Richard Villar - Life On A Knife Edge

Full transcript: Richard Villar on London Real

6:31 Man, and our guest today is Dr Richard Villar, who is an ex-SAS surgeon and author of the book Wing Scalpel which describes the difficulties, dangers and occasional impossibility of providing medical aid to disaster areas and war zones. I think you were present after three major earthquakes, which are Kashmir in 2005, Java in 2006, Haiti, very big one, in 2010 and I think you were also in the Libyan Civil War. Welcome to the show. Thank you very much indeed.

7:03 Did I get most of that correct? You are absolutely perfect. I think I grabbed some of that from your Amazon, you know, thing on your book review on Amazon. So, you know, when I saw, when I first heard about you I was so excited to meet you, because, you know, we see these disasters and we don’t see people like you on the ground. You know, we just never see you doing the work, and I know Haiti was just an incredible mess, and I’m just wondering when you see that, that television news story, and do you think to yourself, man I’m probably going to be called to go in there, and I just wondered what that next 24, 48 hours is like for you, or what it was like for you with Haiti and these other disasters?

7:47 Well, I mean, I fill that gap, actually, even before often the public hear about it. I mean, if you have a disaster, whatever the disaster is and a country wants to give aid, it’ll insert a hospital, a team, or whatever it may be, but you need people on the ground beforehand, and that’s me. And so I will often be there, or on route, virtually at the same time as the news is breaking, because you need somebody to get everything prepared, you know, putting a hospital into a disaster zone.

8:14 I mean, at the end of Haiti we had treated many thousands of patients. You need a big infrastructure, and you need a medic there on the ground. They often call me a surgical fixer. It’s me who gets the hospital organized, or in keep, or in tandem with other people. It’s me who has to ensure the security is correct and so on, that you’ve got the flow of patients in, and indeed you can work out where the patients are going to go afterwards, because in many respects in a disaster you can’t start treating people if you don’t know what you’re going to do with them afterwards.

8:43 So you have to do a very aggressive, what we call triage. Triage comes from the French trier, sort, and you have to sort out at the very start those you can do something for, as opposed to those you can do nothing for. That must be one of the most difficult things to do, to try to, I guess, Americans we say Tri, or triage, a situation where you have to choose between, I don’t know, someone missing a leg, or missing an arm, or this person’s about to die.

9:06 This, I mean, that must. Am I wrong? Are those the hardest days, the early days? Oh, in the very early days you do need to do that. I mean, an earthquake is, to some extent, naturally selecting.

9:15 I mean, you clearly have a disaster, you clearly have people who die there, and there, and that’s clearly a tragedy, but as a medic you can’t do a whole heap about that. Your job is to deal with those people who have managed to survive, or who are in the process of being rescued, and whose chances exist now. Within that group there are some people who are so severely injured you can do very little for them. And so, looking at a patient who is very severely injured, it doesn’t necessarily mean you’ll take the most severe injury first.

9:46 You have to take the patient first for whom you can do something. Resource allocation, basically. It’s, it’s psychologically, it’s it’s, it’s slightly upside down. I mean, in the United Kingdom we will deal with patients, really, regardless of severity, will often take the most severe first, and we’ll simply get on with the job because we have all the resources available. but, as you say, we have resource allocation problems in a disaster area.

10:09 You know, you may have someone who comes in with a hip fracture, let us say a broken hip, but you don’t have anything to mend hips with. You say you can’t start dealing with that patient now. In reality you cater for that before you go as best you can, but there are bound to be some cases you can do nothing for, and so you do the best you can for them. Clearly you do, and you’re always kind, you’re always sympathetic, and you make them comfortable, but you can’t always treat them in the same way as you could back home.

10:33 Yeah. What was Haiti like? Did you, well, obviously you can’t see that coming, but do you, do you already know that you have certain places in the world that are of danger of these things, or they don’t have the facilities if something like that happens? Well, there are areas around the world, aren’t there? There’s the Ring of Fire, the Far East, the Haiti area and so on, where you’ve got tectonic plates which are basically on the move, and you know there’s likely to be a chance you’ll be called, but you never seem to know.

10:56 I always used to think they would happen in September, October. Now I now realize they don’t. Haiti was January. but, no, I mean it seems, by definition, most of the places where earthquakes occur are places which are economically challenged. They are poor places, and so they start off at a disadvantage.

11:18 I mean, I think at the time of Haiti, the earthquake, the average Health Care budget per head of population was something like $54 or something per year. You know, so that was the sort of level of health care they had even before the earthquake occurred. So you know, you’re going into a place that has nothing even before you start. What does that look like when you go? How many days after the earthquake did you land?

11:41 Then I was there 30 hours after the earthquake. And so with aftershocks, I’m guessing, yeah, I think there were the best part of a thousand aftershocks after Haiti, and you get them all the time. Your best friend in earthquake zone is a tent, because it’s the one thing that’ll that won’t bother you when it collapses, but there’s a lot of aftershocks. You’re working in that sort of environment, mostly, actually, you’re not noticing them. They’re there, but you’re so committed to getting the job done, you know, you have little time 30 hours afterwards is already a long time.

12:14 People are already suffering as a result. People are being rescued, dead bodies are being laid out, you know, there’s a lot going on. It’s very, very unpleasant indeed. Even as a medic who’s seen a lot of it, you don’t like seeing it. You don’t, you, if you stop to think about it, it’s quite an emotional place to be, and so you try and focus on the job in hand.

12:35 You have a task to do and you’ve got a lot of really good people coming up behind you in the form of a field hospital who are going to help you out. I guess, do you know how long you’re going to be deployed at a place like Haiti when you go? Well, my job is really to get the hospital going and get started, and so I’ll often be two, three weeks away, I would guess, but the first question I ask, or the first question I ask before I leave London, the first question I’m asked when I get to these places is how long will you be there?

13:03 Because it’s all very well saying you’ll be there, you’ll help people, you’ll be there for a couple of weeks, but actually, for a community that’s got to rebuild itself, that’s not long enough. You’ve got to be able to say to people, I’m going to be there for two or three years, maybe. You know, the group I work with the agency I work with is an NGO, a non-governmental organization, called Merlin, and they are generally there for the long term. You know, that their strength is not only the emergency provision like I helped them provide, but also in the long-term care they provide.

13:31 So they have health education and community health projects, and whatever it may be, and so what will happen is I get in there and try and get the thing started. We then get going with the hospitals. We then treat the casualties in the best order we know how. Slowly the heat comes out of it, and then in come the community projects which then continue for two years, three years, or four years, and so for example Merlin is still in Haiti now. Is that an acronym, or is it symbolic for something?

13:57 I think it’s better, it’s man symbolic. Merlin stands, that’s M L I N, that’s a Medical Emergency Relief International. Okay, and it was originally brought about almost like a sort of UK Médecins Sans Frontières lookalike. Yeah, is that Doctors Without Borders, the one? Yes, yeah, exactly.

14:15 That’s that’s in essence what it was. It then became more of a community type of agency, and does fantastic work, but obviously it also now has to respond to these disasters. It’s now in receipt of a government grant to put together a large standby field hospital specifically for this, and there’s training going on around the UK at the moment to bring that together. How did you get flown in there? Was it on military planes, or was it UN plane?

14:41 How do they get you in there, or you on a like little turbo prop? Well, it’s slightly make it up as you go along. I mean, in essence, you, what happens is you’re at work, and then the telephone goes. You go to the Merlin offices, you get your briefing, they give you whatever data they can. You get hold of maps.

14:59 Visas are generally organized for you. You’re generally jabbed up before you go. You know, I’m jabbed up now in case I need to go somewhere. And then you’ll generally get on scheduled airlines. Now, for Haiti we went off to the Dominican Republic, and that was relatively straightforward.

15:14 We did that through Spain, and the way we went it’s getting into the disaster area, that’s a problem, because you don’t have a travel agency there. You don’t have a table, and the only person I met in the Dominican Republic was a charming Canadian who told me that really I was completely crazy to go any further. They were throwing dead bodies in the road, and they were robbing people, and so on. so that was what I was greeted with. But your job is to basically get into the disaster area by whatever means you can, be that overland.

15:41 Remember, you all you have is a ruck sack on your back. That’s all you’ve got. There are four or five of you. This is what’s called a disaster response team, and there’s me, the medic, there’s a logistician, there’s a team leader, there’s a public health, there are people basically to get this thing started. Is there a security guy?

16:00 Are you armed? No, no, no, no. I mean, I wouldn’t be armed at all. I mean, the, I may be ex-military, but the last thing you need to be is armed. You are aware of security.

16:08 Of course you’re aware of security, and Haiti was big on security. They clearly, it was a conflict zone in essence, even before we arrived. So you have to be aware of that and deal with that as best you know how. Are you protected in some way? I mean, does the common citizen know you’re a doctor and give you a little more slack than if you were a tourist in Port-au-Prince walking through a bad neighborhood, say, two weeks earlier?

16:34 No, I mean, being a doctor used to be helpful. I like to think it is still helpful, but doctors are targets in this day age too, and every year very significant numbers of aid workers around the world come a cropper for being in the wrong place at the wrong time. You just have to be aware of it. And I don’t hide behind being a doctor at all. I guess I hide behind trying to be nice and supportive, and as friendly to these people as I can.

17:06 Your biggest self-defense mechanism, best self-defense mechanism in these places, is a smile. It is generally so. It’s your best treatment, just to be very onside and to be as sympathetic as you can because indeed you are that way. You had that, I think it was the, it was the British Army advert, and one of the things that they did was make sure that everybody took their sunglasses off as soon, sort of, as they engaged the, engage the local population in order to try and build up, I guess, a rapport.

17:34 So I guess that’s, I guess, standard procedure to a certain extent, is not to look mean and threatening. And no, there’s no danger. Well, I say I don’t look mean and threatening. I had this wonderful sequence of pictures. There’s a picture of me taken five minutes before I get into the taxi to go to the Haiti disaster, and there’s a picture five minutes before I get on the helicopter to come out three and a half weeks later, and I have aged about a million years, you know.

