Friday, March 27, 2015

Mass Response to Genocide: Part 3

Everywhere there were volunteers who came in from Bangkok on a day-to-day basis. The American Embassy sent a daily bus; others came by car. Some volunteers took over the job of keeping the diarrhea patients clean (There were new clothes and blankets now); Some spoon-fed the weak. Others ran errands, or helped discharged patients get settled out in the camp, or passed out food. One afternoon I found each patient holding a hard-boiled egg (which not all stomachs were up to handling); another day each had an orange or a loaf of French bread. One elderly European man, with whom I could speak only in Thai, stayed in the tent next to ours all night watching over an especially sick Khmer whom he had sort of adopted.
A few came only to sight-see. The French ward got a group who wanted to feed patients lunch. The doctor explained that they had already had their lunch but some were badly in need of a bath. The visitors said they didn't come to do that kind of work, they just wanted to feed people. We had a couple of Thai student volunteers who mostly just drank our pop. But another Thai girl student stayed with an old lady who was too listless to eat, and kept gently spooning gruel into her. “She's not going to die is she?” the girl kept asking me nervously, “I don't want to see anyone die!” But three or four days later when another patient died, it was the student who rounded up stretcher bearers and escorted the body over to the morgue tent, where a group of Buddhist monks took care of burials. The Khmer refugees themselves had teams of girls (Khmer army medics, we were told) who helped bathe and feed people. Like the volunteers from Bangkok, some were very good, and others not very useful.
As time went on, CAMA sought other temporary help. A Brazilian doctor and his nurse wife arrived, a couple of doctors from USA, and a young Khmer girl now living in New Zealand (who was at first terrified that the Khmer Rouge would murder her.) We now had at least two doctors in tent number 8, and sometimes three. We still received about ten new patients per day, but many others were getting well enough for discharge out into the camp, so our patients no longer had to lie shoulder-to-shoulder.
Cameras and reporters were everywhere. As I worked with an unconscious kid a man with a microphone squatted down beside me and asked me to describe the case. I'm told I was on Voice of America that night. Another night I was on NBC-TV all over both America and Europe as a “malnutrition expert”. I tried to send them to the camp's nutrition doc, but it turned out I was the only doctor in camp that day who had been in Asia a while and who had an American accent. Probably my audience in the next 24 hours totaled around one hundred million. I remember struggling to explain how starvation of the degree seen after six months in the jungle was like being isolated in a blizzard. When the firewood was used up, you will burn the furniture to keep life alive, and finally you burn the house walls themselves. And I remember that my main concern was to keep the TV cameras from showing the folks back home how swollen my own legs had become after a week of twelve to fourteen hour shifts.
Not everyone realizes that Lois was also on TV, her back to the camera as President Carter's wife, Rosalyn, walked through our tent and talked with her briefly. Lois' most memorable utterance was about the horde of reporters, who kept shouting “Get down! Get down” at her while they tried to get the First Lady's picture. Lois finally said, “If they just moved back a little, they wouldn't be standing in the patient's latrine ditch.” And a Secret Service man in the group grinned to Lois, “Say it louder. We're being recorded.”
That second week,we were still dog-tired but felt we could probably make it till more help arrived. Lois and I, with another nurse and Tann, our interpreter, even took our turn at night duty – fourteen hours watching over the whole hospital. There's not much you can do for a thousand unfamiliar patients. Most of the ward aides were sound asleep. We toured all the wards every three hours, restarting a few IV's, carried out a couple of dead bodies (whose beds were shared with other patients) cleaned up one teen-age boy covered with bloody diarrhea from the waist down, watched over a couple of women in labor. Took a 2 am break to visit with the Israeli doctor in the emergency tent – the only other doctor permitted to stay through curfew. He and I watched a Thai construction crew digging a deep-water well and erecting tall poles to light the area. I looked up at the poles and said meditatively “Haman built a gallows, fifty cubits high . . .”  The startled Israeli looked at me; “How did you know what I was thinking? Where did you hear that story?”
“Hey, the story of Queen Esther is in the Christian scriptures too.”

