A Disaster When Boston Doctor Packs His Bags : Medicine: Tom Durant’s passport and visa photos are always close at hand in case he’s needed at a refugee camp or in a war zone.

For Boston physician Tom Durant, vacations are almost always a disaster.

Rwanda, Bosnia, Somalia, Afghanistan, Ethiopia, Kurdistan, Cambodia, Vietnam--whenever catastrophe strikes, wherever refugees flee across borders and crowd into camps, wherever hapless civilians are starving, dying by the roadside from cholera, mutilated by land mines, Durant is sure to show up.

When calamity calls, he puts in for vacation time, dons his lucky Red Sox baseball cap and heads off to volunteer his clinical skills, his infectious humor and his steely immunity to despair built up during three decades of a unique problem practice around the globe.

House calls on the homeless and the helpless are his prescription for anesthetizing “the Mickey Mouse of medical bureaucracy.”

Whether in a dusty tent hospital on the border of Cambodia or Rwanda or in the antiseptic tiled corridors of the Massachusetts General Hospital, where he is assistant director, this stocky, nearly bald medical missionary would never be mistaken for Dr. Albert Schweitzer. And his M-A-S-H-type humor and blunt vocabulary would surely startle the newest of Mother Teresa’s novices, as it sometimes does to veteran nurses and high-tech lab types.

Doc Durant, as he is usually called, except in Vietnam where he gloried in the title of “Tommy Tongue Depressor,” looks and often sounds like a battle-scarred, overage rugby player, which at 66 he still is, to the consternation of his wife Fredericka.

A founding member of the Beacon Hill Rugby Club, he still competes in the dinosaur division, for players over age 35.

“I’m a hooker,” Doc grinningly confessed over coffee and bagels in his office at Massachusetts General. “The hooker is the guy in the middle who hooks the ball out of the scrum, the huddle, while everyone piles on. So in refugee situations you’re used to being buried under burdens of chaos.”

The office is decorated with photographs he has taken of rice paddies in Cambodia, a sampan on the Mekong River in Southeast Asia, sunrise in Somalia, wood fires front-lighting a smoldering volcano in Rwanda, a stone bridge recently blown away from the Bosnian landscape.

Also there’s a rugby poster from the world championship at Twickenham, England, a helmet liner “liberated from an Iraqi militiaman” and some literature not found in your average doctor’s office: a pamphlet on putting the pieces together in Northern Ireland, a treatise on the proliferation of anti-personnel mines around the world, the annual report of the American Refugee Committee, under whose auspices he has treated the forsaken on three continents over the past 15 years.

Comparing the catastrophes he has witnessed is a grim compilation of mankind’s inexhaustible inhumanity.

“Afghanistan had the most refugees, over 5 million,” he begins. “Many had been maimed by the millions of land mines planted by the Soviets. Their planes dropped butterfly bombs, disguised as copies of the Koran, which kids often picked up.

“Kurdistan produced nearly a million refugees. Cambodia has just repatriated the last of its refugees. One Thai border camp became the second-largest Cambodian city.”

Durant has made 14 trips to Cambodia since House Speaker Thomas (Tip) O’Neill dispatched him in 1979 to assess the refugee situation.

“Our plane was one of the first to land in Phnom Penh after Pol Pot took over,” Durant said. “The city once had a war-swollen population of 2 million, but there was no one around. We saw about 1,000 Vietnamese soldiers, a total of two trucks and eight Russian limos carrying government officials, but no more than 20 Cambodians. An empty city, ghostly silent.”

In those crowded camps over the next decade the silence was broken by “harrowing stories we kept hearing about the killing fields. The horror continues. Land mines planted years ago claim 1,000 new victims a month: farmers digging their fields, kids bringing the cattle home. One out of every 230 Cambodians is an amputee.”

Somalia he regards as “by far the most dangerous. Shortly after we left in January four Indian doctors were killed at the hospital. There is more random gunfire than any place in the world. Your rented four-wheel drive comes equipped with a 15-year-old on the roof with a .30-caliber machine gun and a 12-year-old in the back cradling an AK-47. You realize their job is to protect the vehicle, not you.

“Thousands starved to death every day in a schizophrenic nightmare where a mile away there was a market with fresh vegetables and camel meat. But the people had no money. Sooner or later all refugee situations deteriorate. The guys with the guns get a disproportionate share of the food and try to make a buck while the very young and the very elderly die. Most of the gunmen were spaced out on chat, a mind-bending drug flown in daily from the slopes of Mount Kenya because it must be chewed fresh.”

