Inspiring doctors worldwide

18:41, Jan 27 2014
Professor Christopher Bulstrode
Professor Christopher Bulstrode preparing to receive casualties at a base camp in Afghanistan.

He has spent this summer attending to Southland's medical emergencies but the work that has led him here could not be more different. Professor Christopher Bulstrode tells Amanda Parkinson how working in the developing world has changed his politics, career and life.

Christopher Bulstrode has spent his life travelling where the world has needed him.

For the past 30 years, the University of Oxford professor has occupied himself rushing to the aid of countries, and people, in crisis. Now, two years after Southland Hospital's Emergency Department became an accredited training ground, he has elected to take a four- month-long summer secondment in Invercargill.

Professor Christopher Bulstrode
Professor Christopher Bulstrode aboard a British Armed Forces helicopter while providing health care to refugees in Afghanistan.

His career began with aid work, but as it developed it became clear he needed to specialise.

An epiphany from what appeared to be a medical miracle confirmed his decision to become an orthopaedic surgeon.

"I think many people decide on their careers after a single momentary experience; a pretty unreliable way of doing things."


He witnessed the world's first double hip replacement, but it was seeing the patient's life transformed by his now pain-free existence that set Prof Bulstrode's course.

Several years later he became a consultant and then senior lecturer at Oxford University.

He vowed to never train someone as he had been trained, and to be a teacher that inspired.

"At the end of my dreadful training I wrote on my shaving mirror "You will not forget" so that every morning I would be reminded that I would do my utmost not to treat juniors the way I had been," he said.

He was awarded a professorship at Oxford, a privilege he still regards as an honour.

But following early retirement, and after becoming increasingly frustrated with the politics of medicine, Prof Bulstrode decided he wanted to do something completely different.

His wife provided the impetus.

"She told me I was boring complaining about the committee work I was doing, handed me a glass of wine and a piece of paper divided into four with the headings: What am I good at? What am I not good at? What do I like? What do I not like? Then she told me to fill in the four boxes honestly and she would look at my 'homework' when I had finished" he said.

What became evident from this simple game was his desire to return to where his medical career had started. Fresh from medical school at age 25, he travelled to refugee camps in Africa and the Middle East, providing basic health care in treacherous conditions. Now, decades later, his wife had a peculiar solution.

"She said I needed to join the army. Astounded, I said I could not; I had been at the front of peace rallies my whole life."

But his wife, a doctor of education, convinced him the army would provide the challenges he needed while keeping him safe in places that were notoriously dangerous. After a quick call to the British Armed Forces and six weeks training, Bulstrode boarded a plane, like he had done so often before. On this occasion, however, his service was not to an aid organisation; it was to his country.

He touched down in the thick of a war zone in Afghanistan, recalling that, for the first time, his hands were not steady. His scrubs had been swapped for a flack jacket, his surgical mask for a helmet. His hands were heavy with an instrument used not to heal, but to harm.

"The ethical conflict of becoming a doctor in those situations is far more stark than you realise," he said. "You have a loyalty to your comrades that may override the duty to preserve life."

As an academic-turned-soldier, Prof Bulstrode had the wits to realise the two worlds did not often collide.

"When I went into the army, I said to myself that whatever else I had been in the university, I had not been a soldier; now I was, and so I had better do whatever they do, and do it their way."

He completed almost 40 foot patrols, and saw countless patients, both allied and Taliban.

His seven months in the volatile Afghanistan successfully revitalised his passion for emergency medicine, and upon his return he started volunteering for international aid programmes.

His opportunity arrived after the 2010 catastrophic earthquake in Haiti. A magnitude seven quake rocked Port-au-Prince and the surrounding areas, tragically stealing the lives of more than 100,000 people, while also injuring more than 300,000 and rendering millions homeless.

Travelling with a French aid organisation, Mdecins du Monde (MdM), Prof Bulstrode said there were moments when it was "completely and utterly devastating".

"As we drove slowly into Port- au-Prince we couldn't see much damage at first. Then, suddenly, all around us buildings had collapsed, and some were still on fire, and there were bodies tumbling out.

"It was quite clear, though, as the bulldozers went in later on, that some of those people trapped in the collapsed buildings had been alive for a long, long time, hoping to be rescued, but were not."

After witnessing the carnage that appeared on his operating table, he believed he had just lived through something that "would change his life."

"We were operating from dawn to dusk . . . out of a partially collapsed building, surrounded by tents."

"We were just flat out . . . conditions there were such that you would not normally agree to operate, but the patients had no choice and then anything may be better than nothing."

He was part of a team consisting of two surgeons, who completed 450 operations in three weeks. This was more than the hospital he worked for in the UK did in the same time with 20 surgeons.

Upon reflecting on Haiti, Prof Bulstrode realised that in many situations he had been a crusader, heading to disaster zones where his skills were needed. But Haiti also taught him about a hitherto-unrecognised element. This was the problem of bruised pride in those who were receiving the aid.

The Western world had rushed to Haiti's aid, with the mentality that they knew what was best for this tattered community, but it was a conversation with a fellow Haitian surgeon that awakened Prof Bulstrode to the local outlook.

