Monday, November 13, 2000

Doctor helps mend hospitals hurt by war


Efforts lead to medical exchange program here

By Tim Bonfield
The Cincinnati Enquirer

        As chief of surgery at Children's Hospital Medical Center, Dr. Richard Azizkhan is a prominent man in Greater Cincinnati. But in war-ravaged Bosnia and Croatia, Dr. Azizkhan is a hero.

        Ever since the war there ended in late 1995, Dr. Azizkhan has made it a mission to help rebuild medical services. The effort has involved more than a dozen trips to the area, performing hundreds of surgeries on children there, and arranging for many to be brought back for care.

        He has traveled throughout the United States and Europe to ask governments, charities and drug companies to commit millions of dollars in grants and services to refurbish pediatric hospitals in Tuzla and Zagreb.

        He has used his own suit cases to import hard-to-get medical supplies. He has devoted uncounted hours to training doctors, nurses and medical personnel, met with ambassadors and presidents and been interviewed by local television almost every time he visits.

        Sometimes, families of children he has helped stop him on the streets.

        “After the war, lots of doctors and dozens of (international aid) groups were there. Now, we are in contact with only a few,” said Dr. Ivan Fattorini, director of Children's Hospital Zagreb. “Dr. Azizkhan has been a true friend.”

        Now, through Dr. Aziz khan's efforts, Cincinnati will soon be playing a larger role in picking up the pieces of a war few Americans may have understood.

        Next spring, the first doctors and nurses from a new medical exchange program will come to Cincinnati. The agreement was made in Sep tember in Bosnia and sealed last week when a delegation of Croatian medical leaders visited Cincinnati.

        In an era when few U.S. citizens have seen war firsthand, Dr. Azizkhan's experiences offer a glimpse into another world. The war killed almost 300,000 people; about 7,000 were children. Another 100,000 people remain unaccounted for, also including many children.

        Dr. Azizkhan has spent most of his time in the region at the Tuzla Medical Center in Bosnia and at Children's Hospital Zagreb, a leading facility in Croatia.

        “Before the war, these facilities were providing modern medicine. In 1990, I would say they were roughly equivalent to U.S. hospitals in 1980. The war bombed them back to 1930s,” Dr. Azizkhan said.

        Artillery shells hit the hospitals during the war. Operating rooms had to be moved to the basement for safety. Surgery was performed in midwinter with no heat.

        A hospital nursery that previously kept newborns in modern bassinets was reduced to stacking more than 15 babies at a time, side-by-side and end-to-end, on a table next to an old-fashioned radiator.

        “Sterilization was primitive and supplies were limited. Things we throw away after a single use were re-used hundreds of times,” he said.

        “There is no medical insurance to speak of. Families had to pay for and arrange for their own medical supplies. A $100 piece of Gore-Tex (a fabric often used in reconstructive surgery) could cost a year's salary.”

        In Bosnia and Croatia, birth defects and illnesses that are 99 percent survivable here were nearly 100 percent fatal. Not so much because the doctors didn't have the training, but because they didn't have the equipment.

        “Premies died. If a newborn needed a respirator or IV nutrition, they died,” Dr. Azizkhan said.

        In Croatia, the war severely damaged the medical system while flooding the country with refugees, who needed treatment for war wounds plus the normal array of health problems.

        “In 1992 and 1993, we had about 700,000 refugees in a country of 4.5 million,” Dr. Fattorini said. “Imagine 40 or 50 million people entering the U.S. as refugees. That is what it was like for us.”

        Dr. Azizkhan got involved in postwar care mostly by happenstance.

        He has international roots. But unlike some U.S. doctors who participate in medical missions, he had no cultural connection to Bosnia.

        His family roots trace back to Persia (now Iran) with relatives also from Afghanistan, Germany and Wales. As a child he lived in India and England before moving with his family to the United States when he was 11.

        He got involved in Bosnia at the urging of Dr. Jacob Bergsland, a pediatric cardiac surgeon in Buffalo, N.Y., where Dr. Azizkhan worked before coming to Cincinnati in December 1998.

        What started as humanitarian work at a U.N. field hospital evolved into a passion for international medicine and building up medical systems.

        Dr. Azizkhan performed the first postwar laparoscopic gallbladder surgery in Bosnia, a routine service here.

        He worked to redesign six operating rooms and a hospital's war-damaged oxygen system. He worked with local staff to get an MRI scanner and ultrasound equipment.

        Most of the time Dr. Azizkhan tried to stay out of the intense politics of the region. But two years ago, he ended up playing a symbolic peacemaking role when he organized a national conference of pediatricians.

        “Before the war, families traveled back and forth between Bosnia and Croatia to get specialized care. In the old days, the doctors routinely talked. They were friends and colleagues. But during the war, there was no communication.”

        In June 1998, Dr. Azizkhan organized the area's first peacetime pediatric medical conference. It was held in Mostar, an ancient city almost leveled by the war.

        “It was widely publicized. The purpose was to put aside the politics and the ideological differences and take up the banner of what's best for the children,” he said. “Just to see those physicians embrace each other. ...”

        While progress has been made, life hasn't really returned to normal in many places, Dr. Fattorini said. In Bosnia, where more damage occurred, much work remains, he said.

        For years, children who were raped and abused will need psychological support. Those who lost limbs will need follow-up treatment, he said.

        No one knows what will happen if U.S. peacekeeping troops leave, Dr. Fattorini said. But having a continuing partnership with U.S. medical institutions will help progress continue, he said.

        At Children's Hospital here, doctors and nurses have participated in a variety of medical missions, including work in China, Ecuador, Guatemala and Belize.

        Though it takes staff away from Cincinnati, the hospital encourages and supports such involvement, said CEO James Anderson, who traveled with Dr. Azizkhan to Bosnia in September to sign the medical exchange agreement.

        The hospital considers itself among the world's top pediatric institutions. That means getting involved in global health issues.

        “Dr. Azizkhan is a highly committed, highly productive individual. This is not a side activity. This is really part of his job,” Mr. Anderson said.

        For Dr. Azizkhan, the new exchange program is a big success but not the culmination of his work. He sees it as one more step in a continuing global journey.

        In December, he plans a return to Bosnia.

        “I feel very close to a lot of people there,” Dr. Azizkhan said. “When you go there, you are hit right away by the energy and joy of the young people. They have freedom now, a future.

        “They don't look at themselves as a third-world country. They look at themselves as a European nation that went through a war experience.”

        Next year, he plans to expand his involvement to other nations with a mission to Cairo, Egypt. Perhaps in two or three years, he said, he will get involved in Yugoslavia, now that Slobodan Milosevic has been removed from power.

        “I'm very interested in medical systems. I look at this as possibly a lifetime commitment,” Dr. Azizkhan said.

War and rebirth in Bosnia



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