17:58 So I’m looking quite threatening by the end of the time, but at the beginning I’m looking perfectly okay. Do you, do you look forward to these things? I mean, and can you opt out of course you can. Of course you can. You have to move quickly.

18:10 I mean, you know, basically there is no time to play around. You get the call, you have to go instantly. Now, of course, I run a busy practice in UK, it’s based between London and Cambridge. I may be in the middle of clinic, and indeed I think when the Haiti disaster I was called up, I was in the middle of a clinic, and you simply have to go there and then. You cannot wait.

18:29 So I mean, you’re in surgery. When you say in the middle, well, you’re not going to stop in the middle of an operation, but you would, for example, get to the end of that operation and cancel the list, and off you went for the rest of the day. You cannot afford to wait, and basically your job as a doctor, I think, is to take whatever skills you have and to best place them. Now it so happens and it’s simply a circumstance that, I guess, having been through the military, I have become accustomed and have experienced in the field of dealing with providing care in remote environments.

18:59 There aren’t vast numbers of people like me around, and so in certainly in this country, and so my job is to go where the need is the greatest. So if I’ve got 20 people in UK and I’ve got 20,000 overseas, it’s a bit of a no-brainer. You have to go, where you are best able to provide care. Yeah, what does your family say about that? They don’t like it, and I’m not you know, it’s, they understand it.

19:25 But, you know, Daddy, in fact you have to think of friends and family, I think, is that, and it’s difficult to do so. Somebody rings you, you’ve got to go somewhere very very fast, and you are, as it were, hyped up and you’re focused on the job in hand, and you tend to park friends and family when you shouldn’t. They live with every single news bulletin, every single time somebody is injured, an aid worker is injured, it is you. Every single time someone’s kidnapped, it is you.

19:50 It’s not, but that is what they see. So my dad was in the military, and he was in bomb disposal, so he, in the ’80s, so he went to Northern Ireland a lot, and I think it was probably harder on my mom than it was on my dad, cuz he’s there, obviously doing what he’s, you know, paid to do and what he’s been trained to do, whereas my mom’s at home thinking, oh my God, the next bomb could be, you know, could be John Vickers out there having you know, putting his life at risk to, to, to disarm it. So I think it is often times much harder for the family than for the, yours to sort of immersed in it, and it’s what you do, and yes they have lack of information, and it’s, it’s a lot more stressful on them.

20:28 Luckily I was, you know, not old enough to really appreciate what he was doing. But, well, that’s, that is incredibly brave to do that. I mean, that’s, you wouldn’t catch me disposing bombs to be paid. Me, do you have a time where you think you’re going to stop doing this, or is this something you want to do for a long time? Uh, I think there’ll be a natural selection with that.

20:46 I mean, I’m unfortunately prey to the same aging process as the rest of the world, and in due course I will slow down and come to a grinding halt, but the moment they still seem to want me, and I go, you know, there’s actually a certain advantage in age. Most of the places I go to are primitive, and age counts, you know, in here I am in UK, I’m an old codger as far as the UK is concerned, you know, and people look at me, and they sort of, the other day, you, I had a young girl who actually got up in the underground and gave me her seat, and I thought, good Lord, you know, that’s when, you know, I know you’re not pregnant, are you? Exactly, and exactly, and, you know, and when established consultant surgeons call me sir, you know, and I think, good heavens, how old are you?

21:31 Well, I’m, I’m a million years old. There’s certain state secrets, which, fair enough, good answer, but I have a birthday in a week’s time, but I won’t tell you what it is. Okay, but, no, no, it’s, in some parts of the world the older you are the more respected you are in society, and I mean, he is a classic example. Kashmir was the same. You go into a village and the team of which I form part comprises people generally who are younger than me, and then there’s me, who has the distinct disadvantage of not being grey, and so I’m perhaps look a little younger than I really am, but still I’m older, and people, they listen to what I say, and what I seem to say is what the elders listen to, because we can’t do anything without the permission of the elders or the seniors in a local society.

22:17 Sorry. I also think medicine is a classic example of something which the City sort of missed during the, the recent credit crunch, and that is experience, which you only gain by doing and going through. All of these things is incredibly important, and you know, and medicine is, I think, a prime example of all the, you know, the best people in their fields are not the incredibly amazing young, intelligent 25-year-olds, although they’re probably destined for great things.

22:46 It’s the people that have seen, you know, a heart operation or an amputation or whatever the procedure is thousands of times, because there’s absolutely no, there’s no substitute for being there, having done it and gone through it. And you know, we saw in the cities that you just had a lot of 25-year-old guys that didn’t know how to deal with the sort of extreme levels of volatility, and all the tra, you know, and all the market situations that you know they just hadn’t seen in the previous sort of 10-year bull market. So I think being old is obviously enables you to endear yourself with the, than observation, the elders, but also the experience that you have.

23:25 Is it just? It can’t be, you know you can’t book-learn it. No, I think you’re right. It depends also, I mean, I think there are different ages in medicine, or doctors can be different ages, and they have different skills for different ages. I mean, for example, I am a surgeon.

23:41 It is actually, I am a highly educated manual laborer. That’s what I am. When somebody comes in and they need, let’s say, a hip replacement. I mean, we do, up in the Cambridge practice, of run, we do dozens of hip replacements. People want them done.

23:54 Well, when they are under anaesthetic they simply want a decent job job done. And so the hands have got to work well. Now there comes a time in life at the moment. I’m very happy operating. I love operating, and give them, give them a free hand.

24:08 I would simply be locked away in an operating theatre the whole of my life. There, someone would throw away the key, and I’d be in there actually doing the job I love doing it. But there comes a time, and I’ve seen it happen with others occasionally when they just don’t operate quite so well, and so they cope with it by different ways. Some recognize it in themselves, and they simply cease, and they go on to other things. And also you build up to that experience, you know, when people first come and learn to be surgeons, they won’t be able to do a hip replacement after one operation.

24:38 They’ll need to do 100, 150, 200, whatever it may be, and each one is a little bit better, incrementally better. So you have this sort of middle ground in your life, when people are really up to speed doing the manual job that I do, but then in addition to that there’s the, when should I operate and when should I not? The sort of the wisdom comes into that. So there’s a balance, and so the way most was cope with that is we have around us a team of people at different ages, and within that team there are different strengths.

25:03 Some people are good at the technical side, some people are good at the mental side. Very few people are good at everything. But if you make a decent team, then the patient is safe and secure. So when you, when you land in the Dominican Republic, you get that flight into Haiti. Is it Port-au-Prince, or somewhere else?

25:19 Probably airport in our case, Port-au-Prince. Yes. And what do you have? You have a Merlin badge, you have a ruck sack. I mean, is the military even responding to you?

25:29 Is the government exist? How can you even maneuver in, and even get people to do what you say? Well, with great difficulty. I mean, what happens is, we arrive in our little chartered airplane, which I think sat 14 of us, so there were a few others there with us in the airplane from other teams. We unload the airplane ourselves.

25:45 Okay, there’s no wagon to put our gear into, so we have to go and beg, borrow or steal a wagon from the airport staff. Uh, we get to the airport. Immigration simply doesn’t exist. There’s a whole lot of people who are trying to escape. I remember there were five of us in the team going into Haiti, and I counted about 5,000 people coming in the opposite direction, coming out, and I remember saying to the team, how many times have we done this?

26:08 Is nature not telling us something here? Are we not going in the wrong direction? Like a fireman, you know, going in the building, everyone’s coming out of the building. No, exactly that. And then, uh, so in through the terminal building we go, and the first people we meet were actually an American news station.

26:23 And the first question, and I love the media dearly. I mean, here I am doing a podcast, but basically, they do ask very similar questions, and the first is, what do you think of security? The second is, how many amputations are you going to do? And the third basically is, why did it take you so long to get here? And that was the first question that was asked to me as I went through the terminal building into Port-au-Prince.

26:48 Which you don’t want to hear when you basically left your life behind, left your family and friends behind, and you’ve been really rushing to get there quickly, so I, I wasn’t too civil, I think, to the, to the journalist who asked me that question. You know, you have a very nice style, but I wouldn’t want to see him mad. Which the Mad Major, I want to see the Mad Major. I have been called that from time to time, but not on that occasion. But, uh, and so that was the first team we met.

27:14 Um, then through we go. MSF were there. In fact they, we got a message through to them that we were arriving. They met us in a minivan. MSF, Médecins Sans Frontières, the French doctors were that board.

27:24 Okay. Right, and you will work with them. These organizations work together. Are they a crucial part of what you do? You do, it’s, it’s a fairly loose arrangement.

27:31 There are one or two formal arrangements, but basically when you get to a disaster zone and you’re really early in, there’s probably only about a dozen agencies, I would guess, in all who’ve arrived, and you tend to all be roughly the same. You tend to know each other, you worked in places before. As the disaster progresses, the number of agencies increase enormously. You can get, I think, I can’t remember in Haiti maybe six or 700 agencies at that point.

27:54 It starts to get difficult to control, but you have what I call the cocktail party. I mean, in essence you have a small little notebook and a pencil, and you are going around, uh, in our case we at the United Nations base, and you’re meeting one person after another. You’re stopping people in the road, you’re stopping people at meetings, and in the first one or two hours you are building up your contact list for that disaster. There are people you know anyway, but there are these extras, you know, in my case who is going to rehabilitate the patients, who is going to sterilize our water, you know, who is going to provide a generator for the electricity, who, whoever that may be.

28:29 So these are all links you try to develop as you go along. But you don’t have phone numbers for them, because the phone networks don’t work. They’ve normally, and the answer is you don’t, you don’t have, you, either they, the mobile phone, uh, may work in case, the case of the UN, for example, within the area of the UN base there was some mobile reception, so there’s generally some form of communication. If you don’t know, if you have no communication, then at least you know what their, where their location is.

