In the early days of World War II, the Japanese army invaded Burma (now Myanmar) and forced an end to British colonial rule there. Occupying Burma required troops and massive amounts of materiel, though, and the Japanese navy was taking a beating on the 2,000 mile sea route around the Malay Peninsula. And so it was decided that a railway connecting Thailand and Burma would be constructed through dense tropical jungle over hilly terrain with hundreds of rivers, including the Kwae Noi River, made famous by the Hollywood treatment of the story in The Bridge on the River Kwai. The real story of what came to be known as the Burma Death Railway is far grislier than any movie could make it, and the ways that the prisoners who built it managed to stay alive is a fascinating case study in making do with what you’ve got and finding solutions that save lives.

Nutrition from Next-to Nothing

Labor for the massive project was to come from the ultimate spoil of war – slaves. About 250,000 to 300,000 slaves were used to build the Burma-Siam Railway. Among them were about 60,000 Allied prisoners of war, primarily Australian, Dutch, British and American. POWs were singled out for especially brutal treatment by the Japanese and Korean guards, with punishment meted out with rifle butt and bamboo pole.

With the POWs was Doctor Henri Hekking, who had been born and raised in the former Dutch East Indies colony of Java (now Indonesia). He had spent his early years with his grandmother, a master herbalist who served as “doctor” for the native villagers. Inspired by his oma’s skill and convinced that the cure for any endemic disease can be found in the plants in the area, Dr. Hekking returned to Java as an officer in the Dutch army after completing medical school in the Netherlands.

After his capture by the Japanese, Dr. Hekking did everything he could to help his fellow POWs despite the complete lack of medical supplies, all the while suffering from the same miserable treatment. Hekking realized early on that the starvation rations the POWs endured were the main cause of disease in the camps; a cup of boiled white rice doesn’t provide much energy for men building a railway by hand in jungle heat, and provides none of the B vitamins needed by the body.

Weakened by nutritional diseases such as beriberi and pellagra, the POWs either wasted away or became susceptible to dysentery or any of a host of tropical infections. He solved these problems with a little jungle ingenuity. To bolster the protein-poor diet, he cooked blood from a water buffalo slaughtered for the Japanese mess into the POW’s rice. To round out the diet, he recovered B vitamin-rich rice husks from an abandoned jungle village’s grindstones and made cakes that the prisoners ate. Neither were terribly palatable, but the improved nutrition made a difference.

Hacking Solutions, Not Limbs

Still, the jungle and the Japanese dealt out endless punishment, and even with improved nutrition the men were falling sick. Particularly nasty were tropical ulcers; the slightest scratch would become infected in the fetid jungle conditions, and the infection would bore into the flesh right to the bone. Refusing to accept that amputation was the only option, Doc Hekking chose instead to debride the ulcers. Lacking proper surgical instruments, he sharpened the bowl of a teaspoon and scraped dead tissue from wounds. Four men would hold down the patient; the only anesthesia was when the man finally passed out from the pain. The remaining infection was treated with Doc’s herb-lore; one trip into the jungle yielded the fruit of the pomelo tree, covered with a gray fungus that his grandmother had taught him about. A poultice of the fungus yielded a powerful topical antibiotic; years later the fungus was found to secrete a substance similar to penicillin, at the time only coming into commercial availability. By going old school, Doc Hekking was ahead of the curve.

Early on in his internment, Doc Hekking was drawn to the Americans in the camp. He thought they were crazy – laughing and joking in the face of untold misery, and willing to do whatever it took to survive, even when it meant eating his foul but nutritious concoctions. Most of the American sailors and marines in camp were farm boys who had come of age in the Depression, and were used to hardship and making do. Such skills were particularly useful in cobbling together the equipment Doc Hekking needed to help the men. When major wounds needed sutures, James “Packrat” McCone fashioned the needle from a scrounged safety pin. He hammered a flat spot and used a pocket knife to ream a hole for some twine. Boiled for a few minutes, it did the trick. When a badly ulcerated leg needed a special surgical tool to remove infected bone, a POW in another camp fashioned scrap metal into the chisel-like instrument that Doc needed to save the patient’s leg.

When Life Hands You Bamboo, Make Everything

Besides the salvaged metal from food tins and bits of detritus that formed most of Doc’s medical kit, the most common material for hacking solutions to the POWs’ problem was undoubtedly bamboo. Flexible, strong, lightweight and ubiquitous, bamboo found its way into all sorts of camp utensils. Water containers, knives and eating utensils, toothbrushes, instrument holders and dozens of other items were fashioned from bamboo, not to mention the very structures the POWs lived in and the meager furniture they had. Crutches and even prosthetic limbs were made from bamboo for the unlucky amputees in camp. One of Doc Hekking’s innovations to avoid amputation from tropical ulcers was to not dress the open wound, which he feared would result in a warm, moist environment that would hasten infection. Instead, Doc fashioned bamboo splints into a cage that was fastened over the wound, preventing anything from bumping into it and allowing it to breathe. Berated by a British doctor in the camp who wanted to amputate the leg of one patient sporting the contraption, Doc stood his ground. The patient lived.

Doc Hekking’s Legacy

Accurate estimates of the cost of the Burma Death Railway in terms of human lives are hard to come by, but it’s pretty well established that of the 60,000 or so POWs enslaved, about 20% died. That means the railway claimed about 45 lives for every mile of its 268 mile length, or one every 117 feet. An unknown number of Southeast Asian workers were also enslaved, perhaps as many as 200,000 or more. They died at something like a 50% rate, so there may be a body every six feet along that rail bed.

But what of Doc Hekking’s results? Did his men fare better under his unconventional treatments and hacked solutions? It seems so. While the overall POW death rate was 20%, Doc managed to keep his losses to 7% of the 194 men in his camp. And importantly, Doc performed not a single amputation.

Doc Hekking proves that sometimes, you can accomplish a lot with nothing at all, and that knowing things is often better than having stuff.