War zone surgeon counts the nation’s battle scars
Trauma surgeon Charles Pilgrim has operated on soldiers, civilians and Taliban fighters in his time in war-torn Afghanistan and Iraq.
A blast rips through a group of elders as a suicide bomber detonates his explosive vest in Tarin Kowt in southern Afghanistan, killing its target and maiming bystanders.
Four Afghans are rushed to the coalition-run medical centre in a blur of blood and terror with shrapnel lodged in their arms, chest and face.
Australian surgeon Charles Pilgrim and his team get to work to treat the horrific blast injuries, the scale and severity of which is confronting even to the experienced trauma surgeon.
It’s 2010, and the allied forces are half-way through a two decades-long struggle against a fierce counterinsurgency to restore peace to Afghanistan.
“To see four of them at the same time, all with multiple shrapnel injuries to their arms, face and chest, torso; also eye injuries and ear injuries and internal injuries, it was very confronting,” Associate Professor Pilgrim said. “But it’s what we’re there for.”
Royal Australasian College of Surgeons fellow Associate Professor Pilgrim, a trauma surgeon at the Alfred and Frankston Hospitals in Melbourne, completed military deployments to Afghanistan in 2010 and Iraq in 2016, treating the battlefield wounded.
His time on the ground in these war zones put him face-to-face, in a makeshift operating theatre, with allied soldiers, Afghan civilians and Taliban fighters alike.
“The Geneva Convention says that you operate on all soldiers of war, you don’t discriminate: you don’t say, ‘he’s a bad guy I’m not operating on him’,” he said.
“That’s part of the deal. We operate on enemy combatants who were shot and, ironically, sometimes shot by our guys. And so there were times when we had injured Taliban soldiers that were treated by us.”
Associate Professor Pilgrim has completed new research on the injuries sustained by the 30,000 Australian Defence Force personnel who served in Afghanistan, of whom 259 were wounded, including 101 who required surgical management and 53 seriously or very seriously injured. Forty-one soldiers were also killed.
Gun shot wounds were the most common injury sustained, making up 47 per cent, followed by blast injuries at 39.6 per cent, soft tissue injuries 21.8 per cent and shrapnel wounds 18.4 per cent, fractures 17 per cent and traumatic brain injury 11.9 per cent.
The majority of procedures carried out on Australian soldiers were performed by US surgeons due to the superpower’s greater presence in Afghanistan.
Associate Professor Pilgrim has called on Defence to follow the US model and establish a Department of Surgery within the ADF to better support war-zone surgeons to meet the significant challenges.
He said the statistics, published in the ANZ Journal of Surgery, illustrated the remarkable lack of serious injuries given the bloody nature of the conflict.
“It says a lot that we were there for 20 years and there were so few people injured; it was a fairly intense war but it speaks to how professional and how well trained the Australian military is,” he said.
