone in the typhoon. He’s broken it before the typhoon, but he sees there’s a Brit doctor there. Let’s give it a go. Now he is in a bad way and I look at his x-ray because we have in-tented x-ray facility and I simply look at it and I say, you need a new hip, you need an artificial hip.

40:04 But I do millions of those back in the UK, I wouldn’t do one out there because clearly it would be contaminated. So there’s me faced with a patient directly in my mainstream specialty and I wouldn’t do him because it would be inappropriate that I did. So there’s a triage process that is based not only on the severity of injury, but also on the facilities you’ve got and do you have the right kit? We didn’t have the kit to do that and it would have been inappropriate to have done it on that basis.

40:30 I keep thinking of that television series, MASH. I don’t know if you ever used to watch MASH. You know, it was about these surgeons that I think were in the Korean War. And they were all in the same theater operating together. And sometimes they were literally, the bombs would come off and dust would come down and they were hovering over their patients so the dust wouldn’t get in the operating theater.

40:47 How professional is the setup there? Or are there concerns about sterility and all these other things? The setup, the theater tent is sacrosanct. You know, unless you’ve got business to go in that theater tent, you simply do not go in that theater tent. So we had business to be in there, and so we did.

41:02 Now, the wards are different. Yes, they’re sacrosanct, but more people will go on the wards because clearly the wounds have got dressings on, and so the chances of getting contaminated and infected are much, much lower. And indeed, one of the strong points of this particular facility was that every morning at 6.30 AM, the whole hospital would do a ward run. And so you would go around, and you as the surgeon would present the cases that you’ve done the previous day to your colleagues.

41:26 They would ask you questions. And by golly, if you couldn’t answer them, And then you really ought to have a reason for not answering them. And so that was really good for the patients. And so if, for example, a patient had a fever of an onetiology, unknown cause, and you thought it might be due to your surgery, one of the physicians would pipe up and say, had you thought of malaria, or had you thought of leptospirosis, and so on. So it’s quite good to have a debate, and the patients would benefit as a result.

41:51 OK. Are you learning things in those scenarios? Of course you are. Of course you’re learning. OK.

41:56 You’re teaching and you’re learning. And you have so many specialties there. Yes, you have orthopedic surgeons. you have vascular surgeons, you have general surgeons, you’ve got plastic surgeons, you’ve got physicians. And so, on that basis, you’re teaching each other the things you need to know.

42:09 Those first 24 hours, how many surgeries did you perform? I think in the, well, I mean, that first day, I think we got through 21, which is quite a lot for one operating room, it probably doesn’t sound very many. No, it sounds like a lot. If I tell you that when I’m really working hard in the UK, if I do six in a day, I’m doing well. So we’re doing 21.

42:30 That’s a lot. Now, one of the problems, of course, of doing 21 is because you’re not necessarily closing all those wounds the first time around, they go back to the ward. They then come back again. And so day in, day out, gradually, the numbers you are doing are increasing because not only are you getting new casualties in, but you’re also treating the old ones. And so your wards start to get fuller and so on.

42:50 So there’s a logistic issue. So the aim is to get patients out as soon as you possibly can. Did you have anyone die on you when you’re there? Sadly, we did. Yeah, we did.

42:59 It’s a problem. People see a hospital. Okay. It’s a tented hospital. They see a lot of well-trained doctors and they want their advice, but often they seek their advice too late, you know, and some people are unsalvageable.

43:14 You do your best for them, but you don’t always win. And that’s because infections set in or they’re just too much bleeding or just something from a wound. Well, it’s, I mean, different causes really, but I mean, generally, if you bleed a lot, then even if you bleed slowly, if you bleed rapidly, you die from blood loss, of course, don’t you? But if you bleed slowly, you can still bleed, you can still die, because you start to lose the ability to fight infection and so you can just generally be overcome and overwhelmed. And so clearly we would like to get people as early after injuries you possibly can, but if we’re seeing them a week or seven or eight days because the logistics communications are so bad, it gets very hard to treat them. And then in addition to that, operation you do is another surgical stress on that patient and I can remember one one young child he’s about five you know and he’d actually had a corrugated arm injury he sustained a below knee amputation on one leg is a terrible thing in a fight to see that in the five-year-old and a major nerve damage on the other leg and his blood count must have been down in his boots you know and literally the blood was like water you know you normally expect blood to be slightly trickly and thick. I’m used to that. This was really thin and really like water and you knew this child was going to find it very difficult to either survive or he was going to find it very, very difficult to heal. Now, as I left him, when we left

44:38 At the end of the day, he was still doing okay. But you worry about it. Every single operation is another assault on this poor individual. We’ve had a soldier here who suffered from PTSD. He had done a tour in Afghanistan, one in Iraq and his name is Jake Wood and he would talk about in the territorial armor going over there and having these intense experiences you know in theater in war and then coming back to a bank and you know in your practice in your hip and knee surgery you don’t deal with people that die but then you go over here for two weeks and you see this craziness you see patients die and then you have to come back and now you’re wearing a suit and you’re talking to me. Is there some really strange elements that maybe are hard for you to deal with between those two worlds?

