by Pamela Grim
One of the officers stood not far from him, looking down at the prisoner's face as well, shaking his head. “I can't understand it,” he said. “The guy was going to be bonded out tomorrow.”
“Jesus,” I said. “What did he do to get arrested?”
The officer shrugged and kept shaking his head. “Unpaid traffic tickets,” was all he said.
When I was in training, we staffed the helicopter medical transport service. The helicopter pad was on the eighth floor; you had a pretty good view of the city just standing up there, looking out across the campus. When you lifted off on a run in the helicopter, though, peeling away from the helipad with the helicopter canting at some impossible angle, you could see it all, the whole South Side of the city. Block after block of empty brown brick buildings, boarded up and tumbling down. Vacant lots, tattered billboards, derelict trucks, stalled cars, burned-out wood-frame houses. Everything looked either lost or abandoned. And there you were, going out on a mission to save lives, looking down on the whole cityscape from the hull of this vibrating monster. And after a while, after months and months of playing doctor, with too little sleep, too much violence, too many bad nights over broken bodies—in short, after a year or three of residency—all this near-celestial panorama began to look more and more like the ninth circle of hell.
11
HOW TO VACCINATE CHILDREN IN A WAR ZONE
I WORKED AS A PHYSICIAN in Bosnia during the war, mostly in a hospital in Zenica, a town in Muslim-held territory. This gave me a worm's-eye view of the war. Like most of my colleagues there, I didn't see much further than my next patient. Broad political implications were lost on us. All we saw were the humdrum human byproducts of war: land-mine injuries, grenade injuries, shrapnel wounds, along with a not surprising number of suicide attempts.
The hospital was the largest in the region, and daily we would see, in addition to war victims, typical medical things: severe high blood pressure, heart attacks, strokes. We had very little to work with, of course. There were, in the entire hospital, two Bosnian-controlled stethoscopes, a single ventilator, and a vintage 1948 ECG monitor we used to get electrocardiograms (not that we could do much with the information). The hospital had exactly three ampules of morphine, enough to treat fifteen minutes' worth of pain, no high-blood-pressure medication, and frequently no electricity or heat. In the “intensive care unit” the nurses would borrow my watch in order to take a patient's pulse.
It was freezing cold. The sky stayed a uniform gray bank of clouds; only occasionally would we have a couple of hours of gelid sunshine. I soon fell into a routine. I woke up to my little short wave radio alarm, scrounged breakfast (wearing gloves and using a lantern), then plodded my sleepy way down the hill to replace the night doctor in the Zenica Hospital Emergency Department. There I would get ready for the first flush of land-mine injuries produced from the morning reconnaissance missions and the shrapnel wounds from the night before.
One day, though, the routine changed. The public health doctor was sick, so I was asked to go with a nurse to vaccinate a group of refugee children now housed with their parents up in the hills outside Old Vetiz.
“How many do you think will be there?” I asked Jason, the director of the relief agency I was working for.
He squinted. “Twenty,” he said, “maybe forty.”
We were sitting in a cafe in Zenica, drinking a morning cup of Turkish coffee and watching the passersby already out to shop in the market. Across from us was a shopping square where a Serbian shell had landed not long before, killing eleven people. At night you could sometimes hear the shelling, just thick, dull thuds, and sometimes you saw small, mysterious-looking fires up in the hills.
There is this weird domestic side to war. In the market that morning, even though there could be shelling any minute, everyone seemed to be going about their business as if there were no war, as if this were any other time except now; as if this Monday were any Monday in January. It did help that there was chicken and flour for sale now, unlike last year, when everyone starved. There were also raw coffee beans and cigarettes, if you had the right connections. The city was dreary but habitable, except for the shelling. Jason and I could have been sitting in a cafe in any down-on-your-luck town in any Eastern European country. Middle-aged women were nicely dressed, bundled in heavy coats and carrying big quadrangular purses held close to their bodies. The girls, mostly Muslim, wore long dresses and demure scarves to cover their hair, but they still managed, somehow, to be flirtatious. There were boys on bicycles and some old men sitting on the wooden bench in front of the mosque across from us, sunning their faces, talking, talking. And here I was about to vaccinate children. How more everyday could any medical chore be?
