Iowa Alumni Magazine | February 2009 | Features

Breaking the Silence

By Kathryn Howe
An Iowa family unites to give children of war-torn Uganda a triumphant voice.

The young woman labors atop a desk inside a bullet-ridden school in Lukodi, Uganda. She's scared and in great pain—but her doctor remains steady. By the twin glow of a car's headlights, he sterilizes a pair of kindergarten scissors with flame from a match.

Neil Mandsager, 82MD, is as comfortable bringing this child into the world here as he is at Mercy Medical Center in Des Moines. He readies a bandana to tie the umbilical cord, surrenders to his trust in nature, and instructs his patient to push.

A cry rises from the darkness. Neil hands the new mother her son, his mind marking the symbolism of this moment—the circular journey of his life. After all, the first chapter of this child's story begins in much the same way as the doctor's does. Iowa is Neil's home, but so is Africa.

"I always felt in my heart I would come back," says Neil, born 53 years ago last month in a grassy hut in Cameroon, where his father, Robert, 52MD, 68R, had brought the family on a quest to build a hospital in the tiny village of Garoua-Boulai.

That return journey began one spring afternoon in 2006 when Neil received an unexpected phone call from his brother Conrad, who explained that he had founded a nonprofit organization to heal the lives of women and children broken by unrelenting war in Uganda. He called it ChildVoice International, and would Neil help?

As Neil says now, "Something told me this was it."

Even though life had eventually taken them in different directions, the brothers still remained united by their unconventional childhood in a faraway land. Yes, Neil would help. Robert, too.

Through ChildVoice, three generations of Mandsagers—including Neil's son Kyle, a first-year medical student at the University of Iowa—have joined to continue their legacy of humanitarian work in Africa. Through ChildVoice, they've come together again.

Conrad: The Dreamer

Dawn breaks on a May morning in 2004 in the village of Lukodi. Twelve-year-old Concy rises, sets about her chores, and prepares to leave for school. She doesn't know that this is the last day of her childhood.

With tenacity and passion, Conrad Mandsager turns hope for a brighter future into reality for young Ugandans.

Soon, she watches helplessly as soldiers with the guerrilla rebel group known as the Lord's Resistance Army (LRA) bludgeon her family and burn her home to the ground. They don't kill her; instead, they drag her into the wild and rugged African bush.

For more than two decades, the LRA (see sidebar) has waged war against the Ugandan government, terrorizing the people of northern Uganda in one of the longest-running conflicts in African history. LRA soldiers have kidnapped upwards of 65,000 children like Concy and placed them into the rebel ranks.

Terrified and brainwashed, these children march from village to village through the rural landscape, commanded to torture innocent people. They murder, set huts afire, and are forced to commit all manner of atrocity. Some manage to escape, but the unspeakable brutality they've suffered leaves lasting psychological scars. If they somehow make it home, these wounded children often face rejection from their communities, post-traumatic stress disorder, and other hardships. They are lost souls.

In 2005, Conrad was on his way back from Ghana, where he'd been doing some consultant work for another organization. For years, he'd worked as a program developer and consultant serving at-risk populations, and his career periodically took him to Africa. On this trip, Conrad met with a good friend—Ian Lethbridge, the former director of Feed the Children's Africa program—who had spent some time in northern Uganda. Ian described the tragedy there as one of the worst humanitarian crises involving children that he'd ever seen, and he'd seen a lot. But he didn't know what to do; the challenge seemed too great.

Northern Uganda had become a wasteland of burnt towns, with almost 90 percent of the population crowded into Internally Displaced Persons (IDP) camps. Disease and sexual assault ran rampant. Tens of thousands of children roamed the countryside at night, streaming into the country's two largest cities to avoid abduction from their rural villages. Several non-governmental organizations offered short-term solutions like emergency health care and counseling for former abductees and displaced villagers, but it was clear to Conrad that the situation demanded a more ambitious approach.

"These children were just moor-less—some had been in the bush six to ten years," he says. "To think anyone could wipe that experience clean in 30 days was just ridiculous."

He brainstormed the possibilities and spent the next year researching and collaborating with international humanitarian experts and local leaders to create the blueprint for a long-term rehabilitation campus for child victims of war. The program would provide a loving and safe home, along with medical, educational, and vocational support. Children would receive psychosocial counseling and life-skills training. They could stay until they were healed enough to live independently. On a wider scale, the comprehensive effort would promote the region's community development, including projects to ensure clean water and sanitation. By meeting all these needs, Conrad's dream was to empower these children into becoming tomorrow's leaders—the hope for a brighter future for Uganda.

All this looked feasible on paper, of course. However, Conrad's reconnaissance trip to Uganda in March 2006 gave him serious pause. Intellectually, he knew about the grave consequences of this war, but seeing it in person shocked him to the core. "Very rarely do I get into a situation where I feel overwhelmed, like there's no way out," he admits. "But for the first three days of that trip, I couldn't begin to fathom how we'd do it. I wasn't sure how we'd take it forward, but I couldn't throw up my hands and say, 'Oh, well, there's nothing to be done.'"

He dialed Neil's number.

Neil and Robert: The Doctors

"We want to restore the voices of children silenced by war." Neil heard his brother's passion reverberating through the telephone receiver. "That's how we came up with the name. ChildVoice."