45:20 Yeah, it is. It takes a lot of time to get acclimatized to that. In fact, I think the people who notice it more on my family, to the outside world, I just look like me. But you’re a pretty cool guy, so. Well, I don’t feel that. But certainly, my family sees the difference in me.

45:36 They could just see you behaving a little bit different? Yeah, I think so. I think so. I think they give me space. I think they do.

45:43 They understand now that it takes a few days to wind down. It sometimes takes a few weeks to wind down, to be honest with you. And as I talk to you now, I can still see in my mind certain scenes, which I would rather not have seen. But at the time you’re dealing with them, you don’t feel that. I mean, I think that’s quite important for the patient. In a way, when the patient is there, you are on autopilot. You just do what you’re trained to do and what you’re used to do, you do the best you can. It’s only afterwards you sort of sit down and you realize what you’ve done. And I guess the guy with the PTSD may well have been exactly the Yeah, could be years before you kind of process all that information.

46:16 How do you know when to stop that first day when you’re on surgery number 21 and everything’s happening and you want to probably stay up all night for three days and fix everyone? Is there someone that comes and taps you on the shoulder and is this like, Richard, it’s time for you to get some sleep? Or do you know yourself when things are getting blurry where you’re like, I need to take a break and let someone else come in? Well, it’s, I mean, you know, when things are getting blurry, actually earning up to that is difficult.

46:38 So actually you have because you want to keep going, don’t you? you want to keep going because you simply want to keep going, you keep going because you want to be seen to keep going, I guess. No, that we have people around and we just keep an eye on each other. So you go as a team and one of the delights is, you know, we have, there’s a wonderful theatre sister we took with us called Geraldine and Geraldine, fantastic. Very quiet spoken, but every word she said was key. She’d been around a long time, she’d done all sorts of surgery and when Geraldine said, look, you’re tired or you’re not doing things the way she felt was appropriate, she would just tell you and you would just buy time.

47:14 There was also a clinical director to the hospital and his sole job was to keep the troops right. So if he saw somebody who was not performing well, he’d take him out, give him some sleep and bring him back in 12 hours later. Okay. Go ahead. Go ahead.

47:28 There’s always somebody keeping an eye on somebody. You don’t want any… If you see somebody sitting all by themselves out in a corner, so writing a letter home or whatever it may be, then basically you want to worry. There’s something going on. Okay, so go talk to him.

47:40 How much sleep do you get that first night and is sleeping hard for you? We did a wonderful calculation because basically you get very little sleep. We did a calculation for the whole team when we were out there. We said, let’s average it up over four days, over this four-day period, and the average was three hours and 59 minutes. So that’s per night.

47:59 That’s not healthy. It’s not healthy, it’s not, but you catnap as you go along and you just keep things short and have a snooze between operating sessions and so on. And yes, you have a pile of patients waiting for you, but often there’s a bit of a gap where you can just get a little bit of head down, a bit of shut eye and start again. Okay. Are there big logistical gaps that you see right away when you’re there?

48:21 Are you like, okay, we’ve got this, do we need double the amount of space at hospital? Do we need more water because there’s no water? Do we need that x-ray machine because it just broke and I can’t do surgery without it? Are there like things that are big bottlenecks in the process? I say bottlenecks, maybe.

48:37 I mean, we ran out of kit. Okay. I mean, we’ve been, I think after we were operating for three days, we ran out of a lot of equipment. So for example, surgical gowns, we ran out of surgical gowns. So you improvise, we get some to, we order for some to come, but of course the runway is a problem and getting stuff into, to us is difficult.

48:55 So in the interim, we have to improvise. So we simply use plastic aprons. We run out of towels to dry our hands with. So in that case, normally a surgeon would scrub his hands from fingertips right down to elbows. Now, if you go down to the elbow, you need a towel to dry yourself.

49:11 If you just wash your hands, then you can just wave them in the air till they’re dry. And so that’s what we did. So we just washed the hands. So there are certain corners you can cut, which are not ideal corners to cut, but in the circumstances are probably the right thing to do. We ran out of drapes.

49:24 These are the paper drapes or the cloth drapes you use to, as it were, barrier off the area in which you’re operating. And so we simply use the paper from the glove wrappers, and we simply cut holes in those and stuck them over the wound. So we improvise as best we could. OK. Now take me through the next, say, five days.

49:41 Are things getting better? Are they getting worse? More patients coming in or less? I guess everything’s changing by the hour. Well, yeah, sure.

