Was World War I good for
where the experts come to talk

Was World War I good for medicine?

From 1914's grim reality to today's virtual reality, this mini documentary looks at how health care played a key role in the 1914-18 war. It hears how most soldiers actually survived the trenches, but were at great threat from infection and disease. Today's combat treatment can often be traced back to improvements made in the Great War. But does this mean that war is good for medicine?

Full video transcript

Was World War I good for medicine?

From 1914’s grim reality

to today’s virtual reality

It’s hard to do justice with words

what happened here in Ypres

between 1914 and 1918.

So numbers may help explain better.

There were four major battles here,

which were fought ferociously.

The third one alone had 15,000 dead

at the end of the first day.

By the end of the campaign

there were 270,000 dead

on the allied side alone.

In terms of the artillery, the British

in September in one day in 1917

fired one million shells

from over 2,000 guns.

And at the end of all this, Ypres

had how many houses standing?

Just four.

This was the first total war

that mankind had ever experienced.

So, it was a war of a different nature,

which nobody

had experienced before.

New ballistic weapons,

chlorine gas, mustard gas,

higher velocity rifle cartridges,

new improved machine guns...

All of these weapons

and more awaited troops,

heading off to fight in World War I.

And the effects were devastating.

At least nine million dead

and more than double that wounded.

The accepted wisdom is

that the high number of casualties

in the First World War

was caused by the trench warfare

between the two opposing sides,

which went on for years.

However, I’m in a cemetery

where ten thousand of the soldiers

who fought

in the First World War are buried.

How many of these

were killed during combat?

Just five per cent.

Wounds were susceptible to infection,

as they often contained shrapnel

and were sustained while wearing

dirty uniforms in muddy trenches.

Antibiotics had not yet been invented

posing a massive challenge

to war doctors.

Wynand Korterink

is the Medical Advisor

for NATO Headquarters’

International Military Staff.

So, Wynand, tell me: how important

was infection and disease

in causing deaths

in the First World War.

When they started

the First World War,

they didn’t think

about healthcare or medicine.

Instruction of hygiene was poor.

And taking care of patients

was old fashioned in a way.

Anaesthetics

were also a huge problem.

They would use chloroform masks

and other kinds of anaesthetics,

but sometimes, very often, soldiers

would wake up during operations,

others were killed accidentally.

Blood transfusions

were a really messy thing.

Blood had to be pumped out of

one person and into another person.

The lack of hygiene,

especially in the trenches,

with all the lice

and the trench feet etcetera...

That was a purely hygiene issue.

Bad food also.

And the other part

was infected wounds.

And then there is another part

that is infectious diseases.

Actually, the influenza

of 1918 killed more people

than the First World War in itself.

Knowledge of key

medical practices was poor

compared to today’s medicine,

but the outbreak of the war

provided a massive opportunity

to test

new techniques and treatments.

You could say that the battlefields

were one huge laboratory

in the medical field,

where the best in their field

would come to try out new things.

Marie Curie, with her daughter Irène,

went along the frontline

and installed X-ray machines

all along the frontline.

The technique was known,

but was never used on such a scale.

War was looked upon

by many doctors, not as an enemy

because it killed and had maimed,

and had wounded and had made sick.

War was a colleague,

war was a teacher.

War was the doctor of doctors.

It was not just the medical practices

that were often not up to scratch,

some of the personnel

helping the soldiers,

were not qualified to do so.

There was no time for training.

When you got your degree,

you had to go.

Even if you didn’t have a degree at all,

sometimes you had to go,

because you were

needed somewhere else.

So you got unqualified doctors

treating physically and

psychologically unqualified soldiers.

Most people working in healthcare

were actually volunteers.

Red Cross organisations,

but also local volunteers,

nurses from monasteries...

all came to support the soldiers.

One of the best-known injuries

was shell shock,

but while this phenomenon

was suffered by forces from all sides,

they dealt with it

in very different ways.

Shell shock as such

was a huge military problem.

How can you recognise shell shock?

How can you be sure

that someone is not faking it?

You had

some psychiatrists, some doctors,

who were more progressive,

but even as far as 1925,

the military medic,

who wrote the official history

of medical services

of the Canadian army,

wrote that shell shock

was a kind of hysteria

and that there was

no remedy against femininity

as he would describe it.

