RUTHFULLY YOURS

The diplomat is lying on the operating table, his stomach opened up like a handbag, revealing a red inner lining of muscles, fat and blood. Outside the window, the morning sky shimmers in shades of blue and gray over Lake Zurich.

Enrique Steiger bends over the wound and cuts an excess piece of flesh from the edge. “He’s actually a good-looking man,” he says, “it’s just that he had a bit of a paunch.”

Steiger, 52, is tall, charming and tanned. He has a Colgate smile and Hollywood looks. Sometimes he injects a bit of Botox into his own forehead. In the soft light of his operating room, he looks as if he had just come back from a vacation at his house in the south of France. But the hint of a shadow under his eyes reveals that he must be exhausted. Just three days ago, Steiger returned from a war zone — from his other life.

The anesthetized man lying on the operating table in front of him, who is also attractive and tanned, is from South America. He has crossed an ocean to pay Steiger 16,000 Swiss francs ($16,100 or €12,200) for a tummy-tuck. The cosmetic surgeon’s practice in Zurich, with its white paneled walls and fresh flowers, is the go-to place for those who are unhappy with their appearance.

‘I Like Breast Surgery’

The assistants, who are shapely and blonde and wear pink lipstick, hover like fairies over the herringbone parquet floors, offering patients coffee and tea in their velvety voices. There are thick photo albums on the tables in the waiting room, but it’s unlikely that anyone ever has to wait here. Steiger’s patients include politicians, actors and business executives — “the top 5 percent of society,” as he says.

They fly in from Hollywood and Abu Dhabi in their private jets, slipping through the back door after emerging from their limousines. These are the best clients of cosmetic surgeon Enrique Steiger. In his other life, patients arrive at humanitarian Enrique Steiger’s clinic in wheelbarrows, sometimes barely alive.

“Could I have the scissors again, please,” he says, as he pulls up the man’s abdominal wall with two fingers. There is a hole where the man’s navel used to be. “People are very attached to their navels,” says Steiger, smiling as he uses his scalpel, “which is funny, because they’re totally useless.”

He hasn’t had much sleep since his return from a war zone, but he has made three women happier, changing their cup size from A to B and from B to C. One of the women came from London and another from Paris, and now they are napping on the lower level, their heads resting on starched pillows, with fresh silicon in their 18,000-Swiss-franc breasts. He has also done a nose job, tightened a few eyelids and got rid of a few wrinkles with Botox injections, he says. “Our high season begins in September,” he says. It’s the end of summer, the perfect time to improve one’s appearance for the next pool season, the winter ball season and the red carpets — the perfect time for fuller lips and tighter buttocks. Facelifts are his favorite, says Steiger, “and breasts. I like breast surgery.”

‘A Luxury Hospital’

A few days earlier, Steiger was standing in a makeshift hospital tent, studying white bulletin boards where patient data are entered with magic marker in the language of war: gun shot wound, bomb blast, mine explosion.

He looks at the patients in their metal beds, staring at him with dull expressions in their eyes: seven seriously injured Afghan and Pakistani men and a small boy. “They’re all my patients,” says Steiger. “The team was nice enough to set it up this way for me.” The walls are made of plastic and an odor of wounded flesh hangs in the air.

The field hospital where Steiger is working is in the Pakistani city of Peshawar, less than 50 kilometers (31 miles) from the Afghan border. Only two days earlier, insurgents and soldiers were exchanging gunfire here. There were several attacks on schools in a single week. Shots can be heard in the distance at night, while the wounded arrive from Afghanistan during the day. At the center of it all is Dr. Steiger from Zurich.

“I’m ecstatic,” he says. “It’s a great hospital.” Most of the time he operates in the field, where conditions are “really primitive,” in places like Rwanda, Bosnia and Liberia. “But this here, this is a luxury hospital for me.”

A New Mouth

He asks for a flashlight, which he uses to illuminate the face of the first patient on his rounds. The man, slender and with pale yellow skin, was shot in the mouth. Wearing a light blue hospital gown, he tells the doctor that he was driving his truck through the Swat Valley when he drove into the middle of an exchange of fire between Taliban and security forces. He ended up with a hole in his face where his mouth used to be, so that he could no longer eat properly and was unable to control the flow of saliva out of his mouth.

Then along came Dr. Steiger from Zurich and gave him a new mouth. “This one will close very well,” says Steiger, telling the patient that he’ll be able to remove the stitches in a few days.

