OPINION
DOCTORS Lounge
survived to the hospital (there were 12,000
wounded and dead counted just by October,
and it did not let up for four years) died
from mortar attack in their rooms. They had
no light, no heat, no bedding and mostly
rice to eat, but they had doctors, nurses
and family.
The Serb forces controlled, and had cut
off, all access to water and power within two
months. Every now and then there would
be hours of electricity, and people would
power up anything they could.
Imagine, now, the life of a Sarajevan doc-
tor during the Siege - it’s been like that for
years, relentlessly, in parts of Syria. You have
seen the pictures; the medical accounts are
the same: no supplies, no packed cells, no
help, no rest; nothing but the crushed, the
wounded, and the dead.
At Kosovo Hospital when the call came
in, “At least 30 down, shelling by the old
market,” the dispatcher would ask for vol-
unteers. They learned to get the military
details with the medical, to decide if the
ambulance crews should accept the risk.
The ambulances had to drive up the exposed
hillside at 80 mph, two workers and ten
patients piled on top one another, racing
the bullets. All the ambulances got hit. The
hospital had one diesel generator and the
duty surgeon could choose to power only
one: should he send power to the sterilizer,
or power to the anesthesia machines?
They ran out of anesthesia drugs, so they
operated under local, and sometimes only
under courage, even amputations. They op-
erated by candlelight. They reserved water
for medical procedures and drinking; they
had no laundry of any kind. They made
their own instruments out of dental tools,
hardware items and wood. They invented
bone fixators from salvage to save patients’
legs. In the hiding places of the defenders of
Sarajevo, they were making the ir own guns.
After that unimaginable first summer,
the health council decentralized the med-
ical services and the operating rooms, and
made neighborhood clinics trauma-capa-
ble, to get the doctors and staff close to the
victims. This would increase the survival
of everyone involved, and reduce the risk
to families rushing in with their injured
loved ones. Sarajevans by and large lived
underground, or in one room deemed the
safest, for nearly five years.
Eventually the United Nations, who
controlled the airport as neutral observ-
ers, sent limited supplies, but continued
the arms embargo. To get out of Sarajevo,
to get anything from the still-free part of
Bosnia, you had to cross the airport run-
way, a lethal exposure. The new Bosnian
Army dug a tunnel under the runway, 340
meters, entirely by hand. They then could
get medical evacuees and refugees out, and
carry the lifeline of weapons, food, diesel,
medicines, cigarettes in. Black marketers
thrived. International medical and media
“experts” arrived, clean, not in rags or scrubs
stained with the blood of hundreds, took up
the doctors’ and nurses’ time and marveled,
and left without helping, over and over and
over. More or less, the city starved, froze,
hid and fought.
derstand either the old or the new Sarajevo.
Instead of getting generous state salaries,
doctors worked for themselves. The he-
roes of the hospitals took their freedom
and worked for profit, and were roundly
criticized. As in any former socialist state,
the ideologues outnumbered the competent.
Dr. Vladimir J. Simunovic, head of a neural
trauma service throughout the war, worked
through it all and wrote about it in Conflict
and Health in 2007.
His lessons apply very much to peacetime
doctoring: promote peace in your commu-
nity through better health. Lead by listening.
Teach your successors. Decision-makers
must also be the people on the ground, on
the bottom, laboring in the trenches – not
just the brass, who spent their wars at the
desk, not the wards. Build an escape tunnel
if you must (concierge medicine, off-the-
grid practices, locum tenens, banding to-
gether in enterprises for better deals).
Those who have survived a war have
hidden wounds that could still prove fatal:
remember that healing must never stop.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Bar-
ret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
Only after the ferocity of the Markale
market massacre and the pitiless genocide
in Srebrenica did NATO intervene with real
might. Their planes bombed the Serbian
ranks in the mountains, and two months
later, forced the Dayton Peace Treaty, No-
vember 1995.
After that came more experts, more
humanitarian projects, corruption and re-
construction, more and more and more
non-government do-gooders and outright
“grant money profiteers,” who failed to un-
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