In 1999 James Orbinski went to Oslo to receive the Nobel Peace Prize on behalf of Médecins Sans Frontières. Born in Britain and brought up in Canada, it was at medical school that he found a focus for his nascent humanitarianism. And immunology captured his interest. Immunology led him to HIV, and HIV – this was the 1980s – led him to research in Africa. And Africa led him to Médecins Sans Frontières. To Somalia, Rwanda, Afghanistan, and eventually to Oslo. An Imperfect Offering is his account of those years.
Reading his book is like jolting along a terrible road in a nightmare. I struggled to keep everything straight in my head. So many places, so many people, so many acronyms. So much need. Who is doing what, and why? Who is on who’s side? Can’t he slow down and explain? No, he can’t, because that’s how it was. And one begins to experience the nightmare of jolting along those terrible roads, living with the fear of what might be round the next corner. Living with the smell of faeces and vomit and recently butchered human beings. The smell of fear. The smell of horror: the woman systematically mutilated just enough so that she will bleed slowly to death, wild dogs tearing at human corpses, the little sausages scattered in the mud that turn out to be children’s fingers.
Most books about inhumanity are leavened by examples of the human spirit transcending the horror. Very little in ‘An Imperfect Offering’ enables one to close the book feeling good about being human. There seems to be no limit to man’s ability to plan and execute cruelty – and to justify it.
When the Red Cross was founded in 1863 it was possible to find a ‘humanitarian space’ between armies if one undertook, as the Red Cross did, to keep silent about the conflict. But a hundred years later silence seemed to kill more people than it saved. MSF was founded to speak out, but without taking sides. In the 21st century humanitarian assistance has become a political tool. Armies drop yellow parcels of cluster bombs on the ‘bad’ guys and a few miles away they drop yellow parcels of food on the ‘good’ guys. The children of both parties can’t tell the difference between the parcels. Rich countries protect their interests – and improve their balance of payments – by selling arms to poor countries and ensuring that the international wheels run too slowly to stop the slaughter until their perceived ally has won. MSF can try to tell the world what is happening, although to continue giving humanitarian aid, it may have to pay protection money to warlords.
All a long way from the concerns of most of us here. But it is just as well to remember how so many people suffer, and that it is getting more difficult, not easier, to find the space in which they can be safely helped. And that the people who are courageous enough to go and help have to live with unremitting evidence of cruelty and with the decisions they made, not just in the field but for the rest of their lives.
In our safe world, too many people, too many managers, think that we should always be able to make the right decision. We step outside protocols and guidelines at our peril. But even in our ‘safe’ world it isn’t like that. We may come to know after the event if we managed to take the less wrong decision, or we may never know. An Imperfect Offering is a salutary reminder that the world is an uncertain and a dangerous place. We may not all be called to speak out about a genocide, but calling the powerful to account is the duty of us all.
An Imperfect Offering: Dispatches from the Medical Frontline James Orbinski, Rider Books 2008 ISBN 978 1846041013
First published in NASGP Newsletter 'The Sessional GP' October/November 2008
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…