The Dressing Station: A Surgeon's Odyssey
Jonathan Kaplan
256pp, Picador, £15.99

If there's a sure-fire vision of hell on earth, it can be found in an underequipped and understaffed hospital in Africa or elsewhere in the developing world just after a massacre or an epidemic. Most journalists and television crews spend as little time as they can in such places, collecting the facts and pictures they need before retreating from the stench and the misery. It's hard to forget the clinic in Zambia that was so overwhelmed with those dying of Aids that almost all the patients were crammed on the floor, with their relatives fighting over the beds whenever a death allowed one to become vacant.

Jonathan Kaplan has worked in such clinics across the world, but he was able to provide help. As well as a journalist he is a trained surgeon, and has used his skills to take him to both war zones and tourists' haunts. He has had an odd, varied and colourful life, and this is an odd, varied and colourful autobiography. It is a bloody wartime travelogue, a layman's guide to surgery (not for the squeamish), and an analysis and description of a wide range of different medical lifestyles. It's also a potted history of the politics of the different countries and conflicts he has visited, and a vehicle both for his best after-dinner medical stories and for his often angry thoughts and fears on medicine, morality and mortality.

It's not easy to keep the right balance between so many disparate elements and styles, but - for the first quarter of the book at least - Kaplan manages astonishingly well. Stories of a white boy growing up and studying in apartheid-era South Africa are combined with vivid and compelling first-hand reports of anti-apartheid demonstrations and the police brutality used to counter them. There are graphic, detailed descriptions of the resulting injuries that he was called on to treat. Working as a doctor in the townships gave him a close-up view of the workings and realities of apartheid and the moral dilemmas confronted by doctors asked to patch up the "victims of preventable suffering".

Kaplan's solution was to flee to England, rather than be called up for national service in South Africa's increasingly bloody border campaigns. He became an exile and a wanderer, with a detached, bemused and often horrified view of what he found. He observed the intricate politics of the British medical establishment and the decline of the NHS in the Thatcher era; his analysis is balanced against a wince-making explanation of how to carry out a vasectomy, or a poignant and painfully honest confession of the mistakes he made that led to a patient's death. Moving to the US, he casts an equally cool and critical eye over the workings of commercial medicine, the deals that are made between medical research and big business, and the practice of slaughtering pigs so that first-year students can gain a little surgical experience. Subsequently he moves to a war zone, operating on wounded Kurdish fighters in northern Iraq in the period between the ending of the Gulf war and the establishment of "safe havens". His descriptions of life under fire in a squalid makeshift field hospital are among the best passages in the book.

So far, very good indeed. But Kaplan keeps on travelling, and his life and writing both begin to drift. There's a mildly amusing but over-long section dealing with his time as a ship's doctor on a cruise liner in the South China Seas, where he treated typhoid, alcoholic passengers and crew members with VD. There's his experience working with an unhappy film crew in Mozambique, his more interesting adventures with the opium warlords in Burma, and - for yet more contrast - a stint accompanying sick passengers around the world for a travel-insurance concern. He takes on an assignment to research mercury-poisoning cases in South Africa for the late, lamented World In Action . At this point, Kaplan seems to have become more interested in investigative journalism than surgery.

The final section, dealing with Kaplan's unexpected return to the front line in the war between Eritrea and Ethiopia, at last re-captures the immediacy, originality and sense of horror in the opening chapters. His conclusion from all this is: "It was among the world's wounded that I had found the essence of humanity, without disguise; an exile, I had found a home in the suffering of bodies."

To which one could unkindly ask why he then moved on, yet again, to treat the mental problems of the rich overachievers of London. After all that travelling and all those stories, it seems that the moral dilemmas Kaplan faced as a young doctor have never been fully resolved.