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A Single Patient, Writ Large

Effecting change as a physician-journalist

The New Physician December 2007
Children ran after us, bright plastic clogs slapping behind them as we drove through the lush rolling hills.

“Muzungu!” they shouted—white person—a comment I’d rarely heard directed at me, a Chinese-American. Men pushed bikes flanked by heavy bottles of water. Women wearing patterned skirts and wraps sauntered by, bunches of bananas effortlessly balanced on their heads. Straw huts and clay houses lined the roads, framed by plots of banana trees, cassava leaves and coffee plants. The streets were so clean and colors so vibrant, it was hard to believe that eight of 10 people here made less than $2 a day. As if anticipating the question, our driver remarked, “People are poor, but we are proud. We make it a point to present our best to each other and the world.”

This, my second trip to Rwanda, was the prize for Win-a-Trip, a contest organized by New York Times columnist Nick Kristof. For the contest’s second year, Nick chose a teacher and a student to accompany him on a journey through Rwanda, Burundi and the Democratic Republic of the Congo (DRC), making daily blog entries and videos for the New York Times. I was the student. After finishing medical school in May, I traveled to Central and East Africa with Nick, high-school teacher Will Okun and op-ed videographer Naka Nathaniel.

I had applied for the trip because I wanted to effect change by telling stories. Doctors are natural storytellers. We have the privilege of hearing, seeing and experiencing the lives of our patients, but along with that privilege comes the responsibility of advocating on their behalf. Nick, a Pulitzer Prize winner, believed in practicing journalism as activism, and I wanted to learn from him how storytelling could educate and motivate the public.

Journalists are supposed to watch, listen, ask and interact, but not shape the events that are unfolding. Yet physician-journalists cannot abdicate their duty to safeguard life. We were going to be in war zones and poverty-stricken regions where famine and injury persisted, and people went their entire lives without ever seeing a doctor. How would I balance telling the stories as a journalist and responding to the people as a physician?

I quickly realized that finding stories was the easy part. Every day we heard far more stories than we could process and write. In Rwanda and Burundi, we heard of hope and success, a welcome change from the horrors so typically associated with the continent of Africa. Rwanda is emerging from a gruesome era, punctuated by the massacre of 100,000 people in 100 days during the genocide of 1994. Now, Rwanda’s government is stable and its economy is improving. While it is still very poor and lacks needed resources, the country has a system in place to provide universal health care to all of its inhabitants, reflecting values to which even the United States has not committed.

In 2003, a conflict in neighboring Burundi ended, and that country remains the poorest in the world, according to the World Bank. But Burundi also exhibits significant signs of progress. Several projects, like the World Food Programme’s school feeding efforts
and microfinance programs through CARE International and Women for Women, have proven both sustainable and vital to the population’s ongoing recovery.

But our trip also led us to witness bleaker futures. Unlike the hope and optimism brimming in Rwanda and Burundi, the Congo was filled with despair. It is in the midst of a war that has already claimed at least 4 million lives. Tragic stories abound. We were interviewing villagers about their health conditions in the town of Malehe, an hour away from Goma, when a group came toward us with what appeared to be a skeleton wrapped in rags. This was Yohanita Nyiahabimana, who weighed no more than 50 pounds and looked far older than her 41 years. Yohanita was completely emaciated and extremely ill. Her heart rate was in the 130s. She was taking deep, raspy breaths, and though she felt warm to touch, she was shivering. On her groin and buttocks were multiple oozing bedsores, all of them to the bone, all of them teeming with flies.

Her family told us that the war had driven them out of their village. Soldiers came to abduct, kill, rape and steal, and the family was among the lucky ones who escaped. When they came back to the village, they found all their crops destroyed and houses gone. There had been no time to replant crops, and the family had been living on bananas alone. A few months ago, Yohanita fell out of a tree and probably sustained a pelvic fracture, but her family had no money to bring her to a hospital. Her current condition was likely due to immobility, infection and malnutrition. She was now dying in front of us.

At that moment, I realized that there would be no conflict for me between practicing journalism and medicine. What I needed to do was clear. I would tell Yohanita’s story later, but at that moment, she needed medical attention, and I needed to help provide it. I explained the situation to her family: Yohanita was very sick and would die unless she got care from a hospital. The family said that they could not afford it and had no way of taking her to the nearest hospital, which was more than 60 km away. After some discussion, we found a way to transport her to Goma, and Nick and the New York Times agreed to pay for her medical bills, which would total around $100. A few hours later, Yohanita arrived at HEAL Africa and began receiving fluids, antibiotics and food.

Health care workers volunteered day and night at the HEAL Africa hospital in Goma to do what they could to correct the gruesome aftermath of war. Their ranks included physicians specializing in the treatment of gynecologic fistulas, which thousands of women had developed after soldiers and militants used weapons to rape them.

After visiting villages decimated by fighting, interviewing dozens of rape victims, and witnessing the endless streams of refugees, all of whom had had family members killed, we met with rebel leader Gen. Laurent Nkunda. Nkunda was not the only person leading the killing and destruction in the Congo—other rebel groups and even government troops are implicated—but he was a renegade warlord indicted for mass murders and rapes. To hear his claims about being a faithful Christian and pastor called into question my own beliefs: How is it possible that the people at HEAL Africa and Nkunda’s troops are all acting in the name of God?

In my blog, I wrote about Yohanita and about how she represented the human cost of the war in the Congo: When we think about the consequences of war, we typically picture people killed in the line of fire, but the human cost extends to disease and starvation that directly result from conflict. There are thousands more who die silently in their villages. Most readers understood my point, but some responded with incredulity that we would spend money and time to help Yohanita, when the problem was much larger than her. Was it fair to help her and not the rest of the people in the community? Was it a good use of resources to help one person, when many thousands or millions were also dying in the Congo?

My answer is yes. We didn’t go to the village to “save” someone, but we could not have, in good conscience, walked away from a dying person. As a public health-oriented doctor, I cannot agree more that there are larger issues to address: ending the war, and providing food, health care and education to everyone. But we don’t need to have global reform before contributing our best effort to the patient in front of us. Ultimately, we should aim to do what we can to help. In this case, what I could do was to help one person; perhaps, in telling her story, I can inspire others to help more people and improve the overall system.

Storytelling is a powerful way to draw in the audience and illustrate a policy perspective. Readers react to stories and individuals more than they do to dry statistics. Every time we take a patient’s history, physicians are, in fact, practicing journalism: asking the relevant questions to put together the puzzle of someone’s life.

Still, the role of the physician-journalist is complex. I may have worn the hat of a journalist, but I will always have the heart and soul of a physician. I continue to seek answers to big-picture questions and continue to aim for global change—but I will always keep in mind that my primary duty is helping the patient in front of me.
Dr. Leana S. Wen, a recent graduate of Washington University School of Medicine and former president of the American Medical Student Association, now studies at the University of Oxford as a Rhodes Scholar.