In recent months, I’ve taken a growing interest in reading the accounts of health care workers from conflict zones, areas of the world caught in a crossfire of warring factions, where men, women, and children bear the collateral damage wrought by bombs and bullets. Health care workers’ harrowing stories are some of the most unvarnished ones we have to hear, and as a physician myself, I take them in with equal measures of inspiration and disbelief. Hearing about the types of duress they have been under, I have often wondered how I could help.
At first, I thought I could not. Beyond sharing an understanding of our bodies’ inner workings and an instinct to be compassionate towards those who are ill, I find unimaginable what many of my colleagues are thrust into doing. For example, in Gaza they are salvaging or amputating blast-riddled limbs, performing surgeries to staunch catastrophic bleeds with no prior surgical training, maintaining resolve in the face of the indiscriminate suffering of innocent lives which might otherwise be helped with the most basic of medicines, and stemming the resurgence of a debilitating virus that has long been presumed to be eradicated. The sliver in the Venn diagram of where our practices of medicine overlap is inconceivably slim. Yet I have found that they do nonetheless — the embers stoked by these confrontations reach even me, half a world away.
I work in a clinic in Toronto that largely serves patients who are newcomers to our country, many of whom are seeking asylum. The relationship between patients and doctors is frequently one born of unfortunate and unpredictable events. Patients arrive to our clinic from disparate places such as Ukraine, the Democratic Republic of Congo, Haiti, and Pakistan. What funnels someone to me after their long and complicated journey is often an abnormality unseen or unfelt to them: an opacity on a chest X-ray. This white haziness in their lungs, where there should only be the empty blackness of air, is commonly the mark of a tuberculosis infection. In the vast majority of people, such TB is latent and cannot be spread to others in this inactive state.
The specter of armed conflict inflicts damages on people beyond the litany of physical wounds that need tending.
Pinpointing how someone becomes sick involves a careful examination of their life’s circumstances. Overcrowded environments, poor living conditions, economic insecurity, malnutrition, and limited health care infrastructure all, in some form or other, contribute to the spread of TB and other diseases. That much we know. While I had simply accepted many of these elements as hard realities of a life lived on the margins, I now find myself considering how they are intensified by a factor I had always thought outside of my grasp: warfare.
This is because, through the experiences of dispossessed patients, the world’s conflicts fall sharply into focus. I recall a woman from the eastern Democratic Republic of Congo, for instance, who told me that the disordered aftermath of a dubious national election last year incited clashes between military and rebel groups and displaced at least 7.2 million people. Another patient, fleeing decades of fighting in the contested region Kashmir and later avoiding persecution as a gay man in Pakistan, recounted being detained in a center for refugees in a separate country for 10 years. And I was told that in Haiti, where gangs violently tussle for control of a country in tumult, hospitals are scoured and looted for supplies, leaving them barren and all but functionless. The specter of armed conflict inflicts damages on people beyond the litany of physical wounds that need tending. It exacerbates the rates of various diseases. But the fallout of certain ones — including TB, HIV, and hepatitis B — is not always felt immediately. They shape a life in gradual and insidious ways: over years and spanning lifetimes, beyond borders and across oceans.
The interaction between doctors and patients outside of conflict zones has different stakes. But it is not without hurdles. When, and if, an individual can escape the grips of a conflict-ridden region, what can await them in places of purported safety is a different type of hostility. “Communicable diseases like HIV and TB have skyrocketed in this small Ohio town,” Vice President–elect J.D. Vance told CNN on the arrival of Haitian immigrants to Springfield, in his state of Ohio. What ought to be a lesson of courage is easily twisted, instead, into the threat of unfettered incursion and sickness.
Witnessing an extreme degree of anguish and resilience surely rearranges your emotional DNA.
Perhaps spreading faster than any microbe — and potentially as harmful to our health — is the scourge of misinformation. Organizations such as GLAAD and Equality Springfield, which deeply understand the discrimination encountered by HIV-infected persons, stepped in to counter the disparagements. In the county where Springfield is located, active cases of TB marginally increased from 3 to 4 between 2022 and 2023, while HIV cases increased from 142 to 178 between 2018 and 2022 — as they might in any other jurisdiction (such as Toronto) that embraces people from beleaguered countries. Some of the most motivated patients I see are the ones who only now have the chance to receive health care.
Many of the reflections I read from these health care workers end with a changed perspective. Witnessing an extreme degree of anguish and resilience surely rearranges your emotional DNA. That happened to me after I traveled to Port-au-Prince, not long after the 2010 earthquake that devastated Haiti’s capital, to help run makeshift medical clinics in the scattering of schools and churches that still stood. Aspects of humanity both utterly terrible and incredibly uplifting filled those weeks. Although I’ll never forget those scenes, my realizations of needing to live more fully and generously and appreciatively only materialized when I returned home to some relative comfort — as usually seems to happen to those who undertake, and then write about, their expeditions.
When the plane touched down in Miami, I was thinking about the thousands of people whom we helped but who nevertheless had to remain there, sorting through the rubble of their lives, plunged into ruin by a force over which they had little control. Could they see their lives differently? Not, perhaps, as I could, having the chance to take in my lessons and grow my optimisms outside of a place in crisis.
This has made the clinic in Toronto — with the patients who arrive there — a place where I can share and nourish a thing as powerful as any medicine needed during a conflict: hope.
Arjun V.K. Sharma is a physician specializing in infectious diseases and tuberculosis at the University of Toronto whose writing has appeared in the Washington Post, L.A. Times, and the Boston Globe, among other outlets.
This article was originally published on Undark. Read the original article.
