One doctor, 150 countries

Susan Pinker

CMAJ 2000;162:1540

Practising medicine at Santé Acceuil, a Montreal clinic for refugees, means that Dongier, now 47, sees some of the most fragile members of society. His patients hail from countries in crisis and they arrive in Canada with problems unique to the displaced. "These people have left their homes abruptly, separated from their families. They've lost wives, children, their social network. Often they are here alone. They're very isolated."

Dr. Pierre Dongier and his team: Dr. Lavanya Narasiah (seated) and (standing, from left) nurses Manon Kiolet and Michele Limoges, Dr. Renée Pelletier and nurse Michele Racette Photo by: Susan Pinker

But no man is an island. That becomes clear in the busy waiting room at Dongier's clinic, where signs are posted in 8 languages. The clinic treats patients from 150 countries, he says, and whether his patients communicate in Punjabi, Russian, Farsi, Urdu, Kinya-Rwanda or Lengala depends on what is happening in the countries where these languages are spoken. Using interpreters, whom he calls "cultural brokers," Dongier is careful not to erode the newcomers' perspectives on illness. "People have their own explanations about where diseases come from, such as attributing them to bad spirits or to enemies who wish them harm. In most situations there is no conflict between our belief systems. If people trust you and believe you're there to help them, they will take their medication and perhaps go to the traditional healer also. If you are ready to discuss with them, and not present your position as the universal truth, very often people will listen to you."

During the interview, anecdotes surface about his work with the Service Universitaire Canadien Outremer in Guinée-Bissau, West Africa, during the late 1970s, where he was the first doctor in a newly built hospital deep in the bush. A friend who visited him there recalls how Dongier and his wife, Radegonde Ndejuru, waged a campaign against spitting around the hospital during Ramadan. (Some Muslims feel that swallowing saliva during Ramadan violates the fast.)

In Africa, Dongier also had a chance to deliver babies alongside midwives. The midwives' traditional methods — they often used old knives to cut the umbilical cord and cow excrement to staunch the bleeding and bandage the umbilicus. "So a lot of children were dying of tetanus," recalls Dongier. "They had absolutely no idea where the disease was coming from."

He explained to the women that it's better to use alcohol and a clean bandage. However, he knew that in a part of the world where travel is difficult and there is 1 doctor for 10 000 people, bandages can be hard to find. He applies the same logic to newly arrived refugees, whose successful integration into Canadian society hinges on empathy, education and access to small items most of us take for granted. Every second Thursday Dongier takes condoms to the Jardin Couvert, a meeting place for refugees. "I explain what kind of health system we have, the kind of diseases they can get, like flu or STDs, and do a demonstration of the use of condoms."

More often than not, Dongier's patients have been victims or witnesses of violence and torture. "People come here with terrible stories," says colleague Dr. Marie Munoz, "and can be psychotic or suicidal." By consulting Dongier, who has developed expertise in post-traumatic stress disorder and depression, she is often able to find a sensible alternative to the emergency room. "They arrive here disoriented, not able to take care of themselves," relates Dongier.

Dongier downplays the impact war and brutality have had on his own psyche. "Being part of a team helps," he says. "You can share your feeling of powerlessness." And while refugee claimants may at first be paralysed by their experiences, the adjustment period doesn't last long. "They're very strong, very resourceful. They found a way to get over here. Once you help them get started, they manage well."

Dongier, who was raised in France and Belgium and graduated from McGill in 1976, seems unflappable, even when faced with the horrors of torture and incredible loss. But longtime friend Dr. Gerald van Gurp says that Dongier's elegant, unruffled veneer is not detachment at all, but "eternal optimism. Whenever we're discussing social justice issues, which might discourage anyone, he always has tremendous faith in the goodwill of the human race."

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