49:48 They are changing by the hour, because you see, you have a hospital in place. You got great Australian doctors there, you got great British doctors there, and people get to hear of it. There was no other hospital like it working at that time in that area. We got the Americans’ forced services bringing patients into us in that location. They obviously take their own servicemen elsewhere, but the civilians came to us, who were getting a lot of people coming in, a lot of helicopter casualties being brought in.

50:14 I should add that you don’t want to put the, I have to say, the toilet tents near the helicopter landing pad. I found that at my cost. That’s a totally different question. Was that on a different mission you found there? No, no, no.

50:24 On this particular mission. Is that your call to put the toilets near the hill? I can disclaim responsibility for putting them there, but I can claim responsibility for being sat on one when the helicopter landed. It’s not a pleasant experience. As in everything the cover goes?

50:37 You are exposed to the world. Don’t go there. Do you have any pictures of that? Sadly, no. All happily no, perhaps.

50:44 I will want some pictures. We’re going to put them up on the site and maybe while this video is playing. No, that’s right. We can certainly provide this for you. The things change and in the early days in the first few days after the typhoon you’re getting acute injuries, all right Things which require cleaning and closure they require general surgical and let’s say orthopedic bone and joint Skills then as they as the days go by that changes and there’s a less requirement for those sort of skills and at that point You want plastic surgery. I want someone who can cover wounds You know one imagines when there’s a laceration or a cut you can always sew it together You can’t always do that.

51:18 Sometimes you have to simply cover it with a skin graph because it’s not closeable. So that’s the skill of the plastic surgeon or in our case for ourselves because again we’re trained to do that to a certain basic level. And then when that changes of course you start to get less surgical and you start to require more physicians. So let’s say public health are dealing with epidemics and trying to avoid those starting vaccination campaigns and so on. And then you get into community health education.

51:42 So the thing changes on a daily basis. And the job, I think, of the disaster dock is to predict what is going to be required in two or three days’ time, because it’s going to take all of that time to get those people out from their home countries. OK. And are you ordering supplies based on what you think you’re going to need? Yes, you are.

51:58 And are more staff coming in, or is the core team stays the core team? Well, no. More staff are being stood by. So for example, the Australian team was standing by a second team in Australia. The British team, we were standing by a second team in the UK.

52:11 It’s just the composition of that team was different. The first team was highly surgical. The second team would be more medical. And by the time we were coming to an end of our tour, I would say 60, maybe 70% of the cases coming in were medical. They were not surgical.

52:25 In the early days, you could say 60% or 70% were surgical, and the minority were medical. So things were beginning to change, for sure. Is that how you know it’s going to be time for you to leave soon? Yes, you do. That’s right.

52:37 You think, OK, now we’re now getting in control, we no longer need four surgeons, we need two, we need one, let’s start getting some people stood down. That’s why I say to my secretaries back home, only cancel a week at a time. Because what happens basically is we get to the Thursday of the week before, and if they’ve not heard from me, they cancel the next week. But they never cancel beyond that. So we only ever lose one week at a time.

52:59 OK. Because, and is it shorter than you always think? When you say I’m going to the Philippines because of the Thai feeling, do most people think this is going to be months, but you know it’s actually going to be a shorter time? No. I mean, you prepare yourself for six weeks.

53:11 I guess I’m committed to six weeks, but in fact, when you get there, you realize this is not going to be six weeks. It may well be a six-week aid program, but it won’t be a six-week aid program affecting me. My job, as it was with Haiti and others, is to be in there as early as I could humanly be, because that’s what I most use. As we get further away from the event, so I get sort of less use to the aid program generally. It almost is a feedback loop on itself.

53:34 I mean you need to be there as soon as possible and then almost after four or five days You’re by debt. You’re almost de facto not needed anymore, right? Yes, you’ve treated all the patients you can Yes, if someone was in an area where they couldn’t be reached by you it might be too late and then it’s gonna be medical concerns Yes, exactly that exactly that so right now, you know I mean yes, there is a surgical requirement in Takloban in the Philippines as we speak But it’s a very different surgical requirement to the one that I was able to provide Okay, were you guys the best surgical hospital in the country? Would you say I?

54:02 I think, bearing in mind, you’re going to go out to hundreds of millions of people. I wouldn’t dream of rating us. But I think we were very good. And from my viewpoint, the Australians were a privilege to work with. They really were.

54:14 Wow. That’s going to mend a lot of ties here, you know, between the two nations. Well, I don’t think there are any ties to be mended. I think, you know, the Australians and the Brits have always seen eye to eye. We have a very similar sense of humor.

54:25 I think it takes the world, the world finds the British sense of humor very strange, but actually the Australians and the New Zealanders understand it greatly. Okay, they get it And so the only thing I wanted to ask is would your team ever be picked up and moved somewhere after say four or five Days, or like I said, is it pretty much it once you set up camp? You must have to really choose the place you set up very importantly because you know you’re gonna be there for a while You’re going to attract a lot of people Would you ever move or would they ever call you away to go somewhere a hundred miles away?