28:54 You know you may have a, a latitude longitude position. You may have a destroyed house, or an address, or a hotel somewhere where they are, so you know how to contact each other. Are there any egos here? Like one particular charity says no, I have to be running this, or I have to do this, and is there politics and b******t that you have to get through? Um, it’s, it can be quite political.

29:14 I mean, I, I have to say, the my first ever experience, I came out of the army where everything’s relatively efficient. I mean, I think people in the Army now are probably say no, but actually, it, when compared with many things, the Army is quite. People do as they’re told. People do as they’re told. There is a chain of command.

29:29 There is a chain of command, and, uh, and as such you know you don’t necessarily question what you’re told. Now, in civilian life people ask that question. I was never asked to ask to ask in the army. They say why, and so you have to explain what you’re doing, which you don’t always have to do in the Army. Well, I didn’t always have to do in the Army.

29:46 Um, and, uh, so there are a lot of people who, a lot of meetings. I remember when I went to Kashmir and I came out of the airplane and I was ready to roll. This was my first ever big disaster, and I just wanted to get straight out and treat casualties. I assumed that’s what I would be doing, and the first thing I did was, was ushered into a meeting and there I was with about 10 people, and we were talking about things we wanted to do, not actually what we were going to do, but what we wanted to do.

30:12 Now it was so created in Kashmir by the lack of helicopters, but I then for two or three days, there am I in Islamabad doing absolutely nothing, aware that there are many, many casualties who need treating, and I’m simply sat in meetings trying to get out. Now in the end I had to break loose of that, and did so, but that was not by being too civil at the time. What percentage of your time do you think is spent actually treating people rather than, required, you know, to do and handle the logistics of the situation?

30:38 At the start, when you’re first out there, about 90% of the time is actually logistics. Now your job is to convert that 90% logistics to 90% treatment as soon as you humanly can. Yeah, you’re slightly, you have split loyalties. Somebody comes in, let’s say, with a broken arm. You know how to treat it, but you don’t have much kit.

30:57 All you have is that ruck sack on your back, and so however good a surgeon may be in an operating theatre, he is absolutely no good unless he has an instrument, you know. So how can I treat a broken arm if I don’t have instruments to treat it with, or I don’t have plastic C to put on, or whatever it may be? And so my job is to try and keep the patient comfortable whilst everything is being created around them. So I’m linking usually by satellite phone with London all the time, getting a feel for where is the hospital, what are you providing, what is coming with that hospital.

31:31 And my job is also to try and predict what is going to be needed in two or three days’ time, because it’s going to take, let’s say, 48 hours to get things to wherever I am, and is it also your responsibility not only to treat these people that have been damaged by the actual earthquake itself, but if you’ve got 10,000 people, there’s must be the problem with epidemics of, I don’t know, TB or flu or whatever. I don’t know what, you know, the most popular diseases are, but that must be a big factor in your mind. Is that something that you have to focus on, or is that not your job?

32:00 Well, you focus on it. It tends not to happen straight away. The epidemics are not there on day one, if you see what I mean. You, that they will come later, because now interestingly, people think, I, you in Haiti, you would often be faced with many thousands of, let’s say, dead, dead people. There is, actually, unless I’ve got it wrong, there is no health risk to having dead, dead bodies lying around.

32:24 You, there’s a, a strong emotional risk, but there’s not actually a disease transmission issue, of which I’m aware. That is clearly a disease transmission issue from, let’s say, contaminated water. That’s probably the commonest, which was a big problem in Haiti for sure, after, after a month or after a few weeks, for sure, the big, the biggest problem right, for sure. But, and it, it sort of shows, doesn’t it, how things change. You start off with, uh, let’s say crush injuries, so what you really need are orthopaedic surgeons and trauma surgeons, people like me in the early days.

32:55 Then you start getting plastic surgeons, cuz those open wounds now need to be covered with some tissue, some skin, whatever may be. You then start to get into public health to deal with epidemics. So the, the, the phases of requirements of medical professionals changes from day one through to, let’s say, about day 30. It’s, uh, but your job is to try and predict that. If you can, uh, do you have to go in and command something that’s going to be your hospital and your recovery centre?

33:21 I mean, will you go in and take over a gym, and do you have to, cajole with the local officials, military, etc.? Well, I mean, well, Haiti again was a classic example. I mean, remember you’re arriving, you have nothing, and you don’t know where you’re going to be. You just know you are in Haiti, you know, and so you’ve got to basically find somewhere where you can do the most good. Now, that may not actually be at the epicentre of an earthquake, because actually everything may be destroyed, everyone may be dead, or there may actually have been no injuries in the epicentre.

33:51 So we initially, I, what I wanted to do was to put a hospital on the road between Port-au-Prince and the Dominican Republic, because most of the casualties in the early days, because all the hospitals in the early days were regarded as unsafe, they were going by road to the Dominican Republic, and so I thought, let’s stick our hospital on the side of the road somewhere safe and we’ll just pick the casualties up as they come past. Now I went to the various locations on that road, couldn’t really find anywhere suitable, and it just didn’t feel right. It’s difficult to say, give a better explanation than that.

34:22 So we go right into the middle of Haiti, of Port-au-Prince, a place called Delmas, a district of Del And there was a collapsed school. And initially I thought that was a good place to go. It had a bit of a fence around it. It had an old playground. It would seem a secure place.

34:37 We could put guards on it. The problem was that there were actually, uh, sadly at least 40 dead children in that building, the collapsed building. It was a very unpleasant place to work for obvious reasons. Um, and you were having to wear masks, and so on. So it became nonviable very quickly.

34:54 And it was at that particular point that along comes a, a local bigwig. I’ve called him the general, everyone, and sometimes refer to him as Mr Big. Everyone needs a Mr Big, right? And Mr Big was, uh, he spoke, uh, English about as badly as I spoke French, and we communicated very, very well, and, uh, he found us a tennis court, and so we actually were given a tennis court that was supervised by Mr Big. Security was provided by Mr Big.

35:21 Um, and it worked fantastically well. It was about the best location you could ever want a field hospital to be, and Mr Big, in any of these situations, could be the local, what, gang leader, the local military guy, the politician, the guy with the connections. You have to identify a Mr Big, um, and, uh, and it may be somebody who you just can’t imagine is a Mr Big, um, but somebody who is influential, um, who can very quickly get people on side, and is he, is somebody or she is somebody you have to identify with, and you both have to get on, and if you do, then you are 90% of the, the way to what you want to where you want to get to.

36:00 Sounds like the ultimate chess game, you know, trying to figure out that problem in real time when you’re there in the thick of it. Well, yes, but, but you also have to remember the survivors. You see, I mean, actually my job is, I’m a medic, and I treat injured people. Um, but you have people who are uninjured who also want help. Now it’s interesting, I was talking to a really well, very well-known, uh, correspondent with great experience of disasters some while back, and she was saying that she’s noticed that in her disasters everybody who survives is between 18 and 35 years of age, and she’s right.

36:33 You know, is that, um, up until about the age of 18 your survival instinct is beginning to develop. Okay, after the age of 35 I’m a completely hopeless case, and I’m not going to ask you jent, how old you are, but after the age of 35 you’re, you’re toast, you know, and and your survival instincts, t one year left, you one, your survival instincts tend to decline also. But I’m sure that I don’t know if there’s any logic in that, but that’s certainly what it seems statistically.

36:57 Well, it certainly statistically shows. So you have lots of 18- to 35-year-olds who come up to you, and they do not want to know, or which member of their family are treating, or they don’t, don’t really want to know what you’re up to. They’re not taking you off to see Auntie, whoever it may be, with a broken leg. All they want to know is how can you, Mr Doctor, help me get out of this country, set up life in the UK, set up life in the US, you know? so the survivors are already into survival mode, and that wastes your time, because any minute that you do try to talk to them is a minute you could be planning logistics or saving people.

37:32 Right. Oh no, for sure. You have to get quite stern with these people. Well, you can’t get too stern, can you? You know, you are at a disadvantage.

37:39 You are totally exposed. You know, you are there in many respects by yourself, open, open arm, open-minded, open-handed, um, unarmed. You have only your instinct and your, I don’t know, sense of medical responsibility to, to, to, to go by. So it’s, it’s, uh, it works, but you have to always be aware. I mean, your front to these people is clearly one, I’m here to help, and indeed you are, but at the back of your mind all the time is security, not only your own security, but those, uh, for whom you are responsible.

38:12 Now, did you have security issues in Haiti? Oh, for sure. And how did you deal with them? Um, well, I mean, the, uh, well, in fact, I, we dealt with them initially by having our nice Mr Big, who basically took care of things for us. In many respects, and because we had sided with this individual, that was our security.

38:31 Now, that said, you had food riots, uh, taking place, um, which would suddenly develop out of nowhere. People often regard medical institutions, however primitive they may be, as places where you leave bodies, you know, if, and so these were often simply left and discarded by beside us. There were one or two examples of, uh, low-level muggings, not in our agency, but in, I, one of the other agencies, the, a couple of workers were kidnapped, and so you, you know, you have to be aware of security at all times.

39:06 You can’t not be well, you know, when color starts breaking out, is there some point where you have to say that clean food and water is more important for my medical staff, so we can help out, as opposed to giving it to the people that want it when they come up to my hospital? Well, I mean, in theory you, you might be right, but you can never be seen to be doing that. I mean, you know, you have to. If you suffer as they suffer, you know, if they don’t eat, you don’t eat, or you’re not seen to eat.

39:32 You know, if they don’t drink, you don’t drink, or you’re not seen to drink. You know, I mean, I remember on one occasion, um, again in Haiti, uh, a whole load of water is delivered. It’s a really hot weather, really hot weather, and uh, an agency delivers, I think, probably a couple of hundred bottles of water. I am absolutely parched. Now there’s a whole lot of locals waiting to be treated who are looking at this pile of bottled water.