Bosnia, Durant says, “was a completely different ballgame. Refugees in business suits and sports jackets who had lost everything: home, family, workplace. We scavenged for usable medical supplies in the ruins of seven hospitals blown away by the former Yugoslav Army. In Somalia, the deaths were the result of chaotic indifference. In Bosnia, they were premeditated and genocidal.”

But of all his experiences, “nothing matched the horror and magnitude of Rwanda. The number of dead in a short time was greater than any other place: 60,000 to 70,000 from cholera alone. At Goma, across the border in Zaire, corpses lined one side of the road, market stalls the other.

“If you were lucky enough to have a family, you got wrapped in a burial cloth. Otherwise, if you were off fetching water or firewood, you just died where you collapsed from massive dehydration. You can lose one-third of your body weight in two days to cholera’s devastating diarrhea.”

In Goma, Durant witnessed his “first murder. I saw a thief hacked to death in 15 seconds in the marketplace by four strokes of a merchant’s panga, the African machete. The first cut his scalp off, then two ripped apart his chest and the last was to the neck.”

Far from Massachusetts General’s computerized scanners and the latest laser technology, the Boston physician often finds himself practicing the most primitive brand of preventive medicine. “Even in the grimmest situation,” he insists, “there is always something worth doing.”

Four retired firemen from San Francisco and one from San Diego saved more lives in Goma than all the doctors put together, he says.

“They loaded two pumper trucks onto a C-5 cargo plane, put their hoses into Lake Kivu, after clearing the corpses away from the intake, and brought 300,000 gallons of fresh water a day to the camp 10 miles away. Clean drinking water was essential in replacing cholera’s enormous body loss.

“If you can drink, you can save yourself. Our own niche was organizing outreach teams to bring a replacement solution of sugar, salt and water to people in the remote huts too weak to walk to the clinic. In two weeks we inoculated 100,000 kids against measles, polio and tetanus, 10,000 of them were unaccompanied minors whose parents had died in that terrible tribal slaughter.”

Durant, who has taught at Harvard, Tufts and Boston University medical schools, helped launch a massive 10-year training program in Cambodia. All the native doctors had been killed by--or had fled from--the Khmer Rouge who, in their zeal to eliminate the educated elite, targeted for death anyone wearing eyeglasses. Young refugees with no formal education were trained in the camps to give inoculations, run tuberculosis clinics, instruct midwives, even perform surgery and amputations on those mutilated by land mines.

Even Durant’s carefully controlled demeanor of “detached involvement” was stretched to the breaking point one afternoon in Somalia. “We try not to eat in the camps because they have so little,” he said. “I was sitting in the cab of a truck with two small bananas. I stripped one and threw the peel out the window. A little kid picked it up and wolfed it down. Obviously, he got the other banana. It blew me away for the rest of the day.”

The idea of becoming a doctor came to Durant when as a young soldier on occupation duty in Korea just after World War II he saw thousands of homeless, emaciated children foraging for food in trash cans. After graduating from Georgetown medical school and doing his residency at Boston’s City Hospital, he hung his shingle in the Dorchester neighborhood where he was born and still lives in a 100-year-old house.

“The practice consisted mostly of relatives, medical students from City Hospital and some black patients,” he recalled. “It wasn’t very lucrative but it was lots of fun.”

He went to Vietnam in July, 1966, and for two years was Saigon’s public health adviser. Durant’s office in the ornate old city hall built by the French backed up on the mayor’s. The mayor was a Vietnamese physician and also a neurotic alcoholic who rolled a grenade around on his desk and kept threatening to blow away his problems. One day after a long wet lunch, the mayor unholstered his pistol and proceeded to shoot the numbers off on the clock hanging on his side of their mutual wall.

This writer first met Durant in a Catholic cemetery on the far side of the “Y” bridge over the Saigon River. Hundreds of refugee families were living under tarpaulins and scraps of parachute cloth hung between the gravestones. At a clinic under an awning stretched between the outspread wings of a stone guardian angel, Durant was clowning and laughing with the bedraggled urchins lining up to be examined. He fitted his Red Sox cap on one bawling moppet and allowed another to tune in on his stethoscope.

“Tommy Tongue Depressor demonstrates his tomb-side manner,” joked his pal Mike McGrath, a burly ex-Marine from Boston who had come back to Vietnam with the U.S. aid program. The name stuck. So did Durant’s enthusiasm for disaster calls.

Durant has always been too busy to play with what he laughingly dismisses as “doctor’s toys.” He has never belonged to a country club, owned a yacht or gone on a safari. He counts his rewards in the “incredible people you get to work with, real pros who can keep things in perspective and never lose their sense of humor.”

For the last five years Durant has been battling prostate cancer with a bravura toughened by tackling the roughest rugby opponents. “Running off to those terrible places is what keeps him going,” said wife Fredericka.