Wherever he is based, plastic surgeon Simon Heppell’s job is to help people recover after sustaining traumatic injuries.
But there is a world of difference between conditions at the Spire Portsmouth Hospital and those in Camp Bastion, Afghanistan.
Today, Lt Col Heppell shares his experiences with The News.
He says: ‘In Afghanistan we faced lots of variation, lots of business, lots of stress, everything from children, to pregnant women, to burns, to amputations, to cut fingers.
‘There’s no start and finish of the operating theatre session, there’s no outpatient clinic, it’s entirely about fitting in what comes through the door, and that’s many and varied.
‘Yes there are wounding patterns, yes there are patterns of injury that we come to recognise and yes there are certain techniques we can apply that then lend us to support those things.
‘I teach some of those techniques now, both in the UK and abroad.
‘There isn’t anything we do in the NHS or at Spire that will prepare us in terms of practice in what we are going to be faced with because you are never faced with that out of a war zone.
‘What we can do is practise the skills that are applied.
‘It was extremely varied – there were probably 40,000-something patients that went through Bastion in its lifespan and a high proportion of those went through operative procedures.
‘We all consider ourselves to be fortunate to deliver that type of care and that puts a different perspective on the things we see back here.’
Mr Heppell explains how his skills as a plastic surgeon can help save limbs and lives.
‘The problem with battlefield injuries is they are often worse than what you see initially,’ says the 45-year-old.
‘The nature of battlefield trauma is such that there’s a hole you see on the outside, but the energy has been transferred on the inside and sometimes along with that is the mud, clay and sand from Helmand Province.
‘This is why it’s important the wound is controlled before we then put a cap on it. Often the wound that is seen initially is not the one that needs to be reconstructed. Often more tissue needs to be removed to establish that control.
‘Because my skill set is the reconstructive side of that, the presence of plastic surgeons has improved the reconstructive possibilities for our patients because we were able to identify, perhaps better than other types of surgeons, what needed to go, what needed to stay and what potential reconstructive options were in the future.
‘Identifying those early meant they were preserved for later and then wounds were in better condition.
‘Because what I do is reconstruction I have a knowledge and understanding of the way parts of the body are supplied and drained from blood, and how therefore they will stay alive and be moved from one part to another.
‘Whereas other types of surgeons who don’t do that aren’t maybe aware that that bit of skin or muscle hanging off a leg can be used somewhere else.
‘If it’s not doing what God intended, so to speak, then other people might perceive it is no longer useful and discard it.
‘Plastic surgeons are aware how other parts can be used and that increases those reconstructive possibilities.
‘It also means our handling of soft tissues is at a different level to other sorts of surgeons.
‘There’s an awful lot less bureaucracy compared to here and lots of patients coming in through the doors with a need to just get on with it.
‘Certainly it puts the bureaucracy in perspective and what can be achieved when you are just there for the patient, rather than jumping through hoops.’
And the experiences felt in Afghanistan stay with Lt Col Heppell.
He says: ‘I take back team-working, and that’s a strong ethic. And it’s all patient focused.
‘There’s always patients that come to mind, children with lost limbs. The first patient I reconstructed over there was a child, aged about eight to 10, with a broken leg from a land mine. He had lost some of the soft tissue and had an exposed fracture.
‘It had happened two weeks before I got there, but the surgeons knew a plastic surgeon, was on the way, so they kept the wound dressed and I was able to remove some of the skin on his leg and healed his fracture.
‘And we know that because he actually came back to the hospital with another injury about 18 months later. Fortunately it was not as bad and that’s the only way we would really know because there were no health records.
‘I have seen harrowing things and had to think slightly outside of the box and apply old-school medicine.
‘That’s something we were very aware of, there’s western medicine that we have access to and then there’s what we have and what we have available, and what we can apply and utilise.
‘So the kitchen knife, fork, kind of stuff, with the old Second World War ‘make do and mend’ approach.
‘It was simplistic and innovative. Sometimes the simple thing is the most effective and efficient.’
Lt Col Heppell has had a long affinity with the army.
‘I felt it was my place to go over and that’s why I joined the army.
‘I wrote to the army when I was 13 and said I wanted to be a doctor in the army.
‘I was nine when I realised I wanted to be a doctor, and that didn’t change.
‘The way I cope is to have an appreciation that I didn’t cause the injury, this patient is going to be here regardless of whether I’m here or not, so that puts a different perspective on things.
‘There has to be some form or way of accepting the harrowing nature of this and I know colleagues that this was too much for, and that doesn’t make them better or worse for me, it’s just different.
‘I don’t really know how I prepare myself, it is very complicated. I suppose I have a heavy reliance on my family, a lot of contact with them even when I’m away, an open approach to discuss things with colleagues and a strong camaraderie with them and an awareness on return not to keep things quiet.
‘I was fortunate not to suffer from any post traumatic stress and would volunteer to go again.
‘I have a wife and two boys, and they have got used to it. When one of my boys was seven years old, my wife realised he had a picture of me under pillow and that got to me a bit.
‘There was always training and the boys saw dad go away and dad come home, and that’s the key thing – I do come home. And there’s contact while I was away, so then it became very easy for them.
‘They didn’t, nor should they, understand what it’s like to see a bomb or rocket go over your head and then land 50 metres behind the hospital. There’s no reason to explain that to them – the fact is daddy comes home.’