39:56 I want to get in there and have myself a drink of water. They want to get in there and have a drink of water. Um, I’d drink because they are unable to drink, uh, and so you simply have to take it on the chin. And if you’re going to drink water, and if they cannot, then you keep her in water supply, and you drink out of sight. Um, you you don’t want them ever to feel that you are taking advantage of them.

40:21 They know it doesn’t matter. You may not have shaved for two or three weeks. You may not have washed for two or three weeks. They see you as a privileged person, um, and, uh, they see you as extraordinarily wealthy. You may not have two P to rub together, but they see you as having an advantage they do not have.

40:38 You know, the actor Sean Penn went down to Haiti and he was pretty vocal. He ran a camp down there for like three or six months. I don’t know if you were aware of that. I didn’t know that he was. He was very, he said a lot of things about a lot of the organizations that were fighting with each other and not getting things done, and he was frustrating, getting things done, and he said at one point that a fire extinguisher was much easier and better for dispersing a crowd than a gun in Haiti.

41:01 And, uh, I don’t know. I was just wondering if you heard anything about Sean Penn, or his arguments as far as the organizations, or if you agree with that, fire ex. I, I didn’t. I didn’t. Well, I know.

41:10 I think if you get to a point when I’ve got to use either a gun or a fire extinguisher to control a crowd, than I at that point I’ve lost. I’ve lost. Game, set and match. You know, you don’t allow yourself to get to that particular point. You know, um, you can see how it might happen, but, um, if you’re having to use any form of aggro to defend a medical facility, then you’re at the beginning of a downhill slope.

41:32 Do you see some organizations that go there and it’s just a cosmetic. They’re there. They’re not doing anything. They’re, they’re there, very well funded, but they’re sitting around. I mean, you must get some frustration with the disorganization when you’re down on the ground like that.

41:46 They can be disorganized. I mean, we, uh, my job, I guess, is to try and dissociate us from that problem. Um, we’re aware it exists. They have a thing, um, uh, run by the WHO, generally called clusters. Clusters are when different agencies will come together in a disaster zone.

42:03 They normally happen towards the end of each day for about an hour, and you are all briefed about what is going on and where an agency might best be placed. Now, it of course depends on decent information coming through to who to actually disperse that, and in the Haiti scenario, the Kashmir scenario, Java, that information simply wasn’t getting through. So you’re using the clusters again, rather like a cocktail party, to meet people. People, um, but mostly your job is to rec, occasionally you’ll get things out of clusters, but mostly you’re using it just to get a feel for the sort of location that you, as then an individual, can go and develop further on behalf of the organization for whom you work.

42:44 And you’re a short, pretty much a short-term type of deployment guy. Are you there for the three and four weeks to get the show going, as opposed to the six months? Talk about the long-term, I don’t know, logistics. I, I’m there for a, uh, you know, I say a short time, it feels a long time, but I’ll be there for two three weeks, um, getting things started, um, and just getting the treatment underway, and then we then have a sequence of individuals um, all of whom are trained.

43:10 Um, there’s a, there’s a new specialty actually, which is being put together called St, uh, and that’s, uh, surgical training for austere environments. I think they can name it something differently, but, but you know I am, in my normal life, I am a hip surgeon. I work in, I think, called The Villa Badge, where I practice in Cambridge and London, and we do a whole lot of hips and knees, and that’s what we do, and our whole job is basically doing minimally invasive work, um, out in these disaster areas.

43:38 What I do in UK is absolutely no use whatsoever. So I have to be able to do a caesarean section. I deliver a baby. I have to be able to open an abdomen. I have to be able to, uh, amputate a limb or reconstruct an arm or whatever it may be, repair a nerve.

43:52 All things I do not do in UK now, but stuff you probably did in your previous life. Yes, I’ve done in my previous life, and, and so I’m, I’m lucky in that respect, but the, in these day this day and age when surgical training is now so specialist and so focused, we have the younger surgeons, some of whom are very good at doing general things, but many of whom are extremely good at their small bit, but not necessarily familiar with the wider picture, and so one needs to train them, and so that’s what the St is all about. Right.

44:22 Can’t believe you’re doing all those different operations. It’s hard to get my head around that you could be able to do all those little things, you know, and still remember how to repair a nerve and go into an abdomen. That’s, comes from your training in the SAS. Is that right? Yes, it is.

44:35 I mean, it’s, uh, when I joined the Army we went through a whole load of training like this, because obviously a military surgeon is, in generally speaking, what you expect of a disaster surgeon is what is expected of a military surgeon. I was going to say there’s a few better, um, groundings and backgrounds I would imagine that being a special forces, uh, uh, doctor, to compared to what you do now, to help what you do now. Yes, I think, I mean, I think so.

44:58 I mean, you know, I didn’t know when I was with the special forces that I would end up doing as things as I am now, but it seems to have been a natural drift in that direction. Yeah, absolutely. Yeah. Last question about Haiti. What was the biggest thing that shocked you that you weren’t prepared for, and what was the thing that most pleasantly surprised you?

45:15 Um, I think it was the sheer numbers of Haiti. Um, it was, it, there were huge numbers of casualties. Huge numbers. Um, and that I mean, I was sort of in my mind prepared for it, but when you actually get it and you suddenly realize, look, it’s not 25 patients here, I got 2 and a half thousand. You, you, you, that suddenly becomes almost overwhelming.

45:39 Um, I think that was that was that was that. Um, in terms of the actual logistic side and the surgical side, I think the biggest emotional shock for me was when a father came to me with his little daughter. Um, and, uh, the asked me could I adopt the daughter, take it back to him, take, take her back to England, because the mother had been crushed in the earthquake. I mean, how do you handle that? The answer is, with great difficulty.

46:03 You clearly can’t take a child out of Haiti, but that was emotionally ex. I mean, how do you turn somebody down? So that was really quite a challenge. Um, the thing that surprised me, this was actually how friendly they were. You know, actually Mr Big was a nice guy, you know, and the, the, the heavies he had around him were nice people, you know, and, uh, you you imagine them not to be, but they were very, very nice people when they had every reason on earth to be nasty.

46:30 They were, they were charming. Do you get attached to the locals, and do you ever stay in touch? Um, the I don’t stay in touch as much as I ought. I’d love to go back. I’ve not been back to Haiti since the original earthquake.

46:39 I’d love to have done that, and some groups have been back. Um, I always wonder, one of the the problems you have, I guess, is you set these things up, you get them started, and then you go, and you feel incredibly guilty for doing that, because first you set things up by friendship largely. Okay, and you’re sort of feeling you’re letting down the people who have agreed to that. You can, in our case, put a hospital on a tennis court. Um, but you’re letting down your colleagues too.

47:06 You know, you, you, you’ve brought them over from the United Kingdom, you’ve stopped them working in their normal jobs. You’ve brought them. You’ve asked them to turn their backs from their friends and family. You sort of have a responsibility to them, and you feel you want to be there to see them through it all, and you’re not, you’re coming back to UK. Your job is done, and it’s time to go, move, go back into normal life, so Guilt is, is definitely a problem.

47:27 And do you guys have fun over there? I know that’s a horrible question to ask, but you must have to shut off at night and do something, play cards or anything. I mean, do you guys have ways to, to try to get back to normal, so you can go back in the next day? Well, no, because you don’t have a working day. Your working days are all the time.

47:46 You, you do get you get run down. You get irritable. Oh, I’m speaking for myself, but, but you, you have a small team. You sort of know each other quite well, and you recognize it. I mean, I got ratty on one occasion, and, and the public health physician just took me to one side and said, look, go over there, sit down, there’s a can of beer.

48:03 Come back in two hours, and I came back and I was absolutely fine, you know. So, and I think the important thing is you’re not all ratty and irritable at the same time. You know, we all just take it in turns, and, uh, it’s a natural thing to be, uh, but we know each other so well, you recognize it, and the job continues. I picture the average person coming on this, and it seems to be like your 30s something. I’m going to change the world, volunteer that drops into Haiti, and then you have to watch them deal with this reality, where they maybe go into a shock and they forget how to tie a basic suture.

48:33 Does this happen a lot, where you have to kind of see these rookies come in? Well, I mean, you know, bear in mind they are generally, certainly for Merlin, most of them are actually trained up. You know, um, there are a few people who may be very new to it. It may be their first disaster, but mostly they have been trained and lectured to, and they know what to expect. Um, no, I mean, there’s usually a balance.

48:55 You, you know, have a few old like me, you’ve got a few real young ones in the down the bottom, and you’ve got a whole cohort in the middle there. Um, and so there’s generally enough, you just have to recognize when people are suddenly out of their depth without going to them and saying, look, you don’t know what’s going on here. You simply, you help each other. It’s, it’s a huge great team exercise. I have to say, you know, there may be people outside.

49:17 There may be security risks. There may be other agencies who are perhaps being a little more obstructive than you would want them to be, but within the team itself, generally you’re getting on quite well. Well, yeah, there are a few character clashes, but the, nothing more than you’d expect in any organization around the world. Wow, sounds like we got so many different questions for you. I know I keep hammering you with all these intense questions.

49:38 Hammer away. I mean, it’s interesting, because, you know, not only are you a surgeon, which I think in our society is a very a doctor is a very lofty thing, you know, and let alone a surgeon, and now you’re a surgeon that goes to war zones, and tell, tell my family that they, they, they agree with you at all? Well, how do you, how do you, how do you deal with people that, that, to deify you and try to say that you? I look at these great things when you just want to be, look, I’m a normal guy.

50:01 Nobody deifies me, as, as said. No, no, I mean, it’s a no. I mean, I, I, no, that’s that’s not, that’s not something I’ve ever experienced. I mean, the the, uh, um, and certainly not something I would ever seek. Happens, it’s, uh, no, it’s, it’s a job I seem to be able to do, and I do to the best of my ability, and that’s it.