For the last three days, Steiger has been working for the International Committee of the Red Cross (ICRC) at the Surgical Hospital for Weapon Wounded, where he serves as a reconstruction specialist and emergency doctor. He is one of a few dozen surgeons working for the ICRC, the United Nations and other humanitarian organizations in the world’s war and crisis zones. Steiger just completed a mission in southern Afghanistan. Then he flew to Geneva for a briefing on his next mission. After that, he spent a day with his wife in a luxury hotel before flying to Peshawar via Abu Dhabi and Islamabad.

This city will be his home for the next three weeks. He will perform amputations, head surgery and shrapnel removal. Only then will he return to his breast clinic in Switzerland.

A Patient Is a Patient

Steiger is standing in one of the two operating rooms, which consists of an operating table and a few aluminum cabinets containing materials. He is looking at the head of a young man, who is presumably a Taliban fighter. A piece of shrapnel ripped a hole into the back of the man’s head, which Steiger and his fellow doctors are now about to close.He is wearing surgical eye loupes on his nose, with his name engraved in shimmering letters on the frame. He brought along the loupes in a wooden box, like expensive cigars from the more luxurious side of his life. This hospital has no respirator or defibrillators. During anesthesia, patients sometimes sit up, with their stomachs cut open, and shout “Allahu akbar.” This is battlefield surgery in its purest form, says Steiger. “If we don’t have any suction drainage, we have to make it out of infusion tubes.” In Sudan, he says, he even bought stainless steel wire on the market once, which he disinfected and used inside a patient. He begins to clean the hole in the head of his current patient.

The man attached to the head, anesthetized and weighing less than 60 kilograms (132 lbs.), is hardly visible under his enormous black beard and the green sheets covering his body. He’s probably “a fighter,” says Steiger. Who knows how often he has pulled the trigger of a gun or engaged the detonator of a bomb? Steiger shakes his head. “No,” he says, wiping the thought away like the blood he is now pushing out of the wound with a surgical rag. A patient is a patient, he says.

Giving Something Back

Steiger is operating in one of Pakistan’s most dangerous cities. Peshawar borders the tribal areas, partly controlled by Al-Qaida and partly by the Taliban. At the beginning of this year, the Pakistani army conducted a ground offensive against the radical Islamic forces in the area, and US drones were constantly used to attack presumed terrorist hideouts. Al-Qaida leader Osama bin Laden was said to be hiding in the region. Week after week, roadside bombs exploded in the narrow streets of Peshawar, a city of 1.4 million. Steiger keeps working. “I’ve seen worse,” he says.

Twenty-one years ago Steiger, an up-and-coming cosmetic surgeon, discovered that in addition to attractive women and men, there were other things he could shape and change in the world. He was working in Rio de Janeiro for his mentor, Ivo Pitanguy, one of the world’s most experienced cosmetic surgeons. “You’ll be successful,” Pitanguy told Steiger, “but you have to give something back to the world.”

Steiger, in his early 30s at the time, applied for his first UN mission in Namibia. It was 1989, and Namibia was in a transitional phase that would lead to independence. It was a time of heavy fighting between the independence movement, SWAPO, and South African forces. Steiger was given the job of setting up an independent UN clinic. During his six months in Namibia, his infirmary was threatened several times by groups of thugs and once even by tanks. The doctors and nurses did what they could to protect their patients. “It was successful,” says Steiger, who was inspired by the experience.

He went on to Angola after six months, then to Morocco. Finally, in 1994, the ICRC sent him to Burundi and Rwanda, where 800,000 Tutsi and moderate Hutu were slaughtered in the space of only three months. “I had no idea what to expect there,” says Steiger. He had gone there thinking he could save the world, he says, but “they already started shooting at us as the plane approached the airport in Rwanda. But a flight reflex — that’s something I don’t have,” he says.

As a member of a team of doctors and nurses, he worked long days, sometimes 24 hours at a time, eating little and working constantly. The cases included machete wounds, bullet wounds and burns. “And then they broke into my hospital and shot my patients to death,” he says, “and I read them the Geneva Conventions.” He shakes his head. “Rwanda was my wake-up call,” he says, referring to the sense of helplessness and the feeling of being at the mercy of others. Everyone, including the UN, had already left the country, and the whole world did nothing but look on.

Long Hours

The door opens at the front of the clinic as the next patient, a 12-year-old boy named Muhammad, is brought in. Men in white robes load the boy onto a blue stretcher. He stepped on a mine, but it took far too long to bring him to the hospital. Now he has a fever and his leg is infected. In Peshawar, the evidence of war usually arrives with a delay, on truck beds or on the back seats of dented taxis. On the next day, when Steiger visits the boy in the intensive care tent, the infected leg will no longer be part of his body.

