Review of The World’s Emergency Room by Michael VanRooyen

The World’s Emergency Room: The Growing Threat to Doctors, Nurses, and Humanitarian Workers by Michael VanRooyen

 

A review by Jennie and Roger Sherwin

In 1945 when Allied troops liberated The Netherlands, an unlikely warrior accompanied them. American pediatrician Clement Smith flew into Amsterdam and then The Hague to study the effects of history’s first and only clearly delineated famine—in terms of its start and finish—on children born to Dutch women who were pregnant during the “Hongerwinter” of 1944. Following D-Day in May 1944, the exiled Dutch government called for a strike of the national railways to impede the German occupiers of The Netherlands, a call that was answered beginning in September 1944. The Germans retaliated by blocking all food transports into the western areas. Food, already scarce because most of the agricultural land had been destroyed during the war, began to run out. When the Germans finally relented, the severe winter weather, which had frozen the canals, along with the German destruction of roads and bridges to slow the advancing Allies, made overland and water transport of food impossible. From the fall of 1944 to May of 1945, the Dutch people in the affected areas endured a famine, which killed—according to some estimates—up to 22,000, mostly the elderly, and had lasting generational effects.

When news of the famine came to the attention of the exiled Dutch government in London, Queen Wilhelmina petitioned Winston Churchill to broker relief for the Dutch people. An agreement between the Allies and Germany allowed an airlift of food by the Royal Air Force, the Royal Canadian Air Force, and the American Air Force. Called Operation Manna and Operation Chowhound, bombers laden with food supplies were allowed to fly in low, unmolested by German gunners, to drop their life-saving cargoes. The starving Dutch spelled out “Many Thanks” in tulips for the bomber crews to read. Although these crews did not think of themselves as humanitarian workers but as men in service to their respective countries, in effect they were doing the work of humanitarian outreach to a population affected by war, displacement, and starvation.

Clement Smith, whose research would show the famine had a major effect on birthweight but only if the famine coincided with the last trimester of growth, as well as other effects, would go on to become a founding father of neonatology and Professor of Pediatrics at Harvard University. Decades later, the son of a Dutch resistance fighter whose life had been turned upside down by the war and the mass starvation, would co-found the Harvard Humanitarian Initiative with the mission of conducting research to improve humanitarian response to crises, embedding the principles of human rights into these responses, and educating the next generation of humanitarian leaders.

In The World’s Emergency Room: The Growing Threat to Doctors, Nurses, and Humanitarian Workers, Michael VanRooyen, co-founder and director of the Harvard Humanitarian Initiative at Harvard University, professor at Harvard Medical School and the Harvard T.H. Chan School of Public Health, and the chairman of emergency medicine at Brigham and Women’s Hospital in Boston, gives us an up-close look at the humanitarian crises of the twentieth and twenty-first centuries. Written from a very personal yet historically comprehensive perspective, the narrative provides an intimate portrait of the making of a dedicated emergency medicine physician and humanitarian as well as a series of harrowing tales of his and others’ provision of emergency life-saving procedures under threat from warring factions in troubled areas of the world.

What makes people dedicate their lives to helping others, especially under life-threatening circumstances? VanRooyen points to his father’s wartime experiences as the catalyst for his desire to devote himself to helping other people. Michael’s father, Johannes (Joe) VanRooyen, was a teenager when the Nazi Army invaded The Netherlands. At age seventeen he joined the Dutch resistance and helped Jews to hide and eventually to flee to England and to Spain. In 1943 he was caught and sent to Bergen-Belsen, where he was tattooed and put to work in a steel factory. Periodically, he was taken to Berlin and interrogated by the Gestapo. VanRooyen’s description of his father’s torture by the Nazis is not sensational in the least, yet it will nevertheless horrify those of us who have yet to become inured to the scenes of war and refugee crises that have been flashing across our television screens in the United States and around the world as technology has advanced to connect humanity globally. Returning home weighing all of seventy-eight pounds (on a five-foot, eight-inch frame), Joe found his country and its economy in ruins and his hometown deeply affected by the mass starvation. He met and married a young woman from Haarlem, Gertrude Breed. Together, they decided to emigrate to the United States for the chance of a new life.

And a new chance is exactly what these refugees from war were afforded in the United States of the 1950s. Working hard, they soon owned their own home and had two sons. Yet, personal tragedy would dog this young family even in their new country. Gertrude VanRooyen developed metastatic melanoma in her late thirties and died at the age of thirty-nine when the author was eight years old. Although at this young age he could not articulate the effect of this loss on his life, later he would cite it, along with his father’s stories of imprisonment, his religious upbringing, a roadside rescue he witnessed, and his medical training in inner-city Detroit as the seminal events in his life that led to his career as a humanitarian physician

He was clearly drawn to a life of service to others with a wish to provide this service through the field of medicine. Finding a specialty that would most prepare him to do so was the focus of his exploration in medical school. His search led him to the work of Charles Clements, a Quaker and a humanitarian physician who had served in El Salvador, providing medical treatment to the victims of the civil war between rebel forces and the government. In Clements’ example VanRooyen found the combination of humanitarian outreach and provision of emergency medical services that would define his career.