54:53 Or does that rarely happen in your deployments the answers it really happens But the fact is you are trained to do that I mean you have to and it’s probably why if you look at the team we had, there’s a very high proportion of ex-military or ex-Navy people in that. You had to be prepared to move, and so you keep your equipment packed at all times, even if you think you’re in a lovely, tented hospital, you keep your equipment packed at all times. You have the so-called grab bag, which is the small bag with all your vital possessions in it, because you never really know if suddenly, if security is going to take a turn for the worse.

55:26 You know, you’re in an area where there’s a curfew, where you have armed police around, there has been conflict going on in country even before the disaster. They have some very interesting political conflict. They do. It’s quite a violent place. There are a lot of handguns and guns in Philippines.

55:39 There are. We saw a fair few. And so, no, you have to live with that and your neutrality is very important. I mean, medics are targeted worldwide to this day and more so these days than they have been. And so you have to be very, very aware of what’s going on around you, yet in many In your respects, not show that you’re aware.

56:00 You are focusing on the patient, but in the back of your mind, all the time is security. Why are medics a target? Well, I think medics are a target because we are seen, rightly wrongly, as representing the country from which we come. And I don’t necessarily approve of that, but that is the reality. So you have to be aware of that at all times.

56:22 And what was safety like? Were you concerned at all? How did it rate to Haiti? I don’t know why I keep going back to Haiti just because I guess that’s fresh in my mind and I’d seen pictures and images. But how was the danger level and the security in comparison to the place you’ve been?

56:35 I think Haiti was more insecure than what I’ve just been, to be honest with you. We had a security team who were looking after us, the next military security team, and they would advise. If they saw people walking around who weren’t, shouldn’t be there, then they would move them quietly to one side. So they were very, very aware. And so in many respects, you could relax.

56:50 Now and again, the security guy would come up and tap her in the shoulder and say, Be careful about that or whatever it may be but generally we were well looked after for sure and the way you carry yourself is very important you need to act as if you are Feeling safe and feeling yeah, you need to not cower away. Is that what you’re saying? No, I mean, I think if you are relaxed If you’re externally relaxed, then the people you’re with are also Externally relaxed you don’t want to pose a threat or be seen to pose a threat Okay, and and so and you know, I have great political views in the UK But over in those parts of the world I express no political views at all. You do not take sides Your job is there to treat all comers. It doesn’t matter where they’re from. Okay, talk to me about communications Are you can you can you call your your son up on your mobile phone? Can you email people?

57:39 It sounds like you weren’t communicating with your practice here in the UK They just assume you’re not coming back if you don’t call them by a certain date What’s it like? Well, I mean when it when the disasters first start there’s zero communication. Everything goes mobile goes internet goes and so on on. We were given local mobile telephones as we arrived in Manila, so we were armed with a local mobile telephone. We can talk to each other on the assumption there is a mobile signal. By the time we got to Taklaban, there was a degree of mobile signal that was absolutely zero internet altogether. And I hadn’t realised how dependent on the internet I’ve become in many respects. So when you’re talking about communicating back to UK, things you were writing, messages you wanted to send simply were not possible. So it cost me an absolute fortune in mobile telephone calls by the end.

58:22 All right, so you were calling people. I was calling people in the end. Is that an important part? I’m curious if in your earlier days you would just shut off and focus on the mission in hand for a week and not talk to your family. Maybe I’m just assuming.

58:34 Now do you understand that it’s a part of coping with the situation that you do call these people? No, it is. I mean, keeping in contact with home is important. Keeping in contact with family, if you can, is important, because remember, you leave your wife and family at home, everybody, every time there’s a disaster on the news, they presume it’s you. Now that disaster may, or that security breach, may have been a hundred miles away, but as far as they’re aware, it is you.

58:56 And so keeping contact is actually extremely important. To assure them or for you? Well, I think both of us really, but I remember after Haiti coming back to UK and going into my apartment in London and seeing my dear wife, and she had listened to every single news bulletin while I had been away. She knew more about Haiti than I did. I was there immersed in it, dealing in my little area of activity, doing the best I could.

59:22 She was seeing the much bigger picture, which, to be quite honest, was much more frightening. At a personal level, in Haiti, it was a very, very insecure environment. We had, as it were, allied ourself with a local individual who was, as it were, our protector, and he did that extremely well. In Taclivan, again, we had security provided, and that was fine. Okay, I just wanted to ask you when you’re when you’re over there and you are making those calls home Do you try not to get in the details? I’m sure people probably really want to know what’s going on But do you find that you don’t want to dwell on a lot of the hardships just to keep yourself from kind of going to That space and just to keep it less business and more personal Well, I think if you’re talking to people who are not part of the family They want to know what you’re doing and why you’re doing what you’re doing If you’re talking to the family, they don’t really want to know what you’re doing They just want to know what in my case the husband or daddy is it what’s he like?