50:20 I, um, a, you know, it’s what do I need? I just need to, I keep myself as fit as I can. I keep myself as up to date as I can. I talk to other agencies, I talk to other colleagues. I’m involved in training, um, other individuals going out to different parts of the world.

50:36 You know, that, that’s it. It is part of my life. My, my job. I, I wanted to be a doctor at the age of seven. My, my mother gave me a plastic stethoscope, and at that point Richard was always going to be a doctor, and so Richard didn’t have to think.

50:47 He was always going to be a doctor, and I remember I went, I was a medical student at St Thomas’s Hospital, and I remember going to an orthopaedic operating list and thinking, this is what, what I want to do. I then joined the special forces, and at that point as far as I was aware, female patients didn’t exist. You know, I had this totally male environment, and I remember there was one girl in the regiment, one girl. Not actually, she wasn’t a badged soldier.

51:11 She was working for administration, and I remember after about three years in the job she comes in, and she sits down opposite me on my consulting room, and I remember this complete blank expression on my face, thinking there’s something strange here, and I suddenly realized this was the first girl I had treated for three years. They’ve had all been big, fit blokes, you know, um, and uh, but I but I, and so, and I said something. I said. She said, what are you looking at?

51:39 I said, you’re a girl. She said yes, that’s absolutely right. At that particular point we got un like Hass far. I can’t remember what the consultation was for, but we then carried on, but it’s, uh, no. So that was the sort of background, and so I ultimately all I knew was injuries in young healthy individuals, and uh, was dealing with hips and knees, because that is what young healthy individuals and soldiers get a lot of.

52:05 And so out of the army I came and into that existence. I sort of naturally went. Were you, were you badged into the SAS as well? I was, yes, which is relatively rare for a doctor, I think, isn’t it? I’m unaware of it.

52:16 I mean, in my day I don’t believe it had been done before. And you went through the TA, is that right? But, well, I did two selections. I did the TA selection, and I did the regular selection, so I did both. I did both.

52:26 For those in America, can you explain exactly what you just said? Well, the TA is the reserves, so it’s the Territorial Army, and, well, you can explain it better, but most doctors are there as doctors, not as, I guess, qualified soldiers. So you seem to have qualified as a doctor and then passed through all the selection procedures required to, um, to go into the SAS if you just wanted to be a soldier as well? No, I mean, when I was a medical student I belonged to a territorial part of the regiment, um, and I was actually a demolitionist and signaller.

52:55 That’s what I did. Shame to say, I think I failed my SAS medical exams, even though I was a medical student. I, I think I, I think I, I didn’t know the dosage of some antihistamine or something, and that, that definitely did for me. Um, but we did selection. Well, I did selection for the TA SAS of that time.

53:13 Um, I then became regular, uh, and though there was no requirement to do selection as their doctor, it seemed appropriate that I should do so, and so I did. Um, uh, and so I did the two selections just so you know what they’re all going through. Well, I think it’s right to do. I think it’s right, you do it. It would actually gave me, I mean, it gave me my first ever case report, my first ever publication.

53:32 I seem to remember, the, uh, the, there was the, the first publication was actually, um, a soldier on my selection course, and he was looking very unwell by day five or six, and basically selection involves lots and lots of, uh, lots and lots of, uh, walking. Okay, you start off in big groups of 12 or 15 of you, and you narrow that down, and eventually you’re walking long, long distances as a single individual, and you’re navigating from one checkpoint to another to another to another, and trying to do it in a set time, and people just simply can’t do it. This is in the Brecon Beacons?

54:06 It is, it is. And, uh, it’s like a mountainous area. Wales, Wales, in South Wales. I mean, there’s a particular mountain called Pen y Fan, and if anybody knows the army, they will know Pen y Fan, and, uh, it’s, it’s the highest mountain in the Brecon Beacons, and it is always raining, the the, um, so, uh, this guy, I get called to the, to one of the messes, uh, one of the living accommodations of one of the soldiers, and he has a big swollen tummy, and he’s, and he’s looking off color, um, and he tells me that he’s got some big swell and tummy.

54:40 He hasn’t passed water, hasn’t urinated for a whole day, uh, what do I think? Now I’m just about to go out the hills and selection myself, so I wrote this, um, this letter the very brief letter, um, to the local hospital, saying, dear doctor, this man has a swollen abdomen. I do not know why. Please see an advise. It was the most appallingly unprofessional letter I could ever send down to the local hospital.

55:00 He goes, and this guy turns out to be, I think, the first ever case of kidney failure created by excessive, excessive exercise. Wow. Um, because what happens is, when you’re using muscles an awful lot, you, there’s a thing called rhabdomyolysis, where basically the muscle breakdown products can clog up the kidneys, and they can cause kidney failure. This guy had that, and so you know what CrossFit is? Yes, that rabdo, I can’t pronounce it all, is a big thing in CrossFit, because they’re working themselves so hard, they’re smashing their bodies to such a degree that they get, I think they call it rabo.

55:35 I think that’s the name in, um, in CrossFit, but it’s now become much more well known within sporting circles because of what CrossFitters do to themselves. So that was your first diagnosis? Oh, well, it’s, well, I didn’t diagnose that at all, but when I came back from the walking that day, this poor chap was on the intensive care unit, and he was in kidney failure, and, uh, I’d done the right thing referring him to hospital, of course, but it then ends up with this very unique case report, which eventually gets up being published.

56:03 Um, and at the beginning of it all is this awful letter written by me, when I, you know, clearly hadn’t even examined the patient, but at least I, I suppose I’d done what a doctor is meant to do, recognize something is outside of your territory and send him to somebody who knows what to do. Um, so, and then there was very rapidly, so that was my first case report, which came out of the SAS. The, you were in the SAS already? Was in the SAS, and it’s rare for a doctor to go in the SAS, is that what you’re saying?

56:30 To pass selection, to actually become a badged soldier so you become part of the regiment as a soldier rather than just as a doctor. And why, why the SAS? And for my American people listening, what is the SAS? Uh, the SAS stands for Special Air Service. Um, it is a form of the special forces that we have in this country.

56:48 There are other aspects to the special forces in this country. Um, and in the US you have the Delta Force. Okay, and we were involved in the setting up, well, not the setting up, but the, the assistance in the early days of the development of the Delta Force. Their selection was based entirely on our selection, on my regular selection. There were the very early individuals.

57:08 Um, from the Delta Force formed part of that selection. You’re aging yourself. Exactly, exactly, exactly. But I knew it well. Um, and so, uh, basically it was created in the deserts of North Africa in the Second World War, and I believe, and I may be wrong, uh, a listener will no doubt correct me, but the Special Air Service was simply created as a name to confuse the Germans.

57:32 Um, it was actually a military unit, but called it the Special Air Service because it doesn’t quite suggest what it does. Um, now it had a multitudinous roles over the years, um, and uh, has always, I think, it’s always really been fairly low profile until the Iranian Embassy assault in London, that, 198, that was in 1980. Okay, um, and uh, then it became more known. Right, this is when, um, the Iranian terrorists took over, from the, they took the embassy over and held, uh, British hostages that were working at the embassy, actually, a different number of hostages, not just British.

58:14 Right, for weeks, was it? Uh, I don’t, if it was weeks, it was certainly days. Um, but it was a, it was a dilemma. Um, it was also, in fact, it was that movie Argo, of course, which is, which is exactly that era. Um, and there were hostages, of course, in Tehran at the time.

58:28 Um, they were American hostages in Tehran, so it was a major, it was an era when there were hijacks taking place very, very regularly, and there were hostages all over the place, and so we had hostages in the Iranian Embassy. The US had hostages in Tehran. Um, and so that was something which the SAS were obviously involved in, in London, and that’s when I think the public became aware of the SAS really for the first time. And why did you choose the SAS? Um, uh, my father, my grandfather were both in the Navy.

58:56 We’ve been in the Navy since dugout canoes. I think really, uh, I, I remember there was a teacher at school, so shouldn’t you be a marine? Probably I should, do actually. But, uh, the, um, I was at school, and there was a teacher, and he had been in the SAS, and I, he always struck me as a very fit guy, a charming bloke, and I sort of resolved I would give it a go, having no idea what it, what, what it would be like. I then joined.

59:20 I went to the University of London when I was in medical school, and I went to the University of London Officer Training Corps, the OTC um, and there I went on a parachute course, and you had in those days what was called a light bulb, and I went to, in those days, RAF Abingdon near Oxford. I learned to parachute, and I remember the first jump I ever did, and you’re going in this Hercules, it’s going to take you up to 800 ft, and in the same Hercules there was a group of four individuals in light blue overalls, and they were forming what was called a Halo, high altitude, low opening course. Um, and this was a freefall course for SAS soldiers.

59:54 Um, and, uh, of course because we were at 8,800 ft we were dropped first, you see. So, uh, and so the Halo guys are looking at all these novices, of which I’m one, and I’m going to the side door of the Hercules, and you’re just waiting, and the parachute jump instructor is just about to bash you on the shoulder and say go, you know. Um, and that’s when you don’t turn around and say, what, me? You know, and, uh, the, and I look across to this, uh clearly the officer, as I now know.

1:00:21 I didn’t know them, but I now know, and he winks and he gives me a thumbs-up sign, and at the door I go. My parachute deploys, and I end up in a bit of a mist and without a broken ankle, which is quite a fluke for me. Um, but he was SAS, and that I think the combination of the teacher at school plus seeing them on the so-called Halo course meant there was only one place I could go, so, so I did. Any regrets with that decision? Uh, no, none at all, and they, I developed then and still have now the best friends in the world.

1:00:51 You know, it’s a, there’s a, there’s a body of individuals there’s a smallish body. Um, and we’re a bit depleted now because of nature and circumstance, but, uh, there’s a smallish body that we still meet very regularly, and they are friends you would do anything for, and that transposes really from the Army now into civilian life. These are real close buddies. And how many years did you spend in the SAS, and then why did you decide to leave and go to private practice?

