A doctor without borders

Date Published:

Jul 19, 2004


Jennifer Leaning, just back from a taxing trip to Sudanese refugee sites, travels the world in the name of human rights

CAMBRIDGE—The after-lunch meeting has just begun—and snacks of broccoli rabe and ricotta pizza have been brought to tables draped in white linen—when Dr. Jennifer Leaning strides into UpStairs on the Square. She is recently returned from a harrowing two-week trip to the Chad-Sudan border, and the gulf between that desperate place and here seems even greater than the 5,700 miles separating the two. Now she discusses the plight of Sudanese refugees with 15 activists and congressional staffers convened by Physicians for Human Rights and Amnesty International. "There is a systematic attack on villages, livelihoods, and people of the non-Arab population," Leaning tells them, "not just to terrorize them but to expunge them from that part of the earth."

Leaning is an emergency room physician who turned her political conscience and love of travel into an avocation of fighting for human rights, then turned her avocation into her vocation when, in 1999, she was named director of the Program on Humanitarian Crises and Human Rights at Harvard's School of Public Health. She is a pragmatic intellectual who believes Sudan is practicing genocide in Darfur. An official finding of genocide would trigger a legal obligation for other countries to intervene, but Leaning doesn't want debate over labeling the crisis to distract from helping the more than 300,000 people now at risk of dying. She is part of a cadre of doctors affiliated with PHR who interrupt comfortable lives to use their medical expertise to investigate alleged violations of international law in far-flung places.

"I can see a line of sight between making a living here and making a difference," says Leaning, 59. "Maybe I could contribute to a public debate about human suffering."

"She's very brave, very smart, and very effective," says John Shattuck, the former assistant secretary of state for human rights now at the Kennedy Library. "Not many people," says former PHR president Robert Lawrence, "combine her clinical capacity to understand the urgent health needs of a population in a large refugee area and at the same time have a real thorough grounding in international human rights law and know the binding conventions and the universal declarations and all the other things Jennifer could probably recite in her sleep."

What Leaning and John Heffernan, a PHR staffer from Washington D.C., found on their June trip to Chad dovetails with what others have reported is going on in Sudan's Darfur region. After government aircraft bomb non-Arab villages, Janjaweed militia, often on camelback, kill and rape, destroy dwellings and livestock, and poison wells. The government has obstructed humanitarian aid to more than 1 million people displaced within Darfur, and the rainy season will add more obstacles. An estimated 30,000 have been killed, and about 200,000 have fled to Chad. The physician group's conclusion that this constitutes an unfolding genocide goes further than other human rights organizations and adds to pressure on the United Nations and individual countries to intervene.

"The issue of whether you call it genocide is a complicated one, but we're not letting it split us. There's unanimity that this is a colossal calamity, and we have to act in the next month," Leaning says.

Leaning faced a challenge in Chad she never encountered on 14 missions to Afghanistan, Kosovo, Somalia, Soviet Georgia, and the West Bank. She suffered life-threatening dehydration and gastroenteritis. "It was very chastening," Leaning says. "It made me appreciate how tough the people there are, and also how vulnerable," she adds. "When you deracinate them from their life supports, although they will live longer than I would, the environment will still kill them."

In her office at Harvard's Bagnoud Center for Health and Human Rights in Boston, Leaning talks of the difficulties of doing research in such places as eastern Chad. On the wall is a copy of a graph showing the number of Napoleon's troops marching to and from Moscow in 1812, its simple lines a stark depiction of the cost of a campaign in which hundreds of thousands of soldiers died. Leaning is tall, with intense blue eyes and the habit of folding the edge of the binding at the top of a pad of paper back and forth as she speaks. "You always have the feeling," Lawrence says, "that Jennifer has just had three cups of coffee."

Getting from N'Djamena, the capital of Chad, to the first area Leaning and Heffernan visited took four days. They had to hire translators and a driver they felt would slow down at a woman's behest. They inspected tires and brakes, but, in a fateful oversight, forgot to check for a cigarette lighter, a crucial power source. Temperatures, Leaning says, hit 120, and sandstorms felt like smothering, swirling talc.

At dusk on their third day, the SUV got stuck on a rock. Finally, a lorry approached. Leaning waved a flashlight, and men armed with Kalashnikovs alit. "This was an area known to have bandits," Leaning says. "One of them said, `You're lucky we didn't shoot. We didn't know who you were.' " With their help, the car was eventually dislodged. At the first refugee site Leaning's entourage reached, Goz Amer, the UN worker had too little food to share. "Goz Amer," says Leaning, "was much better than other parts."

Thus their trip began.

Though the temperature inside the air-conditioned SUV hit 90 degrees, they could keep windows closed and sand out. Quarters could be as spartan as a sheet sack on a hard floor. They carried prepackaged cheese and biscuits and bottled water. Leaning is a vegetarian who often travels to places where cooked meat is the safest food. "I've lived on bread and rice and PowerBars," she says. "The sanitation in rural Chad is really poor. Flies and sand and other elements go into what's being cooked that I didn't want to identify."

