Indian Journal of Medical Ethics

BOOK REVIEW

A chronicle of war and medicine

SANJAY A PAI

Jonathan Kaplan. The dressing station: A surgeon's chronicle of war and medicine.

New York: Grove Press, 2002. US$ 25. ISBN 0-8021-1707-4.

Why do some people take up the medical profession-or indeed, embrace it? Is it for monetary gain? Or for achieving fame or earning respect from the community? Or-what should be the numero uno reason-to heal people? And, who is a doctor? The specialist sitting in his air-conditioned office, backed by the latest technology and with cutting-edge knowledge? Or the general practitioner who, as jack of all trades but master of none, has to achieve proficiency in a wide variety of subjects? Or a village or barefoot doctor who has to surmount odds of all sorts?

Jonathan Kaplan is certainly a complete doctor. To call Kaplan a surgeon and a journalist would be factually correct, but a master understatement. Kaplan, a South African by birth and an international traveller and physician wrote these memoirs, to rave reviews. The Economist, from London, reviewed it together with Atul Gawande's Complications and placed it several notches higher. The two books are vastly different. Gawande's practice is mainly in large city hospitals and deals with doubt, uncertainty and error in medicine. Kaplan's is about medicine in the trenches.

After qualifying in South Africa, Kaplan trained in England and then in America before embarking on a most unusual career. His travels and travails include Namibia, Zululand, Kurdistan, Mozambique, Burma and Eritrea-before settling down in London. Many of them revolve around being a doctor in the midst of a war. In between wars, Kaplan makes forays into more 'conventional' (by his standards!) careers-being ship's surgeon in the South China sea, biomedical researcher in the USA and investigative journalist in Brazil. His experiences in England about the style of functioning of hospitals will strike a chord in Indians.

Ethical issues surface in many of his adventures. During the course of a study on the treatment of piles, he uncovers the fact that in America, even minor piles, treated by injection of sclerosants in England, are treated by surgery. This is because insurance pays more for operations than for minor procedures. We also learn that there are 2.5 million unnecessary operations performed in the USA annually. Food for thought for those who believe that America offers the best medical care in the world and those who welcome private health insurance in India! He also refers to gift authorship in research, a phenomenon not uncommon in India.

Poverty, poor hygiene, racism and apartheid-ridden South Africa form the backdrop of many of his stories. He states 'A little doctoring can go a long way among people so battered by deprivation and violence.....', and 'I was just a doctor, with uncertain clinical detachment, the vice of restlessness and some tarnished shreds of idealism. It was only in the world's murkiest places that they had any chance to shine.'

Perhaps the saddest of his stories are his experiences as an investigative journalist examining mercury poisoning in South Africa and later, in Brazil. In South Africa, Thor, a British transnational chemical company, openly flouts the law and dumps mercury in the river nearby, resulting in mercury poisoning of the workers. That big industry is ultimately the winner is a comment on politicians and the judiciary. Indians will no doubt recall the Kerala endosulphan poisoning controversy that is still ongoing. There, too, a courageous doctor has fought the odds over the years.

Kaplan's humanity comes through by his very choice of career-going off the beaten track and seeking to serve humanity even at the risk of his own life. Kaplan's style is gripping and he, truly, was doing what all doctors want to do-to heal, cure, palliate and to make a difference. That this difference is being made to the impoverished and damned in developing countries makes it all the more worthy. We found ourselves a trifle envious of the good doctor.

SANJAY A PAI

Consultant Pathologist, Manipal Hospital, Bangalore, India. e-mail:s_pai@vsnl.com