Inside Headley Court, the Rehab Estate for Injured British Soldiers
We spent a day touring the MOD's Surrey mansion, meeting soldiers undergoing treatment and talking about the effects of battle injuries.
The 13th of March marked the end of Britain's operations in Afghanistan. However, the royal ceremony at St Paul's Cathedral to commemorate the occasion received little of the media-zeal the conflict once fuelled. And amid upcoming elections and defence budget cuts, it's not hard to see why many are keen to see Britain's 13-year war in Afghanistan ebbed gently out of public view.
But for many British servicemen injured in the conflict, the campaign isn't over yet; they still have to re-enter society or active duty. And it's away from the dust and the heat of Helmand Province, at the Ministry Of Defence's Headley Court – a £300 million country estate nestled in the Surrey countryside – where this battle is staged.
Walking through the grounds, you're instantly struck by its postcard beauty: rolling lawns, domed hedges, a long gravel approach and bay windows edged in ivy. It looks like any other British manor house, the kind of place they might film an episode of Antiques Roadshow. Until you pass the occasional soldier on crutches, smiling and nodding, a glance downward revealing a carbon-fibre limb replacing a leg lost in an IED blast.
In the facility's Waterloo gym, part of Headley's "Force Regeneration" section, there's an atmosphere of deep focus as servicemen squat, stretch or work fitness balls.
"It's the area primarily responsible for getting people back into active service. Or with more complex trauma victims who can't be re-enrolled to active service, for finding a way back out onto 'Civilian Street'," says Warrant Officer Matt Arthur of the Royal Army Physical Training Corps (RAPTC).
"Part of their adjustment – especially with battle injuries – was going home, learning how to live at home, learning how to live a normal life," he continues. "So that is of as much importance to their therapy as it is being at Headley Court."
Alongside extensive counselling, servicemen who've suffered severe traumas are kept intensely active in physical routines mirroring those of active service.
"When they come to work they feel like they belong somewhere. This is work for them. My job is to ensure they have that service life – that military ethos that binds us together when we join and whenever we work," says Officer Arthur. "From the lowest level patient you are designed a treatment programme, with the main aim for it to be progressive. Obviously people do regress – they may have relapses or there may be issues. But the main aim is for people to progress with a level of function."
Moving to Headley's complex trauma gym, the lack of running machines is immediately evident. "You can probably guess why," comments Arthur, as a young man covered in tattoos with an artificial leg bench-presses next to us.
His name is Tony Checkley, a 25-year-old Grenadier Guardsman who triggered an IED in Helmand Province in June of 2012, losing his right leg below the knee.
"We were just a temporary patrol; it was just a show of force, just to show the people we were about. We were going through a ditch... just tapped it with my toe, really," he tells me matter-of-factly, pausing for breath.
I asked how the realisation he'd lose a leg first hit him.
"It bothered me, but I didn't show it at first because I had family and my kid around me," he says. "I wanted them to go before I started showing emotion... but I come here and see people with more injuries than what I have getting through life and I carry on.
"Took me about three to four week to learn to walk again. I thought it would've just been easy to get up and walk, but missing a limb it's completely different. You're body's wary about things... you get so far and then you have to go for surgery again or something. So you have to start again. Like I've done about five times now."
Talking with Checkley, the part that military stoicism plays at Headley is starkly evident. That, and the impenetrable gallows humour between soldiers: supporting each other by ripping the piss when someone takes a tumble.
In the Officer's Mess, Colonel Alan Mistlin, consultant in Rheumatology and Rehabilitation Medicine, explains the challenges faced by staff here, as well as the complexity of treatments brought-on by IED-related injuries in the wake of Iraq and Afghanistan.
"Complex trauma's not new within the military – we've always had amputees, but it was the severity of the injuries as much as anything else that's changed. And we had to change our ways of practicing," he tells me. "The most expensive piece of equipment we use is the gravity-assisted treadmills so we can actually get them weight bearing from an early stage."
Alongside the technology, there's a heavy emphasis on psychological counselling and graded re-exposure to society.
"As nice as Headley Court is, it's not the real world," says Mistlin. "We certainly encourage nursing staff to take them to the pub, to restaurants, to hotels, to go out for afternoon tea... this is very much what we've had to do with a lot of the physical injuries. There are also a lot of people with mental health issues – PTSD. A lot of them don't like crowds, busy environments, noisy environments..."
