Models and Mentors

Suture or Shoot?

   "Our group started to go into southern Iraq just after the active phase of fighting. And what we found were terribly looted hospitals. That seemed to be the major problem. Doctors were there, but they didn’t have the tools to do their jobs. They didn’t even have light bulbs or beds — everything you could pull out had been taken. It was unbelievable."
— Sheri Fink, MD (’99), PhD, (’98)

Alumna Sheri Fink, MD, opens eyes to wartime’s medical quandaries

By Shawne Neeper

At just over 5 feet tall and under 100 pounds, Sheri Fink, MD, PhD, is a surprising candidate for Jeep rides into war-ravaged Iraq. Yet in spring 2003, the Stanford medical school alumna roamed Iraq’s tank-strewn desert, working with a team to assess the population’s medical needs and haul supplies.

Fink’s service with the medical aid group, International Medical Corps, has taken her to some of the world’s most volatile regions. Dangerous work, yes, but personal safety isn’t on her mind. Fink, 35, is more concerned with exploring what’s right in the complicated ethical terrain of wartime medical care.

Fink’s humanitarian work grew from a passion for issues at the intersection of war and medicine — a passion she now works to spread through writing. Even while studying medicine and neuroscience at Stanford, Fink investigated the Nazi Holocaust and protested genocide in Bosnia. She also took classes in narrative writing. After graduation, her combined activism and storytelling took her into the Balkans to follow the footsteps of physicians involved in the Bosnian war. Five years of travel and interviews culminated in "War Hospital: A True Story of Surgery and Survival," published in 2003. The book research took Fink even farther into the Balkans, to the International Medical Corps, the Middle East and beyond.

All MD/PhD students work at a frenzied pace, says professor Robert Sapolsky, PhD, who guided Fink’s PhD research. “But with Sheri, there was this added dimension of intense social commitment.”

Sapolsky, a neuroendocrinologist, recalls Fink’s reaction to one of his lectures on psychological stress. “I must have said something along the lines of ‘It’s not stress-reducing to feel responsible for something you probably had no control over, like some village in the Balkans being ethnically cleansed.’ Whoa, Sheri was all over me afterward explaining how all of us were indeed responsible because of our passivity. Did I ever wish I’d used an earthquake as an example instead … .“

Amid that picture of her as strident firebrand,” he adds, “it’s also important to emphasize that she’s immensely funny, warm, was beloved in the lab and always won my heart over by sharing homemade baked goods that her yiddishe grandmother mailed to her — just like the ones I grew up on.”

Fink faced a choice of careers in medicine and science. But her values steered her in yet another direction. Early in her studies, she attended a talk by Holocaust survivor Michael Thaler, MD, then president of the Northern California Holocaust Center. After Thaler’s discussion of Holocaust denial, Fink introduced herself.

“She has a highly developed sense of moral justice,” Thaler says. “I think that’s what made her go outside, chase me down, and say ‘I need to do something.’ ” Fink volunteered to help at the Holocaust center to assist Thaler with compiling a database on those who said the World War II genocides never happened. And she studied doctors’ roles in wartime, including a course Thaler taught on medicine in Nazi Germany.

Then a new war erupted among ethnic groups in the former Yugoslavia. Fink recalls, “I heard words like ‘ethnic cleansing’ and ‘genocide’ coming up with regards to Bosnia, so I took note.”

And she took action.

In 1993, Fink and another graduate student co-founded Students Against Genocide. They invited speakers to raise awareness and lobbied Congress for action to stop the killing in Eastern Europe. But working from within Stanford’s safe confines wasn’t enough.

Departure from safety

It was 1997, and the Bosnian war had ended only two years earlier. Bosnian medical students invited world medical students to a conference titled “Medicine, War and Peace.” Fink recalls, “They said the world was teaching them medicine and giving them aid; now they wanted to teach the world how they did their jobs in wartime.”
Thomas Raffin, MD, ’73, co-founder of the Stanford Center for Biomedical Ethics, expressed concern over the safety of the trip to Sarajevo, but located funds for Fink to attend

.“She felt what she was doing was important to the world,” says Raffin, who taught Fink in medical school. “Her own safety was not of paramount importance.”

And this trip was only the beginning. “The stories I heard were so amazing,” Fink says, “so important and relevant to work my medical colleagues and I were doing in the United States.” She secured a fellowship from the UC-Berkeley Human Rights Center to study wartime medical practice in Bosnia. She spent close to a year there from 1998 to 1999, interviewing Bosnians about the war. They told her about a small town, a former resort.“

Of all the stories I heard about war medicine in Bosnia,” she says, “this place grabbed me. Doctors and nurses there had experienced everything described anywhere else during the war, all in this one hospital.”