For anyone who likes delving into the motivations that lead people to do what they do, this is a book that will hold great appeal. VanRooyen gives us an intimate look at the defining moments in his life, including his relationship with and marriage to fellow physician, Julie VanRooyen, who shared his vision of bringing emergency care to victims of conflicts and disasters. For those who are concerned about the global humanitarian crises humanity is now facing, VanRooyen outlines in painstaking detail the circumstances that led to each of the major crises in the twentieth and twenty-first centuries, describing the actors and movements that led to their explosions on the world scene, as well as the main responders who brought aid to the affected populations.

Along the way he provides a history of humanitarian aid and the evolution of humanitarian aid workers from being seen as neutral and protected from the conflicts into which they bravely entered to being thought of instead as pawns of opposing governments and open targets. He doesn’t shirk from discussing the inadequacies or inefficiencies of humanitarian aid efforts and the lack of coordinated approaches to some of the worst humanitarian crises in our time. Nor does he fail to focus on the consequences of starvation and the brutalization of those most vulnerable in the populations affected by war—women and children.

One vignette from the narrative, in particular, will serve to illustrate the effects of war, displacement, and starvation on the vulnerable, resilient but not infallible, women caught in conflict. VanRooyen describes meeting a woman in a camp in Mogadishu who would illustrate these effects without speaking. He and his team were screening children between the ages of one and five for malnutrition when they discovered a child named Fatima with symptoms of kwashiorkor, a condition recognized and so named by speakers of the Ga language, living in what was then the Gold Coast. Cecily Williams, an Oxford-educated physician of British extraction born in Jamaica who studied famine in seventy different countries, first determined that this condition was due to protein deficiency and distinguished it from marasmus, an overall caloric deficiency. Williams translated kwashiorkor loosely to “disease of the deposed child,” such deposition taking place after the birth of the next sibling. Since the mother would no longer be able to nurse the previously born child, he or she would be weaned and thus become vulnerable to protein deficiency.

After VanRooyen and his team examined Fatima, VanRooyen asked through an interpreter for the child’s mother. There was no response. The question “Who takes care of her?” was then posed. Again, there was no response. Obviously, Fatima’s mother had perished or been abducted during the conflict. Finally, a woman motioned to VanRooyen to come with her. They walked silently through the camp to a crude plastic shelter, and she pulled back the flap. There on the dirt floor sat three small children, a small bag of rice, and a pot. When VanRooyen looked again at the woman, she turned up the palms of her hands to indicate her inability to help. Fatima was a victim of the conflict, but so too was this woman, who was helpless in the face of another starving child. VanRooyen’s comment at the end of this vignette, which reflects his combined background in emergency medicine in hospitals in U.S. inner cities and his experience in the field of humanitarian outreach, is worth repeating here:

“The suffering of a malnourished refugee in the squalor of a camp is an affront to human dignity. That dignity is something we all possess and must fight to preserve. Perhaps now I also could better understand my patients in inner-city Detroit or Chicago, where the oppression of poverty and culture of violence drives them to helplessness. The struggle to promote human dignity was not only to be fought in Somalia, but also closer to home.”

VanRooyen has served as a humanitarian physician in more than thirty countries, including Bosnia, Chad, Darfur-Sudan, the Democratic Republic of Congo, Haiti, Iraq, North Korea, and Somalia. He brings an insider’s knowledge and perspective to the reporting of the conflicts and natural disasters that have led to the urgent need for humane and compassionate responses to the millions of refugees now knocking on the doors of conflict-free countries in Europe as well as the United States seeking asylum. Will the world tell them there is “no room at the inn,” or will it find its way to a compassionate solution that raises the dignity of all of humanity?

 

The World’s Emergency Room: The Growing Threat to Doctors, Nurses, and Humanitarian Workers is published by St. Martin’s Press and is available online at Amazon and Barnes and Noble.

Michael VanRooyen is also the co-author of Code Blue: The Making of an Emergency Physician (John Hanc and Michael VanRooyen) and Emergent Field Medicine (Michael VanRooyen, Thomas Kirsch, Kathleen Clem, and James Holliman).

Disclosures:  We have never met Michael VanRooyen, although Roger corresponded with him several years ago through letters of recommendation for two researchers then being considered for appointments to Harvard University faculty and the Harvard Humanitarian Initiative (HHI): Phuong Pham, PhD, MPH, now Director, Program on Evaluation and Implementation Science, HHI, and Patrick Vinck, PhD, now Director, Program on Peace and Human Rights Data, HHI. Roger knew them when he was the Joseph S. Copes Chair and Professor of Epidemiology at Tulane University. Jennie also knew Phuong in New Orleans and later met Patrick in Santa Fe. We consider them close friends. (They are mentioned in VanRooyen’s book). Finally, we have provided editorial services for online and print publications written and produced by researchers within the Harvard Humanitarian Initiative.