"This very clever young Haitian surgeon said to me, 'You know every country has aspects of its tradition which make them proud, however bad other things are. In Haiti, we were taught as children that we were the first black slave state to throw off the wicked white oppressor, and rule ourselves'," he recalled.

"He went on to say: 'Now, after this earthquake, the white oppressor is back at every cross- road armed to the teeth and wearing dictator-dark glasses. We now seem to have lost the one thing that we could be proud of."

After a lifetime of aid work, and bouncing around the developing world, Prof Bulstrode realised that the infiltration of the aid and Western 'saviour' had left the Haitians, who had already been ravaged, now stripped of their pride as well.

He returned to the UK humbled by the extraordinary situations and ethical conflicts he had borne witness to. Since then he has worked in Gaza, Sri Lanka and East Africa.

He explained how similar Haiti and Gaza felt, despite one being the result of an uncontrollable natural disaster and the other a government and cultural conflict.

"Gaza is another aid-sink like Haiti, but it is almost as if there is a proxy war being fought there in the Middle East by the aid organisations," he said.

Travelling to Gaza with Doctors of the World, a subsidiary organisation of MdM, Prof Bulstrode was appointed both a medical and political position.

"My role was not only to co- ordinate a push to get as much surgery done as possible, but also to tmoignage ['bear witness'] to what had happened in Gaza. This was a new and much more political role for me."

It was in this role he saw the "dishonest war" that disguised itself in foreign aid.

Israel is supported by the USA. Conversely, Palestine receives copious amounts of aid from the European Community, funnelled through grants to large NGOs, he said.

"So the Israeli and Palestine conflict is almost a proxy war between the EU and the USA."

The complexity of a region that has fought war for more than 2000 years shrivelled into this simple - but in Dr Bulstrode's opinion - less than gentlemanly analogy was infuriating.

He faced several weeks in a war zone, not unlike he had while in Afghanistan, but this time his scrubs were back, his hands only armed with a scalpel, and the danger of looming air rockets haunted his reality.

In his Gaza flat he was confronted with the choice of leaving his grill-gate open to make for a quick escape in the event of an Israeli air raid or closing it to secure himself from being kidnapped by Hamas.

"Personally I did not rate choosing between being burnt alive, and being kept in a dungeon for a year or two . . . I decided to leave the gates open, but every time I heard a sound on the stairs up to the flat I felt sure that my time of freedom, light and air was over," he said.

His time in Gaza left Dr Bulstrode furious, he worked in "filthy" hospitals, witnessed highly trained professionals bathing in scrub sinks because they presumably had no running water in their homes, and the despair of a society lacking compassion.

"To think that people can behave this way to each other and that we, in the developed world, are, in effect, paying for this was deeply upsetting to me . . . I don't want to go back to Gaza again."

He returned home deflated by the entire situation, but still passionate about aid work and more so about training. His wife and he focused their intellect and skills into an international training programme.

"So the 'Training the Trainer' courses that we run all over the world started. I think that now over 20,000 doctors have been through one of our courses."

The courses' reputation spread by word of mouth all over the world. "We have trained Russian psychiatrists in Czechoslovakia, nurses in Kenya, surgical examiners in Sri Lanka, and doctors in Brisbane, Australia," he said.

Then one day out of the blue, he received a phone call from a clinical leader at Southland Hospital inviting him to work in Invercargill.

"I always wanted to come to New Zealand, to see where all those really nice junior doctors who prop up the UK healthcare system come from," he said.

At the very start of the call, the clinical leader asked Prof Bulstrode if he knew where the city was.

"I didn't really have any idea" he said "But I was told, 'Well, it's not the end of the world, but we can see it from here'. I just loved that description and my wife put her thumbs up and said, 'That is exactly what you need, something completely different'."

This year is Prof Bulstrode's second contract with Southland Hospital.

He said one of the exciting factors about working at this end of the globe is everything is different, but the same.

"You are constantly contrasting things, saying to yourself, "Now why don't we do that in Oxford?", or, 'Why don't they do that here'?"

After just three months back in Southland Hospital, Prof Bulstrode said there were many things the department had taught him.

"Morale in the department here is brilliant," he said.

"Ambos are really good. They give you the low-down on patients you have never seen before, because they know them from the community. That is something I am not used to."

He mentioned how nurses are so competent here in Invercargill that even when under intense pressure they can remain polite and positive. He also complimented the department's St John's volunteers, who help the staff and patients so much. "They are fantastic, quietly talking to the patients and doing things we don't have time to do. It makes a big difference for frightened patients." The motivation is always training and, for a man who has dedicated his life to helping others, it is an easy concept to conceive.

"An ED department should not be called an emergency department, it should be called a training department;" he said "It is such a great place for doctors to learn to take responsibility," he said.

"It's the most fantastic place for showing young doctors the whole breadth of medicine and getting them to make decisions."

He noted Southland Hospital has an "incredible" emergency department, but he would love to help show the juniors throughout the hospital how to make better use of their time when learning from the seniors.

Prof Bulstrode is hoping to return next summer to New Zealand's deep south. "One of my dreams is to run a training course here, like we do in Oxford, because this hospital is ideal for it."

The Southland Times