Operating In Danger Zones

By Marguerite Johnson

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 something 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.

With reporting by William Dowell/Paris, with other bureaus