TIME: Almanac 1990/1990 Time Magazine Compact Almanac, The (1991)(Time).iso/time/011689/01168900.002

Text File | 1990-09-17 | 10KB | 186 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.