Robert (left) and Neil Mandsager apply their invaluable medical knowledge toward the success of ChildVoice.

Conrad explained how he'd asked many children in Uganda to tell him about their experiences. But they were too ashamed to discuss the past. "One mark of our success will be when they get their voices back," Conrad said, "when they are fully engaged in their lives once again."

This is too big for us, Neil thought. But he couldn't get the children out of his head. No child should live like that. He yearned to return to Africa, and here was a chance—and a tremendous opportunity to do something meaningful with his brother, with whom he hadn't spent much time since their days playing football at Wartburg College. A few short months after their phone conversation, Neil stepped onto African soil for the first time since his family left Cameroon in 1964. It felt right.

After talking with Conrad, Neil agreed to serve on the ChildVoice board of directors and lend his medical expertise. Now, he needed to take a firsthand look at the situation to help his brother and the other volunteers identify the best way to proceed. They made contact with other area agencies and earned the confidence of village elders and government officials, who recognized that the future of their children was in peril. A local family offered about 100 acres for the ChildVoice campus near Lukodi, the scene of that terrible LRA massacre that destroyed Concy's family and dozens of others. The dream inched toward reality.

The team decided that health care was the most logical place to start. As Neil devised a strategy, he told Conrad one thing was certain: "I need help from Dad."

No one knew tropical medicine like Robert Mandsager. Ever since he was a little boy, growing up on a farm in Hardy, Iowa, he had aspired to be a medical missionary. Shortly after graduating from UI medical school in 1954, Robert relocated his family to Africa (Conrad was a year old at the time). The Mandsagers spent ten years in Cameroon, treating patients in a grass-covered dispensary while overseeing the construction of a hospital. The destitution remains impossible for Robert to fully describe. Malaria, intestinal parasites, pneumonia, hookworms, diarrhea, malnutrition—no wonder four out of five infants did not live to see age five.

Dorothy (far left) and Robert (far right) Mandsager traveled with their sons to Uganda in 2007, reliving their days of humanitarian work in the 1950s and '60s.

In the end, Robert and his wife, Dorothy, determined that their children would have a better life back home in Iowa. After Robert completed a UI general surgery residency, the Mandsagers settled in Marshalltown, where he practiced medicine until his retirement in 1994. When his sons asked him to lead a medical team bound for Lukodi, Robert felt humbled.

Robert, Neil, and the team opened a long-abandoned Lukodi medical clinic in the summer of 2007, treating 500 patients over the course of five days. Neil watched in awe as Robert drew upon invaluable knowledge from his days in Cameroon. With his memory undimmed by the passage of time, Robert manned the microscope to identify the various parasites and infections so patients could receive the correct medications.

"It was an experience I won't soon forget—working alongside both my father and brother, each a hero of mine in his own way," Neil says.

Today, local practitioners staff the clinic, which continues to examine about 1,200 patients each month. Recently, a maternity ward opened to assist expectant mothers.

Situated on the East African plateau, Uganda is bordered by Kenya, Sudan, the Democratic Republic of Congo, Rwanda, and Tanzania. Uganda is home to multiple ethnic groups with some 40 different languages spoken here.

ChildVoice has also rehabilitated the old Lukodi primary school into a temporary refuge until the permanent campus can be built on the nearby acreage. In November 2007, the Lukodi Centre welcomed its first participants—30 young mothers, many still children themselves (all abducted by the Lord's Resistance Army or raped and abused in displacement camps), and their 36 babies. At their new home, vulnerable girls do not have to sell themselves for food and shelter. Here, they live in peace, take parenting classes, and work to develop a trade.

Concy, now 17, is one of them. The Ugandan army eventually rescued her from the LRA's grip—but not before she spent two long years with the rebels, forced to mutilate the faces of innocent villagers and beat them with logs. The emotional scars won't ever completely disappear, but today she's optimistic about her future and that of her year-old son. She props her baby on her hip, gives him a hug, smiles. She goes to classes, learns how to bake and sew. Each day moves her farther away from the nightmare she endured.

This past summer, Neil returned to Uganda with another medical team to evaluate the health of the women and children at the center. Girls who could once hardly speak have begun to laugh and sing. Like Concy, their voices slowly return.

Families: The Future

ChildVoice launched a capital campaign this winter to raise funds to build facilities that will eventually aid up to 1,000 children. However, the Mandsagers don't plan to stop in Uganda. They hope to one day replicate this program in other parts of the world, such as Sudan and the Congo. Conrad estimates that some 35 ongoing conflicts in the world employ 300,000 child combatants.

"We feel indebted to see the people of Africa rise up out of misery and enjoy a life free from war and poverty," says Robert. "What they endure . . . it grips you and becomes something you never forget."

ChildVoice volunteers have transformed the old primary school in Lukodi into a haven for mothers and their children.

Even atrocity fails to dampen the indomitable African spirit—a determination to live with joy and gratitude that inspires the Mandsagers to serve.

On every front, ChildVoice is a family affair. Conrad and Neil's mother, their wives, and their sons volunteer with the organization. They haven't felt this connected in a long while. "We're united more than we've ever been," says Robert. "It's like starting over."

When they began this incredible project, the Mandsagers dreamed of strengthening the bonds of African mothers, fathers, sisters, brothers. It turns out they gave themselves the same gift in return.