I walked down to the offices and found my driver, Amir. The first thing he had me do was put on a flak jacket. We were going to Travnik to the local hospital to pick up the vaccines we were to use—nothing fancy: measles, mumps, rubella, tetanus, diphtheria. The route was largely secure, I was told, or at least it was the week before. Then it was on to Old Vetiz, where a group of Muslim refugees was expecting us. Amir, the driver, was a big, beetlebrowed Bosnian, slow-moving and serious. He and I loaded up vehicle 778, a venerable Land Cruiser, with ice chests and powdered milk and headed south out of town, past the refugee market where Jason and I had drunk coffee, past the dead steel mill, past the horse-drawn wagons and the stream of pedestrians, both local and refugee, heading into town.
We also passed the occasional UNPROFOR tank: lone, white monsters with “UN” stenciled on the doors and hoods. Each tank had a soldier sitting upright in the turret. I would wave as we went past and the soldier would wave back. Tanks or no, they looked like sitting ducks.
Amir drove like a madman, just like all the other Bosnian drivers I had ridden with. There was the usual Central European pedestrian-be-damned attitude, but Bosnians here had one-upped this to anything-smaller-than-a-deuce-and-a-half-be-damned attitude. Passing was performed under heart-stopping circumstances: around blind corners, on one-lane bridges, in the midst of some townlet where children were playing. No one's horn, lights or brakes really worked. In Bosnia it was probably much safer to be shelled than to be driving.
We were traveling through what was the frontier between Bosnia and Croatia when they were at war. The land was now entirely desolate. Large houses stood vacant, with roofs missing or whole front walls gone, allowing you to see, doll house-like, into what was once someone's life. Barns were flattened. There was no livestock anywhere. No telephone lines; no roadway signs. The road itself was cratered from shelling. We detoured up hillsides and down into river beds to get around the worst of it—of course without ever slowing down.
Amir pointed out the bullet/grenade/shell blasts in the stucco of the houses and the frames of the eyeless windows. He told me that this area had been shelled for weeks and everyone who lived here had died. First the Croats took the territory and killed all the Muslims, then the Muslims retook the territory and killed all the Croats.
“Stupid,” Amir muttered more to himself than to me. “Stupid, stupid.” He sped up to pass a small pickup truck with several large panes of glass loaded in the back. This was the first civilian vehicle we had seen since we left Zenica. Glass, I thought. Well, at least someone was optimistic about the future.
The hospital in Travnik was smaller than in Zenica but just as bustling, perhaps more so. The corridors were crowded with Muslim women and children, one-legged men on crutches, tired-looking nurses. We made our way to a large freight elevator, possibly the only working elevator in Bosnia. The doors opened in slow motion and closed with the stolid finality of a tomb. We inched our way up, the wires twittering above us. A man—a double amputee—had wheeled his wooden wheelchair in at the last minute, and he sat looking around as if still dumbfounded by fate. Amir shook his head.
“This country…” he said under his breath.
We got lost and stumbled around until we finally found the pediatric ward. No on
e there, though, had any idea where the vaccine was stored. A snippy pediatrician told us we had come on the wrong day at the wrong time and of course that was why no one knew where the vaccine was. And she was terribly busy (she didn't look particularly busy) and we should wait until they had time to look, if they had time to look. Amir translated this for me in an undertone, punctuating his narrative with Bosnian expletives and a shaking head. We waited until it became clear they had forgotten us. Amir pushed me forward. “Say something,” he told me.
“Say what? I can't speak enough Bosnian to say anything.”
“No, no. Say something in English.”
“She can speak English?”
“Just go ahead, talk.”