That single hospital served the town of Srebrenica, the site of one of the worst massacres of the Bosnian war, through Serb siege and attack. The medical staff pushed their skills and ethics to the limits as they struggled to live up to the code of the Hippocratic oath: First, do no harm.

But where is the greater harm: not to treat the war injured or risk treatment without appropriate training or supplies? Who will be treated first — the youth who will die without immediate care or the man whose family holds the medical staff at gunpoint?

Fink visited Bosnia repeatedly over five years to research War Hospital. It follows Srebrenica’s hospital staff from the start of the siege in 1992 through their evacuation near the end of the war in 1995. Around 8,000, mostly men and boys, were massacred when the town finally fell to Serb forces.

Fink’s book focuses not on the horrors but rather on what medical workers can and can’t do when facing them.

“I wanted to show what happens to human beings who are put in inhuman circumstances,” Fink says. “

The most shocking thing for me, in writing the book,” she says, “was discovering how doctors and nurses who had this sacred pledge to sustain life became so caught up and involved in the actual war.”

In addition to treating war’s victims, Fink says, doctors also made armies stronger. “And there were doctors,” Fink says, “who decided simply that they would save more lives by taking lives and literally shook off their medical coats and picked up guns and went out to fight.”

Fink’s own approach to medicine and war is different. While she was in Bosnia, there was fighting in nearby Kosovo, another part of the former Yugoslavia.“I thought ‘Gosh, this is crazy,’ ” Fink says, “I’ve been sent over to study war medicine and here I am, 10 hours’ drive from where it’s actually happening.”

She spent time with doctors, nurses and aid workers in Kosovo and wrote an article about their work. Several months later the fighting intensified, NATO began airstrikes and Physicians for Human Rights dispatched Fink to the Kosovo-Macedonia border to interview refugees.“

But when I got there,” she says, “there were 100,000 people in the no-man’s-land between Kosovo and Macedonia, and they desperately needed doctors.” So she pitched in at an International Medical Corps tent.

The corps hired Fink and sent her back into Macedonia and Kosovo and then to Mozambique. She helped set up aid programs in Chechnya and northern Afghanistan. She started the Iraq program with other doctors a year ago.

Fink says little about the danger in these areas. And her idea of a vacation might surprise some people. After weeks working in southern Iraq, Fink visited the International Medical Corps team in northern Iraq and had a chance to unwind.

Compared with southern Iraq, Fink says, “The north was a big vacation — relaxed. It was more peaceful. People were going out at night. Though things can become violent in the blink of an eye; recently Erbil was bombed. One hundred people died.” She acknowledges the danger, then moves on to describe her priority: the aid work.

Delivering the goods

Her initial job, as one of the first non-military foreigners to enter Iraq in April 2003, was to assess need. Hospitals were stripped of everything that wasn’t bolted down. They had doctors but needed medical equipment, beds and generators. And they needed medicine.

Black fever is endemic to southern Iraq. Spread by sandfly bites, this protozoan parasite is a child killer that leaves its victims gaunt, their bellies bloated with a swollen, diseased liver and spleen. Hospitals had run out of medicine, and parents had given up bringing their sick children for treatment.

Back at her base in Kuwait, Fink gathered supplies. She met with UNICEF officials who had black fever medicine but were blocked by United Nations security imperatives from entering Iraq. Fink, as a volunteer in a small, non-governmental organization, could and did cross the border again.

In a rented truck with a doubtful, hired driver, Fink passed dry, flat fields cut with row after row of army trenches. Abandoned military hardware lined the route. Children picked through the rubble, looking for anything of value. But in the end, Fink delivered the black fever drugs to the large modern hospitals in Al Kut and Amara.

On her next trip back, she met children, critically ill from black fever. “I can’t forget seeing these kids with very advanced disease,” she says. “But one after another, the doctor showed us this drug was now being given, was going to save these kids.”

Returning to the United States, Fink began research on the global AIDS problem, for what she hopes will be her next book. And by lecturing at bookstores and public forums, including the World Affairs Council of Northern California, she’s getting the word out about medical issues in war.

“I think she’s always going to be doing things like this,” says her bioethics professor Raffin. “We need more Sheri Finks. She herself is a warrior for peace.”
Fink is planning to return to Iraq this spring, to write about mass graves there. She won’t be doing aid work this trip, she says, “unless something comes up...”

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