Physician trades battlefield medicine for training humanitarian doctors

Medical doctors in Syria have been attacked by nearly every faction in the country’s civil war, including the Islamic State and government forces loyal to President Bashar al-Assad (who happens to be a physician). Hospitals have been bombed repeatedly, either by accident or because they’re seen as shelters for warring factions.

In Syria and in other conflict zones, humanitarian aid workers can no longer rely on the insignia of relief organizations to shield them from harm.

Dr. Michael VanRooyen, an emergency physician who has worked in more than 30 war and disaster zones, and who now trains the next generation of humanitarian doctors at the Harvard Humanitarian Initiative, is not deterred by the increasingly perilous conditions under which so many of his trainees and colleagues operate.

“From here, you think everything in Syria is terrible and anyone who lands close to Lebanon is putting themself in harm’s way,” he said. “But if you know the ground truth, you can still get in.”

STAT recently spoke with VanRooyen, 54, at his home in Wayland, Mass., about his new book, “The World’s Emergency Room,” which weaves anecdotes from his career into a broad prescription for the future of humanitarian medicine. He also discussed his new job leading the ER at Brigham and Women’s Hospital in Boston, and the curious connection between his latest hobby and a doctor colleague who learned to slaughter a goat in his free time.

This transcript has been edited and condensed.

When you do simulation-based training, you take pains to put hostile child soldiers in the paths of medical workers. Why child soldiers in particular?

Child soldiers are a uniquely complicated problem. In the simulation, these children are both armed and often accompanied by adults, so trainees don’t know who’s exploited and who’s not, and they have to deal with these kids not as an adult but as a child. A child with a weapon. If anything can frustrate or unnerve someone, it’s this situation.

It was a young soldier in Zaire who put the barrel of a machine gun in your mouth, right?

Yes, in the middle of an interrogation. Many of the soldiers in Zaire were children or teens. Recruiting child soldiers is common across many African conflicts.

Aside from bribery, how do you handle these situations?

What they want — even more than money — is respect. And it sounds silly, but ultimately it’s about treating them nicely. I speak calmly and respectfully and give them something like gum or cigarettes and tell them I’m a doctor and offer to help if they need it. I ask their name, where they come from, and tell them mine. It personalizes it for them, which I think makes it a lot harder for them to abuse you.

You write that humanitarian aid is moving to a more local model, instead of Western saviors swooping in to manage everything. But depending on the politics of the region, that could make it even harder to coordinate an effective response among aid organizations. Any antidotes for that?

If you ask the average person what’s wrong with humanitarian aid, many will say organizations don’t collaborate and are wasteful. And they wouldn’t be entirely wrong, because in some cases you’ll have multiple organizations gathering data and trying to solve similar problems without sharing what they know. The need to rapidly deliver services supersedes the desire to collect data, but data collection is extremely important.

Two of our researchers at HHI, Patrick Vinck and Phuong Pham, developed a system called KoBoToolbox, which is essentially a way to send surveyors out with hand-held data collection devices. Once they survey the population, they can upload it, aggregate, instantly map it, and merge that data with other organizations. It’s been a very big contribution to the field.

It’s well-known that battlefield medicine has grown much more dangerous for medical workers and all other humanitarian aid workers. Are you still tempted to go back into the field?

I miss it a lot, actually. But I realize there’s an era for everything, and this is one where the field is better served by sort of creating the environment for others to do it. But some day when I’m not running a department and HHI, I’d really love to do it again. It’s a privilege to help in the field.

How challenging is it to go from practicing that sort of medicine to working a Tuesday day shift in a Boston ER?

The emergency department is so diverse and wildly interesting that boredom is never an issue. Humanitarian relief is mainly about populations and logistics and setting the stage to manage operations. In the emergency department it’s really about individual patients and a personal touch. So in many ways it’s a really wonderful counter-balance.

Now that you’re in a leadership role in emergency medicine in Boston, what’s on the agenda?

I’d like to build an oncology emergency department. We take care of trauma patients or heart attacks or strokes by bringing them right back and having a team descend on them, but patients with oncology emergencies have even higher mortality, and they may be deceptively ill.

At the Brigham, we’re building a clinical and research program and models around better oncology management, so high-risk cancer patients will be taken care of immediately by a staff that’s trained in oncology emergencies. I hope we can do better by them.

Tell me about your friend who slaughtered a goat.

Carlos! Fascinating guy. I was working as a physician in a mission hospital called Tenwek in rural Kenya. One of the physicians was an Argentinian surgeon, and on his day off, he was slaughtering a goat out back. I’m like, “Carlos, don’t the cooks usually do that?” And he just says, “No, I’ve never done this before. My favorite thing is to do something for the first time.” He slaughtered a goat. He built his own guitar. I thought that was a great thing.

Thus your new hobby?

Yeah. Keeping bees is super fascinating. They’re complex and endlessly interesting, and in the end you have something delicious to show for it. There’s a lot to learn, and I don’t know if I’ll be doing it forever, but for now it doesn’t take too much time, it’s fun for the kids, and I get to give my neighbors honey.

Some people might find it less than surprising that someone who thrived in the chaos of humanitarian medicine might feel comfortable in a swarm of bees.

(Laughs.) Bees are a lot easier to manage.