I found the pediatrician in a back room, smoking. “Excuse me.” I cleared my throat. “This is our one chance this month to get the refugees vaccinated.” I was lying, of course. I had no idea what the schedule was. “It's imperative we get the vaccine today, now.”
“Yes, please,” the doctor answered.
Ten minutes later we were given the boxes of vaccine. Amir was muttering menacingly as we rode the elevator back down.
“She speaks English?” I asked Amir.
“She can speak maybe four words of English.”
“So why did you have me…”
“She was too embarrassed to say she didn't understand you. Besides, you are an American. In front of you she has to pretend that she knows what's going on. It's the way they all are.”
“Who all are?”
“Bosnians. My countrymen. They're idiots. They don't know how to organize anything. Everything they do in this country gets fucked up. These people are worse than the Russians.”
We got back in the truck and continued on to Old Vetiz, where we would pick up a nurse. On this route fighting had been heavy as well, Amir told me, but many of the houses appeared at least marginally intact and inhabited. Some had windows barricaded with long, stout logs set at an angle. This was the best protection available in case of shelling. Other houses had been surrounded with rolls of barbed wire. There were some jury-rigged fences, a few chickens and some goats here and there. We finally rattled into a damaged but still intact-looking village. This would be Old Vetiz. We turned off at a small road lined with houses and stopped at a house snug up against the road. Amir beeped his horn loud and long. A window banged open and a woman's voice responded. For a moment she and Amir engaged in animated conversation, then the window closed with a bang.
“That is the nurse,” Amir said with a sigh. “She'll be here in a moment.”
Amir and I got out of the truck and walked down to the corner. We both stood gazing around at the blue, cloudless sky. It finally dawned on me that this was a beautiful day, almost spring. Old Vetiz was Sunday-morning still. We both watched a jet, high and silent, head east. The wind shook the trees a little, and three old men, each with a walking stick, rounded the corner and ambled slowly in our direction.
Amir pointed to a curve in the road. “See there.”
He about-faced and pointed down the opposite way. “Five hundred meters,” he said. He turned to the left. “Five hundred meters.” He looked at me. “Muslims held this—five hundred meters square. Muslims held this and all around them were Croats. Nothing but Croats. It was a siege. No one could get in; no one could get out. The Muslims had some guns, weapons, you know, but not much. The Croats had more weapons but, to be frank, they didn't have that much either.” He studied the house where the nurse lived. “That nurse and one paramedic were the only medicine here. For six months.” He glared at the old men. “If you were shot in the leg and got blood poisoning, you died. If you were pregnant and couldn't deliver your baby, you died. If you went crazy, you also died…”
“And then?”
Amir squinted up toward the hills, thoughtfully, as if he was trying to remember. “And then the BIH army came over the mountains. In the middle of winter they made it through. They chopped trees down to get a truck in. They had food and weapons, and it was the first time these people had eaten something other than potatoes for months. The doctor came with them and he turned a schoolhouse up in the mountains into a hospital. That's where we are going.”
“So this town is Muslim now?” I said.
“No, no. There are Croats here, too.”
“Still?”
“Well,” Amir said, “for now.”
The nurse was big, bright and bustling, with hennaed hair, red-buffed fingernails and a suitcase-sized handbag. She lit up a cigarette as soon as she got into the truck and then talked a mile a minute to Amir as he silently drove on. We soon left the river valley and started up into the mountains. The air became alpine crisp, and the mountains surrounding us still cast a morning shadow across the road. We passed from a cratered village road onto a dirt track, ascending all the while. Eventually we turned into an almost impassable trail and climbed still more until we reached a small clearing where a couple of ramshackle buildings sat. There were some children playing on the frozen ground in front.
Amir grunted. “Well, they know we're coming.”
When we got out of the truck, the children stopped and stared, as usual, chiefly at me, the obvious outsider, the infidel. The littlest ones stood at the door of the main building, regarding me somberly as they sucked their thumbs. We stepped through a small, rough-timbered door and into the hospital.