They interviewed refugees about their experiences in Darfur and promised to use their stories to try to effect change. "It validates their private sense of outrage," Leaning says. "It's not just a personal tragedy but a grave disruption of what the international community thinks is right."

One young man had a leg swollen from serious infection following a machete accident. Leaning tried, in vain, to convince him to come with them to get medical care, then left him money for antibiotics. She met a woman who fled Darfur with a baby at her breast and three other children. The Janjaweed shot at her, striking her in the elbow and side and taking a piece of her baby's finger. For 10 days, she walked and hid, wounded, scrounging for water and food.

"I will never forget either of those people," Leaning says. "The guy with the calf wound who was so courteous and brave but who could not organize his mind to get the medical care he needed either because of his responsibilities or fear of the unknown. Or this young woman, who was so heroic in saving herself and her four children. And these are two people of 200,000."

Near the end of the trip, Leaning got sick, probably from the carrot and beet salad she ate before they went to the desolate desert on Chad's northern border with Sudan. "We felt a fair amount of pressure to cover a lot of ground despite the rainy season and poor terrain. We didn't have that much sleep and we weren't eating that much. We were drinking, but the air conditioning can prevent you from realizing you're getting dehydrated," Leaning says. She was hardly perspiring when they arrived at the Bahai area.

"It is an appalling place," Leaning says. Eighteen thousand refugees were there, many huddled under scattered, scraggly trees. Their animals were dying of thirst. Here, feeling faint, Leaning had to lie down. By the time she started vomiting, she was already dehydrated. She needed intravenous fluids. She carried sterile equipment, because of AIDS, but the rudimentary site had only a liter of rehydrating fluid and their sugar water wouldn't replace crucial salts and electrolytes. "My pulse was 140, and it was hard to find," Leaning says. Afraid her veins would soon collapse, she quickly had the only other doctor there at the time put in an IV. She asked to be evacuated that night.

Their satellite phone was low on power, and the car had no cigarette lighter. Nobody would fly in at night in a sandstorm. Land mines and bandits made it too risky to drive four hours to a clinic in Iriba. They called Brigham and Women's Hospital to see if they could add oral rehydration salts to the IV sugar water, but the phone died. So, for six hours, Heffernan gave Leaning a tiny cupful of the salts every 30 seconds, and Leaning willed herself not to vomit or lose consciousness. At dawn they could drive to Iriba. "You have this animal sense when you know it's bad," she says. "I became entirely focused on finding a way out."

The aborted call to Boston had been enough to get word to PHR, which, for the first time in its 18-year history, activated its emergency medical services. Leaning was treated in Iriba, then airlifted to N'Djamena.

So ended Leaning's most recent mission, more than a half-century after her first. When she was in first grade in New Paltz, N.Y., she was one of six children selected to deliver the chickens the class had hatched to poor, immigrant farmers from Eastern Europe. "I don't recall the encounter with the farmers or the transmission of the chickens," Leaning says. "I just remember being part of this important charitable mission."

Thoreau may have been content to travel widely in Concord, but for Leaning, who lives in an expansive center-entrance colonial on a bucolic street in Lincoln, staying close to home has never been enough. Her mother grew up in Japan, the daughter of YMCA missionaries. Her father was a former British diplomat who had friends around the world. They split when Leaning was 6. "Current events, the news, and insights about the news were extremely relevant and salient in our household," she says.

In 1965, when Leaning was an undergraduate at Radcliffe College, she took a leave to spend a year in Tanzania. She taught in Dar Es Salaam, then set up child care in a village experimenting with rural agriculture. In 1967, she and the husband she later divorced (she just remarried) honeymooned with a trip around the world. They hitchhiked from Nairobi to Cape Town, traveled steerage on a freighter between Singapore and Ceylon, now Sri Lanka. In 1969, she visited Kabul, where her mother was teaching; in 2002, she returned to Afghanistan on a PHR mission during which she visited prisoners and uncovered a mass grave.

"Consciousness and appetite for life and yearning for a future is something everybody is born with," she says. "I was fortunate that I was born in a time and context that allowed me to thrive and prosper. I feel connected, and not intimately, personally responsible for everyone's grief and suffering, but in a complex, organized social way, I feel responsible." The afternoon that starts with the meeting at the restaurant ends with Leaning participating in a crowded public forum on Sudan at Harvard's Kennedy School of Government. In the month since she's been home, an additional 12,000 refugees are estimated to have fled to the Bahai site where she got ill.

"The chance is now," Leaning says. "It's almost slipping past us."


Jennier Leaning, a faculty associate at the Weatherhead Center for International Affairs, is professor of International Health in the department of Population and International Health at Harvard's School of Public Health.