‘Mormon Mother Teresa’ Tries to Ease Suffering in Somalia : War: A physician’s assistant from Baltimore holds God’s proxy, deciding who will be cared for first--and sometimes who will die.

Death surrounds Carol Forrest, taunting and challenging her in the casualty ward of a blood-splattered Somali hospital halfway around the world from the comforts of America.

A 3-year-old girl shot in the head; a little boy dead on arrival; a starving woman found unconscious on the side of a road, so thin she was thought to be a child.

Who will care for the victims in this lawless, anarchic nation on the Horn of Africa, where 350,000 Somalis died last year? For Forrest, a physician’s assistant from Baltimore, it is God’s calling.

She toils to save Somalis consumed by their own society run amok with guns, clan fighting, crime, famine, and a lack of native doctors, medical equipment and personnel. She holds God’s proxy, deciding who will be cared for first.

“We patch people up and we send them out,” she said. “They get shot and they come back again. I feel sometimes I’m helping people get well so they can keep doing what they’re doing.”

Bandits roam the streets and highways plundering and murdering the very relief workers who are trying to save their country. “I think my religious background has given me the foundation and the strength to be able to come here,” said Forrest, a devout Mormon.

“I sometimes feel like a Mormon Mother Teresa. I feel very strongly that I was supposed to come here for a reason.”

The cruel reality of Somalia is mirrored in Forrest’s log.

Sunday, Dec. 20, 1992: “Wow. What a rough day. I can’t begin to describe to you how I’m feeling. We had so many casualties today and no doctor was there to take care of them. Just me.

“There were two men with abdominal eviscerations (intestines hanging out). One man had two gunshot wounds to the side which tunneled superficially yet who knows where. . . . Two gunshot wounds to the left femur. One to the left humerus. One to the right hand. Multiple cases of shrapnel. Other gunshot wounds to the abdomen.

“Two serious car accidents. Another man had half of his feet blown off. The list goes on and on. And where were the (Somali) doctors during all of this? Good question. I did my best to triage. I left the less-serious and tried to manage the more-serious. It is absolute bedlam and utter chaos.”

Each dawn brings a new onrush of victims who line the corridors of Digfer Hospital, a hellhole of human misery--74 casualties alone on Sunday, Jan. 10.

“There was a lot of clan fighting which apparently the Marines broke up,” Forrest wrote in a letter Jan. 15 to her parents, Bobby and Doris Forrest, who live in Kansas City, where she was born. “We had 74 casualties, 54 gunshot wounds. Eleven of those people needed operations to explore their abdomens.

“It was absolutely insane. There were bodies lying everywhere. You just had to leave the less-serious and some of them laid around for hours waiting for us to get to them. Amazingly enough, there was only one death in the emergency room, although about four died either in surgery or just after surgery. I was wiped out for two days after that. I need to care more about the Somali people.”

And who will keep Forrest herself from death’s grip, at the age of 38? Her sanctuary is a house with walls and steel gates manned by bodyguards with rifles. There’s a hole in the wall of one of the rooms. A gunman took a shot at her boss but missed.

She awakens about 7:30 each morning and reads her Scriptures for half an hour, either the Bible or the Book of Mormon. She prays.

She came to this land of little from the comforts of teaching French and German in Maryland schools. Her father was manager of one of the largest motorcycle dealerships in the country, but she never rode a motorcycle.

“They didn’t want me to because they’re dangerous,” Forrest recalled.

She changed careers from teacher to physician’s assistant in June, 1989.

“My best friend was a medical student at Johns Hopkins and she and her roommates were always talking medicine and I was hooked,” she said. “I really enjoyed teaching but I didn’t feel like it was what I should be doing with my life. Once I found medicine, I knew I should be in medicine.”

Until last November, Forrest had served for 18 months in the Central African Republic as medical officer for the Peace Corps and the U.S. Embassy. She says she does about 80% of what a doctor would do.

She arrived in Mogadishu two weeks before Christmas as a paid volunteer under contract with the International Medical Corps for six months until June. The Los Angeles-based nonprofit organization provides surgery and medical care in high-risk areas, using American and some foreign personnel.