1:00:14 You know, what’s he feeling like they want actually to share their problems with you And so actually it’s not unknown to ring from a disaster area when you’ve already had the X deaths and heaven knows What else you’re surrounded by chaos to actually be told and look, you know the gas bill needs paying So you you have to you have to handle that That’s the real disaster So, how long were you there for? How many days and when did you know you were going to leave? We were there for 12 days and we knew we were going to leave about literally 36 hours before we left. We knew we were going to have to leave. Now, the leaving is not as easy as it sounds because remember, you’re in a destroyed area, Takloban. Every single flight is booked for weeks ahead. You’ve got some C-130s, some Hercules is going out, and so as a matter of doing the best we could to go out with the refugees. Now, I actually took a refugee flight out and that was an experience I wouldn’t want to repeat, I have to say.

1:01:16 What was that like? Horrendous. I mean, horrendous as the doctor with me. I don’t mean it was uncomfortable, yes, it was. Hercules, I don’t know how many people it’s designed to take, but this one had at least 120 on board and we were standing.

1:01:30 No seatbelts. you’re not seated. I mean a few casualties were seated but everyone was stood for the whole flight. That’s take-off on the cruise and landing in turbulence. You are stood. Now I basically, so you’re shoulder to shoulder, I found a little corner where I could sit down and I’ve described a thing called refugee foot I have to say and refugee foot was basically I sat down, there was a woman beside me with a couple of kids and she wanted to sit down so she said to me in broken English, would you mind if She sat down on the floor beside me, I said, feel free.

1:02:01 So she sat down, but she sat down on my foot. And I didn’t know quite what to say. You’re sat on my foot, Madam, but I thought I’d just let her sit there. She wasn’t the lightest individual in the world. And she sat there for two hours and my foot is numb to this day.

1:02:15 On your foot? She sat on my foot for two hours. I had no blood to my toes for two hours. I didn’t really know what to say. And I didn’t really want to get her to move because she was so exhausted.

1:02:22 She had these two children who were really screaming the house down. And you felt terribly sorry. These people were leaving an area where this had been their home. They were leaving behind them, families and friends, one presumed, awful memories, and they were going somewhere to a future they couldn’t really predict. It was like one of those scenes out of a movie really drew at the heartstrings.

1:02:49 You really wanted to cry yourself to be, and there was a lot of tears, a lot of tears in that flight. And the spirits were very down. One or two. It was interesting, a lot of young people, I remember talking to one of our very well known BBC correspondents many years back and she said that she had noticed after disasters that people between the ages of roughly 18 and 35 years were predominated. The very young and the very old were no longer there and that’s quite true because the very young had died, the very old had died, but between 18 and 35 they had a survival instinct which sort of got them going, held them together.

1:03:23 That Hercules was filled with a lot of 18 to 35-year-olds. There were some elderly, and there were a lot of families too, mothers with children like the young lady who sat on my foot. That’s terribly sad to see. They are a whole life change with no predictable future. And probably less equipped emotionally to deal with it than the older people who have probably seen a few things in their years.

1:03:49 This is probably the biggest event of their life. Oh, for sure, and that would remain with them for the rest of time. But I guess for the 18 to 35-year-olds, maybe the 18 to 20-year-olds, at least they have got their health, at least they’ve got a future they can try. There’s a sort of lovely optimism at that age, I think, where the whole world is open to you, which is a wonderful thing to have, and I guess they had that. I want to ask you a question, something about myself.

1:04:17 I mean, I heard the reports about the Philippines, and then heard the reports about the Philippines, And then I got something, quite honestly, that was probably Philippine news fatigue. And I know that this happens at times in conflict places in Africa, or it happens, you know, with the Iraqi war where the people, Americans hear about it so much that all of a sudden you kind of tune it out. And I had a hard time placing myself there and trying to understand what was going on.

1:04:38 And I wonder, do you find that with people with disaster areas that it’s hard to really communicate with the public what’s really going on or the urgency of it? And do you find that frustrating? I do, in a way. You know when you come to these things, yes, you form part of this great sort of lift of hope and desire to assist. But even though you’re there for a short period at the start, you know by the time you come back, the media, the news will have moved on to something totally different.

1:05:08 I think the charities, the NGOs, like the world to know what’s going on, because obviously there’s a lot of money that comes in at that particular time, and that money is used for that particular aid programme and to roll it onwards for the months and years that follow. So it’s important actually to get the message out and I think people in some respects are slightly suspicious of the media. I really support it because actually it’s a two pronged attack here. You’ve got people like me that provide the aid, you’ve got the media that are getting the message out about that aid. Now I’m a hopeless message passer but the media basically get that message out. So it’s good to involve them I think in those early days.

