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Latest News 7 February 2021

Headley Court "An absolutely groundbreaking place"

The name Headley Court will resonate with almost every single military amputee of the last few decades.

The Defence Medical Rehabilitation Centre in Surrey, which was operational between 1985 and 2018, set thousands of members of the British Armed Forces on the road to recovery. Among limbless veterans, ‘Headley’ quite simply became shorthand for rehab.

But while the building and its staff mean different things to everyone who has passed through the doors of the imposing mansion and spent time in its beautiful gardens, the advances in rehabilitation that were achieved there were genuinely revolutionary.

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Headley Court was renowned not only for rehabilitation, but for its famous gardens

Emily Mayhew, Historian in Residence at the Centre for Blast Injury Studies (CBIS) at Imperial College, London has written a book, A Heavy Reckoning: War, Medicine and Survival in Afghanistan and Beyond, about the “casualty continuum” of the last few decades.The book tracks the journey from the battlefield, through the recent advances in trauma medicine and rehabilitation, to look at what the future might hold for those living with blast injuries.

It features these emotive photographs, which were taken by military photographer Rupert Frere, and concludes that Headley will go down in history as a place that worked “genuine miracles”.

“Nobody was expecting them, nobody had prepared for them, and nobody had trained for them. If you had asked any physiotherapist or prosthetist before 2008 if a double amputee could learn to walk again, their mindset would have been; probably not."

“But suddenly, when bombs and IEDs were detonated in Afghanistan, their shock waves reverberated all the way back to Surrey. These were young men and women who didn’t just want to walk again, they wanted to run and play sports. They had expectations.

“I will always remember talking to a physiotherapist who worked at Headley Court, who told me about the first time he spoke to [Blesma Member] Mark Ormrod. He asked Mark, who is a triple amputee, what his expectations were, and Mark told him he wanted to be able to run again. The physio told me his first thoughts were that Mark was going to have to change his expectations, but very quickly he realised he was the one who was going to have to change his expectations.”

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Headley saw many changes to the way healthcare professionals approached rehabilitation

REHABILITATION

This kind of mindset, echoed by many, many injured Service personnel who came through Headley Court’s doors, led to one of the most astonishing leaps in the history of military rehabilitation. “In a way, the staff at Headley didn’t have any alternative,” says Emily.

“They had previously carried out a lot of sports rehab, and their mantra was; if you get a skiing or a rugby injury, we will get you back skiing or playing rugby. As a team, they worked out how to do things.

“But what really helped rehabilitate blast injury amputees was having a multi-disciplinary team approach. When the patients arrived, they sat down with a group of medics – consultants, physiotherapists, prosthetists – and they looked at everything. Goals were set, timetables were given... People stuck to their plans, kept their focus. It was intense, but this patient centred approach brought rapid and permanent change.

"There was nothing in the textbooks before 2009 to say this was actually possible"

Emily Matthews, Historian in Residence at the Centre for Blast Injury Studies

“And the physios at Headley were prepared to do whatever it took. They were there for the pain, but were also providing psychological support – judging when was the right time for people to work on their own, or to try some competitive walking, realising when they did and didn’t want to talk... They learned it all.

“As a historian of complex casualty I could see that, in the past, healthcare professionals just didn’t talk to each other in this way. The pain people didn’t talk to the psych people, and so on. The patient could often be stuck in the middle. It wasn’t like that at Headley. It was joined up, with everyone on the same path.

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The lawn at Headley Court came to be seen as a rite of passage for lower-limb amputees to conquer using their new prosthetic legs

Life after injury

Soon, staff at Headley were in a position in which they would be watching three double amputees standing on their prosthetics, chatting to each other in the garden. There was nothing in the textbooks before 2009 to say that this was actually possible!”

The garden at Headley has particular significance for many ex-Service personnel who have spent time there. Its lawn, long enough to whack golf balls down, was the perfect space for re-learning to walk in a pleasant, non-medical environment. “The lawn became a walking metric,” says Emily.

“Could you walk to the end and then come back on your prosthetic legs? It was quite a way, and it wasn’t that even a surface, so it was a challenge and, if you got there, it afforded you an incredible sense of achievement. People would carve their names into the wall at the end of the garden to prove they had reached it.”

Emily’s link with photographer Rupert Frere came through a family tie. “My cousin worked with Rupert in the Army in Afghanistan,” she says. “His posting was in media liaison and he was assigned a military photographer. My cousin asked me if there was anything that I would like photographs of, because he knew I had an interest in this field. 

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People would carve their names into the wall at the end of the garden to prove they had reached it.

FROM BASTION TO HEADLEY

“I asked my cousin if Rupert could get shots of the field hospital at Camp Bastion. It happened to be the year that the military suddenly started to suffer serious IED blast injuries, so Bastion was becoming a really important site for the treatment of trauma.

“Rupert photographed the MERT helicopters, the forward medical posts, everything… As a historian, these are the images that you want to exist. Then, in 2014, I was commissioned to write a book about the medical process in Afghanistan. By then, we knew that something extraordinary had been achieved, with hundreds of people alive who perhaps might not have been considering the nature of their injuries.

“I wanted to include Rupert’s photographs from Afghanistan in the book, but I also commissioned him to photograph Headley, because I didn’t have photos of arguably the most important part of this process; rehab. I asked Rupert to get pictures of the place rather than the patients. It was starting to close down, and was mostly empty, but that didn’t matter because it was about the building, the fabric of the place, and in particular the garden. That’s what people remember.

“Rupert took an extraordinary set of photographs. They stand now as a tribute to a remarkable place, and we have used them in the book, and in some exhibitions, to highlight the importance of rehabilitation.”

As the Historian in Residence at Imperial College, Emily not only keeps a record of what is going on in the field of blast injury, but also interprets how things were done in the past, and how current researchers in the field can learn from that.

“An article written 100 years ago can be as relevant as one written today,” she says. “We might have a meeting about a topic and I’ll say: ‘They did this 60 years ago, I’ll get the article for you’.

“I’m the only person in the country doing this, and I think it’s the best job in the world. The CBIS is a bioengineering department, bringing solutions from engineering to the problems of the human body. In past conflicts, like WWI for example, the outcome for soldiers with blast injuries was very poor. The very nature of blast injuries impacts on the ability for those injuries to heal properly. Part of my job is to think about what might happen to this cohort
of people in the future by learning from what has happened in the past.”

Rupert’s images and Emily’s writing will stand as a record that will help to do just this. “Headley represents rehabilitation, and rehab is the best way of minimising pain for these patients going forward,” she says.

“I always talk about ‘life beyond survival’, and rehab is what secures that. Headley will go down in history as an absolutely groundbreaking place.”


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