Dunedin maxillofacial surgeon Darryl Tong has swapped the safety of the South Island for one of the busiest trauma hospitals in Afghanistan and Iraq.
But the swap is only temporary; Mr Tong is working in his Army Territorial Force capacity as Major Tong and is treating soldiers and civilians injured by bomb blasts, ballistic trauma and other combat related events.
He is working 18-hour days in the multinational medical unit (MMU) in Kandahar, which is run by Canadians under the auspices of the International Security Assistance Force.
When he is not operating on maxillofacial injuries he helps out in the trauma bays with resuscitations and stabilisations, or helps other surgeons with their operations. These have recently included penetrating brain injuries, multiple orthopaedic injuries and burns.
But despite that Maj Tong is still smiling.
"It is frequently a high-stress environment, but there is an excellent esprit de corps and some very talented people around. Having good dining and gymnasium facilities at the base also helps. I can't complain at all, compared to those soldiers out in the field. They are the ones who deserve all the credit and who we, in the medical services, are here for".
The New Zealand Defence Force has been sending a medical team to Kandahar for the past 18 months, each of them doing a six-month stint at the MMU. The unit is several hundred kilometres away from the 120-strong New Zealand provincial reconstruction team based in Bamyan.
The hospital building is spartan, he says, but is relatively well-equipped. "It's perhaps better equipped than some of our smaller hospitals at home. We have a CT scanner and basic laboratory services for blood products and lab tests. It's hot and dusty here, with lots of flies and constant noise from aircraft and heavy vehicles coming and going."
The unit has two surgical teams at present, one Canadian and one Danish, and each team has an anaesthetist, general surgeon, orthopaedic surgeon and operating theatre staff.
The unit's nursing and technical staff are from New Zealand, the Netherlands, Canada and the United States. An Australian primary care doctor acts as a liaison officer for the air evacuation of patients and is the senior trauma team leader.
Maj Tong, who at home is part of the New Zealand Army's 2nd Health Support Battalion has, as well as doing his civilian medical work, had ballistic trauma experience in the US. He arrived in Kandahar in late March, and is expected to return to New Zealand this month.
Most soldiers and civilians injured by bomb blasts in Afghanistan are taken to the MMU, which is the main referral base for southern Afghanistan.
The unit has the only neurosurgeon and maxillofacial surgeon in southern Afghanistan, so receives referrals or transfers of patients requiring those services.
"Being the only maxillofacial surgeon for Southern Afghanistan was quite daunting at first, but you just get on with the work and do the best for the patient. Being the first Kiwi to assume this role is very special."
Despite his experience, Maj Tong says the numbers and severity of the trauma the unit treats is sometimes "incomprehensible".
"In civvy street, you simply do not see patients with three limbs missing, face and head injuries all in one individual. Everyone gets the best treatment possible and for local nationals, that treatment is a universe away from what they could ever hope to receive in a country whose infrastructure has been decimated by the Taleban. Sometimes, resources at the MMU cannot sustain the patient and hard decisions have to be made about their survival."
The highlights for him so far have been being able to save the eyes of three coalition soldiers, and treating an 18-month-old boy who fell into an open fire, receiving second and third-degree burns to his face and scalp.
"Battle related injuries or improvised explosive device blast injuries are challenging in surgical repair. There are often bits missing and, as a surgeon, you must be meticulous in cleaning out the wound, be it face, arm or leg. We are constantly reminded that our unit is in a war zone, mainly by the types of injuries we see, as well as by the rocket attacks on the base itself."
The other New Zealanders working alongside Maj Tong include fellow Dunedin-based intensive care unit nurse Staff Sergeant Fiona Thomas, Linton-based ICU nurse Major Shaun Fitzell and Lieutenant Sheree Mudford, a radiographer, also from Linton.
Laboratory diagnostic technician Captain Kevin Drysdale, from Nelson, recently finished his six-month deployment to the unit and has returned to New Zealand.
Maj Tong says he is extremely proud of the performance of the Kiwi contingent of nursing and technical staff in Kandahar.
"They are well-liked, and have that typical Kiwi way about them. They are respected for their skill base and are often showing others in the team new skills or knowledge. They have a can-do attitude, and are not afraid of hard work and pitching in to help others. It makes me proud to be a New Zealander and part of the NZDF."
He says, from a professional point of view, "we don't know how lucky we are back home".
"Operating here puts the world in perspective and many of the problems we face at home seem all of a sudden very small and insignificant. It makes you appreciate what is truly important in life."
- Judith Martin is the editor of Army News
