TIME: Almanac 1993/TIME Almanac 1993.iso/time/011689/01168900.002

Text File | 1992-09-23 | 10.2 KB | 201 lines

                                                                                MEDICINE, Page 56

Operating in Danger Zones


Volunteer doctors and nurses risk their lives to treat the
suffering in the world's trouble spots


    A small convoy of Toyota Landcruisers escorted by armed
rebels threads its way over a mountain pass in northern
Ethiopia. In the vehicles are members of a European medical
team on their way to staff a hospital in territory captured by
guerrillas. Thousands of miles away another medical corps
travels with a caravan of packhorses through rugged terrain
into Afghanistan. There its members will treat victims of the
war between the Afghan resistance and the Soviet-backed
government. At a headquarters building in Paris, shortwave-radio
antennas turn toward Africa. A faraway voice reports that a
cholera epidemic has struck refugees fleeing Mozambique's civil
war. Within 48 hours, prepackaged containers filled with
medical supplies are on the way.

    Around the world, in war zones and areas stricken by natural
disasters, a special breed of doctors and nurses are infusing
the Hippocratic oath with new force, risking their lives out of
a commitment to what Dr. Bernard Kouchner, one of the founders
of the movement, calls "the duty to interfere." Volunteer medics
 are treating tribespeople for malaria and tuberculosis in East
Africa, performing amputations on victims of land mines in Sri
Lanka, building clean-water systems in El Salvador and operating
surgical clinics, often under gunfire, in the Palestinian
refugee camps of Lebanon.

    Some serve out of a sense of moral mission, much like that
which inspired Dr. Albert Schweitzer to go to Africa in 1913 to
open a hospital at the village of Lambarene in what is now
Gabon. Others seek adventure, challenge, an opportunity to hone
their skills in a real-life laboratory where nearly every case
is an emergency. Many discover that much of what they learned in
medical school is irrelevant to the life-and-death crises and
health needs of the world's poor, and go on to make a career of
volunteer medicine.

    "As a doctor, I feel one should go where one is needed,"
says Dr. Swee Ang, 40, a physician from Singapore who was
working at the Sabra refugee camp for Palestinians in Beirut at
the time of the 1982 massacre by Phalangist militiamen. After
surviving the ordeal, she returned to Britain to marshal
support for the Palestinians before resuming work at Bourj
al-Barajneh, another refugee camp in Beirut. "I'd seen how the
Palestinians had suffered," she says, "and to abandon them after
that and not do something would have been a crime."

    Dr. Christophe Paquet, 31, had just finished medical school
in Paris in 1984 when he accepted his first assignment in
Honduras. "It was a very strong experience," he says, "and I
was hooked." After subsequent postings to Thailand, Sudan and
India, he is now studying public health at the University of
California, Berkeley, to further his international work. "In
France and elsewhere we are becoming more and more
specialized," he says. "It's not the kind of medicine that is
needed in the Third World."

    The volunteer medical movement is dominated by three
Paris-based organizations -- Medecins sans Frontieres, Medecins
du Monde and Aide Medicale Internationale -- whose aim is to
bring medical assistance to troubled and neglected corners of
the world, without regard to political orientation or
government approval. The need these groups serve is illustrated
by an M.S.F. poster showing a doctor examining a sick child.
Beneath the photograph is the caption IN THEIR WAITING ROOM:
MORE THAN 2 BILLION PEOPLE.

    The three groups, including branches in Belgium, Holland,
Spain and Switzerland, dispatch some 1,500 doctors, nurses and
logistics staff a year to more than 40 countries. The most
innovative and the largest of the three is M.S.F., with an
annual budget of $25 million, most of it coming from private
contributions. Not only has the group pioneered the principle of
practicing medicine without regard to territorial borders, it
has also engineered practical breakthroughs in disaster
preparedness. They include a series of 50 "kits" containing
materials designed to handle most emergencies. A cholera kit,
for example, provides virtually all the supplies needed to
treat 500 victims of the disease.

    While the French medics are renowned for their valor in
areas of conflict, organizations in other countries are also
contributing medical assistance to places in need. Among them:

    Britain's Medical Aid for Palestinians has sent more than 70
doctors and nurses and many tons of medical supplies during the
past three years to Palestinian refugee camps in Beirut and
southern Lebanon.

    West Germany's Cap Anamur Committee, named after a freighter
the group chartered in 1979, has rescued nearly 10,000
Vietnamese boat people and sent some 900 doctors and nurses to
Uganda, Ethiopia, Mozambique and elsewhere.