The British and the French looked

upon the psychologically wounded

and sick more in gender terms.

The psychologically wounded were

feminised, they were weaklings.

And how better can a psychologically

wounded soldier prove

that he is better again

than to do his bit at the front?

So, Germans looked

upon the psychologically wounded

in economical terms. They were

a bit like factory workers on strike.

This meant that in general

German doctors were satisfied

when they got their psychologically

patients back to the weapons factory.

They didn’t fight anymore,

but they did their bit for the war.

There was terrible suffering

on the front, but also back home.

Not just because most

of the vital food and medicines

were sent not to them,

but to the front.

During the war civilian

healthcare suffered enormously.

For instance in France, before

the war there was one doctor on,

I think, 2,500 civilians.

During the war it was one on 14,000.

And if there was a doctor,

he had no medicines

because they also

were ordered to the front.

If we put ourselves back a hundred

years with what they knew then,

did they do the best job they could?

From a military point of view

they did a marvellous job.

Without medicine,

without medical care

the battles would have

been fought with far less men.

Because of that they probably

wouldn’t have lasted that long

and the war probably would have

been over before November 1918.

With a different outcome because

the US wouldn’t have joined in.

Medicine during the war did not

only save lives, it cost lives as well.

The enormous number of injuries and

the specific nature of the wounds,

meant that both sides

had to reconsider

how to treat their wounded soldiers.

This led to changes,

especially in how to get soldiers

from the battlefield

to the hospital bed.

On the military side,

the whole system of evacuation

and how to organise an evacuation,

got specialised during World War I.

At the beginning

of the war they realised

they needed to change healthcare,

and all the logistics,

but especially healthcare.

So for example,

they needed mobile hospitals

and doctors and stretcher-bearers

at the front to bring the patients back

because they lay wounded

on the battlefield for days.

So they needed an evacuation chain.

Wounds to the stomach had

to be operated as soon as possible

and as near

to the frontline as possible.

So advanced

surgical stations would open

at only one and a half miles,

two miles from the frontline.

The speed of treating soldiers

became a key issue in World War I.

Four out of five battlefield deaths

occur in the first hour

after being wounded. This

became known as the golden hour

and has today even been refined

to the first platinum ten minutes.

Real evacuation change started here

and now we have the golden hour

and the ten-one-two, etcetera.

All kind of improvements

of the inventions that were done here.

While some claim that medical

advances helped civilian healthcare,

there is also evidence that civilian

advances helped during wartime.

Some say:

Look at the Second World War,

without it we wouldn’t have penicillin.

No, penicillin came from 1928.

But it was strange stuff,

we don’t use that.

And then in 1942 there was

a huge fire in Boston, in a nightclub.

Had nothing to do with the war.

All medicines were gone

and then some doctor said:

I have some of that weird stuff here.

Maybe it helps.

And it did help,

it did help enormously.

So what... And then he said:

Well, let’s get this to our soldiers.

In fact, I think, penicillin is

one of the most neglected...

...causes for allied victory.

The Germans didn’t have penicillin.

The medical advances of World War I

were built upon in later conflicts.

Korea saw the development

of the mobile army surgical hospital

or MASH.

By the time of the Vietnam War, air

ambulances became more common

and quicker to treat injured soldiers.

In the Korean War, 17,000 casualties

were evacuated by helicopter,

but by 1969 in the Vietnam War

200,000 casualties a year

were transported by air.

This plus the number

and availability of hospitals

meant the treatment

fell to less than one hour on average,

down from the average

of four to six hours in Korea.

And after the experience in Vietnam,

many civilian hospitals in the US

introduced air ambulances.

And they continue to play

a key role in Afghanistan today.

The medical part

of ISAF was focussing,

not only on the field hospitals

that we have deployed,

but also on bringing

the patients to those hospitals.

Over a hundred helicopters were used

to bring these patients

to central hospitals.

The problem today is not

the lack of advances in technology.

Unimaginable advances have been

made since a hundred years ago.

The problem now is

that there are too few doctors

and medical personnel

to practise that medicine.

