Doctors Without Borders in Action

Sociologist Renée C. Fox considers how communications from Médecins San Frontières/Doctors Without Borders keep her connected with the achievements, trials, dreams, and values of medical humanitarian action. She is the author of Doctors Without Borders: Humanitarian Quests, Impossible Dreams of of Médecins Sans Frontières, published by Johns Hopkins Press.

I first became aware of Doctors Without Borders/Médecins Sans Frontières (MSF) in 1993 and I began to explore the possibility of making a sociological study of this medical humanitarian organization. Some twenty years later my long, questing relationship to MSF in the role of a participant observer—or what some of its members refer to as an “inside-outsider”—is the basis for my newest book, Doctors Without Borders.

It is reasonable to assume that my involvement with MSF will wane with the publication of this book. But I don’t think this is likely to happen. The values and principles that MSF espouses, its world-view, and the way that it translates its precepts and vision into action and deals in its “culture of debate” with the intrinsic challenges and dilemmas that humanitarian action entails, continue to strongly and deeply link me with it. So does the fact that it is a medical, social, and moral exemplar for many of the students I have taught.

Virtually every day I search MSF’s multiple websites for its latest reports from all the places in the world where its personnel on the ground are dealing with the ravages of natural catastrophes, epidemics, massive malnutrition, violence, armed conflict, large-scale displacements of populations, and refugee influxes. It is not only MSF news bulletins that I seek, but also the richly descriptive and moving blogs from the field, where MSFers write about what they are observing and feeling as they carry out their work, including first-hand testimony about human rights abuses and what MSFers perceive as inadequate responses to the humanitarian crises they face. I also correspond via e-mail with numerous members of MSF with whom I have established enduring relations, who keep me informed about their activities and about the salient events and issues with which MSF is grappling.

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In December 2013, I was most struck by the MSF dispatches that dealt with the situation in the Republic of South Sudan, where MSF has been working since 1983. Tensions were high in many regions of South Sudan, MSF reported, and its emergency teams were increasing their response to these affected areas by treating the injured, donating drugs and medical supplies to health facilities, and providing relief for persons displaced by violence, while “call[ing] on all actors to respect medical facilities and workers and to assure safe access to medical care.”

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As I write this blog, I am preoccupied with the announcement made by MSF on the first of March that, after two decades of work in Myanmar, it was “deeply shocked” to have been expelled from the country by the government. The precipitating factor in this expulsion was a report by MSF that it had treated some two dozen Rohingya Muslim patients in a community in Rakhine State. The Muslim patients had been attacked by local Buddhist civilians and security force members, many of whom belonged to an extremist Buddhist group in predominantly Buddhist Myanmar. The government repudiated the MSF report and denied the occurrence of an earlier, more serious attack on Rohingya Muslims in the village of Du Chee Yar Tan that resulted in the deaths of at least forty men, women, and children, according to the conclusion of a United Nations investigation.

“Today for first time in MSF’s history in the country,” MSF declared, “HIV/AIDS clinics in Rakhine, Shan and Kachnin States, as well as [in the] Yangon division were closed and patients were unable to receive the treatment they needed.” These clinics served more than 3,000 people with tuberculosis, as well as 30,000 HIV/AIDS patients. The enforced departure of MSF would have the most drastic effect on Rohingya Muslims in the northern villages of Rakhine State and in government camps, for whom MSF was the primary and often the sole provider of medical care.

A day after the expulsion, the Myanmar government backtracked by announcing that it would allow MSF to resume operations everywhere but in Rakhine. MSF agreed to resume activities, but communicated that it remained “extremely concerned about the fate of tens of thousands of vulnerable people in Rakhine State who currently face a humanitarian crisis.”

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In March 2014,  MSF launched an emergency response as soon as it became apparent that an outbreak in Guinea of one of the most deadly forms of Ebola virus disease had threatened to reach epidemic proportions. According to its reports, MSF immediately flew some thirty-three tons of medical supplies to Guinea, including “supplies necessary for isolating patients, putting sanitation measures in place, and protecting its teams.” Twenty-four MSF doctors, nurses, logisticians, and hygiene and sanitation experts were already in the country (where MSF has been present since 2001) running projects to treat HIV/AIDS and malaria.

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I received e-mails from Malawi on December 25, 2013 and on March 13, 2014. They were sent by V. S., a woman I came to know through her affiliation with MSF. She is presently working in Malawi under the auspices of Dignitas International, a nonprofit medical humanitarian organization cofounded by two former MSF physicians. The organization’s work—principally in Malawi—is centered on a community-based approach to HIV/AIDS and tuberculosis in resource-limited settings. V. S. had administrative responsibility for Dignitas’s HIV care in hospitals and “out in the districts.”

“We’re working together with MSF on upgrading screening for HIV, TB, sexually transmitted infections and related conditions in the prisons,” she wrote. She expressed particular enthusiasm about the expansion of Teen Clubs for HIV-positive adolescents that she and her colleagues had created.

Dignitas is “full of former MSFers,” wrote V.S., “so I’m still close to the fold.” She plans to return to MSF when the work with Dignitas is done.

Printed at the bottom of each of her e-mails was a quotation from Alice Walker: “Look closely at the present you are constructing—it should look like the future you are dreaming.”

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Communications like these news dispatches, reports, testimonials, and letters continually connect and re-connect me with MSF, the achievements and trials of its medical humanitarian action, its value-commitments and community—and its dreams.

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Renée C. Fox is the Annenberg Professor Emerita of the Social Sciences at the University of Pennsylvania. She is the author of Experiment Perilous: Physicians and Patients Facing the Unknown, In the Belgian Château: The Spirit and Culture of a European Society in an Age of Change, and In the Field: A Sociologist’s Journey and coauthor of The Courage to Fail: A Social View of Organ Transplants and Dialysis and Observing Bioethics.  Renée Fox’s recent conversation with Baltimore’s NPR affiliate, WYPR, can be heard here.