Michael VanRooyen: Rebuilding places that peace abandoned

“When they put the gun in my mouth, I decided it wasn’t so ridiculous after all.”

In 1996, Michael VanRooyen was on a relief mission to Nyankunde Hospital, near Busia in the Democratic Republic of the Congo, then called Zaire.

Zairean soldiers, under assault from the Ugandan- and Rwandan-backed forces of Laurent Kabila, had met the plane carrying VanRooyen and a load of medical supplies as soon as it landed.

The soldiers accused VanRooyen of being a CIA spy, intent on re-supplying Kabila’s rebels rather than a hospital. To VanRooyen’s claims that he was a doctor, the soldiers replied that the lanky American couldn’t be because he was too thin — unlike local physicians whose elevated status often led to expanding waistlines. When VanRooyen retorted, “That’s ridiculous!” the soldiers chose a simple way to convince him of how serious they were.

“The Congo in 1996 was worrisome,” VanRooyen says today with the understatement born of a career spent in conflict zones. “I’d never equate it to someone being taken hostage in Iraq, for example, but it was scary.”

VanRooyen and his traveling companions on that trip — a relief worker colleague and the plane’s pilot — were held by the local soldiers for five days while fighting raged nearby. Doctors at Nyankunde Hospital, the supplies’ destination, eventually negotiated their release, at a cost to VanRooyen of $6,000.

That trip would be VanRooyen’s introduction to the vast, dysfunctional nation that occupies much of Africa’s midsection. Then called Zaire, the nation received its current name — the Democratic Republic of the Congo — from Laurent Kabila, who overthrew dictator Mobutu Sese Seko in 1997 and who was himself assassinated in 2001.

After such an introduction, it’s to VanRooyen’s credit that he has ever gone back. Today, as co-director of the Harvard Humanitarian Initiative (HHI), associate professor at the Harvard School of Public Health and at Harvard Medical School, and emergency medicine specialist at Brigham and Women’s Hospital, VanRooyen is working with HHI researchers and physicians to probe the roots of the sexual violence stemming from the continuing conflict in the Congo’s eastern border region, which has seen little peace since his first trip 13 years ago.

Founded in 2005 by two professors at the Harvard School of Public Health, the Harvard Humanitarian Initiative seeks to draw on expertise from Harvard’s various Schools to conduct research that sheds light on humanitarian crises around the world. VanRooyen and HHI’s other co-director, Professor of the Practice of Global Health at the Harvard School of Public Health Jennifer Leaning, say the research will inform relief organizations, governments, and the United Nations as they design and execute crisis responses.

HHI’s work in the Congo aims to illuminate the roots of the sexual violence that is epidemic there. Women throughout the region are being raped and mutilated by any of several armed groups that are still active. HHI’s program centers on the work of Panzi Hospital, a facility in the provincial capital of Bukavu, which treats more than a thousand raped and injured women each year.

“Sexual violence is a common feature in conflict, [but] sexual violence in the Congo — some people think it is entirely different,” VanRooyen said. “Not only have women been assaulted by multiple assailants, but in many cases, women come to Panzi Hospital because they’ve been assaulted by sticks or knives or weapons, causing internal and external injuries. Women are incontinent and suffering tremendous infections. Many have died as a result.”

The program uses a two-pronged approach: one, administered by Harvard-affiliated Brigham and Women’s Hospital, supports Panzi’s clinical work, while the other, administered by Harvard, uses research to understand the violence, probing the records of the thousands of sexual assault victims, conducting focus group interviews in the community, and talking to the soldiers themselves about the problem.

Throwing himself into a double life

VanRooyen has divided much of his career between big-city emergency rooms and headline-grabbing global crisis zones.

Tall and thin, VanRooyen’s restless energy has taken him not only to natural and man-made disaster areas, but also to the top of Aconcagua, South America’s highest peak. Intellectually, VanRooyen’s energy has resulted in more than 50 publications related to international emergency medicine and a key textbook, “Emergency Field Medicine.”

Though he conducts much of his work under difficult circumstances, one of the first things one notices about VanRooyen is his sense of humor. Level-headed in a crisis, VanRooyen is also quick with a quip or a self-deprecating tale when the crisis is past.

“He’s extremely gifted as a leader, a researcher, a teacher. He’s confident without being a ridiculous risk-taker. And he’s got a wonderful sense of humor,” Leaning said. “I feel we’ve created a powerful unit here.”

VanRooyen’s interest in international relief grew naturally from his interest in emergency medicine.

“[A crisis zone] is almost like the Emergency Room of the world. It’s a place where there’s the worst forms of human vulnerability, the worst forms of violence against people, and the most difficult environment,” VanRooyen said. “It’s an opportunity for tremendous innovation and engagement.”

