Must Read!! Doctors at War

80140100810940MAlmost two years ago, Mark De Rond, an ethnographer at Cambridge University in England, sent a manuscript to the Culture and Politics of Health Care Work series at Cornell University Press. As co-editor of the series, I reviewed the manuscript — Doctors at War — which has just been published . It was done in the form of a of field notes describing De Rond’s months embedding with surgeons in a field hospital in Afghanistan during what is euphemistically dubbed – in the US at least – Operation Enduring Freedom. In other words the US war in Afghanistan, which is being waged not only by the US military but also by allies from other countries like the British, who, with the Americans ran Camp Bastion. The British Ministry of Defense (MOD) had asked De Rond to go to Afghanistan to study teamwork among British and American surgeons in the field hospital at Camp Bastion. As he describes it in the book, Camp Bastion was “the most successful trauma unit anywhere in the world.”

From the moment I began reading, I knew how important this book was and the contribution it could make not only to the healthcare literature but also to the literature of war. The MOD agreed that De Rond had a great deal to contribute to our understanding of how people work together under stress and encouraged him to not only write a report but to turn his work into a book. Then when the MOD saw the book, the tune changed and the MOD tried to block its publication. De Rond was forced to get a legal opinion in order to proceed with publication.

When you read this book – and please, if you have any interest in the folly of war and its human cost, you must read this book – you will understand why we loved it and the MOD hated it.

In it De Rond follows a British surgeon whom he calls Jesus and his colleagues in their daily round of trauma surgery. As he reports, between 2006 and July 2013, “just short of 20,00 casualties to the field hospital.” These not only included military personnel but locals who were injured. These physicians had to treat enemy combatants as well as civilians, many of them children – collateral damage of the war on terror.

Which has produced its own terror. Day after day, they wade elbows deep into the blood and guts, veins, and limbs, of what this elective war has wrought. We see not only the amazing feats of modern trauma surgery – which thanks to modern technology and the skill of these surgeons, nurses, and other battlefield hospital personnel, save people who would have died immediately in other wars. We also see the horrific wounds and trauma with which they will have to cope for the rest of their lives. After only a short stay in Afghanistan, De Rond himself has to deal with the trauma of what he witnessed.

I urge you all to read this important book, which as Chris Hedges says in his foreword to Doctors at War, “shines a light on a reality we are not supposed to see. It is a reality, especially in an age of endless techno war, we must confront if we are to recover the human.”


Haiti /UN/ Cholera OpEd in New York Times

Renaud Piarroux’s OpEd on the UN cholera coverup in Haiti just appeared in the New York Times.  To read much more about this travesty read Ralph Frerich’s Deadly River, which I had the honor of editing at Cornell University Press.


Cholera patients received treatment at the St. Nicholas Hospital in St.-Marc, in 2010. Credit Dieu Nalio Chery/Associated Press

Marseille, France In late 2010, the Haitian government asked me to investigate a cholera outbreak that struck that autumn following the arrival of a United Nations peacekeeping unit. It quickly became evident that some of the peacekeepers, who had been rotating through Haiti as part of a mission started in 2004 to provide security and stability, had introduced cholera from Nepal, where the disease had been flourishing.

By scrutinizing the most affected areas and using maps to trace the disease, I demonstrated how the epidemic originated with the peacekeepers. I published my findings in a July 2011 article, and an independent scientific team confirmed my conclusions within a few months.

Despite the evidence, the United Nations refused to take responsibility for its role in the spread of the disease. As late as April 2012, a spokesman for Secretary General Ban Ki-moon said publicly it was not possible to conclude how cholera arrived in Haiti.

The denials lasted until last month when the United Nations finally admitted that it was involved in the cholera outbreak. A United Nations spokesman said the institution needs to “do much more” to come clean.

As a result of the United Nations’ introducing cholera in Haiti, then covering up its role and not doing enough to stop the epidemic, some 10,000 Haitians have lost their lives, and thousands are still being infected each month. This was a preventable calamity, and each time I return to Haiti to conduct field assessments, I am devastated by the loss of life.

Cholera is an acute bacterial disease that can cause uncontrollable diarrhea and kill within hours. A person becomes infected by ingesting contaminated food or water. It is fatal in up to 50 percent of victims who don’t get adequate rehydration therapy.

The epidemic started after a United Nations-commissioned Haitian contractor emptied the peacekeeper camp’s septic tanks, which were teeming with cholera bacteria, into a tributary of the Artibonite River.

In face of the scientific evidence, the United Nations’ denials have been shocking. For years, starting days after the first batch of cases appeared, United Nations officials did everything to suggest that the outbreak began in the brackish waters of the Artibonite River delta, far away from the peacekeepers’ camp. Later, the emergence of cholera was attributed to climate anomalies. Poverty and poor infrastructure, weakened from the earthquake that had hit in January 2010, were also blamed.

The United Nations also did its best to deter epidemiologists from tracking the origin of the epidemic. And Nepalese peacekeepers, in an effort to hide evidence, removed the pipes that connected the camp’s latrines to the stream below.

The United Nations’ stonewalling had ripple effects. Convinced that the spread of the disease was the result of intractable problems like climate and poverty, the Haitian government wrote a response plan that assumed the bacteria would linger in the environment indefinitely and new cases would continue to pop up. Cholera became accepted as part of the daily life of Haitians. One Haitian official told me he was comfortable with the status quo, as “only” 1 percent of cholera patients were dying. By incorrectly blaming Haiti’s climate and poverty, the United Nations crushed the hopes of Haitians.

The United Nations is developing a new strategy. Officially it will be the second phase of the plan drawn up in 2012 that was never fully put into place for lack of funding. This time, the United Nations will not be able to hide behind its fatalism. It has a second chance to clean up its own mess.

To rid Haiti of cholera, the United Nations needs to help reduce the vulnerability of the populations where the disease is rooted. In these areas, priority should be given to projects aimed specifically at improving access to clean drinking water. Only a little more than half of Haitians use a safe water source.

The United Nations must also help Haiti strengthen its ability to detect and control outbreaks. Field teams must respond immediately to cholera alerts, investigate the cause of the outbreak, educate the affected people, and secure clean drinking water through chlorination. The cholera response teams set up three years ago do extraordinary work, but they are too few and poorly equipped, and their funding is not guaranteed.

By admitting that it was involved in the outbreak, the United Nations made only a first and timid step toward a full assessment of its responsibility. The United Nations must continue to open up about what happened in Haiti, rectify the damage, and establish policies that prevent such disasters in the future. Its credibility is still on the line.

Finally UN Admits – Sort of — To Role in Haiti Cholera Epidemic

DRcoverI was thrilled to have edited Ralph Frerichs book Deadly River on cover up of the Haitian Cholera epidemic, which was published by our series on The Culture and Politics of Health Care work at Cornell University Press. Deadly River is a great medical detective story with French epidemiologist Renaud Piarroux as the book’s hero — the diligent scientist who traced the epidemic’s origins to UN Peacekeepers from Nepal.  Finally, the UN is beginning to fess up and Ralph has written a great OpEd for the Boston Globe about what the UN has to do next.  Please check it out. Also please check out Ralph Frerichs website.