“I wanted to do something tough,” she said. “I wanted to go where I could make a difference for a long time. It’s a personal challenge to see if I had it in me to measure up. Seeing the starvation and the hopelessness of the war, I figured this is one of the best places I could be.”

So it is.

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Thursday, Jan. 14: Forrest is in perpetual motion, propelling herself through dark corridors and small examining rooms where the only light is the sun squinting through windows.

She is staring at death in the anguished faces of those who plead for care and cry out in pain. She is everywhere--in the wards, in the operating rooms, in the pharmacy. She implores her Somali colleagues to work faster.

“I have a drive in me to leave a mark for good in the world, not for the personal recognition, just to do something that will help the world be a better place,” she says.

The wounded and sick lie on crude tables soaked with blood.

Flies hover over a 13-year-old boy. His brother is standing at his side, nonchalantly holding up a plastic bag of blood he has donated for the boy’s surgery.

There are no blood banks here. The family must bring their own or a husband or wife or son or daughter dies. Forrest once gave of her own blood to save a man who had no family. Blood is good for only 30 minutes out of refrigeration, so the doctors must hurry with the boy.

Forrest is rattling off orders to her Somali colleagues to keep fluid moving in his vessels intravenously until he gets a blood transfusion in surgery. She is trying to determine if he is paralyzed. The bullet from bandits entered his lower back.

“Does he have two IVs in? This should be coming out very quickly.”

“Ask him to move his legs. I cannot lift the leg.”

“Ask him where he can feel.”

The boy is swathed in blood. Nurses turn him over to carry him to surgery. He screams in pain.

There are many others. One man with gunshot wounds in his leg and thighs, another hit in his shoulder. They were stopped by highway bandits who took their cars.

Across from the boy is a 65-year-old man moaning in pain, “Oh, Oh, Oh.”

“This man has a huge hole in his right hip,” Forrest says. “He’s very tender here, which would be an indication to explore the stomach to see if any organs were hit, plus it could have nicked some of his small bowel. The rectal’s OK. He’s got a fractured hip. You can feel it’s shattered. I can’t tell if it’s into the abdominal cavity.”

“In the States we could do MRIs. You could do CAT scans. You could do X-rays. We can do X-rays here, but they’re not very good quality and we’re really low on film so we’re being very selective about it.”

“Wiggle your toes,” she tells another man with a bullet wound in the big bone of his upper leg. There is so little of everything that his leg is immobilized with a cast made from cardboard. What little drugs there are are kept under armed guard.

Forrest is concerned because there is no pulse in the man’s lower leg, meaning there is no blood supply there. He needs immediate surgery and she must find a general surgeon to repair the vessel.

Forrest shouldn’t even be working this Thursday. The day before, she fell ill herself with diarrhea and fever, almost passing out at the hospital, exhausted from helping save the lives of most of those 74 casualties in that Jan. 10 clan fighting.

“I didn’t stay home today because I knew they were going to be busy and they would need us,” she says. “I feel tired and weak but I don’t feel frustrated today. Today was fairly smooth. For the most part we had the supplies we needed. We were actually able to get people that needed to go to the operating room to the operating room.”

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Many wounded Somalis were dying in the emergency room because there is no telephone system and it was taking up to three hours to get them to the operating room.

But the real problem, her colleagues say, is that the war has taken its toll on the Somali doctors and medical staff, many of whom fled the country.

“When things are relatively quiet, they tend not to show up,” said Robert Goodman, an orthopedic surgeon from Durango, Colo., who worked with Forrest. “There’s a lot of work to be done on the wards and in surgery, but some of it we can’t do because we don’t have the Somali personnel to help. That part is very frustrating.”

The frustrations for Forrest are many: lack of supplies, the language barrier, and the work ethic. “The incredible amount of casualties coming in at once and the lack of personnel to deal with it, it’s very stressful trying to decide who you’re going to take care of first.”

So every day after work she exercises for at least an hour, jumping rope, doing calisthenics, and walking inside the walled compound of the IMC. It is too dangerous to go out on foot and she must be driven everywhere.

After a lousy day, she returns to the 10-by-10-foot room she shares with another IMC worker. She strums her guitar and sings one of her favorite songs, “Sunshine on My Shoulders,” escaping from the lows of Somalia to the fantasy world of John Denver’s ballad.