    The U.S.'s International Medical Corps has trained 120
Afghan medics and set up 50 clinics in the country, treating
50,000 patients a month. I.M.C. is currently recruiting for a
project in Honduras.

    The African Medical and Research Foundation, founded in the
U.S. in 1957, is noted for its Nairobi-based Flying Doctor
Service -- physicians who fly to remote parts of Kenya,
Tanzania and Uganda to provide surgical and general health care.

    For more than a century, the International Red Cross has
been synonymous with war and disaster relief. But it operates
with government backing, relying on diplomatic negotiations to
smooth out difficulties. By contrast, M.S.F. and similar
organizations insist that when diplomacy fails, it is not only
their right but their obligation to bypass official channels.
Says Dr. Michel Bonnot, 35, the founder of Aide Medicale
Internationale: "Our principle is to place medicine above
affairs of state. What happens when there is a civil war in the
Third World? The first thing the government does is cut off
medical support and demand that the doctors leave. Governments
cannot be allowed to use medicine as a weapon."

    The idea for a volunteer medical corps willing to go
anywhere had its origins in the 1967-70 war in Biafra, when the
state sought to break away from Nigeria. Bernard Kouchner, a
young Marxist just out of medical school in Paris, signed on
with the French Red Cross. In Biafra he was influenced by the
Christian humanism of another French doctor, Max Recamier, who
argued that the importance of saving an individual life
transcended politics. Recalls Kouchner: "Recamier's philosophy
was simply that a man who is dying is a man who is dying, and
that is all there is to it."

    As the horror of events in Biafra unfolded, Kouchner became
convinced that Recamier was right. When Nigerian forces closed
in on the hospital where Kouchner was working, the doctors
asked to evacuate their patients. The Red Cross ordered them to
stay on the grounds that they would be safer in a hospital under
the Geneva Conventions. As the troops drew near, many patients
bolted into the forest. "It was unbelievable," recalls
Kouchner, who is now France's Secretary of State for
Humanitarian Action. "Some of them were carrying their own
plasma bags. Others had been operated on, and their intestines
were hanging out as they ran." Outraged, Kouchner and Recamier
decided to organize their own pool of doctors who would put
medical needs above bureaucratic procedures. Soon after, the two
doctors helped form Medecins sans Frontieres.

    Today a growing corps of experienced medics look upon
volunteer medicine as a career. Salaries are minimal: doctors in
the field are paid between $700 and $800 a month, nurses
somewhat less. But most of those who go abroad feel they are
more than compensated by a sense of venturesome achievement.
Stephane Michon, a French nurse, contracted malaria during a
tour in Thailand, but she readily said yes when M.S.F. asked
her to go to Sudan to work with refugees.

    More than adventure, Afghanistan offered sheer terror --
"the most extreme of all situations I've ever known," says
Maria Muller, a West German nurse and veteran of five missions
to Viet Nam. Five medical facilities in rebel territory were
destroyed by Soviet bombs, and medical care was administered
under the most primitive conditions. Amputations, says Muller,
were "unimaginable. We had only a small amount of a narcotic,
Trapanal. The saw came from the nearest work shed, and the
amputation knife was a dagger from one of the rebels."

    The medics' heroics in Afghanistan have boosted their
stature. Increasingly, international health organizations have
sought them out for advice and assistance. The volunteers are
well positioned, for example, to provide early-warning
information on epidemics. M.S.F. is conducting AIDS research in
Zaire and Rwanda, two of the most afflicted areas in Africa,
while its clinics in the war-stricken zones along Sudan's
southern borders are documenting the spread of the disease
northward.

    The development of highly mobile medical teams has shortened
the international response time when disaster strikes. Within
72 hours after a catastrophic earthquake hit Soviet Armenia
early last month, the French government and volunteer
organizations dispatched the first of nearly 700 trained
personnel, including doctors, firemen and experts in excavation
techniques, to assist the victims. The effort was eventually
joined by scores of countries around the world.

    As the volunteers themselves acknowledge, what drives them
to undertake such missions of mercy -- and others far more
perilous -- is not some-thing easily explained or understood. "I
know it is not possible to save everybody in the world," says
Dr. Jean-Louis Menciere, a French anesthesiologist working in
Sri Lanka, "but to do something about it is better than doing
nothing."  As more and more people become committed to the idea
that, as Bernard Kouchner puts it, "mankind's suffering belongs
to all men," the day may not be far off when there will be a
substantial pool of medical personnel at the ready, prepared to
alleviate pain and promote better health, wherever the need
exists.