1:01:16 Well, I mean, I spent, I suppose, all about 14 years um, be it reserve and regular, and more reserve again. The, um, you, I then left the, the regiment. I then became part-time regiment, part-time healthcare, working for the National Health Service, and then I ended up in Cambridge, and there I stayed as a consultant for about 15 years, and then I decided, actually, the National Health Service, good though it is, wasn’t quite for me. Um, and it wasn’t allowing me to develop an area of my practice which I hold very dear, and that is, uh, what’s called minimally invasive surgery.

1:01:50 That is, if you have a sore hip, do you need a hip replacement, probably know that it should be possible to stop you getting there, and so my job was to try and create an operation which was trying to delay the day when people needed hip replacement surgery. I’m going to look you up in a few years. My hips are getting clicky. We get you all in the end, don’t worry about it. Um, that’s well said, you know, we, we had a, a Territorial Army soldier here named Jake Wood a couple of months ago, and, and he had tours in Iraq and then Afghanistan, and, um, he was funny, because he was a TA, so he would work in Canary Wharf and then get called out to these, you know, major conflict zones, and go back, and, and he developed quite a serious form of PTSD, post-traumatic stress disorder, which I’m told can happen when anyone sees anything that’s quite traumatic, uh, you see a car accident, maybe, some of your tours, uh, you know, in Haiti or in Kashmir or these other places.

1:02:47 And I was just wondering if you ever think that you’ve experienced some PTSD on your own through your various tours and then, secondly, what your thoughts are on the phenomenon on being a doctor? Um, the answers, I’m sure I have. Um, in fact, the thing that got me, I wrote this recent book, I think you announced at the very beginning, called Wing Scalpel, and it started off as Wing Scalpel, almost like a writing therapy. Um, cuz I had repeated nightmares after Haiti.

1:03:13 Um, and it stemmed really from an aftershock, uh, when I’d been walking along the street and I’d seen, uh, two little children basically crushed under, um, under some rubble, um, and one was dead, one was half alive and was calling for my help. I went along to see this little girl, and in the process of trying to console her, there was an aftershock which completely wiped her out, and I just got away by the skin of my teeth. Now that gave me, ultimately, dreams, so you saw this all happen, saw this is all, this, this is all happening, this is all happening before my eyes, and so, um, at that point I managed to roll out of trouble.

1:03:51 I guess it was simply reflexes that allowed me to be here today. Um, but that comes back a little less now, but certainly straight after Haiti it was coming back an awful lot as a dream, so I wrote this down, and that actually comprises the first chapter of the book um, it’s just the dream I have related to that, and then the book, then followed from there, uh, based on the daries and the various disasters I’ve been to. The, um, so you know, it’s that, I guess, is a form of PTSD, isn’t it, that, now?

1:04:23 Um, also, after the Falklands War, I was involved in the Falklands war. The operation I was involved in was not a good one to be involved in. It had, was estimated at a 30% chance of survival. Um, I’m alive to tell the tale, but I didn’t know that at the time. Um, that again gave rise to a lot of PTSD.

1:04:42 You live with it, or I had to live with it. I had to get on with work, and then, I some years later, the Sarajevo conflict came up, and I was sent out to Sarajevo to, during the siege of Sarajevo to, um, run a medical team in what we call the Swiss cheese hospital, which is right down by the front line. The Swiss cheese hospital was called that because it was so full of holes from the Serb artillery, and um, I remember standing in the driveway of my house in Cambridge, waiting to be collected for the trip to Sarajevo, and suddenly this wave of fear comes back over me, the same fear as that I’d had in the Falklands war.

1:05:17 Now, you park it obviously because you’ve got to get on with the job, but there is something under the skin all the time. There’s something there which mostly you can live with, and have to live with. The best thing, I think, from a personal view about PTSD, is PTSD. I clearly don’t have a full-on version of it compared to a number of my colleagues, but it is simply to be aware it is there, and so when you have a response, then you know you’re going to get the response.

1:05:42 Um, now some of my psychiatric colleagues will tell me that PTSD is perhaps not quite as common as was once thought, but it is certainly a problem in some cases, certainly a big problem. What is that phrase? Physician, diagnose thyself, or no, physician, heal thyself. No, I’m hopeless. I mean, it’s, it’s the last thing on earth you should do.

1:06:02 Um, no, I mean, I’m not intending to go to cachas to get all this way sorted. I mean, I’ve lived with this type of feeling for more than two or three decades, and so something I’m used to. It’s not something which is pleasant, but it goes with the territory. So, Falklands, you were down near the Falklands? I was involved in the Falklands war again with a special forces operation.

1:06:20 Yeah, she, that sweeping generalism that, that makes me not want to ask any more questions. He says things like that. There’s a, um, there’s a guy I’m not sure if you’ve heard of him. His name is Eric Greitens. He wrote a book called The Heart and the Fist.

1:06:33 He, um, he sort of, similar to you, he started off life. Um, he went to, I think it was Harvard. He was Ivy-educated, then he was a Rhodes scholar. Um, and during all of his free time, he decided to, uh, he went to Rwanda, um, to help in, um, I can’t remember the exact name of the charity, but he’d go into these camps and try and provide as much help as he could. He went to the, um, he went to Colombia.

1:06:57 He went to Bosnia, just to, you know, he was, he, he just felt like he should be giving something back, and went to, to help out, um, on the ground there, and then he realized that he actually didn’t want to, um, he didn’t want to just help, post, um, all, all of these issues going down, all of the, um, you know, post these conflicts having started. He wanted to actually do something to effectively um, help out prior to that, and so he joined the Navy SEALs, and he obviously had, you know, he was just about, he’d been off all these lovely jobs, post-studying at Oxford, um, and he said, you know what, I’m not going to do that. I, I want to go, and I want to go and join the military to try and defend the weak, as it were, and he has, so he left, and he went through, um, hell week, and he qualified, um, into the Navy SEALs, which, you know, which is not an easy thing as I’m sure you’re aware of, and, um, then subsequently went to all of these different conflict zones, and helped out as a soldier, no longer just as a sort of relief worker.

1:07:54 Um, so I thought it, it’s quite interesting because it’s a fairly similar parallel. You know, he’s obviously not a doctor, but he’s doing, um, you know, he’s doing similar things to you, and, and subsequently having left that, he now runs a charity that, um, when injured, uh, soldiers and, uh, military personnel come back, he tries, he tries to find them work. So I think it’s either the Crusade goes on, or something like that. So he’s a sort of fairly, uh, inspirational man, and I think there were very strong parallels, and it’s definitely a book worth reading if you have time.

1:08:23 The Heart and the Fist. In the Fist, I should remember that. Straight onto Amazon, straight after this. I, yeah. Yeah, and, and we’ve, we’ve just had actually a video, um, video question posted by one of our viewers.

1:08:34 We’re going to be doing this more, and I’ve actually just played them, uh, for Richard, but one of them was, was quite simple question, but, you know, you’ve seen so much in military and in peacekeeping, but he asked quite simply, is man naturally, um, a peaceful or warlike? I know that’s a general thing, but, but what have you seen? His man or his woman, um, the the, uh, I, I think mankind is not naturally peaceful. He’s not naturally peaceful. I mean, I would like to think he is, and I think it’s right that we should be reminded that we should strive for that.

1:09:04 Um, I don’t see myself as warlike. I try. I know I’ve seen a lot of conflict, um, but I try to find the, the most peaceful way out of trouble. Um, but I think what my time and the services certainly showed me is that there are some very nasty people around. There are people who just don’t think like normal.

1:09:26 Um, and you know, I guess our security services, our special forces, our police force deal with these people habitually, all the time, in civilian life. The likes of ourselves we are protected from that, I think, in many respects, but there are some particularly evil people around. Um, the bulk of us are absolutely fine, and we get on with each other very, very well, but there is a co, there’s a cohort of people who are violent, and that’s the way our creator designed them.

1:09:53 So mankind, much as you know, much as I think throughout the history of mankind, um, we have tried to, uh, avoid war and conflict. No generation has ever been successful in doing so. That’s very honest opinion. You were in Libya for the Civil War there, and that must have been different, because these other conflicts were more natural disasters, and you’re, you’re ex-SAS, but you were there in a civilian capacity, is that right? Yes, it was.

1:10:21 I was, what, what happened, and was that strange to, to, to observe in that way where you were kind of powerless to act in a military way? Well, I’m, I’m very happy to be powerless to act in a military way. I mean, you know, I am, I am an ex-soldier, but I am a medic, and that’s what I do, and, and so, do you consider yourself a, a medic or a soldier first and foremost? A medic. Always, always have done.

1:10:43 You, I even, when I was a badged SAS soldier, I would always wear my uh Medical Services, or RAMC, stable belt. I would wear an SAS badge with a wing dagger, but I would always wear the medical stable belt. I felt that was the right thing to do. Right. Um, no, I mean Libya, basically, uh, what I’m asked to do is to form part of a team to help get casualties out of Libya and treat them.

1:11:05 Now, we can either, well, get casualties out of Libya, we, we can treat them in Libya, if we so wish to do so, um, but I decided that it would be better to take casualties from the conflict, take them across the border into Tunisia, where you could actually treat them under more relaxed, secure circumstances, and so it was going to be, as it were, a two-prong, uh, plan. We were going to have a fairly rudimentary facility within Libya itself, in a, in a town called Nalut, um, which is in the Nefusa Mountains, um, and then we were going to operate out of a hospital in Tataouine. You remember Luke Skywalker’s planet, Tatooine?

1:11:42 So, in Tatooine, and we’re going to join up with the Tataouine hospital, and that’s where the casualties would be shipped to, and so my job was to create that, and so part of the work was in Libya, part of the work was outside. You tend to find, mind, when you’re in a conflict zone, actually, you are either as a medic extraordinary busy, or you’re doing nothing. You know, take no Lo, and I think the population of Nalut is about 100,000 normally. Okay, that’s depopulated down to 7,000.

