Book Review

Dust to Dust: A Doctor's View of Famine in Africa

N Engl J Med 1993; 329:287July 22, 1993

Article

Dust to Dust: A Doctor's View of Famine in Africa
By David Heiden. 209 pp., illustrated. Philadelphia, Temple University Press, 1992. $29.95. ISBN: 0-87722-912-0

Dust to Dust is a remarkable Triple Crown achievement in medicine, photography, and writing. Dr. David Heiden, a San Francisco physician, has taken the weak pulse of African famine victims and amplified it through a stethoscope of light and tears. The result is a must read not only for the general public but particularly for the medical community. Dust to Dust is a house call no one should miss.

The black-and-white photographs shot by Heiden in Ethiopia and Sudan in 1985 and 1987 are stark yet sensitive. From a grainy shot of one of his colleagues quietly reflecting at a mass grave for 530 victims -- marked only by three tilting wooden crosses -- to a single tear streaming down the cheek of a malaria victim, these photos bring the dead back to life. Heiden consulted with more than two dozen top photographers in the editing process, and with the exception of one out-of-focus portrait in the prologue he has produced a body of work that any professional would be proud of.

The accompanying text pulls no punches, giving the reader an insider's view of the politics of famine. “It is a story about how we became a part of the disaster we were sent to contain,” writes Heiden. His diary entries are remarkably honest. For example, that for March 27: “I may have killed a child this morning with an injection of chloroquine.” The staff, “punchy with fatigue and emotionally overwhelmed,” is exhausted and sick. There are moral dilemmas: how to treat a woman dying of tuberculosis -- for which no drugs are available -- whose cough is infectious and whose bed is needed for sick children. There are language problems. A patient directed to take a teaspoon of sedative by mouth gets the same dose by injection and is almost sent into a coma. There are cholera and meningitis; poisonous snakes and scorpions are often their roommates; there is little food. The experience left Heiden forever changed: “It still bothers me when I see anything left on the table.”

The images in the book bring back the nightmare. Some look biblical -- sunbeams surrounding fleeing refugees in rags. Others show moisture-seeking flies collecting on the mouths and eyes of skeletal children too weak to shoo them away, or the noble faces of Ethiopians stripped of everything except their dignity.

Just as Heiden's car pulled out of one camp, a “dust devil” or mini-tornado went through the latrine, sending pink toilet paper flurrying. A colleague called it “a ticker-tape farewell . . . from the spirits.” More important, Heiden, who has done tours of duty in Somalia and with Kampuchean refugees in Thailand, holds a prescription that we can all subscribe to. It's called caring.

Stan Grossfeld
The Boston Globe, Dorchester, MA 02125