Mud and hundreds of refugees covered the bleak Kosovo hillside. Joelle Tanguy, the executive director of the American branch of Doctors Without Borders, had dodged a Serbian roadblock and driven through miles of burned and deserted ethnic-Albanian villages to get there. After assessing the needs of DWB's medical teams already in the field, she flew back to New York to prepare in case the crisis got worse.
It certainly has. But New York, with one of the world's highest concentrations of doctors, has sent exactly one physician to the relief effort. Clerical volunteers and personal checks have poured into the midtown office of Doctors Without Borders, but surgeons are tougher to come by.
The six-month commitment that DWB requires from its volunteers is a substantial hurdle, but money is the larger problem. "The American doctors who want to go usually have just finished their residency or are in the last year of residency," Tanguy says, "and these people have huge loans. That's a big deterrent. This is what sets them apart from their European partners, who can go through medical schools without owing money to anybody." The lone New York doctor in Macedonia, Ramona Sunderwirth-Bailly, a pediatrician at Bronx Lebanon Hospital, got her medical degree in France and works with Doctors of the World, an aid group that splintered from Doctors Without Borders in 1990.
The arch, diminutive Tanguy, 39, was born and raised in France and moved to the U.S. in 1984. In 1989, she went to Armenia as an earthquake-relief volunteer, expecting to return to her computer job. Instead, she signed up for DWB missions in Liberia, Somalia, and Bosnia, where she learned such tactics as making sure emergency food supplies are controlled by female refugees: "Men tend to divert it to the military instead of feeding the weakest." Five years ago, she was sent to the embattled terrain of Manhattan to lead DWB's nascent New York office.
Despite a firsthand view of so many tragedies, Tanguy is an unshakable optimist. "We are the lucky ones," she says. "We can go to a disaster and do something about it. When people feel helpless is when they are just looking at still pictures of a tragedy -- and the ones you see in the Times are always the situation at its worst. Our experience feels more like a video, where a starving child ends up being taken to a nutritional center and then a week later is back on his feet, smiling and jumping."
Founded in Paris in 1971 as Médecins Sans Frontières by a member of the Communist medical-students' union, the group attempts to be stridently apolitical. When the U.S. government established a centralized 800 number for Americans wanting to donate to Kosovo relief groups, Tanguy declared her organization would accept none of the money collected -- potentially millions of dollars -- lest DWB be seen as an agent of nato, a perception that could limit its access to the war zone. As the refugee camps become recruiting grounds for the Kosovo Liberation Army, DWB must avoid becoming the de facto medical unit for the rebels; the group withdrew from Somalia in part because of similar problems.
"The next step is to get back into Kosovo, and figure out what happened to those populations that didn't cross the border," Tanguy says. "The next step is eminently political, eminently complicated in terms of finding our own security within this very military environment." Not a scenario likely to get New York doctors booking plane tickets to Belgrade.