In the EU only

we are expecting to have

a lack of about one

million health workers by 2020.

So the world is changing.

There’s a growing shortage

of doctors worldwide.

A growing shortage of nurses.

In a hundred years

we will reach ten billion people,

over ten billion people in the world.

There aren’t going

to be ten million more doctors

graduating in the next fifty years.

But the only way to alleviate

that is to use technology.

Less medical personnel

means more flexibility is needed.

Telemedicine could provide this.

We don’t have doctors

to put on every ambulance,

so I’m going to give you a virtual

doctor. We cannot be everywhere.

With telemedicine we can be

mostly everywhere we want.

It can save lives. If before...

Such patients,

their transfer was done within hours.

Now with this system,

we can do it within the hour

because we get the information

and then if we have a helicopter

the decision can be taken very fast.

Doctor Arafat has seen

how this system has saved lives.

For example,

when he saw irregular heart signs

on patient information

being sent back from an ambulance,

he could see

that urgent action was needed.

The doctor jumped in the helicopter

and in six minutes treated the patient.

If the helicopter wouldn’t

have been sent with the doctor

and would have worked

the normal way,

the patient would have

had to go for about forty minutes

driving in the ambulance.

The chance that this rhythm would

have deteriorated into a cardiac arrest

and we could have lost the patient,

was very high.

So, not being present should

no longer be an obstacle

for doctors wanting to treat patients.

Operations have already taken place

with the surgeon on one continent

and the patient on another.

On September 7th 2001,

Jacques Marescaux from Strasbourg

at the European Telesurgery Institute,

was in New York

and operated

on a patient in Strasbourg.

He took her gallbladder out,

a cholecystectomy,

using the Zeus robot.

So, the patient is in France with

a team of physicians and surgeons,

the robot is hanging above her

and he is in New York City

driving the robot,

taking her gallbladder out.

On the morning of September 11th

he was on his way

down to the World Trade Centre

to give a press release.

He didn’t get hurt, but obviously

something else happened.

So, it’s the most

missed story of 2001.

But telemedicine brings

its own new difficulties.

You have time zones.

You have geography.

You have bandwidth, right?

You have nations

with different belief systems,

cultural values and languages.

The American physician

will be treating or giving advice

to someone

who is working in another country,

which may not be recognising

the qualification of that doctor.

While treatment has

developed over the years,

many injuries are remarkably similar,

such as amputations

and traumatic disorder.

But dealing with post-traumatic

stress disorder or PTSD

has seen active engagement

with affected soldiers going back

to where they were injured

to face the place and situation

where the problem started. But what

about those who can’t come back?

Well, now the place

can come to them.

The Virtual Reality Medical Centre is

an example of how this can be done.

Executive Director,

Brenda Wiederhold, showed me

how it offers virtual reality scenarios

to help PTSD sufferers

confront the source of their stress.

This treatment helps

against IED attacks,

which are linked causing PTSD with

the most common source of injury

for soldiers serving in both

the Iraq and Afghanistan wars.

And PTSD’s aftereffects,

such as depression,

have led the US army

to initiate schemes

such as the National

Suicide Prevention Week.

We want to start therapy at a lower

level of stress and then build up.

We’ve talked to them

before the therapy begins,

we’ve found out

what their specific trauma is

and so we start at a lower level,

a world that is not as traumatic,

for instance the battalion camp

or the market place.

And then we go up to the battlefield

as they can deal with that stress.

Now what I should say also:

The sounds are quite important here.

I just heard a sniper

shooting from somewhere.

Correct. So you look up at a rooftop

and you might see

one across the street.

Your heart rate is up to 92

and your respiration is at...

Very high.

We’ve had people come out and say:

I can deal with anger better,

I can talk to my children

without getting upset,

my wife and I have

a better relationship,

I’m able to go on another tour of duty.

I’m able to hold a civilian job.

Another guy:

I’m able to get my college degree.

But part of a mental recovery

can involve physical recovery.

The Dutch Ministry of Defence's

rehabilitation centre addresses both.

The centre aims

to help people to be confident

and carry out tasks

they could do before.

We treat not only amputees,

but also people with brain injury,

people with knee or ankle complaints.

You can train stability,

but also balance.