We left ward 8 in the hands of a Dutch lady, Eva Hartog, a TV personality who brought a team of eight Dutch nurses to work with the three American doctors who would inherit our tent. A letter from our Brazilian doctor friend several weeks later said the whole hospital is now in more permanent buildings, and there had been a day when there had not been even one death in the whole hospital. New waves of refugees were coming in then, some with war wounds on top of their starvation and diseases. Sa Kaew now had a small surgical unit, he wrote.
The day we left, several cases of epidemic meningitis (meningococcemia) threatened the camp, but I guess it did not develop. Most of the patients were visiting back and forth. Kids were playing games, or standing in line for milk, wearing their tin bowls on their heads as helmets. The girl on the TV spot who couldn't walk squealed in pretend terror and ran, when her sister told her I was coming to give her a shot. It's good to know we made a difference, but I don't mind admitting that all of us were glad to get away and rest.
A week or two later, my colleague at Maesariang, Dr. Bina Sawyer and two more nurses went down to another refugee camp. Even being the only doctor there, in her absence, seemed leisurely in contrast to Sa Kaew.

But once in a while I still reflect on how much difference a single piece of mail can make when it carries the right offer.

Wednesday, March 25, 2015

Mass Response to Genocide part 2

The dead bodies were still there or, more probably, new ones. What struck us most about the hospital was the lack of conversational background noise. Just coughing, in a constant undercurrent.
Our new tent, Ward 8 (someone later altered the numeral to depict a snowman-like figure gripping his belly) was ninety feet long and twenty feet wide, open sided, with 150 sick human beings, everyone crowded in at random, lying on bamboo mats on the ground. About fifteen more outside the far end of the tent were under lean-tos of plastic and sticks. Some had tags noting treatment given at the Thai border; others had letters inked on their arms standing for medicines they had received; Q for quinine, F for fansidar (another anti-malaria drug). We had no idea what some of the other letters meant. We had no translator the first couple of days, and the patients spoke only Khmer.
If any of them had education, they weren't about to let the Khmer Rouge soldiers among them know about it. It is said that Pol Pot's government summarily shot anyone wearing eyeglasses. The Khmer Rouge's brave new world had no use for any schooling other than their own indoctrination. Those first few days, no refugee wanted to call attention to himself by being the first to do anything.
Lois and I, with a clipboard and basket of medicines, started on the nearest patient. We marked a number 1 on her arm, listened to her chest, felt her abdomen. Started her on
anti -malaria treatment, B-complex for beri-beri, and iron for anemia, made a note on the clip-board, and moved on.
Patient number 4 had diarrhea. There were no bedpans. Those patients who were strong enough crawled to the 8-inch-deep latrine ditch at the edge of the tent. Weaker ones lay where they were. There were no clean clothes to change into; that first day there wasn't even a rag to wash them with. We found some old newspapers to put under her, gave her paregoric and an antibiotic, started a bottle of intravenous fluid, hanging the bottle from the tent frame on a bent piece of wire.
We moved slowly on down the tent. Some had massive swelling of their legs and bellies from protein deficiency; many were burning with fever. Many were pale from severe anemia, or too weak to stand, from lack of vitamin B. Both the Khmer (Cambodian) and Vietnamese armies, seeking to win their war at any cost, destroyed each others farm crops. Many of these people had had nothing to eat for months, except leaves from the trees in their forest refuge; no protection from malarial mosqitoes and other jungle fevers. Several had deep ulcers, bed sores from lying for days in one position out in the jungle. Many children lay listlessly, or having a futile try at their mother's dried up breasts. Children and some adults had arms and legs not much bigger around than my thumb.
      I felt a dull, bitter anger inside me toward leaders who make war and make other people pay the price. But mostly there was only time for squatting down again to listen to another chest, feel another abdomen, start another IV bottle. My muscles ached with the constant bending, kneeling, and stooping. We drank quarts to replace the sweat. On later days we ate all the lunch that Winnie and Aree packed for us, but that first day the scene was all too new for us, we weren't hungry. Somewhere in that day, an American Embassy doctor pitched in and helped; but by sunset, when it was time to go, we still hadn't seen everybody.
      Bob Jono and I had to stay after dark to attend the nightly staff meeting, where the day's problems were ironed out. When I learned that each group had to provide a doctor and nurse every five days to cover the whole 1,200-bed hospital from 6 pm to 8 am, I thought I'm finally getting too old to take it anymore! We got back to town about 7:30, ate supper and fell into bed.
But as we weathered he first few days, things got better. We got a small tent to keep our medicines and eat our lunch. We built up our stock of medicines, and what we didn't have we knew where we could trade. Bob found us a refugee who spoke fluent Thai and a little English, and we could finally communicate with our patients instead of practicing veterinary medicine. Weena mass-produced a gruel of milk and protein food made by Thailand's Kasetsart University and passed it around, a cupful to each patient twice a day, to supplement the food from the camp kitchen. We got so we could finish morning rounds by 3 pm, and one afternoon we cleaned out the dirtiest mats and had the patients lie in three rows, with space to walk between. We discharged enough healed patients into the larger camp (now numbering 35,000), bringing our tent's count down to 100, and moved all the outside patients in under the tent. We shared medicines and nurses with tent 9 next door, where a couple of American doctors on loan from some research group were getting acquainted with clinical medicine.
      And the tent grew noisier. People had enough strength to talk now, and sometimes even smile. One little girl with diarrhea and pneumonia and no family to look after her, whom we left each night not expecting her to survive till morning, sat up one day and began shouting something. Tann, our translator, grinned and explained, “She' s saying she doesn't want that old soup, she wants a fish!” We not only found her that, but a banana too.
Excitement broke out at the far end of the tent one afternoon. A girl who had been separated from her family a year ago suddenly spotted her father and sister walking by outside.
      There were discouraging things too. People who couldn't be persuaded to eat, the comatose who sank lower and lower and quietly died a few days after reaching camp. (Miserable as the camp was at first, it was a big step up from starving unattended in the hills.) Our ward averaged about one death a day now, as did other wards. The record for the whole hospital and camp was 42 deaths in a single day.
      We got to know many of our patients after a fashion. (Asking their personal history was taboo; there were still Khmer Rouge agents among them.) There was the mother who hated shots more than her three kids did. The one-legged man on crutches who led his blind friend with a stick. The young man with TB. The comatose girl with cerebral malaria who developed a bed sore overnight when there was no one to turn her. The old man with gradually healing leg sores.
In our second week there, an Israeli team arrived to take over the tent next door from the departing American researchers. Wearing green scrubs emblazoned with a red star of David, they soon developed a receiving ward and accepted all new hospital patients around the clock for emergency treatment before distribution to other wards. The Israelis were a friendly bunch, but we were embarrassed to have only ham sandwiches to share the day they arrived.
      The hospital as a whole, now down to 1,000 patients was under the joint direction of the International and Thai Red Cross, but we other groups operated under them almost independently: the French “Medicin Sans Frontiers”, World Vision, C&MA (us), and the Israelis. A group of Catholic sisters took care of about 400 orphans; a German doctor had a special nutrition unit, and a lab technician from somewhere opened up a blood bank. He drew blood from the many visitors to the camp and split each unit into two two half pints. (When your hemoglobin is down to 2 grams, even half a unit of blood can double it. The French unit delivered two or three babies a day. Even at full term, they mostly weighed only 3 or 4 pounds.
     to be continued . . .

