SPH Student
Still Recalls
"Smell Of Death"

Randolph Fillmore
School of Public Health

After two years of practicing medicine in The Netherlands, Lucie Blok--now a master's degree candidate in the School of Public Health--happened to wander past The Netherlands office of Medecins Sans Frontieres, or Doctors Without Borders, the international relief organization that is most often first in the field when violence and disease threaten to erase whole populations.

"I went into the office and talked with them about what they did," Blok recalls. "They offered me a job. I accepted." That was in 1989.

Apparently not an organization to waste time, MSF immediately sent her to Northern Uganda's border with Sudan. "Even Ugandan government workers looked at me with amazement when I told them I was going to Northern Uganda," Blok says. "The area is one of the world's most dangerous because of cattle raiders from Sudan and Kenya. They carry rockets and automatic weapons."

The military sophistication of the cattle raiders was not matched by other aspects of Northern Uganda. There she found no other doctors, but she did find plenty of poverty and illiteracy.

"There was no referring to specialists," she quips.

Blok worked in Northern Uganda from 1989 until 1993, when she was posted to the MSF office in Amsterdam where she was appointed a health adviser. During 1993, she consulted for MSF in Sudan, Rwanda, Liberia, Somalia, Afghanistan and Burundi. But she was not back in Amsterdam long before she found herself knee-deep in death in Goma, Zaire, during the first six weeks of the 1994 refugee crisis and cholera epidemic. Blok recalls a hastily convened MSF meeting in Amsterdam when the crisis broke.

"We thought we were preparing for 200,000 refugees, and we were able to put 60 MSF people 'on the ground' in Goma within a week."

The 200,000 refugees quickly doubled, then tripled.

"When we arrived, there were thousands of bodies," says Blok. "It was difficult to tell the living from the dead. We set up a small tent as a clinic and immediately had 1,000 patients with cholera. Almost two thousand a day were dying. The lake was infected with cholera, there was no other water. Immunizing against cholera was futile. The vaccine would have been hard to get into the field and the logistics of getting it there may have taken a week. By that time, everybody would have been dead."

The Goma refugee population quickly swelled to a million. "We did what we could, but we didn't even have tents in the beginning," Blok says. "When thousands are dying, the critical question becomes, What is to blame? Is it the water, food, sanitation, the crowds? Just moving around in the crowd made me claustrophobic. By the end of the first week we had a clinic set up with tents in neat rows."

According to Blok, working in such a catastrophic situation, and with scarce resources, tested the endurance of everyone. "Before long there were 200 relief agencies in Goma and the [United Nations High Commission for Refugees] was coordinating everything. I drew up a plan and presented it to the UNHCR."

Besides the thousands dying of diseases, Blok also saw firsthand the psychological effects of violence and loss.

"Fifty thousand refugees died in the first month," she says. "I saw many refugees who were so traumatized in the midst of thousands dying that all they could do was sit and stare. They didn't collect wood or water or come to the clinic. I think some died just from the psychological trauma."

Surrounded by death and suffering day after day, relief workers sometimes suffer, too.

"Doctors Without Borders forces people to take time off, to take a walk, to sit by the lake," Blok says. "Some of the staff came to me during the worst part of the crisis and told me I was not setting a good example because I was not taking a day off. But, besides running the clinic, I had the press to deal with, and meetings every day. I usually worked past midnight. After we finally got everyone to sleep, I often stayed up until 3 a.m., just to get some time to myself. But then it started again at sunrise. Once--after six weeks--I just had to leave. I needed a break."

Relief workers routinely get post-trauma counseling by MSF, Blok says, or they participate in group talk sessions to come to grips with what they have witnessed. Most bounce back for the next crisis.

Blok, who has nearly finished her MPH, is finding a theoretical framework for the work she knows so well by touch.

"I am focusing on strategies and methods for evaluating interventions and measuring their impact," she says. "When I get back to Amsterdam and return to working with MSF, I will be able to contribute to the process of developing new and better tools for emergency interventions."

"Populations In Danger"
The Exhibit

"We designed this exhibit to draw attention to the millions of people in the world who live in fear of their lives and in deplorable circumstances as the result of natural disasters or political violence," says Lucie Blok, an MPH student who designed the exhibit content and who has worked for Doctors Without Borders since 1989. "Much of the suffering in this world goes unnoticed, even by the media. By highlighting the human suffering in places from Bosnia to Burma, we hope to raise awareness."

The opening of the exhibit also marks the closing day of Issues in International Health, a January intersession course taught by Kami Kandola. "It is valuable to learn about issues in international health, especially at the undergraduate level, because students may be more receptive to perspectives they may not be exposed to in their later education," Kandola says. "I hope that by exposing students to a diversity of renowned experts in this field, they will carry the information with them."