The system

has been used since 2008

and treats

about fifty patients a week.

It’s so successful, it’s now being used

to treat military and civilian patients.

Colonel Mert,

this particular part of the facility,

you have the gym here,

you’ve got some tennis courts,

you’ve got

a swimming pool behind us,

how do you use these to help

treat the illnesses and injuries?

Well, the military rehabilitation centre

is the rehabilitation centre

for the military.

It’s an obligation

that we have to our servicemen,

to just keep on looking

for new ways to treat these patients.

We want to keep them

as active servicemen.

In the end, it’s about the therapist,

which gives help

and treats the patient.

The facility is just facilitating.

Less medical personnel means

more reliance on new technology.

But the developments

in the medical field

in the near future are encouraging.

We see developments in technology

that will allow us in the near future

to have

unmanned patient evacuation.

We can also see very, very

smart ways of artificial limb steering

with the brain-machine interaction

that will really improve prostheses.

But perhaps also very important

is that we realise better

and we understand better

what shell shock or today PTSD is

and how perhaps we can manage

people to get a normal life back.

Smart watches are getting popular.

But a smart watch is

a very advanced computer

compared to the stuff

that we had six, seven years ago.

There is a GPS in it and there is

a heart rate monitor in it and...

There’s accelerometers etcetera.

So, that gives a lot of possibilities

to monitor the function of a patient.

The near future with nanotechnology

and with 3D-printing,

stem cell technology,

will change healthcare tremendously.

We’re on the brink of a new era

that started already in World War I

realising what we needed.

Today we realise what we can do.

Technology is now so far

that we can make it into production

and implement it in modern medicine.

And finally, one of the key

messages from these Flanders Fields,

from what happened

a hundred years ago,

is that while medicine

can advance due to war,

it doesn’t necessarily

need war to advance.

The invention of penicillin in 1928,

the unravelling of the DNA

structure in, what was it, 1953?

All peacetime progress.

Why don’t we ever say:

peace is good for medicine?

War is our scourge;

yet war has made us wise.

And, fighting for our freedom,

we are free.

Horror of wounds

and anger at the foe.

And loss of things desired:

all these must pass.

We are the happy legion, for we know

Time's but a golden wind

that shakes the grass.

Siegfried Sassoon - Absolution (1915)

Was World War I good for medicine?

From 1914’s grim reality

to today’s virtual reality

It’s hard to do justice with words

what happened here in Ypres

between 1914 and 1918.

So numbers may help explain better.

There were four major battles here,

which were fought ferociously.

The third one alone had 15,000 dead

at the end of the first day.

By the end of the campaign

there were 270,000 dead

on the allied side alone.

In terms of the artillery, the British

in September in one day in 1917

fired one million shells

from over 2,000 guns.

And at the end of all this, Ypres

had how many houses standing?

Just four.

This was the first total war

that mankind had ever experienced.

So, it was a war of a different nature,

which nobody

had experienced before.

New ballistic weapons,

chlorine gas, mustard gas,

higher velocity rifle cartridges,

new improved machine guns...

All of these weapons

and more awaited troops,

heading off to fight in World War I.

And the effects were devastating.

At least nine million dead

and more than double that wounded.

The accepted wisdom is

that the high number of casualties

in the First World War

was caused by the trench warfare

between the two opposing sides,

which went on for years.

However, I’m in a cemetery

where ten thousand of the soldiers

who fought

in the First World War are buried.

How many of these

were killed during combat?

Just five per cent.

Wounds were susceptible to infection,

as they often contained shrapnel

and were sustained while wearing

dirty uniforms in muddy trenches.

Antibiotics had not yet been invented

posing a massive challenge

to war doctors.

Wynand Korterink

is the Medical Advisor

for NATO Headquarters’

International Military Staff.

So, Wynand, tell me: how important

was infection and disease

in causing deaths

in the First World War.

When they started

the First World War,

they didn’t think

about healthcare or medicine.

Instruction of hygiene was poor.

And taking care of patients

was old fashioned in a way.

Anaesthetics

were also a huge problem.

They would use chloroform masks

and other kinds of anaesthetics,

but sometimes, very often, soldiers

would wake up during operations,

others were killed accidentally.

