Even from the other side of the world, the numbers are hard to bear. When a brutal war leaves only a few dozen doctors to care for a country of millions, how do you change the fates of the 64,000 children who die each year? How do you rid the ground of the cruel and unexpected fire of 8 million landmines, which percolate to the earth's surface when it rains, crippling and killing without discrimination? How do you tell a hopeful mother her baby will never thrive?
You start small, says retired Concord pediatrician Caroline Dueger. Four years ago, Dueger and her husband, a retired cardiologist, began traveling to Siem Reap, Cambodia, a city that is home to the mighty stone ruins of the Angkor Wat Temples and, nearby, the newborn Angkor Hospital for Children. There, the Duegers have helped establish a medical education program that has trained hundreds of Cambodian doctors and nurses to take charge of their community's public health. Dueger has helped recruit other international volunteers to Cambodia and has watched the small hospital develop into a 41-bed institution with intensive care, emergency, surgery and dental services, where more than 80,000 kids have been treated.
Despite those advances, Angkor still doesn't have a bacteriology laboratory. Doctors there now are forced to guess, by the process of elimination, the causes of both routine and serious infections. Across the world from that city and those sick children, Dueger is determined to make that work easier.
On Tuesday, the 68-year-old woman will embark on a two-month, 3,000-mile bike ride from San Diego to Florida in order to raise money for the hospital. Through donations from friends and colleagues, she has already secured $9,000 for Friends Without A Border, the nonprofit organization that manages the hospital. That money will help pay for the lab's startup costs.
Though she is well-traveled, Dueger has never undertaken such an ambitious physical challenge. On winter days, she has spent hours preparing her body for the journey, but her mind is never far from Siem Reap. During her trip, accompanied by 28 other riders from a women's tour group, Dueger hopes to hold additional fundraisers to support heart surgeries for Cambodian children in Malaysia, operations which can cost up to $1,000 each. Across the country, for 80 miles a day, Dueger will wear a T-shirt with a map of Cambodia on its front.
Dueger and her husband, Walter, have been volunteering their medical and teaching skills in developing countries for years. Their eyes were first opened to the dire state of world health in 1987, when they visited Kenyan village hospitals with a doctors' tour group.
"The diseases were so far advanced, it was like walking into a textbook of pathology," said Dueger. "The level of need is so different from what we think of here."
For a while, the couple worked at an Indian reservation in South Dakota - "Third World medicine in this country," as Dueger puts it - where doctors were scarce. Since 1993, they have spent several months each year in countries including Nepal, India, Nigeria, South Africa, Latvia, Papua New Guinea, Brazil, Mexico, Belize and Cambodia, working in established hospitals or bringing public health services to rural areas in need. In Nepal, the Duegers were a five-day walk from electricity. In Nigeria, they lived in the apartment of a village chief. In Brazil, they treated patients along the banks of the Amazon.
They last visited Cambodia in November. Soon after that trip, when she saw the lab was no closer to completion, Dueger decided she would make the cross-country journey.
An inexperienced and timid fundraiser, she began calling old friends, co-workers and medical school classmates, telling them about Angkor and its children. Many people were as taken as she is with the hospital, where bright murals cover the walls and grinning children learn about hygiene and nutrition. There's something about the place, Dueger said.
"What I'm seeing there is things are working. I've been on a number of projects that start out well but somehow fail," she said. "But people are happy there. They've got all the right attitudes about public health. You just get this positive feeling of excitement. It's personal, not sterile, and the volunteers come back with rave reviews."
Walter Dueger shares his wife's enthusiasm for Angkor.
"The young doctors there need the kind of experienced teaching we can give them, and it's very enjoyable to share knowledge with a young doctor. It's a very good feeling you get," he said. "It also has eased our transition into retirement, having this volunteer experience to gently pass out of the scene."
Friends Without A Border was founded in 1996 by Japanese photographer Kenro Izu who had traveled to Siem Reap to photograph the temple ruins. As he worked, Izu was most touched by the children he met, many of them crippled and sickened by landmines, malnutrition and untreated disease. With money raised by Izu, the hospital opened in 1999. The organization now has 5,000 supporters across the world and is striving to sustain itself with an all-Cambodian staff. This summer, the hospital grounds will welcome a Medical Education Center where even more Cambodians will receive training in health care.
The medical problems in Cambodia echo the ones in other developing countries, Dueger said. Many are caused by poor sanitation, hunger and lack of immunization and early intervention. Children whose heart rhythms are not listened to develop unchecked murmurs and disorders. Tuberculosis, AIDS and other infectious diseases are common and difficult to assess. Building a bacteriology lab at Angkor would offer doctors a chance to treat children earlier and with correct antibiotic medications, Dueger said.
"It's inconceivable to walk into a place and see meningitis in one corner and a blood infection in another and realize you can't culture it," she said.
After almost 30 years as a pediatrician in New Hampshire, Dueger left the comforts of clean offices and managed-care debates and traveled to the complicated center of medicine's purpose. She recalls many children whose stories have stayed with her, and her photograph albums are filled with such faces: a child whose body was burned from head to toe and another whose legs were torn apart by a school yard landmine. There were the still, dark eyes of a 12-year-old girl with rheumatic heart disease: She would not receive the valve transplant she needed in time to recover.
One infant with encephalitis did survive, despite an unpromising future. In a country where doctors are rare, blind faith is the double-edged sword.
"His mother was so happy that he had lived," said Dueger. "The child was never going to develop any further, but she was beaming."
(To learn more about Friends Without A Border, visit www.fwab.org or call (212) 691-0909. Donations can be sent to Friends Without A Border, 1123 Broadway, Suite 1210, New York, NY 10010.Kristin Proulx can be reached at 224-5301, ext. 304 or at email@example.com)