Dreams Realized, Dreams Changed

Today I had the privilege of visiting Médecins Sans Frontières (MSF, a.k.a. Doctors Without Borders). I have long admired this organization, and I think like many kids interested in health, it was a dream of mine to one day work for them. I had a total blast at today's information session, which greatly changed the way I see and understand MSF and their mission. The man who gave us the presentation admitted that MSF is deeply passionate - perhaps obnoxiously so - about their core principles. These are: humanity, independence (in terms of their funding), impartiality (nondiscrimination of patients), neutrality (i.e. in conflicts), proportionality (care based on most urgent need), medical ethics, professionalism, aid control (proving direct care without intermediaries), transparency & accountability, and bearing witness (advocating for their patients' stories). Interestingly, sustainability is not a core principle. This means that MSF is going to do whatever it takes to provide the community's most urgent needs, even if it means importing resources rather than using local resources. This also means that they do not prioritize strengthening existing health institutions or working with local agencies in order for them to carry on MSF's work once they leave from their missions. (Although, as clarified during the break when I asked the speaker a question, MSF does do some longer-term missions in which they do work on strengthening existing health services in order for them to build capacity.) While it sounds like MSF has an extremely thorough top-down (he called it "vertical") approach in all their missions, which I think is absolutely necessary when providing emergency care, it was hard for me to grasp the lack of dedication to sustainability. That being said, I understand that in order for MSF to do emergency relief and do it best, it cannot be focused on sustainability, otherwise they would have to compromise the quality of care on the ground. Additionally, one organization cannot do it all; MSF is an emergency medical care provider, it is not within its mission to strengthen global health systems. This push and pull between wishing for more sustainability and grasping the sacrifices that need to be made in order to provide the best emergency care possible was a topic of deep conversation among my friends and I on the train home from the information session.

Another element of these key principles that I found to be very interesting was that of neutrality. MSF constantly walks a very fine line where they do not get involved in political and other disputes...yet they are vocal about violations of human rights and other codified codes of conduct. Both neutrality and advocacy are key principles for their organization, which can at times be counterintuitive. MSF can and will only enter a country if the government invites and accepts them, but they have to make sure that they do not accuse or shame the government, otherwise they might be kicked out of the country, therefore leaving many without access to emergency care they may need. An example of the balance between neutrality and advocacy arose a few years ago when MSF treated patients in Syria that were (pretty obviously) affected by illegal chemical weapons. MSF felt obligated to speak out on the use of chemical weapons, as they are illegal, but MSF could not make a blatant statement saying they were absolutely positive chemical weapons were used and that they were pretty sure the Assad regime were the ones to use them. All they could say was that they had to halt care because of effects of what look like could be chemical weapons... (See a statement here). It is the tough call between staying in the country to provide care or speaking out about an issue of conduct and risk being kicked out. One element of MSF that I learned about that really stuck out to me was that MSF has a research component called CRASH, which is a French acronym for "Le Centre de Réflexion sur l'Action et les Savoirs Humanitaires" which is essentially an agency that does research on MSF's humanitarian action, critiquing how it is provided and how to improve. I think this is really fantastic that such research is conducted and so highly valued because humanitarian aid, as evidenced by this info session as well as many other learning experiences I have had, can be incredibly complex, especially regarding issues of neutrality, impartiality, and independence. When do you keep your mouth shut just so you can provide medical care and when do you speak out about inhumanity?

One point that our speaker was adamant about what the preservation of a humanitarian space; MSF will only work if there is humanitarian space. This means that MSF will only enter in an area of need if all parties involved can acknowledge, respect, and agree to MSF's neutrality and impartiality. If this is violated at any point in an MSF mission, the organization will pull out immediately, without hesitation. Most recently, this humanitarian space has been violated by bombings on MSF hospitals (see my post about the Humanitarian Conference - the President of MSF Switzerland gave a speech about this). When this happens, it is clear that a party involved no longer sees MSF as neutral but rather on one side or the other (most often as a western imposition) and decides to take retaliation. The most notorious example is the bombing of an MSF hospital in Kunduz, Afghanistan in 2015. Preserving the view that medical relief workers are neutral is absolutely imperative to successful aid work. One element of establishing this neutrality that I thought was very interesting, especially coming from my Diplomacy & World Affairs major background, was that MSF often has contact with what are often considered "rebel groups" in negotiating and solidifying this humanitarian space. For example our speaker worked on a mission in Colombia years ago and met with FARC leaders in order to confirm (not negotiate!) the humanitarian space there for the mission. From a diplomatic standpoint, it is much more difficult to speak with leaders of groups such as these, and I would really like to learn more about how MSF communicates with these rebel groups and how they are perceived in these groups as well.

Lastly, on a more personal note, I found this information session very reassuring to my career path (or lack thereof). For the past year (approximately) I have been feeling the obligation or pull to go to nursing school and pursue more hard, clinical science so that I may be able to provide direct care myself. I have been worried about this though, partially because I was not planning on such a path so I have not taken the required prerequisites in school, and partially because I get a tad queasy with needles (but all other blood and gore and such doesn't bother me at all, interestingly enough...). One major hesitation I have had regarding this inkling for medicine has been that I am not sure that my character is fit to such a career. After some self reflection (and, yes, long phone calls with my mom), I have realized that who I am may be much more conducive to some sort of managerial job where I may be in charge of organizational projects. During the information session today, the speaker made a point about how most people think that MSF is 90% doctors, nurses, and medicine personnel, but in fact the majority of the staff at MSF are logisticians and administrators; those who manage and organize field work and missions. While it doesn't sound as glamorous to be a logistician than it does to be a nurse or doctor, it was reassuring for me to hear that jobs using my more natural skill sets are important to the field that I am interested in. I am still very lost and far from discovering what path I want to pursue as a career, but this certainly helped to reassure me.

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