The 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. "We 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 School's Carl Taylor, MD, DrPH, professor emeritus,
"We treated soldiers only if they checked their weapons at the door."
- Mike VanRooyen
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.

Gilbert 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."

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