On the Road with Doctors Without Borders

Why a ragtag medical team trades hometown comforts for Third World hell

| July-August 1999

She is amputating the boy's arm and leg: In a spray of blood and bone chips, the surgeon's saw slices through the devastated tissue. The boy is 14. They have removed his right forearm below the elbow and his right leg below the knee, because a few hours earlier he had with foolish curiosity touched a land mine. Somehow he has managed to cling to life despite the shock and blood loss. Now his severed stumps flop like dead fish over the side of the stretcher as he is carried, unconscious, out of the operating room in Butare Hospital, on Rwanda's Burundi border.

The doctors of Médicins Sans Frontières (MSF)—Doctors Without Borders—are highly skilled in amputations; Rwandan MSFers are especially experienced in the repair of terrible mutilations, since the brutal Interhamwe militia often cut off victims' hands before (or sometimes in lieu of) killing them. “Sometimes I think, What are we doing here?” says a Dutch nurse named Selina. “Are we doing any good when 38 out of 40 children we see will be dead anyway? All this money we spend!” She pauses. “You have to take meaning in the small things. A grandmother whose grandchild died in Sudan didn't have anybody to help bury the child. I took the people from the Feeding Centre with shovels and I carried the dead child through the rain. We were sitting down. The child was lying there dead and the grandmother's slipper was broken, and while we fixed it she took a big knife and cut her toenails! And then we went on. Death is such a part of life here. They dug a hole and laid the child down and filled it up with leaves, and the grandfather said thanks to those who helped, and they went home.”

Humanitarian medicine is more than medical heroics. A woman once asked her for an empty medicine box, Selina recalls, because the cardboard would make a good wall for her house. “I like to do something for people. In these situations, if you are not going to do it, no one will do it—while if I don't go to work in Holland, another nurse will,” she explains. “It's not that we are doing more important things than raising a family or keeping a shop; it's all important. Sometimes I think it would be nice to have a family like my sisters have, but sometimes they think, ‘It would be nice to go everywhere like Selina.’ It's a need for me to do something for other people—but I'm doing it for myself, too.”

As our small team—myself, photographer Greg Locke, and artist Bonnie Leyton—endlessly crisscross Rwanda, we find a Scottish nurse, Julie, in a mobile hospital, a simple van trundling along the road searching for the weakest—“the vulnerables”—among thousands of refugees. She is reluctant to be interviewed; so severe is her discomfort that her face contorts into wooden self-consciousness. But the instant she takes her leave of us, the joy on her face—youthful exuberance, even exultation—returns. Her feet hardly touch the inch-deep mud as she glides from patient to patient.

The slimy mud road to Byumba cuts for miles through the exquisite greens of the terraced, conical Rwandan hills, perpetually topped with black storm clouds in the rainy season. Suddenly, the hospital van pulls onto a side road at the edge of a village; the rear and side doors spring open, a table slides out the back, and staff quickly assume their rehearsed positions. The lame and the halt form a queue behind the van. The first MSF assistant checks for fever by touching each face and chest; an aide hands out oral rehydrants to those who need them. Others await bandaging or a medical interview by the side of the van. Indifferent to the mud and omnipresent rain, Julie and her assistant prepare gauze bandages and antiseptic, watch for symptoms of cholera and malaria. They are utterly focused: There is silence, a calm fusion between medical worker and patient.

We spend the night at a gracious colonial MSF compound, where MSF newcomers brace themselves to meet increasing numbers of refugees. The tension mounts; people fear that the crisis may be too much to handle. Eighteen medical and administrative people will arrive in the next 24 hours; they will need food, mattresses, medical supplies, and instructions. The day after, 19 more will arrive as MSF mobilizes fully for the 1996 Rwandan emergency, dragging European and Canadian volunteers out of comfortable homes and aboard any air transport they can commandeer—23 physicians, 26 nurses, 29 logisticians, 15 water and sanitation experts, 19 administrators, 2 psychologists, and 2 epidemiologists, 116 volunteers in all.

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