Dr. Anne Walker, a Palos Verdes Peninsula resident and Disaster Doctor

Anne Walker (front row, third from left), with fellow volunteers and residents of Kutupalong refugee camp in Bangladesh.

Counting the number of people in a refugee camp is an inexact science, but it is generally agreed that Kutupalong in Bangladesh is currently the largest in the world. Estimates put its population as high as 1.3 million people, almost all them Rohingya. The Rohingya are a mostly Muslim, ethnic subgroup that until recently was concentrated in Myanmar, in Southeast Asia. But the government of Myanmar, a former British colony known as Burma, has targeted the Rohingya in a series of vicious attacks that, in the words of the United Nations Special Rapporteur on Human Rights for Myanmar, “bear the hallmarks of genocide.” Starting around August of 2017, survivors began fleeing en masse on foot over the border into Bangladesh, and assembling in a swath of dense jungle near the Cox’s Bazar area. The Rohingya stripped the bamboo trees to erect shelters, and a teeming settlement sprang up seemingly overnight. If the 1.3 million figure is accurate, Kutupalong now has about as many people as Dallas.

The clinic where Walker volunteered sees as many as 800 patients a day, many of them children suffering from diseases that in the developed world are easily preventable.

Anne Walker, a Palos Verdes Peninsula resident and doctor, recently returned from Kutupalong. Walker was volunteering with other physicians, something she has been doing periodically for almost a decade. The arrivals in Kutupalong, she said, are people without a country, wanted by neither Myanmar nor Bangladesh, who fences the camp and regulates who can come in and out. Walker said the the camp’s spartan conditions and the recent trauma endured by most of its occupants made for challenging medicine.

“A lot of them have PTSD, and so they have a million somatic things affecting every system in the body. We saw a lot of respiratory stuff. They live in little huts and cook with wood, so they’re constantly breathing smoke and dust. Diarrhea, because the water is not clean,” she said.

Walker described the conditions with a frankness that could be mistaken for despair. But although she is clear-eyed about the difficulties of treatment, she is not put off. Instead, she expressed a desire to return, especially as a shift in the seasons signals the arrival of monsoons, whose torrential rains make an already difficult situation even more challenging. It’s an approach to medicine that, while relatively rare, is deeply felt.

Salman Naqvi, a pulmonologist at Hoag Hospital in Newport Beach, is the founder of Shine Humanity. The group coordinates physicians in various crisis zones around the world. He first met Walker on a trip the group organized to Haiti following the 2010 earthquake. When he began organizing doctors to go to Bangladesh, he reached out on the messaging service WhatsApp. He got a good initial response, but had a hard time expanding the group beyond its core. “Certain kinds of people want to do this, and then do it again and again. But the majority don’t care,” Naqvi said. Physicians are not compensated for going, and must pay for their own transportation. Many of the volunteers were young, he added, and about 80 percent were women. “The heartwarming thing was we saw these physicians from all over the world: the United States, but also Australia, South Africa, Turkey, Pakistan. It’s a very addictive feeling: a high you get by doing work for others .”

 

 

Her own trail

Walker recently returned from another trip to Asia, but was not working on this trip. She was mountaineering in the Himalayas. She had previously been to Nepal and Bhutan, and this time was headed for the base camp at Mount Everest. She didn’t take the altitude sickness medicine Diamox — “I hate to take it because it gives weird side effects. It numbs your fingers,” Walker said — and began to feel ill around 15,000 feet. She took a day to rest, and woke up in the middle of the night with a bad headache. She was supposed to ascend to 16,500 feet the next day, but the combination of feeling ill and reports of bad weather convinced her to turn back. (Back in Kathmandu, she ran into some people who had pushed ahead: they ended up spending three days in the hospital.)

The decision to turn back was made easier by the fact that she was hiking by herself. Although most people feel safer making the trek in a group, Walker said being on her own made her feel more in control.

“I don’t like to hike with other people. I don’t feel comfortable enough to do that. I don’t want to hold them back. I don’t want to feel any pressure to go faster or slower,” she said.

Walker was born and raised in Corning, New York, a small town upstate. When she was growing up, the nearby Chemung River overflowed during Hurricane Agnes and flooded the town. Eighteen people died, and her father headed up disaster relief.

Around the same time, she remembers receiving handwritten letters postmarked “Rhodesia” from her brother, who was serving in the Peace Corps. (The area was part of what is today called Zimbabwe, which gained independence from the United Kingdom in 1980.) Several more of Walker’s seven siblings also served in the Peace Corps, as did her father after he retired.

Walker got her chance to work overseas in her third year of medical school, which she spent in Ghana. The early exposure to a low-tech doctoring convinced her that the challenge was for her.

“It was really good, because you learned to trust your instincts. The medicine is old-fashioned, you use all your senses,” she said.

After medical school, she spent a year in pediatrics at Harbor/UCLA. Then she took what she called a “year off” to get a master’s in public health, and then returned to UCLA to focus focus on obstetrics and gynecology. After building her practice, she resumed volunteering after the tsunami that devastated Indonesia in 2004, but had difficulty getting placed. She had more success after meeting Naqvi, and went to Haiti with Shine. She has since returned to Haiti, and also traveled to Peru and Pakistan.

 

Helping better

Volunteering exposed her to a well-documented paradox of foreign aid: do-gooders jumping into a disaster zone sometimes create more problems than they solve.

“You go in for a week and you do a zillion surgeries. But in the meantime you’ve taken business away from local doctors. And if you do surgery, you leave patients in need of follow up. Now where do they go?” Walker said.

Asked what a medical aid program would look like if she could design it and expense was no object, Walker said the first step would be a thorough examination of the area, including identifying needs and the kinds of service already being provided. The key, she said, is finding out what the people living there feel they want, rather than trying to impose a system on them.

“Feel out the whole system, and from that point build what they want: build the clinic way they want. Build it where they want it, so that people will actually come. And staff it with their people,” Walker said. “Provide expertise, if it’s needed. We’ll guide you along the way. It’s like teaching a kid how to ride a bike. They just need a push to get them going.”

Perhaps not coincidentally, this description sounds a lot like the Humanitarian Assistance Program for the Rohingya, the group with whom she spent her time in Bangladesh.

The program got off the ground thanks to the effort of Los Angeles native Dr. Anam Ali. She was working with OBAT Helpers, an organization helping Pakistanis who had been stranded in Bangladesh during a conflict more than a decade ago. Last August, when attacks on the Rohingya intensified and the exodus began, Ali and some colleagues traveled there and saw that, “Basically everything needed to be done.” So they helped set up shelters, a temporary learning center with a rudimentary school, and a clinic. Today, the Humanitarian Assistance Program is the only permanent health facility serving the camp. When fully staffed the clinic treats up to 800 people per day, and often closes up shop with a line of people still waiting, Ali said. (The Bangladeshi government does not permit doctors to sleep in the camp, so volunteers must walk 40 minutes in and out each day.)

Walker was especially taken by how the program was teaching people in the camp to do basic first aid, including blood pressure checks and CPR. Given the feeling of hopelessness that can define daily life in Kutupalong, the sense of purpose these skills provide to camp residents can itself, good medicine.  

“A lot of the health facilities in camp are temporary; we are there to stay. We’ve been there since day three, and we don’t plan on leaving. I don’t think this population is going anywhere, and as long as they are there, we will be there,” Ali said.

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