VanRooyen felt pulled to emergency medicine almost from the time he first decided to become a doctor, in high school in the small town of St. John’s, Mich. He remembers being awed by emergency responders who helped a local kid whose tractor had overturned on him in a ditch. VanRooyen, who had been riding down the road shortly after the accident, was the first on the scene.

“I just stayed with him, held his hand, and talked to him,” VanRooyen said. “I was absolutely stunned by the whole event, but as the emergency responders got there, I realized how good they were. Even in my small town, they were great, cool, and calm.”

VanRooyen attended Michigan State University, graduating in 1984. He went to Wayne State Medical School, graduating in 1988 and getting his first exposure to life as an emergency room physician at Detroit Receiving Hospital. He did his emergency medicine residency at the University of Illinois, Chicago.

“It’s unlike any other field of medicine,” VanRooyen said. “It’s fast-paced and the needs are tremendous. You not only have to be really good talking to people and listening to them, you have to make life-and-death decisions very quickly. I was very impressed with the doctors who did it well.”

It was while at medical school that VanRooyen began to explore the field of disaster relief, cramming all his fourth-year rotations into one part of his schedule so he would be free for a self-created traveling fellowship. During that year, he spent time first in India with the Indian Red Cross. Then he traveled to Geneva to do research with the International Committee of the Red Cross, and wound up the year observing Maryknoll priests in El Salvador ministering to community members during that nation’s civil war.

After his residency, VanRooyen worked for a year and then continued to explore relief work. Together with his wife, Julie VanRooyen, a pelvic surgeon and urogynecologist, he spent a year abroad, doing research in London, working at a Kenyan mission hospital, and working in Somalia for a small non-governmental organization called Samaritan’s Purse.

When he returned to the United States in 1993, he took over as medical director of the University of Illinois Medical Center, but continued to divide his time between his administrative, clinical, and relief work, spending time in Bosnia, Sarajevo, Sudan, and Rwanda.

During the 1994 Rwandan genocide, VanRooyen followed the Rwandan Patriotic Front during its push that would topple the government and end the killing. Once in Kigali, VanRooyen began work to reopen the capital city’s Central Hospital of Kigali.

“The city was empty,” VanRooyen recalled. “They had buried most of the bodies but everything was destroyed. There were remains, there was still blood in many places. The hospital was a huge mess. It had been torn up and several thousand bodies were buried on the grounds.”

The hospital had to be scrubbed clean and restored from the ground up, VanRooyen said. VanRooyen and other relief workers began with the surgical ward, the emergency ward, and the inpatient ward. Then they restarted the lab and radiology department. Then they had to re-establish the hospital’s entire administrative structure.

In 1997, he moved to Johns Hopkins University but continued to live a divided professional life. He worked with the United Nations, the World Health Organization, and Samaritan’s Purse. He worked in North Korea, Kosovo, Iraq, and in Honduras after hurricane Mitch.

“I’d pack my clinical schedule and then go abroad for a month or so, set up operations, get things started, get all the other staff in, then leave and check back,” VanRooyen said.

The more VanRooyen saw, though, the more he was dissatisfied with the way disaster operations were conducted.

“I saw many organizations making the same mistakes. I saw competition in the field, lack of follow-up, lack of accountability,” VanRooyen said. “The intention of doing good does not mean that you’re doing good work. I thought the humanitarian community needed to evolve with respect to accountability and outcomes.”

VanRooyen began to work in earnest on an idea that had been forming for some time: that humanitarian efforts could be enhanced through research and analysis.

The idea of taking a research-based approach to humanitarian relief had gotten a skeptical welcome when he had first raised it with his colleagues, but VanRooyen’s department head at Johns Hopkins was more encouraging. VanRooyen began publishing studies, writing, among other things, a case study of reopening Kigali’s Central Hospital so future relief physicians could learn from the experience there.

During his years in the field, VanRooyen met Leaning, who was also active in disaster relief, approaching it from a human rights standpoint. The more they talked, the more they agreed that research could improve relief organization operations. “Harvard is unique among any other university in the world in that it has these huge, powerful, innovative programs in business, law, medicine, public health, government,” VanRooyen said. “I thought it would be quite something to build an institution that would be an analytic resource for NGOs, the U.N., and government organizations on an array of complex issues in humanitarian response.”

An additional way to make an impact, VanRooyen said, is through mentoring bright young students and scientists, thus building capacity to handle the world’s ills.

“We can change [the world] most dynamically and appropriately by multiplying ourselves,” VanRooyen said. “By multiplying ourselves with people who are better than ourselves — they’re absolutely stellar, smart, motivated, experienced. … I wish anybody a career where they’re completely excited about their work; they’re driven by it; they’re inspired by it.”