School in Wartime Page 2
The Changing Face of War
In the second half of the 20th century, the changing face of war
has meant that battles are fought more frequently in and near villages
and cities, and less often in trenches and on battlefields. The
School's faculty members who served in Vietnam, and more recently
in Sudan, Iraq, Rwanda, and Bosnia, have found themselves dealing
with civilians as much or more than soldiers.
Public health practitioners increasingly find themselves working
on the health problems that arise from collapsed internal social
structures, displaced citizens, and the obliteration of "normal
life" for civilians. As war destroys homes and villages, many
become refugees, stuck in temporary camps with poor sanitation that
often leads to public health catastrophes, notes W. Courtland Robinson,
PhD candidate and research associate at the School's Center for
International Emergency, Disaster and Refugee Studies (CIEDRS).
Frederick Burkle, who was drafted into the Vietnam War in 1968,
was stationed at a casualty receiving facility in Dong Ha, six miles
from the demilitarized zone. Fighting occurred mostly at night,
which was when the casualties came in. His daytime hours, however,
were far from restful, as nearby families and refugees — who had
no other medical care available in that province — flooded the center.
saw up to 250 children a day," he said. One morning he saw
a suspicious abscess under a child's arm and his Laotian interpreter,
trying to translate, took out a dictionary and pointed to the Vietnamese
word for "plague." Burkle saw five similar cases that
same day, and realized that he was facing a potential outbreak of
bubonic plague, transmitted quickly by rats found in abundance in
the refugee camps. Relying on a drug treatment of tetracycline and
chloramphenicol, Burkle eventually treated a total of 155 children
and scores of adults in what turned out to be the "worst epidemic"
of plague that century in Vietnam, he recalls. That year, the number
of plague cases in South Vietnam totaled 780, almost 60 percent
of the reported cases worldwide.
Physical trauma is not the only problem afflicting displaced people.
During the civil war in Bosnia and Herzegovina, for example, the
Taylor, MD, DrPH, professor emeritus,
International Health, struggled to establish early care and rehabilitation
programs for children suffering from post-traumatic stress disorder
(PTSD). "Psychological care is just as important as physical
care during times of war," says Taylor.
"We treated soldiers
only if they checked their weapons at the door."
- Mike VanRooyen
Burnham, MD, PhD, MSc, associate professor, International Health,
who spent six years in the military and currently directs CIEDRS,
notes that public health professionals are often the ones on the front
lines. While political scientists can theorize about the social collapse
that occurs during and after wartime, Burnham says, the mission of
public health professionals is to "be there — to collect data
and restore order."
Mike VanRooyen, MD, MPH, who also directs CIEDRS, knows how difficult
it is to impose order in an environment of guns and killing. While
he worked in a civilian hospital in southern Sudan, VanRooyen was
uncomfortable that armed combatants often sought treatment there.
"We decided on a policy that we'd treat soldiers only if they
checked their weapons at the door," he explains, "and we
enforced it. They were civilians when they entered, not soldiers."
Taylor also found himself on the front lines while on a mission for
UNICEF in Baghdad, in the days just prior to the Gulf War. He and
a colleague were whisked from their hotel by two armed men, who drove
them to the compound of Yasser Arafat, then-chairman of the Palestine
Liberation Organization. Arafat treated the two doctors like emissaries
from their country, explaining to them his political motivations in
siding with Saddam Hussein. Two days later, Taylor left Baghdad on
the last flight out of the city before American bombs began raining
from its skies. (He would later return on a mission for Physicians
for Human Rights to work on the alarming malnutrition and PTSD rates
among Iraqi children, the results of war and sanctions.)
Despite the diametrically opposed objectives of war and public
health, VanRooyen believes that "medical diplomacy" can
be a positive, essential force in a crisis. "We can make real
collaborative efforts," he adds, "because public health
has an important role to play."