1:12:08 Okay, because everyone has fled, and so the only people left behind will, in some shape or form, be involved in the fighting. Now, they are generally healthy unless they are injured, and so as a medic, you are not really very, very busy until suddenly there’s a contact, and x00 Gaddafi forces fight x00 Rebel forces, and you end up with casualties to deal with over a space of a day or two, and then it’s silent again. So, so actually, if you want continuity, you want a surgical team to be continually busy.

1:12:37 It’s actually best if they’re a little bit away from the conflict zone, um, and so you can focus on basic rudimentary treatment where the action is keep them alive, and then get them back to somewhere which can be more comprehensive. I mean, let’s take, well, let’s take Afghanistan, for example, and at the moment it’s, I think, it’s, isn’t it, 38 hours from injury of a, a UK soldier to getting them back to Birmingham for treatment. That’s remarkable when you think about it, you know?

1:13:07 So, so you can try and emulate that if you can wherever you are. Okay, so that was my job in Libya. So, um, the, these two things now. Obviously the Libyan side of the border was a very different kettle of fish to the Tunisian side of the border, but both had their challenges. Was that through Merlin as well?

1:13:22 That was through Merlin. Yes, indeed, and I guess you could have opted out of that as well, but that was more of a, a war conflict, obviously? Did you have to think any differently before going in there, as opposed to Haiti, where it’s an earthquake scenario? Oh, yes, you do. Well, I mean, Haiti, interestingly, was, it’s not an official war, as it were, but there’s a lot of conflict in Haiti.

1:13:41 Okay, um, but no, you do. I mean, you are reliant on what little intelligence reports you can get, and where they come from. You need people to help you cross the border. You can’t just drive in your Nissan and say, here I am. So you’ve got to, um, there comes a point, doesn’t there?

1:13:58 I mean, most conflict zones have got what I call Graham Greene cafes, and there was a wonderful, um, example of that in Tunisia. These are cafes right on the border, on the boundary of the conflict, and so there’s a place called Dehiba, which is south of Tataouine, and right on the Libyan border, and you go into this cafe and it’s filled with smoke. It’s got these circular, sort of, metal tables, and around the tables you’ve got steel-eyed individuals big jackets on, all in their mid-20s, passing brown paper envelopes to an.

1:14:29 So this is where you go to negotiate, uh, and this is where you go and sort out transport across borders or whatever it may be. Um, because you need someone to help you. You’re going into a war zone, you have no real idea what’s the other end, and so there comes a point when you are passing your security to somebody else, and that judgment has got to be key, because you’re never quite sure who you are passing your security to. And so when we cross the border, as we did, and you’re driving at the rate of knots.

1:15:00 I remember they had this Berber driver, um, who had this, uh, his headgear on, and we were driving so fast that the headgear came half undone and was flapping my face. I have this, this image of me driving about 160 km per hour on the Nefusa Mountains with a faceful of Berber headdress. And he keeps on turning to behind me, saying, is all okay? And then not looking at the road. So I felt at that point my biggest hazard was not Gaddafi at all.

1:15:25 That was the Berber driver. And then we come around a corner, and there is a roadblock, and you’re just thinking, now what roadblock is this? And they’re all armed. They clearly are looking at you suspiciously. Now, it so happens that’s a rebel roadblock, and we are fine, but you just don’t know.

1:15:43 Um, so there comes that moment when you might have made the wrong call for security. We made the right call for security, but it was, you know, you can tell it could be, uh, it’s a, it’s a knife-edged decision, really. Have you mentally prepared yourself for being kidnapped and taken for a long period of time by some forces in a conflict zone that you go to? Not at all. Not at all.

1:16:06 Uh, um, I, I park that. I think, if I genuinely believe that I wouldn’t do it, I clearly take precautions, and we have, you know, so proof of life questions, and so on, which are, which are things you leave before you go. Um, you know, I mean, you’re probably aware of proof of life, but basically, if somebody is kidnapped, you need to know, or the people who eventually are negotiating with kidnappers need to know that the detainee is still alive. And so you leave behind questions, or answers to questions.

1:16:33 Um, I’m not very good at those. I mean, it’s like passwords and computers, you know, sort of, um, who is the, what was the name of your second cousin’s aunt’s first dog? You know, and that’s, so, so you forget your proof of life question, but you know, and so, you know, my, my concern is, at the end, I’ve never had to use proof of life. I never want to ever use proof of life, but I rather suspect I would fail the test, and if I was asked to use it. So, um, yes, you have that in the background, but, you know, I know, if, if you genuinely felt that was a significant risk, you wouldn’t do it.

1:17:07 Do you ever think about the genuine possibility that your former unit in the SAS might come and rescue you someday? I mean, I, I don’t know if they ever would. You know, I mean, I’m, I’m, uh, you know, they think, the docs, the docs in trouble, let himself sort himself out. No, they, no, I mean, I’ve got very good friends. Clearly, I have, and I’ve got a lot of time for these individuals.

1:17:27 Uh, um, The, uh, they work under extraordinary adverse circumstances. They do jobs which I think most of the world doesn’t really realize how significant they are. I remember talking to one, uh, commanding officer of the regiment some not so long ago, really, and I said, why do you do it? And he says it’s the only job he’s done which he, in which he feels he really can make a difference. You know, um, and uh, that was a very, uh, sort of humbling thing to hear.

1:17:57 This is an SAS, or this is a, Merlin? No, no, no. This is a special forces commanding officer, and uh, you know, I really thought that that was a perfect answer. He really felt he was making a difference, and actually was one of the kindest chaps in the world. What, um, what advice would you give to the 20-year-old Richard Villar if you could make a call to him and tell him something?

1:18:18 You can’t say carry on. That’s too easy. What, uh, what bit of advice, or, or the right dosage for that? Anti… yeah, but would you tell him anything to do differently, or to mind better, or anything like that? I would.

1:18:32 I think I would say that, uh, never let an opportunity pass you by, and say yes to everything. That’s what I would say. Okay. Never, never say no, never say no. Wow to anything, to anything.

1:18:46 Okay. Um, similarly, what would you say to that 20-year-old that’s listening who thinks, okay, I, I, I want to go into medicine, the SAS, to an organization like Merlin? What, what advice do you give to them? I mean, I think anything is possible, providing your focus. I mean, you know, I’m, um, my daughter is 18 years old yesterday, and she is scheduled to take A levels, and I was saying to her only yesterday that I saw it rather like SAS selection, taking A levels, you know.

1:19:21 Um, you basically, absolute focus, total focus, you have, at the end, an objective, let nothing get in the way. Um, and over a short space of time, SAS selection lasts, in essence, six months. Anyone can focus for six months. A-levels, the final rundown, is a couple of months from now. Anyone can focus for two months.

1:19:40 Just sit in that rut, look forward, and get to that end point you want, and you’ll get it. Okay, that’s good advice. Are you optimistic about, um, medicine in this country and people going into medicine and and what you see, and the younger surgeons coming up, and also in some of the military? I mean, look, look at, I mean, medicine is incredible privilege. You know, incredible privilege to be a doctor.

1:20:02 It is never boring, you know. I I can never think I haven’t had one day in my entire career when I said I don’t want to go to work. It doesn’t matter what aspect of medicine it is. You know, um, it’s changed. I start off life being very general and doing a lot of trauma.

1:20:17 I’m now a specialist hip surgeon. I edit an orthopaedic journal, whatever it may be. I do all these things. Every single part of it is fine, you know, and, uh, and I always think it’s a bit inadequate when people, I was interviewed for this editor post I now do. I mean, I’m a part-time editor of an orthopaedic journal, and they asked me, why do you want to do this?

1:20:35 And I said, well, am I allowed to say because it’s fun? You know, for some reason, people aren’t allowed to say they do something because they enjoy it. When a patient says, I say to a patient before surgery, look, we’ll enjoy doing this. They look horrified, and I say look, actually, we do this because we actually like doing it. The act of surgery is fun.

1:20:53 We take it terribly seriously, but within ourselves, do you like doing it because it’s a challenge, because you like the rewards that you get afterwards, seeing somebody heal? What makes it fun? Is it the, rather than, is it the actual act of, you know, cutting somebody open, or no? Well, the act of surgery is, it is fun to do it, to respond to the challenge of doing it well. Yeah, every operation is different.

1:21:17 The one before, you know, you’d have thought that having done, I’ve done just short of 9,000 hip keyhole operations in my career. There’s a lot, you’d have thought by now, um, it would be totally routine. It’s not. I mean, every single one is different, and I see every single one differently, and there’s always something unexpected, I guess. The thing that I like, and keeps me going, is that patient walking in the door about six weeks after surgery, smiling.

1:21:43 Yeah, and that’s what I love, and that’s what keeps me going, you know? Um, you know, whenever you suddenly feel a bit despondent because you’ve got a bit too much work on or, or, or whatever it may be. Actually, when that patient walks in and smiles, it makes it all worthwhile, you know, so I keep, I, I guess I’ll keep going till they take me out, complaining, I would guess. Yeah, that’s my next question. What’s the next five years for you?

1:22:05 You’re still involved with Merlin, so you still could be called into a potential conflict, and you’re going to keep doing your private practice? I keep going as I am. I mean, as I say, I mean, in due course, they’ll look at me and think, this guy’s just too old and too crochety, and, uh, you know, and so, uh, we’ll put him out to seed, I guess. And, but, the, uh, not at the moment. I enjoy too much what I’m doing.

1:22:23 I mean, I have, you know, you know, I don’t believe in retirement. I don’t. I’m not quite certain there, there’s no magic day you get to when you suddenly say, right, I’m going to pick up my golf clubs or I’m going to start gardening. I mean, that’s not what I felt life was about. There’s just too much to do.

