Omar Barre, Somalia.--The rudiments of famine medicine are fairly straightforward.
"A belly like this," says Dr. Bill Barnett as he gently squeezes the swollen stomach of a boy of 3 or 4, "and the reddish tinge to his hair means 'kwashiorkor' -- acute malnutrition. Starvation, really."
He listens to the little boy's chest through his stethoscope.
"He has worms, too," he says. "During one of its states, the ascaris worm passes through the lungs, so a common complaint is coughing. The question is whether there's bronchitis or pneumonia as well."
Next he pulls down the boy's lower eyelids. They are a pale white.
"This is a crude hemoglobin test -- no labs here -- but when the inner eyelid is this pale, it means anemia, which accompanies both 'kwashiorkor' and worms."
Quickly, Dr. Barnett asks questions through an interpreter about fever, abdominal cramps, night sweats. Then he writes his diagnoses on a small card.
In order, the boy has: malnutrition, worms, malaria, scabies, anemia and an upper respiratory infection.
"But the real diagnosis is war," he adds. "All the villagers' food was stolen by bandits as soon as it was harvested. They starved, and they're just now recovering.
"Now, let's see your brother," Dr. Barnett says, lifting the boy out of his mother's lap to make room for the silent child standing beside her. "He's the sick one."
In fact, there are more than 200 sick ones lined up outside the compound of densely woven brush where a team of American medical missionaries has set up its open-air clinic. Most of them are women and children, and with few exceptions, the diagnoses are numbingly similar.
It's the third week in a row that the group from Samaritan's Purse, a crisis relief agency founded by Franklin Graham, son of evangelist Billy Graham, has visited this quiet little village some 30 miles inland from Mogadishu. The two doctors, three nurses and a medic will examine all but a handful of those in line before their medicine runs out, and although they should long ago have seen all 500 people in Omar Barre, there seems to be an endless supply of sick children.
However, there is not an endless supply of medical workers and medicines. There would be even fewer if not for a unique collaboration between Samaritan's Purse and the U.S. Marines.
The medical workers from Samaritan's Purse conduct similar clinics every day throughout Mogadishu. They work miracles, but they are volunteers funded by donations, and their numbers are few.
On the other hand, there are enough military doctors and medics to care for 25,000 troops in a shooting war. Fortunately, that never happened, so the troops' medical needs remained minor.
That left their doctors sitting around with nothing to do. But because regulations prevent using military medicines and supplies to treat civilians, they could do nothing to alleviate the suffering around them.
Then Samaritan's Purse offered to swap medicine for manpower.
The Marines provide doctors, medics and armed guards for the forays into the countryside; the missionaries provide drugs and a logistical network built up in the months before the troops came ashore. Everyone is a volunteer, including the gruff-looking guards who give up their few off-duty hours to come to the clinics.
Once the cots and tables are set up, their principal duty is crowd control, a job they apparently interpret as requiring them to hold a gun with one hand and pat children on the head with the other.
"This is what we came for," said Sgt. Michael Meyer, a Gulf War veteran. "It's what I came for anyhow, to help these people."
It's a strange job for soldiers, going off with missionaries to care for sick and hungry children -- not a job for which boot camp, with all its orchestrated aggression, prepares them. Yet in the post-Cold War world, soldiering has increasingly come mean to peace-making, and that, the sergeant says, "is a different mind-set."
One wonders if anybody has really got it yet -- as the regulations against civilian medical relief prove.
Not surprisingly, some of the troops haven't figured out their new duties. They ooze a kind of arrogance toward "these people" that rekindles memories of a time when sending troops was the white man's burden, not humanitarianism.
As a result, the Marines often patrol in a rainstorm of rocks nowadays, especially in the cities.
But they're simply soldiers. What's really worrying is watching their political and diplomatic leaders flail around with no clearer idea of how to bring about peace in Somalia than a 19-year-old Marine with an attitude.
Three months and 30,000 troops later, Somalia appears no closer to a political solution than it was in the beginning. The United Nations and the United States argue over when an international peace-keeping force will assume control of operations in Somalia. But that just changes the uniforms of the peace-keepers; it doesn't create a government or perform any of the services it's supposed to provide.
The system of clan elders has tried to reassert itself in the countryside, but their authority was swept aside at gunpoint in the civil war. Their influence may never be the same.
Worst of all, the warlords' weapons caches -- and therefore their power -- have been left untouched. Speaking of arrogance, one of the main warlords sat out the long-awaited Reconciliation Talks in Addis Ababa last week and another used them as a cover for trying to take over Kismayu. They have no interest in a political solution, and that's still the problem.
Little wonder that most of Somalia's educated classes, all the people who would know how to run a government if one existed, remain in exile. They fear the waters of anarchy closing behind the departing Marines, and absent a death wish, limit themselves to theorizing about solutions on "Nightline."
None of which gets a single pill to sick children, or resettles refugees, or brings seeds to farmers before the rains start later this month.
"Stopping the famine was the easy part," observed Dr. Barnett. "Fixing this," he said, waving a hand to take in the whole of Omar Barre, "is what will be hard."
B.J. Phillips is a columnist for the Philadelphia Inquirer.