Sunday, March 22, 2015

Mass Response to Genocide

Fall harvest time was never very busy at Maesariang Hospital in northwestern Thailand. Patients don't want to leave their fields unless they are practically dying. Seeing some of the refugee horror stories in the Bangkok newspapers, and having time on our hands, we wrote a letter to the mission refugee committee, offering some time if they needed us. A telegram from committee member Pat Coats asked for as many as possible to come right away to work at the Cambodian border, 500 miles to the southeast.

Half the hospital wanted to go, but of course our hospital in Maesariang had to be kept running too. Five of us finally went, Rosa, a Puerto Rican nurse; Mala, a Karen nurse; Weena, a Karen aide; and my wife, Lois and myself. We got the telegram October 25 and were on our way next morning, taking the bus to Chiangmai, and the overnight train to Bangkok.
We would be on loan to CAMA services, Inc., the service arm of the Christian and Missionary Alliance mission, which has long worked in Cambodia. We drove over to their offices to meet our co-workers and learned that the Thai military had just opened a large refugee center at Sa Kaew. The International Red Cross had set up a hospital there with several hastily gathered medical teams. CAMA had a permanent medical team forming in the Netherlands, but it would not arrive for two weeks.

Some of their workers had helped in the search for refugee groups along the border near the Thai border town of Aranyaprathet,and reported thousands scattered here and there in the bush, many dying or too weak to walk. They were being moved back away from the border to cut the risk of hot pursuit into Thai territory by the advancing Vietnamese army tanks. These refugees were mostly people pressed into service by the Khmer Rouge, whose army remnants were backed up against the Cambodian forest border with Thailand. 
It's a three-hour drive by mini-bus from Bangkok to Sa Kaew; good highway through farm country, where the pervasive vinegar-like smell of the drying tapioca crop permeated the air. Our guide said we might as well stop at the camp before going on to our living quarters in Sa Kaew town, ten miles further on, so we pulled off on a dirt side-road, where armed guards checked all traffic, and handed out passes for those authorized to enter the camp.

