While traveling through Nicaragua for two weeks last November with a group of fellow trauma surgeons, Dr. Hansjurg Holdener, 39 and Swiss, was reminded of Afghanistan. For nine months ending in the summer of 1985, he was the chief of surgery at an International Red Cross hospital near the Afghanistan border.
"The Soviets there," Holdener said, "were like the contras in Nicaragua. Both killed civilians, both blew up hospitals, both took hostages from sickbeds, and both saw nothing morally repulsive in killing children -- the Soviets with bombs that look like toys and the contras by laying mines in fields where children play."
Holdener is one of many friends of Nicaragua who came to Washington last week to persuade Congress to vote against contra aid. He was joined by Dr. William Burman, a trauma surgeon and professor of orthopedic surgery at the State University of New York in Brooklyn. The two physicians differed from most opponents of contra aid because they went beyond the usual protests that that aid is morally wrong and politically ineffective.
They visited congressional offices, starting with those of the speaker of the House and the House majority leader. They explained that if Congress is serious about offering humanitarian aid to Nicaragua, then it ought to know about a project proposed by a group of North American trauma surgeons willing to work among the war's victims.
Holdener and Burman, who visited hospitals and clinics in Managua, Leo'n, La Trinidad, Esteli, Matagalpa and other Nicaraguan areas, report that "the majority of those suffering wounding, maiming, paralysis and death are not military but civilian casualties." At the Aldo Chavarria hospital in Managua, for one example, they learned that the prosthetic department, which replaces 600 limbs a year, was overwhelmed by the increasing number of amputations.
The project proposed by the two surgeons is a comprehensive orthopedic and trauma care hospital, to cost $20 million and be part of the humanitarian aid that Congress says it wants to offer to Nicaragua. It would be located in La Trinidad in Esteli province about 100 miles north of Managua. An existing structure -- an abandoned Seventh-Day Adventist 90-bed hospital -- is there. Holdener and Burman, each of whom has promised to donate a year of work at the proposed hospital, have persuaded 12 members of the American Association for the Surgery of Trauma to form an emergency committee of physicians to offer their services also.
These are the trauma doctors -- genuine blood and guts heroes -- who see battlefield violence in its full medical horror. In Nicaragua, according to a Feb. 13, 1987, story in the American Medical Association News, "more than 70 health facilities have been completely or partially destroyed by the contras, and an additional 40 health units located in war zones have been closed due to the threat of contra attack. Several clinics have been destroyed and rebuilt as often as three times in the past four years. Further, it is estimated that the health care system has sustained more than $30 million in damages, resulting in the loss of health services for up to 15 percent of the population."
In September 1987, the Unitarian Universalist Service Committee reported in "Health as a Human Right in Nicaragua: the Impact of 'Low-Intensity Conflict' " that contras routinely kill or abduct doctors, nurses and other health care workers. Overall, with more than 5,000 war-related deaths in Nicaragua, the "fatality rate is more than 10 times greater than the proportion of U.S. citizens killed in Vietnam." Health care and education received 50 percent of Nicaragua's budget in 1983, and 18 percent went for defense. As a result of the contra war, the numbers are now reversed.
Before traveling to Nicaragua, Burman, who is 39 and served for two years in Utah in the Indian Health Service after graduation from medical school in 1975, had listened to the Reagan administration's ominous line about the "Soviet beachhead" in Central America. In two weeks, Burman met one Russian -- an orthopedic traumatologist treating war casualties in Managua. He met East Germans who had built and were staffing and equipping a hospital for war victims.
"As I made the rounds with these doctors tending the desperate needs of victims of bomb blasts, antipersonnel devices and mortars," Burman recalls, "there was no doubt from watching the developing doctor-patient relationships whose influence will be lasting in this region."
Congress, finally and for once, has said no to sending weapons to Nicaragua. The moment has come, beginning with Holdener and Burman, to send doctors. Whether seen as reparations for what damage our military aid has done or as an enlightened change in foreign policy, for an estimated $20 million, Congress could send to Nicaragua the kind of humanitarian aid that truly is humane. If competing with communism is the goal, let it be in hospitals, where lives, not ideologies, are at stake.