U.S. Doctors Teach, Learn in Bosnia

Behind the lines of war here in central Bosnia, American doctors and nurses are teaching Bosnians how to run their country’s first emergency room. But the learning runs both ways.

“I’d like to think that I do more for these people than they have done for me, but that’s never been my experience,” said Dr. Karyn Chermel of Oak Park, Ill., on her fourth visit to Bosnia-Herzegovina as a volunteer.

During the shift change of emergency room supervisors at 2 p.m. on a summer Sunday, Chermel inherited two patients, both wounded Bosnian soldiers, from Dr. Bill Bozeman of Pensacola, Fla.

“There are a lot of heroes here--the people,” Bozeman said. “The ability of people living with incredible stress to endure is stunning--what happens here is so completely alien to our own experience.”

The emergency room project, sponsored by the Los Angeles-based International Medical Corps, is not big as aid efforts go, and it may not endure: A last-ditch $500,000 from Britain’s Overseas Development Administration runs out in December. Still, the project is a microcosm of the commitment and concern among private international agencies battling misery in the former Yugoslav federation.

More than four dozen private groups are at work in central Bosnia. They come from Europe and the United States principally, and make up a never-enough network of people putting themselves on the line.

They chip in with different specialties: doctors and nurses; experts on medicine, sanitation and logistics; social workers. Supplementing governmental offerings, they contribute water-purification equipment, generators, milk, food, vitamins, diapers.

At one refugee center near the U.N.-designated “safe area” of Tuzla, Islamic agencies sponsor psychologists to counsel women whose husbands are missing. The International Medical Corps immunized 2,400 children in five days at the same camp, while a French agency conjured up barbers who never wanted for customers.

Dutch and French aid agencies helped International Medical Corps establish Bosnia’s first emergency room, located at the big regional hospital here, converting what used to be an administrative wing for trauma care.

“They were doing triage in the foyer, sending patients off to specialist units the old way when we got here,” said Dr. J.R. Pyles of Maryland, the director at the emergency room project. “There’s still some resistance to us among older doctors at the hospital, but the younger ones recognize that we practice pretty good medicine.”

In June, the emergency room facilities held 2,000 patients, half of them war casualties, the rest the type of sick and injured people that any city of 150,000 generates.

“We get a steady stream of sniper and land-mine casualties until there is heavy fighting; then casualties arrive in large numbers from aid stations in the field,” Pyles said. One day last week, more than 100 wounded soldiers arrived.

The volunteer doctors, together with nurses such as emergency specialist Becky Lundqvist of Anchorage, Alaska, are essentially teachers: a particularly valuable commodity in Bosnia. The medical school in Sarajevo is closed, and so are all of the country’s nursing schools.

“I have learned more in these days than ever in my life. I’m a better doctor every day. The Americans . . . I have never seen such enthusiasm,” said Sanela Galijasevic, 28, one of the young Bosnian physicians being trained as an emergency room specialist.

Like many workers at the government-run hospital, she is unpaid. The Bosnian government is broke. “Two months ago we got a food parcel and some Bosnian money. Before that we got some money in October,” the young doctor said.

A steel town sapped by war and a steady influx of mostly Muslim refugees, Zenica is less than an hour from Sarajevo, but it is, at least for the moment, a peaceful enclave in a country at war. Most things work. Bosnian Serb shells are sporadic, more reminders than inflicters.

But in 1993, Croats and Muslims battled across Bosnia, and Zenica was a tragically different place when Chermel first arrived as a volunteer late that year.

“People were starving; patients were coming in wheelbarrows through the snow. I lost 20 pounds the first month I was here. The people came to work every day without pay because they wanted to learn from us. I have never seen such courage,” she said.

At 46, the gray-haired Pyles, who practiced as an emergency specialist in the Baltimore area for 12 years, gets a salary of $28,000 a year for his work in Bosnia.

There are fringe benefits.

“You get a little burned out after a while. I wanted a change,” Pyles said. “Then you work at a place like this and you realize again that you are helping. It has restored my love for medicine. My knowledge and skills are probably better utilized here than they would be any place in the world.”

One thing that has surprised them, the U.S. specialists said, is that Bosnia refuses to fulfill preconceptions they brought from home.

“We thought they would be separate ethnic communities, but that’s wrong. Different sorts of people live in the city--and work here together at the hospital--just like in any big city,” Pyles said. “Most of them say they don’t care for politics or war or ethnic hatreds--they just want to get on with their lives.”

There are everyday frustrations in the life of a volunteer doctor in a foreign country at war.

And there are successes that will linger for a lifetime. In particular, there is Amir Stankovic, a 29-year-old father of two, horribly burned in a gas explosion late last year.

“There were a lot of things he should have died from, but he didn’t,” Pyles said. “He lived with enormous pain; one day he begged me to cut off his legs. I wouldn’t, and he hung on.”

For eight months, Stankovic grappled with agony while U.N. officials searched for a hospital somewhere in the world that would take him as a long-term charity patient.

“It was just a question of whether he would die from natural causes or by suicide. And then they found the hospital. The look on Amir’s face when we winched him into the helicopter--in the middle of an air raid--will stay with me for the rest of my life,” Pyles said.

Stankovic, a Bosnian Muslim, is recovering slowly at the one hospital in the world that volunteered to take him. The hospital is in Tel Aviv.