Blood transfusions

were a really messy thing.

Blood had to be pumped out of

one person and into another person.

The lack of hygiene,

especially in the trenches,

with all the lice

and the trench feet etcetera...

That was a purely hygiene issue.

Bad food also.

And the other part

was infected wounds.

And then there is another part

that is infectious diseases.

Actually, the influenza

of 1918 killed more people

than the First World War in itself.

Knowledge of key

medical practices was poor

compared to today’s medicine,

but the outbreak of the war

provided a massive opportunity

to test

new techniques and treatments.

You could say that the battlefields

were one huge laboratory

in the medical field,

where the best in their field

would come to try out new things.

Marie Curie, with her daughter Irène,

went along the frontline

and installed X-ray machines

all along the frontline.

The technique was known,

but was never used on such a scale.

War was looked upon

by many doctors, not as an enemy

because it killed and had maimed,

and had wounded and had made sick.

War was a colleague,

war was a teacher.

War was the doctor of doctors.

It was not just the medical practices

that were often not up to scratch,

some of the personnel

helping the soldiers,

were not qualified to do so.

There was no time for training.

When you got your degree,

you had to go.

Even if you didn’t have a degree at all,

sometimes you had to go,

because you were

needed somewhere else.

So you got unqualified doctors

treating physically and

psychologically unqualified soldiers.

Most people working in healthcare

were actually volunteers.

Red Cross organisations,

but also local volunteers,

nurses from monasteries...

all came to support the soldiers.

One of the best-known injuries

was shell shock,

but while this phenomenon

was suffered by forces from all sides,

they dealt with it

in very different ways.

Shell shock as such

was a huge military problem.

How can you recognise shell shock?

How can you be sure

that someone is not faking it?

You had

some psychiatrists, some doctors,

who were more progressive,

but even as far as 1925,

the military medic,

who wrote the official history

of medical services

of the Canadian army,

wrote that shell shock

was a kind of hysteria

and that there was

no remedy against femininity

as he would describe it.

The British and the French looked

upon the psychologically wounded

and sick more in gender terms.

The psychologically wounded were

feminised, they were weaklings.

And how better can a psychologically

wounded soldier prove

that he is better again

than to do his bit at the front?

So, Germans looked

upon the psychologically wounded

in economical terms. They were

a bit like factory workers on strike.

This meant that in general

German doctors were satisfied

when they got their psychologically

patients back to the weapons factory.

They didn’t fight anymore,

but they did their bit for the war.

There was terrible suffering

on the front, but also back home.

Not just because most

of the vital food and medicines

were sent not to them,

but to the front.

During the war civilian

healthcare suffered enormously.

For instance in France, before

the war there was one doctor on,

I think, 2,500 civilians.

During the war it was one on 14,000.

And if there was a doctor,

he had no medicines

because they also

were ordered to the front.

If we put ourselves back a hundred

years with what they knew then,

did they do the best job they could?

From a military point of view

they did a marvellous job.

Without medicine,

without medical care

the battles would have

been fought with far less men.

Because of that they probably

wouldn’t have lasted that long

and the war probably would have

been over before November 1918.

With a different outcome because

the US wouldn’t have joined in.

Medicine during the war did not

only save lives, it cost lives as well.

The enormous number of injuries and

the specific nature of the wounds,

meant that both sides

had to reconsider

how to treat their wounded soldiers.

This led to changes,

especially in how to get soldiers

from the battlefield

to the hospital bed.

On the military side,

the whole system of evacuation

and how to organise an evacuation,

got specialised during World War I.

At the beginning

of the war they realised

they needed to change healthcare,

and all the logistics,

but especially healthcare.

So for example,

they needed mobile hospitals

and doctors and stretcher-bearers

at the front to bring the patients back

because they lay wounded

on the battlefield for days.

So they needed an evacuation chain.

Wounds to the stomach had

to be operated as soon as possible

and as near

to the frontline as possible.

So advanced

surgical stations would open

at only one and a half miles,

two miles from the frontline.

The speed of treating soldiers

became a key issue in World War I.

Four out of five battlefield deaths

occur in the first hour

after being wounded. This

became known as the golden hour

and has today even been refined

to the first platinum ten minutes.

