Salving the World

Sudan, Zambia, Bosnia-Herzegovina, Tajikistan. They're all countries the U.S. State Department has advised avoiding at all costs. Deb Van Dyke has called each of them "home" -- at least temporarily. The 49-year-old nurse-practitioner spends about half her time caring for patients at the Mad River Valley Health Center in Waitsfield. But for up to six months each year, she volunteers for the international humanitarian aid agency Medecins Sans Frontieres, or Doctors Without Borders. She's watched children die of starvation and disease in the line of duty. Her clinics have been shelled.

"I don't know if it's radicalized me or humanized me," says Van Dyke, whose quiet manner and kind face belie her harsh experiences overseas. "I've gotten more grounded in reality."

Founded in 1971 by French medical doctors, MSF now serves 80-plus countries and operates on a nearly half-billion-dollar budget. Currently, more than 2500 doctors, nurses and logistical experts are working around the globe in situations that range from mildly dangerous to severely perilous. A Google search for "aid workers killed" yields hundreds of hits. MSF's Web site lists 18 killed in 2003 alone. Arjan Erkel, a Dutch MSF volunteer working in Dagestan, was kidnapped by armed gunmen in 2002. Despite intense international pressure, he has yet to be freed.

Cooperating with the press isn't part of Van Dyke's job description. She agreed to be interviewed for this story only after a great deal of thought, and with considerable reluctance. But as an MFS volunteer, speaking up about what she sees in the field is a crucial part of her work. In MSF-speak, it's called temoignage, which means bearing witness to suffering that would not otherwise make the world's radar screen.

Whistle-blowing can make a dangerous job all the more so. While serving as field coordinator in a Zambian refugee camp in 2001, Van Dyke realized that another aid agency was skimming food rations for profit. As a result, refugees were suffering from severe malnutrition. When Van Dyke took her allegations to United Nations officials, she was putting herself -- and the MSF mission -- at considerable risk. Several years earlier, a Jesuit Relief worker who pointed out this same malfeasance was shot in the stomach.

For volunteers like Van Dyke, however, the gains far outweigh the discomfort and personal risk. "I get such satisfaction from working with local people who are in such great need," she says. "It may be the first time in their life that someone has listened to them, cared for them, treated them. You give them hope."

These sentiments undoubtedly drive many MSF volunteers. Wherever conflict and disaster strike, it seems, dedicated teams of health-care professionals are there treating staggering numbers of people: therapists providing counseling in Palestine; AIDS treatment programs in Kenya; in France -- a country not normally associated with hardship -- social support programs for immigrants and drug addicts.

Understanding the importance of prevention, MFS also focuses on public health. Workers provide vaccinations, improve sanitation and set up water-treatment facilities. Because MFS teams are so small -- staffs of just three or four serving as many as 250 patients a day -- it's vital to train locals to help. These people often continue to do medical work in their countries, making MSF's work more sustainable.

With such an expansive reach and broad mission, you might expect MSF to be a lumbering, bureaucratic beast of an organization. Not so. Lightning-quick and remarkably agile, the nonprofit is an aid agency Donald Rumsfeld would envy. In October 2001, volunteers were forced to evacuate an office commandeered by the Taliban in Kandahar, Afghanistan. As soon as they were ousted, though, MSF personnel reclaimed the office, restocked medical supplies and began rebuilding the city's devastated infrastructure. In Iraq, surgical teams were in Baghdad's al-Kindi hospital at the start of the U.S.-led war. Trucks loaded with supplies were in the city just six days after the bombing began. Despite the capture and subsequent release of two volunteers and the evacuation of its Basra team, MSF personnel are still on the ground.

This kind of dedication hasn't gone unnoticed. In 1999, the organization was awarded the Nobel Peace Prize, along with a check for almost a million dollars. Citing a willfully ignorant, profit-driven pharmaceutical industry, MSF announced it would use the money for a "Neglected Disease Fund" to treat tuberculosis, malaria, sleeping sickness and Leishmaniasis, a parasitic disease that affects some two million people each year and is fatal if untreated.

Volunteers like Van Dyke personify the organization's commitment. But, with characteristic humility, she deflects the attention. "The real story," she says, "is the life and people in these places -- their courage, resilience, and love amidst it all. It's not about me. Working with them has just given me a deeper understanding of the world and an urgency to work for something better."

Van Dyke is neither a globetrotting dilettante nor a blank-eyed Birkenstocker. She's an aid worker's aid worker, driven by a world-wise, field-forged philosophy of compassion and relentless determination to make the world a better place.

This view permeates her life. Locally, Van Dyke is involved in the peace movement and also organized a group called the Green Mountain Global Forum, which brings in speakers to talk about international issues. Before joining MSF, Van Dyke worked with such underserved populations as inmates, immigrants, American Indians and people living in Appalachia and in inner cities.

Looking at the trajectory of Van Dyke's life, it's not difficult to trace activist origins. She was born to a middle-class Quaker family in Michigan. Her great-grandmother was a suffragist. As a child, Van Dyke often hiked in the woods with her grandfather, an experience that instilled in her a deep respect for the environment. This love of nature later propelled her towards an Outward Bound program as a teenager. It was a formative experience and she credits the program with teaching her self-reliance and improvisation, skills that would later prove essential overseas.

Van Dyke also came of age in the '60s. "In that generation," she says, "you did something for the world, rather than doing something for yourself." It was a notion that stuck. After graduating from the University of Michigan with a degree in natural resources, she took a summer job with the state of Maryland evaluating its coastal zones. It was a great job, but it didn't provide much of a challenge. And she realized she wanted to work with people.

During a rainstorm one day, Van Dyke wandered into a local library intent on a lazy afternoon of reading. While browsing through the racks, a book caught her eye. It was Immaculate Deception by Suzanne Arms, which was vigorously attacking accepted beliefs about childbirth in the U.S. Reading it was an epiphany.

"I realized that if there was anything I could do with my life, it would be giving women choices about how they would have their babies."

She applied to the El Paso Maternity Center, a competitive midwifery school in Texas, where, she says, only 12 of 400 applicants were accepted. With no background in medicine or childbirth, she assumed her odds of acceptance were slim. But for reasons she still cannot fathom, the school's director tracked her down several months later. She offered Van Dyke a position and gave her one day to decide.

This entree into medicine was also a baptism by fire. Van Dyke was a novice. The hours were long and difficult. The center performed well over a thousand births each year, a staggering number for even large, modern hospitals. Like Outward Bound, though, the midwifery program was a proving ground. While learning to catch babies and care for mothers in labor, Van Dyke was also honing skills -- compassion, teaching, dealing with crises -- that would be vital in her later work.

After El Paso, Van Dyke came to Vermont to work as a midwife. It was a good fit, but still not perfect. The women in the Green Mountains were seeking her services as a matter of choice rather than need. And the field of midwifery itself was too limited. Seeking to broaden her scope, in 1986 she enrolled in Yale's nurse-practitioner program.

Soon after graduating, Van Dyke left for Nepal to work in a primary health-care center. There, her eyes were opened. "We saw lots and lots of cases related to poor water and sanitation… I was treating the same people over and over," she says. The U.S., Van Dyke realized, has an advanced public-health system that's too often taken for granted: a safe food supply, universal vaccination, reliable water and sanitation, safe birthing practices and emergency facilities that are quickly accessible by most of the population. "In poor countries," she points out, "people die of preventable, mostly infectious diseases."

Van Dyke returned to the U.S. and went back to school again, this time at Harvard, for a Masters in Public Health. While in the program, she met several Medecins Sans Frontieres veterans. The organization had just set up a New York recruitment office, and she decided to give it a try. The interview was "very intimidating," she recalls. They asked, "How would your loved ones feel if you came home in a box?" Van Dyke left the meeting sure that she'd flunked. But she'd underestimated herself.

The first two offers that came her way were "too risky." But Van Dyke accepted the third MSF mission, in 1993, to Tajikistan, a small country on Afghanistan's northern border. "I had to look it up on a map first," she remembers. With jagged, knife's-edge mountains and a bleak, brown landscape, it was not a welcoming environment. She arrived at the end of a civil war between the Moscow-backed government and Islamic United Tajik Opposition.

Bombs and bulldozers had destroyed people's homes. Checkpoints were everywhere and Russian tanks rumbled down the streets. At night came the staccato pop-pop-pop of Kalashnikov assault rifles. Food was hard to come by. "You'd go to local markets," she explains, "and all they had was boxes of matches and pasta. The war had just devastated the economy."

Van Dyke and the other members of her team -- French-speaking expatriates -- began rebuilding the area's health-care system. She visited remote villages in a "mobile medical unit," a white 4x4 pickup. Her team set up a supplementary feeding program, revamped a clinic and trained local staff in Western-style medicine. But the Tajik physicians bristled at the notion that they needed to be taught and the assignment ultimately was cut short.

As frustrating as the situation was, Van Dyke thrived on the experience and even returned the following year to work in the northern part of the country. "I enjoyed the team's camaraderie. I loved the intimacy of the work and the generosity of the local people," she says. "They would follow our Jeep and give us pomegranates or invite us in for dinner."

In letters home, Van Dyke described riding horseback in the mountains and local village weddings; lunches of fresh fruit, nuts and, occasionally, vodka. But those sunny accounts are overshadowed by darker images. Refugees returned to find their homes demolished and their former enemies running the health-care system. For these people, a simple trip to the hospital was something to be feared.

"There was an amazing amount of distrust," Van Dyke says. "I think what I really came away with was an understanding of the inanity of war." Ten years later, she adds, Tajikistan is at peace. "They have rebuilt their lives," she says. "It's a miracle."

In 2002, Van Dyke accepted a position in South Sudan; it proved to be her most challenging assignment. Five decades of civil war between the Sudanese government and the Sudan People's Liberation Army had mired the country in a colossal humanitarian crisis. By the late 1990s an entire generation, she says, knew nothing but war and hunger.

The work, needless to say, was breathtaking in scope. Along with 60 local staff, Van Dyke worked at an outpatient center, maternity ward and therapeutic feeding program that served a community of more than 100,000 people. The set-up sounds sophisticated, but buildings were little more than mud huts with thatched roofs. Patients' beds were made from wood pallets that cargo planes had used for food drops. There was no X-ray machine and no surgical facilities. Imagine "ER" but without electricity, fancy diagnostic tools or the option to walk off the set.

Security was also an ongoing problem. The MSF camp was located near a railway that supplied the Sudanese government's garrison towns. Men called muraheleen guarded the tracks. The Arabic word means traveler, but Van Dyke describes them as little more than unpaid thugs the government allowed to loot, kill and kidnap freely.

Later, though the buildings' roofs bore MSF logos, the camp was bombed by a government plane. Van Dyke and the others saw it overhead, barely visible against the African sun. Then the sound of its engines dropped to a low hum and everyone ran for shelter. A moment later, six bombs exploded on the camp's food-drop zone, killing two people and injuring 10 others: an awful event, but not as bad as it might have been, according to Van Dyke. One week earlier, hundreds of women had been waiting in line to collect food where the bombs landed. "It can always have been worse," she says.

In her typically philosophical fashion, she points out that the tragedies her work entails -- whether in war-torn central Asia or peaceful central Vermont -- are counterbalanced by miracles. In Tajikistan, Van Dyke's team was able to save two men critically injured by a grenade. One had a gaping hole in his chest. There was no way to tie off the artery and his blood pressure was dropping. They hooked him to an IV, packed his wound and hoped for the best. The other patient was worse -- an abdominal wound severe enough that his intestines leaked out. Van Dyke expected to see sheets over both men's heads in the morning. The next day, she walked into the clinic and found the man with the chest wound sitting up in bed.

Van Dyke is privy to a rare worldview. Big-picture suffering and small miracles. Abundance and deprivation. Humanity at its best and at its worst. "Having one foot in Vermont," she says, "gives me continuity in my practice and the opportunity to know families in the Valley. Working overseas has taught me about the world's inequalities, human resilience and bonds of family that are universal."

Donations to Doctors Without Borders can be made on www.msf.org [1].