1:22:37 Um, I, the thing that probably got me going, apart from the stethoscope being given to me when I was age seven, I was read all those wonderful stories about the, the tropical diseases, doctors, the yellow fever vaccine, malaria, polio, all those things that my forefathers used to do, and they were, they struck me as real ventures, you know. Um, and so you sort of get caught up in it. Um, and medicine is just filled with fun. It is a really, really good thing to do.

1:23:03 I interview for medical students in one of the key London teaching hospitals, you know, and, uh, I guess I’m just looking for people who enjoy life. Who, uh, I remember there was one girl who we interviewed, and, uh, I said, you know, I said, what are you going to do after this, you know? Uh, when this interview is over, what are you going to do? She says, well, I, I’m going to go and watch Merlin. And I thought, this, this was the, the television programme, and I, not, not my Merlin.

1:23:27 No, no, no, but I’m going to go and watch Merlin, the thing, and I thought, well, you know what, the hell, I, this, is struck me as, um, you know, what a charming answer, and she was obviously just filled with fun, and I thought, you know, and that will come across to a patient, and a patient will feel comfortable with her, because this is all about, isn’t it? Medicine is patients. You know, you are asking a patient to come and have an operation, to go to sleep, to have a scar, to wake up with a bit of discomfort.

1:23:53 You ask them to go through this totally unnatural act for the sake of them feeling better afterwards, you know, as my wife would say, only Ada dafty wants an operation, and yet sometimes we need it, and so we have to, um, come across to a patient in a way, um, that makes them feel comfortable about making a hugely unnatural decision, their first parachute jump, you know, who wants to leap out of an airplane, completely daft to do, but actually, um, the people who you are with, you trust, they’ve learned to read your emotions, and they help you through with it. And that’s my, I guess my job is to do that medically. So being a doctor is all about customer service, really.

1:24:31 Patient service. I mean, it is all about patience, all about patience, nothing more than that. Wow. Now, no, I watch the news now, and I see things happening around the world. Do you watch the news with a, a slightly different eye, and think, I might have to go there, or do you have certain hot spots that are in the back of your mind, where you’re like, I might have to make a trip to XYZ?

1:24:50 No, I mean, I’m, whenever I hear of hot, thought, cuz they happen all the time, don’t they? Um, my instant reaction is the medical side. You know, I mean, uh, you know, we, we um, the absolute tragedy of the Boston Marathon. You know, you’re thinking of the patients totally, but actually my mind is already and I’ve already emailed my colleagues in Boston and said wish them well with what’s going on. You know, it’s, uh, so my, my, my, my thoughts are totally with the medics and how they’re handling that situation.

1:25:19 So yesterday it seems like some two bombs went off at the conclusion of the Boston Marathon. This is going to come out about a week and a half later, but, um, and you said it looked a lot like, similar to, say, IED triage. I was just wondering what went through your mind when you heard this news? I mean, I heard it last night at midnight here. Uh, what do you think?

1:25:36 And yeah, did you, you email people? What would you do on the ground? I’m just kind of curious what, what that does to your mind. Well, I mean, it’s, my immediate reaction was I saw the explosions, and I instantly saw that the estimate, when I first read of it, I, I think I’d heard of something like two, two unfortunately killed, and at the time, and I think 22, I think, was the original estimate for the injured. We now know it is much, much more than that.

1:26:03 Yeah, much higher than that. Um, but when I saw the explosion, instantly I knew it would be higher than the estimate we had. Um, and you could see, I mean, in my view it was clearly intentionally placed. It couldn’t be anything else. Um, and I was looking at the why, why couldn’t it be anything else, from a complete layman’s perspective?

1:26:20 Well, I mean, why could it be a boiler that blew up or something? Well, because it struck me it was in the middle of the crowd that was watching, and there were two explosions that were timed, and two and two together. Exactly that. And then I saw individuals falling to the ground quite distant from the explosion. Um, so I guess yeah, of some sort, you know.

1:26:38 So it had that look of something which was obviously planned. Um, and some sort of shrapnel injuries were taking place. Um, no, I mean, when you’re faced with that, you are faced with a huge problem, and there are a few of you on the ground, and there are a lot, lots of casualties to deal with. You prioritize as best you can, and, uh, so it’s airway, and it’s breathing, and it’s circulation. So the thing that people will will kill people first, of course, is airway obstruction.

1:27:06 So the individuals who have got an airway at fault, your job is to keep that open. There are various ways of doing that, either by positioning the patient appropriately or by holding the airway open. You can do that. You’ll have no gear at to hand. There’ll be no medical equipment to hand.

1:27:21 Um, when it comes to bleeding, um, most bleeding points will respond to pressure, okay, um, and or elevation. It’s very rare for a bleeding point actually to not respond to pressure. You may have to lean very, very hard, uh, but again, if you’ve got 50 casualties and only two of you treating them, then you have to make your choices. So you, you would just take care of business in that situation. Would you just switch a different gear in your head, and you would just know exactly what to do and start taking care of people?

1:27:52 It’s largely instinctive. You do that, and then uh, it’s, it’s act first, think later, really. It’s instinctive because you’ve done it so many times. Right? I don’t think it’d be instinctive if I was there, or just a junior doctor, but you’ve been through this in many different parts of your life.

1:28:08 I think that’s why it’s become instinctual, because you just got so much experience of it. Yeah, I mean, as a doctor, it’s, uh, you have to act very, very quickly at times like that, and that you will make some mistakes, but you must continue acting with the best beliefs you have, um, because you will save lives in the process. Well, I hope you’re there the next time that something like that happens, you know, or if I ever see that happen, I just, I’m going to look around for you, cuz I’ll just feel so much better if you’re around.

1:28:34 They’ll put me out to grass by then, probably, maybe, maybe. Um, Richard, if people want to get a copy of Wing Scalpel, how do they do it, and your other book, um, and how do they get a hold of you if they need their hip fixed, like me? If they want to get a hold of Wing Scalpel, then they, uh, simply go on to Amazon, and they can get Wing Scalpel. It was published by Pen and Sword. If they want to get hold of Knife Edge, which is about my time in the SAS, then they, again, they go on to Amazon, that’s actually published now by people called Vineyard Press.

1:29:01 Okay. And if, if they want to find you, otherwise just to thank you for an awesome interview, do they find you at your medical practice, or Richard Villar.com, or any other way, or do you lay low on the radar otherwise? I, I, how can I lay low on the radar when I’m sack a podcast like this? But, the, uh, no, I, I I’m part of what’s called The Villa badua v a r b AJ wa V V badar practice in Cambridge, if they go to Villa bad.com or Richard Villar.com, both will lead there.

1:29:30 Uh, we got emails and secretaries and all sorts of people to help. Okay. And just, I mean, lastly, anyone you know thinking about service in Merlin or any of these organizations, maybe not even on the front line, maybe in some other way, um, what do you encourage them to do to contact the organization? Or, oh yes, I mean, you know, I think Merlin is always keen to welcome supporters. Now, now that support can be in all sorts of different ways, be it financial, be it physical, be it just simply in time.

1:29:58 Some people can go out and help serve, but to approach Merlin first of all, they will point you in the right direction if there is a job to be had. Now, clearly, when there’s a disaster on, there’s more, there are more slots for activity, as it were, um, but they are a thriving institution. They do a whole heap of good, and they’re always looking for good people to help them do. Do you think giving money immediately when you hear about a conflict is the right thing to do?

1:30:21 You see it always as a knee-jerk reaction when this happens, happens, this happens, everyone’s out trying to collect money for that immediate case, and does that frustrate you, or do you think that’s a, a smart thing to do, or a human thing? I, I think collecting money is fine. Um, I think it’s a wonderful thing to do, and none of what we could do could have happened without money. I, it’s all very well with the best will in the world. I mean, who’s going to pay for the airplane?

1:30:42 Who’s going to pay for the tent? Who’s going to pay for the anaesthetic we use? So we need that. I think the point is to direct it towards somewhere that will use it properly. There are some places to which you can donate money, and it probably isn’t going to be used to its best advantage.

1:30:58 I think Merlin takes it really seriously, so, uh, the administration costs are tiny compared with the amount of money that actually goes out to do some, to do some good. Right, which is an important thing. Oh, for sure, for sure, definitely. Um, that was a lot of fun. Um, thank you so much for coming.

1:31:14 I, uh, yeah, I feel like we could even sit you down for a few more hours and get deep into some of your old stories, which you might not be able to tell, but, um, it was extremely informative, and I’m actually, I can’t wait to get your book and read it myself. So, thanks for coming on. Thank you very much indeed. And, uh, Patrick, thanks for being with us. No problem.

1:31:32 Are we going to see you again, or what? Maybe, maybe. Okay, that’s not, I mean, that does that conflict with being a host on London Real, some potential job change? Well, I just don’t think I’d have the time to, to, what, if everyone, like, got on and did, like, a campaign to keep you, to stay? Would that be it?

1:31:50 I think that might not be well received in my first view of work. Fair enough. Well, if you’re listening to us on iTunes, if you, please click and subscribe. If you would like to see, um, Richard Villar in all of his glory, you can come see us on YouTube channel London Real TV. We’re also on Twitter.

1:32:06 Uh, we’re on Facebook. I’ll be posting a picture of the three of us out, uh, on Twitter and Facebook. Now on the website as well: londonreal.tv. If you want to help out and, uh, intern for the show, just send me an email at [email protected]. And again, it’s always the ones that I never know that are going to be awesome.

1:32:24 So, um, thanks so much. It was, it was really good meeting you. Thanks indeed. Does this rolling start, and then you, like, says who, who it is, and obviously Red Band makes the monkey noises. So, uh, we did a rolling start band.

1:32:37 We did rolling St. It’s called momentum brother. It’s good, man. I like it. Well, for people that don’t know, we are here with Mr Brian Callen. Than, who, uh, people that, uh, don’t know is a comedian and an actor.

1:32:47 Uh, you might have seen him in, uh, such films as