Headley saw its peak influx of battle casualties during Afghanistan's Operation Panther's Claw in 2009, and these continued to arrive in massive numbers well into 2010. In 1996, the facility had 30 outpatients. By last year they'd seen 16,000 outpatients and just under 2,500 admissions. And although the last Afghan casualty entered Headley nine months ago, Colonel Mistlin estimates the entire support process for Afghan-injured here will continue for another three to four years before discharge.
Many servicemen return to work suffering increased pain in damaged limbs and elect for an amputation, which requires further surgery, training and mental health counselling, especially regarding phantom pains from freshly amputated limbs, beginning the entire rehabilitation process again.
'It's a long tale," admits the Colonel.
Inside the prosthetics department, artificial legs sit loosely propped against the wall. Chief prosthetist Mark Thoburn, himself an amputee after losing a leg in a bike accident in 1992, is joined by 32-year-old Stuart Robinson of the RAF, here for a check-up.
"Over 300 patients [come] through this department with a significant number of double and triple amputees. So it's a lot of limbs," says Thoburn as he examines Stuart's prosthetic leg.
Stuart was injured in Afghanistan in 2013 when his open-top patrol-vehicle initiated an IED. Thrown clear in the blast, he lost his left leg below the knee, broke his forearm, his spine in 18 places and suffered multiple fractures to his arms and shoulders. The vehicle's forward-mounted machine gun was also torn loose, breaking his jaw and smashing his teeth.
"Basically, the long and short of it was I got injured in February in Afghanistan, and then I woke up in Birmingham [Queen Elizabeth Hospital] and it was April. Literally, in my own mind, in my own memory, there' s no recollection whatsoever," he says. "I remember waking up and seeing that I'd lost my left leg... I knew that I'd been in a bad way."
In traction, incapable of movement and with his jaw wired shut, he was unable to communicate for months.
"My five-year-old son come in and he took it really well, 'cause he's really at the age where they can understand things but they don't go into too much detail – they just get on with things," he explains. "So I thought, 'Why can't I adopt that mentality?'"
Stuart also jokes about the gags that get everyone through here. "It's kind of a sick, trying-to-get-you humour. Everyone falls over here at some point, and if you don't laugh at yourself – well, there's no other option really, is there?"
A microprocessor limb like his costs around £40,000, taking roughly two weeks from casting to laser-line manufacture before it's fitted. But IED-related casualties here also fuel extensive research and development studies, particularly when comparing prosthetic limb movement and weight distribution to able-bodies.
In the Gait Analysis lab, another IED-casualty, 22-year-old Lance Corporal Sam Stoddart, crosses the room repeatedly, wearing a carbon-fibre brace. Attached to his leg are a series of retro-reflective markers, each movement registered by infrared cameras along the walls, while under-floor pads measure the weight distribution of every step.
The pointman of a patrol in Afghanistan, in September of 2013 Stoddart triggered an IED while crossing an irrigation ditch, his heel taking the blast, resulting in open fractures to his tibia, fibula, calcaneum and midfoot. The blast failed to sever the limb, and through research at Headley – alongside analysts like University of Salford research fellow, Sarah Bennet – his carbon-fibre ankle-brace eradicates all pain when walking or running, though he still suffers when standing still.
Among all the IED victims here, Headley's modes of treatment are regarded as fiercely positive. But more than that, there seems to be a competitive kinship among battle-casualties that keeps them motivated.
"You start to see other people and how they're progressing, and it sort of motivates you – guys a lot worse than yourself," Stoddart tells me. And beyond the microprocessor limbs, the neuro-teams and embedded clinicians, there's a more cathartic side to rehabilitation: the gardens.
"Gardening is referred to for a wide range of skills, from balance, motor skills, confidence... Year on year, the seasons change and there's always things to do," explains horticulturalist Anna Baker. "And often when patients come back for another admission, they like that they can see what they were doing last time, and some of them almost track or judge their own recovery on how the garden is. It can be quite profound."
This makes perfect sense. Outside of the labs and gyms, it's a beautiful place: the lawns, snug greenhouses and chicken coops epitomising that mid-morning stillness of country estates where men have sought solace from the brutalities of war since The Somme.
But even in this picturesque setting, with its army of psychologists, neurologists, prosthetists and physical therapists ever on-hand, there's still the sense that, for many here, it's their re-entry back into the alien bustle of society where the real recovery begins.
More stories about British soldiers: