Doctors give life to places they visit

AS someone who travels chiefly for pleasure, I sometimes feel guilty that I’m living off the fat of the land and contributing virtually nothing in return. Far better to improve the world during your travels, like the volunteers who work in needy, sometimes dangerous places for Doctors Without Borders.

The group, founded in 1971 in France as Medecins Sans Frontieres, is a nonprofit organization devoted to critical medical care. Its first mission was to famine-stricken Biafra, Nigeria, followed by Nicaragua after the 1972 earthquake and Cambodia in 1975, where doctors ministered to refugees fleeing the Khmer Rouge.

After that, branches of the organization opened in Belgium, the Netherlands, Switzerland and Spain. Then, in 1992, the group came to the U.S., where it raises money chiefly from private donors and enlists expertly trained physicians to work in some of the most remote, hard-pressed corners of the world.

Every year, about 3,000 medical volunteers take time out from their careers at home to join the missions, which last six months to a year. Those who are accepted are placed within six months, though they cannot specify where they want to go, and they cannot travel with a partner. In the field, they work with doctors from other countries and paid local staff members. For their efforts, they get transportation, accommodations, medical insurance and a monthly stipend of about $750.

It’s all-inclusive but not exactly a cruise. Andrew Schechtman, a family practice physician from San Jose, spent 12 months in Liberia during the West African country’s civil war about three years ago.

When the conflict heated up, he and his colleagues had to move from reasonably comfortable accommodations in Monrovia into the hospital where they worked to avoid artillery shelling on their commute. Five of them holed up in one room, sleeping on the floor around the satellite telephone, tending patients and eating a steady diet of lentils from the hospital’s diminishing stores.

Schechtman is first and foremost a doctor, but he is also a traveler. “I used to take long trips, for instance six months in Southeast Asia,” he told me in a telephone interview. “It was nice, but I didn’t get to know people. In Liberia, I lived alongside the local staff and really got to know the culture.”

Last year, his colleague Jeanne Cabeza, a San Diego-based internist, lived near the border between Thailand and Myanmar, where she treated patients suffering from tuberculosis, a curable disease that kills about 2 million people a year. She also loves to travel and has signed up for a second mission starting in November. She hopes it will be to Niger in central Africa, where the group has mounted a huge effort to care for famine refugees, especially critically malnourished children. “I will go anywhere,” she told me, “but I really want to see sub-Saharan Africa.”

For both physicians, the real recompense is the chance to make a difference, to work hard and get results they can see immediately.

Cabeza said that much serious illness in the U.S., such as heart disease, stems from social problems doctors can’t do much about. “In Thailand, $40 worth of medicine can save the life of a dying 20-year-old,” she told me by phone.

In war-torn Liberia, Schechtman tended patients with gunshot and artillery wounds. “As a doctor, it was the best work I’ve ever done,” he said. “I was saving lives every day, using every ounce of my effort.”

Spiraling violence in the West African country exposed Schechtman to the same dangers as his patients.

But, he said, even missions removed from war zones have subtle dangers. “There’s little support system,” he said. “If there’s a road accident or you have an appendicitis, there’s no one to treat you. You’re the only doctor around.”

The safety of volunteers is much on the mind of the group’s New York-based Executive Director Nicolas de Torrente. “We don’t go where there is active fighting,” he said.

But volunteers are always unarmed and in violent places they have only their medical bags, neutrality and identity as humanitarian aid workers to protect them.

These weren’t enough June 2, 2004, when five volunteers were killed on a routine mission in Afghanistan, where the group had worked for more than 20 years. The organization later left the country.

“Getting caught in crossfire is one thing,” De Torrente said. “But we can’t expose our people to an environment where they are deliberate targets. In all, 48 workers from aid organizations have been killed there. It’s a trend.”

Unlike other aid organizations, Doctors Without Borders doesn’t promise confidentiality when it mounts a mission. It speaks out about what its volunteers witness -- ethnic cleansing in the Darfur region of western Sudan, for example, or Russian government closure of refugee camps in Chechnya -- which some critics view as taking sides.

Nor does the group wait for the consent of all parties in a conflict before it enters a troubled country, such as Haiti, where political strife has caught thousands of civilians in the crossfire.

This group has one major goal: providing acute care in critical situations.

To do that, De Torrente said, it must move fast, unimpeded by bureaucracy and the need for official permissions. Its unaffiliated status and largely nongovernmental funding -- about 80% of its budget comes from private donors -- help make that possible.

The organization has teams on standby, logistical centers and warehouses full of specially designed medical crisis kits containing, for instance, supplies a doctor would need to treat 600 cases of cholera or 150 gunshot wounds.

When the tsunami struck South Asia on Dec. 26, the group was there, thanks in part to $125 million in emergency donations. As money and aid flowed into the region from a range of relief organizations, contributors to Doctors Without Borders were asked for permission to use tsunami funds in other areas suffering from less-publicized crises. As a result, since the beginning of 2005, the organization’s volunteers have been able to treat twice as many starving children in Niger as in the same period last year.

I won’t be going to Niger any time soon, but I hope Cabeza gets there. She and other volunteers are proof of the good that can come from travel, prompting casual wayfarers like me to venture into the world with consideration and compassion.

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Susan Spano also writes “Postcards From Paris,” which can be read at latimes.com/susanspano.