It was a four-room schoolhouse. We had entered a sort of anteroom that served as the triage area: a ten-foot-by-ten-foot cubicle with a desk, a sink and a couple of chairs. To the right, through two blankets that served as doors, was the hospital “ward.” Amir pulled a blanket aside and I peeked in. There were four beds, neat as pins, two of which were occupied by dozing soldiers with bandaged heads. We walked beyond the anteroom into a larger room, which appeared to be the rest of the hospital. There were two examining tables and off in the corner an oversized ceramic stove. An ancient gentleman with a luxurious, snow-white mustache looked up from where he was stirring the fire. A woman standing by one of the examining tables lifted her arms and enveloped each of us in turn in an enormous embrace that smelled of peppermint. Introductions were made. The peppermint lady proved to be a practical nurse. The man by the stove was called Asur. His sole function seemed to be to feed the stove with firewood. A tall, gawky young man with acne was introduced as the paramedic. He would actually administer the vaccines. I was to perform a quick physical exam.
These were refugee children we would be seeing. Most of them were two to three years or more behind on their vaccinations, if they had received any at all. Already there were rumored to be several cases of German measles in the refugees from Bihac.
But first, of course, was coffee. This was made and served up while the nurse, the paramedic and the old man looked on, kibitzing all the while. It was good dark Turkish coffee but I really didn't want to drink it. There seemed so little here—five small cups and they used a metal medical-instrument tray to serve them on. The sugar bowl was passed from hand to hand, the precise amount titrated on a little spoon before it was slowly stirred in. The sugar bowl was almost empty.
As we all sat drinking silently, I heard a faint hum outside—like the muted noise of traffic or a rushing river. I listened for a moment before I realized it was the sound of children—many children.
“How many kids are we going to see?”
“I don't know. Maybe a hundred.”
“Croatians and Muslims both?”
Amir glared at me. “This is a Muslim clinic.”
“Why is it so far out of town?”
“Muslims don't go into town. There are Croats in town.”
“But town is still a part of Bosnia.”
“Muslims don't go to Croat clinic.”
“Why is that? Because they can't?”
“No, because they are Muslim.”
Suitably unenlightened, I examined one of the vaccination kits while I finished my coffee. It was supplied by the World Health Organization a
nd was rather ingenious. Needles and syringes were packed in a box, the box doubling as a waste container as the syringes were used. You attached a plastic syringe to the metal needle using a spring-loaded device. After use, the needles were to be inserted into a small plastic cup and the syringes put back into the box container. When the kit was finished, the box, now filled with flammable syringes, could be burned, leaving just some ash. The only medical waste was the small plastic container with the needles, which could then be buried. Even more ingenious was the fact that all the information about how to use the box was relayed using pictures only—no words. A universal medical device.
I tried to imagine a world with a hundred diseases just like AIDS—diseases that could savage a whole generation in a heartbeat or two—in which no one had the power to stop them, nothing worked. That was life before vaccines. Polio, measles, rubella—killers all—and in just one generation we have forgotten them. To many doctors, myself included, many of these diseases are almost theoretical. I, for example, have never seen a case of diphtheria or pertussis. The two cases of tetanus I have seen were both in intravenous drug abusers, the only safe harbor for the disease remaining in the U.S. In one the diagnosis was made not by me but by a Filipino nurse, who said she had seen hundreds of cases back in the Philippines. Here in Bosnia I had already seen several cases of rheumatic fever and a case we thought was miliary tuberculosis, diseases now rare in America. It was sobering to think that the mundane process of vaccinating these children might ultimately save more lives than any UN-brokered peace treaty. At least I told myself that.
Finally the time came to open the side door that led outside. By now the faint roar of children had turned into a tidal wave of sound. When the door opened, the crush outside was so bad that one child fell immediately onto the floor while two others spilled over on top of him.