1:05:46 I think they do a lot more good than they think they do. What was the one thing that surprised you about your whole tour at this time in the Philippines in a good way and in a bad way? Something that you just didn’t expect to happen on both sides? Well, I mean, the bad way for me was the children. You know, I mean, it’s difficult to deal with children who are injured.

1:06:04 You know, I’m a father of three myself, and in every child you see your own child. And so, yes, I’ve seen children in previous disasters, but I didn’t know whether it was because it was save the children or because it was just the way it was but there are a lot of children we treated and that was hard to deal with I think. The best thing I think the best thing was I was required on this occasion to do a lot more other than just orthopedic surgery which what I do back in UK it was nice to find I could still do it and the skills I had learned many years ago still applied today. What kind of things were you doing? Well I mean a lot of foot surgery I mean I do hip and knee surgery for example so I’m doing a lot of feet. We’re doing skull fractures, we’re doing all pelvic fractures. Yes, I guess I deal with those in UK too, spinal fractures, things which I don’t normally deal with back home but I was obliged to deal with there and it went well and I was pleased that it did. How do you rate the overall international community for their response to the Philippines and then like from just you personally from what you guys saw are there’s anything that you would do different if this were to happen again in a year? No, well I mean the international community is It’s getting better at it.

1:07:09 It is. I mean, there’s still faults. It’s still difficult to get there quickly enough. I don’t quite know how you can get there any quicker than we did. But if I compare, let’s say, the Philippines in 2013, with Kashmir in 2005, it’s chalk and cheese.

1:07:26 2005, the international community was really found wanting, to be honest with you. The Philippines, yes, there were problems, but far fewer. And I think the disaster relief has become slightly more professionalized. We now are heading towards surgeons and physicians being qualified in disaster relief. We haven’t quite got there yet, but training, special training, is now providing you.

1:07:46 The College of Surgeons, thanks to a good colleague David Knott, has put together a program called STAE, Surgical Training for Austere Environments. This is training people like me, let’s say who are specialists in the UK, to do general types of work because in that part of the world you can’t be fussy. You have to deal with everything that comes through the door. The international community is a lot better now than it used to be. In terms of what would happen next time, I think the one thing I would want is somebody there even before we got there.

1:08:16 We got there very early, but we want to insert people as rapidly as possible into these areas to report back. So you need very good communications by specialists. You need medics on the ground, not just administrators. You need medics there, not just to do, but to assess and to report back at the earliest opportunity. So maybe get people like you or with training much like you to go there right away and just start triaging the situation and then bring in the team.

1:08:45 Maybe if those people were told they’re not going to go in to actually operate and be the doctors and that you were only in for 72 hours to assess, maybe they could get some people interested. No, no, no. Sure. Exactly. But you need to insert people, so they need to be skilled at being inserted by whatever means are required.

1:08:59 Now, that’s an area which needs work. It sort of exists. But we’re looking at the medical surgical facility does exist. Now, I say that exists for the Australians. The UK is bringing together, as we speak, as it were, an Australian look-alike, which I think we can modify and maybe improve on slightly, but probably not much, make it perhaps a little more specialist than the Australians provide.

1:09:21 But that’s not a criticism of Australia. It’s simply the way the Brits are thinking and the skills we can offer. But no, if we can have individuals in there really from minute one after the disaster, that would be brilliant. Brilliant. Now, the US, I mean, the Philippines is an ally of the US, the UK, a lot of old school ties.

1:09:41 But did that help the effort? Or is it becoming more agnostic, the international community’s response to all countries worldwide, in your opinion? No, I mean, the answer is we all cooperate. If you go to a disaster era, you have a British zone, an Australian zone, a US zone, it may be. So there are areas that, and people are slightly territorial about it, but only slightly. In reality, you know you’re all there together. There is a remarkable teamwork.

1:10:08 I mean, as I was saying, for example, with the American helicopter pilots, service helicopter pilots, bringing civilian casualties to our hospital. So there’s a great link there. So we all agree, we argue a bit behind the scenes, but we actually all agree when it comes down to it. amazing to believe. I remember when you were here last time we talked about Haiti and famously Sean Penn went down there and he was doing a bunch of efforts and you know he likes to bitch a lot but he was complaining that the doctors without borders weren’t communicating with these people and it was territorial and I don’t know how you you organize things like that in such a disaster zone when different organizations are involved and ultimately egos. I know you’re all there for one mission but it just seems like it must be impossible to you know chart out territory. Well yes but Yes, but you have to know the system, I think.

1:10:55 And I think if you go to your first one and only disaster, you would be very confused about all. And you wouldn’t quite understand what was going on. And it does seem to be totally uncoordinated. But actually, once you know how the system works, and that’s the advantage of going to plenty of disasters, then you can cut through all the obstructions and go to the people that matter. They have things called clusters.

1:11:17 Every day, wherever the UN is based, or the WHO is based, World Health Organization, you will have a cluster. And that’s when all the representatives from the different agencies will come and they’ll just talk to each other. There’ll be a presentation and an update. So you get a feel for what’s going on. It’s never quite as informed as you’d like it to be, but it’s a start.