Real evacuation change started here

and now we have the golden hour

and the ten-one-two, etcetera.

All kind of improvements

of the inventions that were done here.

While some claim that medical

advances helped civilian healthcare,

there is also evidence that civilian

advances helped during wartime.

Some say:

Look at the Second World War,

without it we wouldn’t have penicillin.

No, penicillin came from 1928.

But it was strange stuff,

we don’t use that.

And then in 1942 there was

a huge fire in Boston, in a nightclub.

Had nothing to do with the war.

All medicines were gone

and then some doctor said:

I have some of that weird stuff here.

Maybe it helps.

And it did help,

it did help enormously.

So what... And then he said:

Well, let’s get this to our soldiers.

In fact, I think, penicillin is

one of the most neglected...

...causes for allied victory.

The Germans didn’t have penicillin.

The medical advances of World War I

were built upon in later conflicts.

Korea saw the development

of the mobile army surgical hospital

or MASH.

By the time of the Vietnam War, air

ambulances became more common

and quicker to treat injured soldiers.

In the Korean War, 17,000 casualties

were evacuated by helicopter,

but by 1969 in the Vietnam War

200,000 casualties a year

were transported by air.

This plus the number

and availability of hospitals

meant the treatment

fell to less than one hour on average,

down from the average

of four to six hours in Korea.

And after the experience in Vietnam,

many civilian hospitals in the US

introduced air ambulances.

And they continue to play

a key role in Afghanistan today.

The medical part

of ISAF was focussing,

not only on the field hospitals

that we have deployed,

but also on bringing

the patients to those hospitals.

Over a hundred helicopters were used

to bring these patients

to central hospitals.

The problem today is not

the lack of advances in technology.

Unimaginable advances have been

made since a hundred years ago.

The problem now is

that there are too few doctors

and medical personnel

to practise that medicine.

In the EU only

we are expecting to have

a lack of about one

million health workers by 2020.

So the world is changing.

There’s a growing shortage

of doctors worldwide.

A growing shortage of nurses.

In a hundred years

we will reach ten billion people,

over ten billion people in the world.

There aren’t going

to be ten million more doctors

graduating in the next fifty years.

But the only way to alleviate

that is to use technology.

Less medical personnel

means more flexibility is needed.

Telemedicine could provide this.

We don’t have doctors

to put on every ambulance,

so I’m going to give you a virtual

doctor. We cannot be everywhere.

With telemedicine we can be

mostly everywhere we want.

It can save lives. If before...

Such patients,

their transfer was done within hours.

Now with this system,

we can do it within the hour

because we get the information

and then if we have a helicopter

the decision can be taken very fast.

Doctor Arafat has seen

how this system has saved lives.

For example,

when he saw irregular heart signs

on patient information

being sent back from an ambulance,

he could see

that urgent action was needed.

The doctor jumped in the helicopter

and in six minutes treated the patient.

If the helicopter wouldn’t

have been sent with the doctor

and would have worked

the normal way,

the patient would have

had to go for about forty minutes

driving in the ambulance.

The chance that this rhythm would

have deteriorated into a cardiac arrest

and we could have lost the patient,

was very high.

So, not being present should

no longer be an obstacle

for doctors wanting to treat patients.

Operations have already taken place

with the surgeon on one continent

and the patient on another.

On September 7th 2001,

Jacques Marescaux from Strasbourg

at the European Telesurgery Institute,

was in New York

and operated

on a patient in Strasbourg.

He took her gallbladder out,

a cholecystectomy,

using the Zeus robot.

So, the patient is in France with

a team of physicians and surgeons,

the robot is hanging above her

and he is in New York City

driving the robot,

taking her gallbladder out.

On the morning of September 11th

he was on his way

down to the World Trade Centre

to give a press release.

He didn’t get hurt, but obviously

something else happened.

So, it’s the most

missed story of 2001.

But telemedicine brings

its own new difficulties.

You have time zones.

You have geography.

You have bandwidth, right?

You have nations

with different belief systems,

cultural values and languages.

The American physician

will be treating or giving advice

to someone

who is working in another country,

which may not be recognising

the qualification of that doctor.