Our first impression was of barbed wire and mud. The camp was only in its fourth day of operation, bulldozed out of swampy rice fields, sheltering about 30,000 black-clad people behind a fence. We had to step from grass hummock to tree root to get around. At one point, Lois had to reach elbow-deep into the mud to retrieve a shoe.

The hospital area was on slightly higher ground but otherwise chaotic. We were introduced to someone who said, “Fine, go to work in that tent over there.” We had been up since 5 am, some of the girls needed a toilet, and we hadn't even seen where we were supposed to lodge. But the word was “Work a little now, so you'll know the problems by tomorrow.”

I entered the indicated tent, where a harried-looking doctor was carrying a large cardboard box. Motionless patients lay every whichway on bamboo mats on the mud floor. We had to duck to avoid the bamboo cross-pieces in the tent frame. His box contained a jumble of paper cups of pills, syringes, bottles of liquids, bags of intravenous fluids, six-by-eight inch cards and so forth. The first thing that happened was the bottom dropped out of the box and everything slid among the patients. I went to find another box, finally dumping some bottles out of a carton I found in a supply tent. A patient needed a shot. I borrowed one from the more organized tent next door. The doctor himself had only started work that morning. Two Red Cross doctors had already quit after working only two days. He looked at another patient. “The A on his arm means he's been given ampicillin. We'll give him another shot of it now.”

“That's an every-six-hour drug,” I said, “Who gives it at night when we're gone?”


Most of my three-hour stint that afternoon was spent looking for things. The doctors in the far tent spoke French. The British lady presiding over a card table full of medicines in Tent No. 1 was having enough trouble supplying her own patients, so I hunted among the unattended supply tents. I began to get dizzy every time I stood up. The heat was oppressve, and I was wet with sweat. The other members of our team were presumably off with other doctors. Several dead bodies, rolled up in the mats on which they'd lain, were in a row between the tents. No one paid them much attention. It began to rain lightly.
At dusk, our guide found us and told us to round up and move on. I found Lois way over in the orphans' tents, following a doctor with no more idea than I where to find the medicines he was ordering. Then the word word went through the hospital, “They're unloading another convoy. Come and help!”

Out on the road we stood in back of several large Thai army trucks, helping down emaciated people who couldn't have weighed more than sixty pounds apiece. Most needed help to walk, and held on to small bundles or cooking pots. Several husky young volunteers scrambled up into the truck to hand down a half dozen people who made no effort to move. Some felt very hot to the touch. I found myself trying to hoist the mid-section of a rather large unconscious man onto a piece of cardboard. Four of us struggled through the mud to the fence and pushed apart two strands of barbed wire to hand him through to volunteers inside.

We were all bone-tired on the 10-mile ride into town. I admired the two Red Cross doctors who had managed to last two whole days. We got Chinese food at a restauurant, and finally arrived at the house rented for us by CAMA. A lady introduced herself as Winnie, and said there was plenty of bath water and clean beds ready, dormitory style. It was Winnie, and later her husband and Aree the cook, who made life possible during those next two weeks. Other teams told us later about their grungy hotel rooms and worse food, and coming home too tired to fix any dinner, but after our second day we always had a hot meal waiting.

Up next morning at sunrise. Our team leader, Bob Jono, told us we would have our own newly established tent to work in today. Remembering the disorganization of the day before, we stopped in town to buy a couple of folding card tables, plastic baskets, cups and tea kettles to carry water in, and five-gallon cans to carry it from the camp's water tanks.
We looked like we were on safari, moving through the hospital gate. On subsequent days we also carried cases of pop and big containers of crushed ice to combat the heat exhaustion we had felt the first day.
To Be Continued

Wednesday, March 11, 2015

New book coming

My blog posts have been infrequent lately, taking second place to a new work in progress, as yet untitled.
It is non-fiction, an inspirational collection of brief profiles of actual people I know - or have known - personally. Probably 1,000 to 3,000 words each, in final draft. They are people who have touched other lives around them, whether in their local community, or on a much broader scale.

Some of them I discovered by merest chance; others were my colleagues for several decades whose work took unexpected turns. I will try to discover how those lives did take that turn and, where applicable, because any of us might find such possibilities in our own future.

I think you will find them interesting, with occasional surprises. Deo volente, it will be ready for market this fall.

I am also trying to improve this blog and the nearly defunct website from which it sprang. I am a klutz with computers, so it may take awhile before I get two-way comment capability.  Come visit.