1:11:36 And so generally the first thing you do when you arrive at these places, you’ve got a little notebook, you’re writing down names, you’re writing down mobile telephone numbers, you’re going to a cluster. I call it the cocktail party, where you’re going from one person to another to another, you’re making very, very rapid links. And that gives you the infrastructure that you need to make your particular bit of the operation work. But you’re right. People don’t communicate as much as they ought, but they probably communicate enough.

1:12:01 In this wonderful world, there will be this wonderful hangar based somewhere, I don’t know, in Malta or somewhere, which could fly anywhere in the world. But actually, it can’t work that way because, remember, when there’s a disaster, communications are down. So you can only guess at what is required. And you’ve then got to get this great monolith of a large field hospital into a disaster zone. That means you’ve got to land an aeroplane.

1:12:26 All these things, which seem so simple back in UK or US or wherever it may be, but in practice are enormously difficult when the whole infrastructure has been destroyed. Does your SAS training help you in these situations? And if so, what part of it? Oh, enormously. I mean, it’s taught me, you’re in a team, but you still have to look after yourself.

1:12:46 It’s a strange paradox. And you have to be comfortable in your own skin. It is stressful. You’ve got to, you don’t get much sleep, as I think we’ve already established. Sleep deprivation adds to your stress.

1:12:56 And so you have to know when to control yourself. Even though there’s somebody around who’s gonna be keeping eye on you, it’s better you bail out before they bail you out, as it were. It teaches you to survive. It teaches you, I guess, to work with very little food inside you. It teaches you also that life is not predictable, that actually there are some forces even greater than those of the special forces, and that’s nature.

1:13:24 You just can’t beat it. It teaches you basically just to deal with discomfort as best you can. When you land back in the UK, what are the first few things you notice? How lucky we are. It doesn’t matter.

1:13:38 How all those issues that I thought were big were actually very, very tiny. I remember, I was walking into, I arrived back in UK, and one of the first things that happened was I was stopped in London by a guard in the London Underground, and I was challenged for my oyster card. This is the card. And so I got the oyster card out, and this woman says to me, she says, you haven’t registered your oyster card to get on the London Underground, and therefore you are going to be fined.

1:14:09 And I looked at her at that point. This is what the first greeting I had back in UK, and I was going to say, look, dear, I’ve just come back from the Philippines. I’ve just seen heaven knows how many fatalities, and I said, no, listen, I won’t do that. Because to this individual, this was terribly important, but actually it wasn’t. Actually what these poor Filipinos were going through was seriously important.

1:14:32 There’s no problem I’ve got back in UK that is as important as what they’ve got. It’s a very grounding experience. You’re going to keep doing this for a while longer. Are you going to be on watch front in the five, 10 years? I have no idea.

1:14:43 Look, I’m as old as time. You said that last time, and you refused to answer my question when I asked how old you were. I’m not going to try again. Well, I mean, I had Tyrannosaurus Rex was a pet. So no answer, but you are still on call right now.

1:14:55 I’m still on call at this very moment. Do you get a break? I mean, do they know to give you a month off or two months off? Well, I’m sure they do now. And we’re getting to a situation now when we’re going to have sufficient teams, I think, in the UK, so we can be on six-weekly standby.

1:15:07 But at the moment, I’m on standby. If they want me, I’ll go. And if they don’t want me, I won’t. It’s as simple as that. OK.

1:15:13 So back to business in the UK. You’re back to your practice. Right now, as if it never happened, but it did. That is a very strange thing. You know, we always ask the guests that come here, and I might have asked you before, I’m going to ask you again.

1:15:22 You know, if you could make a phone call, Richard, to the 20-year-old, Richard Villar, I don’t know if you were in the SAS at that point or not, and give that young man a bit of advice. After all you’ve seen and all the disasters you went and covered, what would you tell him or what would you tell him to do differently? I’d say to do differently. I think I would I would say listen to your elders more than I did and I would also say Never say no to anything Okay. All right. Oh, they say youth is wasted on the young actually, that’s what old people say Yes on that same note What’s the best advice you’ve ever received whether it be in the military in your practice or even in one of these these disaster zones You must have been green at one point in these things and now you’re probably one of the more experienced guys Yeah, so well, I think I mean I people regard me as experienced I regard myself still as learning I mean, it’s the what’s the most useful bit of advice I’ve been given I think it was It was by a very elderly and established surgeon. He simply said follow your instinct You may not be able to explain why you’re doing what you’re doing But if your instinct says you do it then you do it and that’s very relevant when you’re in those situations For sure for sure. Okay, and don’t build the latrines next to the helipad exactly Okay. On that final note, to the 20-year-old that’s listening to this that who knows might

1:16:36 Want to go into the military or become a surgeon or potentially do something like that you’re doing, what advice do you give to them? How can they prepare themselves for this or should they get into it? Well, I mean, I went into the military by firstly joining the territorial army, which is our reserve army, and then I joined the regulars. And so that’s one way of learning. But I think that joining the military or joining the services is slightly outside the mainstream for a medic even in this era now. Just be comfortable outside your rut. That’s what I would say to him. If you want to do something, just do it.