Steiger works in the hospital 12 to 14 hours a day. As the clinic’s specialist for reconstructive surgery, his work involves fixing shoulders, the top of the skull and hands that no longer work. He spends evenings in the delegation’s guarded house with a Canadian and his friend Dr. Carlos, a Mexican with whom he worked in Liberia. The humanitarian workers live in a small universe here, moving back and forth between the clinic, a restaurant called the Orange House and their lodgings. The streets, markets and alleys of Peshawar, crammed with cars and motorized rickshaws, are too dangerous for the ICRC. The old city is off-limits, and so is nightlife and anything that could be remotely entertaining.

For Steiger, the policy means spending his evenings at his lodgings or in the same restaurant, where he now sits at a low table, eating grilled chicken and drinking water. He talks about all the things he would be doing now if he were in his Swiss life. He says he could be standing on the golf course with his wife and improving his handicap, or that he could be spending every night at a different party.

When he leaves his office in Zurich for the day, Steiger usually gets into his silver Mercedes and drives along the so-called “Gold Coast” along Lake Zurich and up to his hillside villa. It’s a white building with slate-black window frames and a row of spherical box trees in front. The grounds include a green pool, bamboo plants rustling in the evening breeze and a Thai meadow. He has five motorcycles and a Porsche in the garage, toys he could be playing with now. Instead, he is sitting in this simple restaurant in Peshawar, where he spends his time patching together Afghans. Why?

Why — that’s always the first question, he says.

‘We Don’t Need Do-Gooders Here’

Steiger doesn’t consider himself a do-gooder. “We don’t need do-gooders here,” he says, pointing out that humanitarian aid work is extremely tough, the kind of work that requires people who function well. It’s also an area in which skilled professionals are needed, from surgeons to engineers to logistics experts.One of the reasons he does this, he says, is that the work here challenges him, from both a human and a medical standpoint. “Here, in a single day, you get five injuries on your table that you wouldn’t see in a year in a major European university hospital.” In fact, his patients at home stand to benefit from his experience in crisis regions, he says. “There’s hardly a body part I haven’t operated on in the field.”

Besides, he adds, “someone has to do it.”

War Junkies

He eats slowly, preferring to talk about the potential for addiction inherent in this line of work, with its daily extremes and its dangers. Many of his fellow humanitarian workers have turned into “war junkies,” says Steiger. After their war missions, they were simply unable to return to their old lives. The same thing would likely have happened to him, he says, if it weren’t for his wife and their daughter.

It isn’t easy to talk to Steiger about feelings, about whether it infuriates him that a female Afghan patient bled to death because her husband refused to give his consent to her treatment, or about whether he finds it easy to return to his other life, the life of breast implants and parties, after a mission. “I don’t understand why people have to psychoanalyze everything,” he says. In his profession, he adds, he can’t afford to succumb to big emotions.

He reflects for a moment. Well, he finally says, there are one or two things that he hasn’t been able to forget.

‘I Lost a Piece of My Joie de Vivre’

One was the little girl in Rwanda who suddenly crawled her way out of a pile of bodies that used to be her family, with burns on both of her arms. She was the only survivor. When Steiger took the girl to the clinic and treated her, “she didn’t even grimace, the whole time.”

His daughter Manou was the same age at the time, says Steiger, and all he wanted to do was take the girl with him, remove her from the hell of Rwanda and simply board a plane with her. “But luckily I had a boss at the ICRC at the time who asked me: Why this particular child? Have you discussed this with your wife?”

It was the first time that the boundaries between his two lives became blurred. “I lost a piece of my joie de vivre in Rwanda,” says Steiger. “The lightheartedness isn’t there anymore.”

It was during that time, during the horrors of the Rwandan genocide, that he hit upon the idea for his mission, which he has been promoting ever since. “Somehow I owe it to the ones I lost,” he says.

Humanitarian Force

His idea is that Switzerland should provide a humanitarian protective force, an autonomous and quickly deployable, armed emergency unit capable of operating in even the worst crisis, including natural disasters and armed conflicts. It would consist of 500 men and women who could build a refugee camp for 100,000 people within 72 hours, aid workers capable of protecting themselves and their patients, so that they would no longer be forced to look on as the patients are butchered by marauding forces.

He also images a “beautiful” field hospital, the kind the Germans have in Afghanistan, with sterile rooms, modeled after a small county hospital and capable of setting up shop within hours. “When a conflict erupts and everyone else leaves, we could be there. We could build infrastructure and provide security, air transport, ground capacity and medical care.” This emergency unit, he says, could at least prevent the worst from happening. “There are already aid workers all over the place,” he says. But there is one thing he knows from experience: “When rebels turn up somewhere, I can’t get to the hospital, and what good is an expensive surgeon who’s sitting in an air raid bunker, waiting until the population has been wiped out?”