While treatment has

developed over the years,

many injuries are remarkably similar,

such as amputations

and traumatic disorder.

But dealing with post-traumatic

stress disorder or PTSD

has seen active engagement

with affected soldiers going back

to where they were injured

to face the place and situation

where the problem started. But what

about those who can’t come back?

Well, now the place

can come to them.

The Virtual Reality Medical Centre is

an example of how this can be done.

Executive Director,

Brenda Wiederhold, showed me

how it offers virtual reality scenarios

to help PTSD sufferers

confront the source of their stress.

This treatment helps

against IED attacks,

which are linked causing PTSD with

the most common source of injury

for soldiers serving in both

the Iraq and Afghanistan wars.

And PTSD’s aftereffects,

such as depression,

have led the US army

to initiate schemes

such as the National

Suicide Prevention Week.

We want to start therapy at a lower

level of stress and then build up.

We’ve talked to them

before the therapy begins,

we’ve found out

what their specific trauma is

and so we start at a lower level,

a world that is not as traumatic,

for instance the battalion camp

or the market place.

And then we go up to the battlefield

as they can deal with that stress.

Now what I should say also:

The sounds are quite important here.

I just heard a sniper

shooting from somewhere.

Correct. So you look up at a rooftop

and you might see

one across the street.

Your heart rate is up to 92

and your respiration is at...

Very high.

We’ve had people come out and say:

I can deal with anger better,

I can talk to my children

without getting upset,

my wife and I have

a better relationship,

I’m able to go on another tour of duty.

I’m able to hold a civilian job.

Another guy:

I’m able to get my college degree.

But part of a mental recovery

can involve physical recovery.

The Dutch Ministry of Defence's

rehabilitation centre addresses both.

The centre aims

to help people to be confident

and carry out tasks

they could do before.

We treat not only amputees,

but also people with brain injury,

people with knee or ankle complaints.

You can train stability,

but also balance.

The system

has been used since 2008

and treats

about fifty patients a week.

It’s so successful, it’s now being used

to treat military and civilian patients.

Colonel Mert,

this particular part of the facility,

you have the gym here,

you’ve got some tennis courts,

you’ve got

a swimming pool behind us,

how do you use these to help

treat the illnesses and injuries?

Well, the military rehabilitation centre

is the rehabilitation centre

for the military.

It’s an obligation

that we have to our servicemen,

to just keep on looking

for new ways to treat these patients.

We want to keep them

as active servicemen.

In the end, it’s about the therapist,

which gives help

and treats the patient.

The facility is just facilitating.

Less medical personnel means

more reliance on new technology.

But the developments

in the medical field

in the near future are encouraging.

We see developments in technology

that will allow us in the near future

to have

unmanned patient evacuation.

We can also see very, very

smart ways of artificial limb steering

with the brain-machine interaction

that will really improve prostheses.

But perhaps also very important

is that we realise better

and we understand better

what shell shock or today PTSD is

and how perhaps we can manage

people to get a normal life back.

Smart watches are getting popular.

But a smart watch is

a very advanced computer

compared to the stuff

that we had six, seven years ago.

There is a GPS in it and there is

a heart rate monitor in it and...

There’s accelerometers etcetera.

So, that gives a lot of possibilities

to monitor the function of a patient.

The near future with nanotechnology

and with 3D-printing,

stem cell technology,

will change healthcare tremendously.

We’re on the brink of a new era

that started already in World War I

realising what we needed.

Today we realise what we can do.

Technology is now so far

that we can make it into production

and implement it in modern medicine.

And finally, one of the key

messages from these Flanders Fields,

from what happened

a hundred years ago,

is that while medicine

can advance due to war,

it doesn’t necessarily

need war to advance.

The invention of penicillin in 1928,

the unravelling of the DNA

structure in, what was it, 1953?

All peacetime progress.

Why don’t we ever say:

peace is good for medicine?

War is our scourge;

yet war has made us wise.

And, fighting for our freedom,

we are free.

Horror of wounds

and anger at the foe.

And loss of things desired:

all these must pass.

We are the happy legion, for we know

Time's but a golden wind

that shakes the grass.

Siegfried Sassoon - Absolution (1915)

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