1:17:09 And medicine, is it something you would choose again? Oh, for sure. I love my job. I wake up to this day every morning. I’m going to wake up tomorrow morning. I’m looking forward to tomorrow. It sounds very corny, doesn’t it?

1:17:24 Yes. Nothing better than watching a patient come through the door of your consulting room after surgery with a smile from ear to ear and I can never tire of that ever. I’ve been very thankful to some surgeons in the past definitely you know it must it was interesting because before you came over I was just trying to I was just picturing you and you being in the Philippines and just you know being in an operating theater and you know you know cutting humans open and it just is so hard for me to conceive that you can do that and you’re skilled to do that and then you can keep your wits about you and and you know heal these people it’s uh i know doctors are regarded as almost god-like figures in a way because of the magic you can perform but i get it you know it’s a it seems like a wonderful thing just to have that that skill the the moment you actually ever felt your god-like figure then it’s time to give up i mean you know we are but humans well trained i mean there’s a sensation which i don’t think the public necessarily knows is when an operation is about to start you’ve got all the preparation in the world you’ve talked to all your colleagues, you’ve talked to the theatre sisters and theatre nurses, you’ve got all the instruments ready, and then you are stood by yourself, by that patient, that’s one on one, and there’s no one you can call them. At that point you are on your own, you’re flying solo. And that’s a responsibility which actually some people find very difficult

1:18:42 To shoulder, and it gets to me occasionally even to this day, but it’s a huge responsibility, which personally I take enormously seriously. Right, very seriously every time. Oh, for sure, have to. I believe you on that. Richard, you have a few books out.

1:18:57 You’ve got wing scalpel, and then it was on a knife edge that you’re previous? Well, it was called knife edge, yes. Yes, okay. Are you gonna be writing any more books or are you taking a break from that? I love writing.

1:19:07 I don’t know what it is. I love writing. When do you find the time to do this? You’re off to Geneva tomorrow to go to a group of mountaineers. Is that true?

1:19:15 Yes, in my other life, I’m a mountaineer. I’m what’s called an international mountaineer. We have our annual general meeting in Chamonix tomorrow, and so that’s where I’m headed. That’s a tough life. your very visit, when do you find time to write?

1:19:25 I write every day. I make sure that every day I write a thousand words. I don’t mind what I write. If I’m writing a book, that’s the thousand words. Otherwise, it’s a diary.

1:19:32 Otherwise, it’s a blog, whatever it may be. I write a thousand words a day. I have done for more than 15 years. Man, I’m gonna start making myself do that. You’re making me better, that’s good.

1:19:40 Do you have a blog? Do you have people who can meet you or they wanna see your practice? How do they get ahold of you? Well, my practice is based in Cambridge. I belong to something called the Villar Bajwa practice.

1:19:48 We do, basically our job is we are a conservative surgical practice. That is, we try and conserve and preserve joints rather than replace them if we can. So we do a lot of biological stuff. For example, we’ve done the stem cell work now on hips and knees. And so there’s quite a lot in the biological era.

1:20:05 I mean, however good joint replacements are, and they are absolutely brilliant. In reality, if we can prevent people even needing one, so much the better. So that’s really the thrust of the practice we run. Okay. When I need my hip replaced or worked on, I’m gonna come to you in a few years.

1:20:20 Richard, thanks so much for coming on. You’re always welcome here, and just thanks for giving us your thoughts. I was just really surprised and honored when we got a call from your assistant, so. Well, it’s a pleasure to be here, of course. It’s funny, because we talk a lot about here, about spirituality and consciousness, and you have a lot of Zen qualities about yourself, and when you go on these disaster reliefs, you come back with a real appreciation for what’s around you, and yeah, it’s very grounding, and it’s a lot of what our show is all about, so go figure an ex-SAS surgeon teaching us things on London Real.

1:20:51 So if you want to follow Richard, you can follow him on Twitter. It’s at hip and knee, or it’s a villa badgewire, they can find you. I think it’s at, they’ll find a villa badgewire, yes. Okay, fantastic. If you’re watching us on iTunes, you can see both of us.

1:21:03 Again, I’ve got someone else in a suit in my studio. It’s been happening a few times lately, and you can see the extremely good-looking Mr. Richard Villar. We don’t know his age, but you are, he’s not single, neither am I, and please subscribe on iTunes. We’re on Twitter, we’re on Facebook.

1:21:17 As we say on London Real, it’s about the journey. Richard I wish you well on yours. Thank you. Thank you.