War & Medicine : War Artist CommissionAwarding Body: The Wellcome Foundation
Date Awarded: 1st November 2007 - Date Completed: 29th November 2007
Residency with Joint Forces Medical Group in Helmand Province, Afghanistan.
"The role of the AMS is to contribute to the conservation of fighting strength and morale of the Army. The AMS is responsible for advising commanders on the maintenance of health and prevention of disease in the Army in peace and, in addition, the collection, medical classification, evacuation and treatment of the sick and wounded in war. "
I feel fortunate to have been born into a generation that was not required to join the military. My two grandfathers were conscripted to fight in wars. My paternal grandfather fought in the First World War and I experienced his war through the romantic childhood abstraction of the objects, postcards and papers that he left behind. My maternal grandfather was nearly a generation younger and served for six years in the Second World War. He was unable or unwilling to describe his experiences to his children, but forty years after the conflict, he began to recount his stories. A very dignified and restrained man, he began to describe in measured tones the legacy of his time at war. He first talked of the planes that he had flown, his friends and the places he was stationed. He described his experience of malaria, of leave in Blackpool, meeting his future wife and becoming engaged. He showed me his medals and downplayed their significance. He described putting his parachute on and preparing to his abandon his gun turret on the instruction of his pilot, only to find at the door of the aircraft that a seagull had hit the plane, rather than flak.
In his seventies, he retained his love of flying, but chose to join gliding clubs in Lancashire. I found it confusing that he never appeared interested by powered flight, despite loving to show me around aircraft deposited in museums around the country. Eventually he explained that during the war he had committed to never voluntarily fly again in a plane with high-octane fuel. This balanced, caring, compassionate man had suffered from the traumatic memory of repeatedly witnessing as a teenage airman the horrific burn injuries of his colleagues. He explained that at the start of the war an unreal fatalism had kept him going. He described a day-by-day acceptance of fate, which had enabled him to sustain his routine of waiting, preparing and operations. It appeared that life had become more difficult after he married in 1942. His fear of leaving a widow and repeating the tragedy of his father’s premature death meant that the construct of fatalism was no longer enough to block the reality of the danger he faced. In a restrained way, he explained that for the last three years of the conflict, from the age of 22 and re-christened ‘old’ Bill in recognition of his tenure in a very young man’s war, he had lived under constant stress.
There are many things, which fascinate me about this self-effacing man. I will never know much of what he endured or overcame. My experience of life will always be moderate compared to his. Throughout my life and particularly as I arrived at, and then past, the ages at which he was compelled to enter military service, I questioned where I would have found my breaking point, if tested in this way. And as post-traumatic stress became the subject of Hollywood reviews of the American Vietnam experience, I began to wonder how generations who had experienced war had managed to adjust to life after conflict.
The work of the Army Medical Services is integral to both of these questions. The ‘Role 1’ and ‘Role 2’ facilities at Camp Bastion occupy an interesting territory. They serve a dual purpose. In maintaining the combat-readiness of heavily trained military personnel through medical and welfare support, the AMS functions to enable individuals to remain in the field of battle. However the 102nd Field Hospital is also the place that serves to assess, treat and, if necessary, begin the process of evacuation of the injured from the field of conflict, from their units and possibly from Afghanistan. Many ‘Notifiable’ casualties will begin a sudden and enforced transition, either temporary or permanent, from active duty under the care of the Foint Forces Medical Services. The abrupt and shocking transition from military readiness to possible incapacity and eventual civilian life, is managed by individuals from the same organisation that has maintained their ability to mentally and physically cope with the structured and demanding routines of war service.
I couldn't hope to understand the complexity of the patients’ experiences or the demands of the medical staff, but I was interested in understanding how service people engaged in medical support, and those receiving it, rationalise, prepare and continue to work within this gateway between theatres of war and evacuation.
Military medicine is not new. The origins of the Royal Army Medical Corps are traced back to the formation of the regular army in 1660. The recognition of the role of medical regiments, as a vital component of military effectiveness, gradually increased through the conflicts of the following 550 years. The integration of support for physical and mental health is also not a new idea. The ex-services mental health charity, ‘Combat Stress’, states that the ancient Greeks recorded symptoms of what is today called post-traumatic stress amongst soldiers after battle. Variously described as 'soldier’s heart', shell shock, war neurosis, battle fatigue and PTSD, combat related mental illness has been documented throughout military history and is now recognised by the MoD as causing suffering in a greater number of veterans than physical injury.
War is an arena where extremes are tested and medical sophistication is demanded. I was very grateful for the opportunity to learn more about the understanding and approaches that are being applied in Afghanistan. On my return, I sought to develop work that responded to the extraordinary experience of witnessing individuals striving to support others to maintain an elite level of health, while preparing for the possibility of treating them again for the most profound threats to their mental and physical survival.
Text by David Cotterrell, derived from original commission proposal.