For years he has been discussing his idea, which he calls “Swisscross,” with politicians, potential donors and the senior management of the major humanitarian aid organizations. A US university is working on a study about his project, and he already has prominent supporters, including former German President Roman Herzog.

But he also has critics, at the ICRC, for example, which considers carrying arms a taboo and believes nonpartisanship is the best protection in a conflict.

Preferring War Zones to Boring Cocktail Parties

Some veiled nurses from Europe walk into the restaurant in Peshawar. As they nod to “Dr. Enrique,” he lowers his voice a little and says that he doesn’t tell the people here about his other life as a cosmetic surgeon. “I really live a privileged life in Switzerland. You don’t have much in common with the rest of the population,” he says. “I feel 10 times better here, with these wonderful people, than at boring cocktail parties.” In a place like this, in Peshawar, life is reduced to its essential elements, he says. “You work with what you have, and you improvise,” which is something he loves.Anyone who spends a few days with Steiger in his two worlds quickly gains the impression that this is a man who always smiles and never sleeps. He seems like a helping machine, created to tinker with God’s work. Those who aren’t born beautiful are made beautiful in Steiger’s hands. And those who would otherwise have died are brought back to life in those same hands.

He says things like: “I get by with very little food,” or “I work until two or three in the morning almost every day.” He says that he doesn’t want to be the focus of attention, and yet he is the kind of man who naturally attracts attention, no matter where he goes.

In Zurich, he is the celebrity plastic surgeon whom the tabloid media call to ask for his opinion on the bust measurement of Swiss TV hostess Michelle Hunziker. In Peshawar, he is the man who, as his patients believe, can perform miracles, the man who, with his surgical scissors, can bring a little order into the disorder of their lives.

But even as he sews one patient back together, the next one is being shot. And even as he injects Botox into a patient’s forehead to smooth out wrinkles, the next wrinkles start appearing around the corners of the mouth. His work is an attempt to slow down the inevitable, aging and death, and even though he knows that it’s a fight he can never win, it all makes sense for Steiger. He makes other people happy and, in doing so, finds his own happiness.

‘I Love Beautiful Women’

Three days after Peshawar, where he performed five or six operations a day, Steiger is standing at the window of his practice in Zurich again, with his view of the lake. He is flipping through a large book of Helmut Newton photography and philosophizing about beauty. The desire for completeness lies in man’s genes, he says. “I love beautiful women.”

After one of his missions, doesn’t he sometimes have the feeling that he is wasting his talents on vain people while he could still be saving lives?

“When a young woman comes to me, very pretty and terribly unhappy, because she’s had a baby and now her breasts look like two squeezed-out rags,” that’s when cosmetic surgery can also be a life-saver of sorts, he says.

Sometimes he asks himself: “Does it really make sense to reattach the arm of a child soldier in Sierra Leone, when you know that he’ll be wielding a weapon again as soon as he’s released?”

The people who come to him “live in a society in which they are surrounded by beauty, and in which beauty establishes identity,” says Steiger. This can go well for 20 or 30 years, he adds, but anyone who has been part of this beauty culture also has a lot to lose. Steiger is still satisfied with the way he looks, but when his eyelids start to droop, he too will have them tightened, he says. He has even given his mother Botox injections to smooth out her wrinkles.

A Little Dose of Happiness

His next operation is a facelift, Steiger’s specialty. The patient, a woman, is in her early 50s and works on the executive level at a major corporation. Steiger has taken photos of her, from the front and from the side, and he has also pinned up a picture of her as a teenager. Today her cheeks are sagging, the corners of her mouth are crooked, and the gravity of aging has stretched the woman’s face.

When Steiger performs the operation, it looks a little like the scene in the film “Face/Off,” when John Travolta has the face of Nicolas Cage surgically attached to his own. Steiger pulls the woman’s facial skin away from her head, tightens it and moves around the musculature underneath. Later, when he reattaches the skin to the head, it does look as though he had created this woman’s younger sister in the space of only a few hours. Once again, Steiger has dispensed a little dose of happiness.

Cutting along the right side of the face, he talks about the advantages of his method, of the natural effect he can create. With each word that he utters, it’s as if he were taking another step away from his time in Pakistan, from the amputated legs and arms and the shoulders ripped off by bullets.

Steiger is scheduled to perform another breast operation the next day.

Translated from the German by Christopher Sultan

URL:

• http://www.spiegel.de/international/world/0,1518,732631,00.html

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