Book: Suburban Shaman: Tales from Medicine's Frontline
Authors: Des Spence
Journal: BMJ (2006)

The order has come down the line and the next big health push is on. The barrage of health promotion literature has paused after weeks of bombardment. Comrades in arms, we stand on the duckboards taking deep draws on our fags, the acrid smoke of cynicism and sarcasm filling our lungs. The fresh faced recruits are naive and excited, but few will ever return. New officers have replaced the wounded who now lie in distant hospitals but will never leave.​leave.



Figure 1

Cecil Helman



The whistle blows and we are going over the top. The remorseless heavy chatter of the middle class opens up on us. I see soldiers dropping on either side of me. I throw myself into a bomb crater in no-Spam-land. The stench of putrefying initiatives is everywhere, limbless, bloated, decaying in that thick bureaucratic mud. A futile waste, but this is trench warfare, this is general practice. For 27 years Cecil Helman survived in the front line and now he tells his story.

The son of a psychiatrist, Helman trained in South Africa during the apartheid years. His stories of medical school will resonate with those pounded by the cosh of rote learning of yesteryear. The oddball collection of students will give many readers a sense of deja vu and send them running for their yearbook. And when a “white” man develops Addison's disease and becomes “black,” the hypocrisy and the racism that blighted Helman's beautiful country become all too apparent. Unwilling to be conscripted into the regime's army, Helman leaves his homeland.

Led Zeppelin, flares, and maths teacher beards welcome him to a depressed and post-1960s London. Disillusioned with medicine, he studies anthropology, only to return to medicine a few years later. His view of medicine is by now fundamentally altered by what he sees as the forced segregation of Western medicine from other healing traditions. As a general practitioner in a rising and vibrant multicultural London he develops a depth of insight into health and society that only a family doctor can have. His poetic vignettes of the old, the sick, the poor, the rich, and those desperately trapped in between are moving, honest, and funny. As an immigrant he understands the isolation and the cultural dynamic of medicine that confound Western conventions.

Lastly, he reflects on that most primal and primitive culture of all—medicine. He questions our vast cathedrals, hierarchy, and the mumbled incantations that culminate in the ritual sacrifice of local general practitioners at grand rounds. While hospitals endlessly churn but seemingly never learn about the broader themes of health, patients are caught in a kaleidoscope of subspecialties with no one able or willing to see the patient as a whole. Holistic care is now only a thing of myth alive only in the pages of those fables written by NHS quangos.​quangos.




Figure 2



Cecil Helman: war poetry

Credit: DORON SWADE




For all those tired of the censored and Royal College of General Practitioners approved manuals that we discard after the first chapter, distracted by a snail on the window, get this for your health centre dugout—it's war poetry.