Life in Crisis

Life in Crisis: The Ethical Journey of Doctors Without Borders

Peter Redfield
Copyright Date: 2013
Edition: 1
Pages: 338
https://www.jstor.org/stable/10.1525/j.ctt24hsw6
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  • Book Info
    Life in Crisis
    Book Description:

    Life in Crisistells the story of Médecins Sans Frontières (Doctors Without Borders or MSF) and its effort to "save lives" on a global scale. Begun in 1971 as a French alternative to the Red Cross, the MSF has grown into an international institution with a reputation for outspoken protest as well as technical efficiency. It has also expanded beyond emergency response, providing for a wider range of endeavors, including AIDS care. Yet its seemingly simple ethical goal proves deeply complex in practice. MSF continually faces the problem of defining its own limits. Its minimalist form of care recalls the promise of state welfare, but without political resolution or a sense of well-being beyond health and survival. Lacking utopian certainty, the group struggles when the moral clarity of crisis fades. Nevertheless, it continues to take action and innovate. Its organizational history illustrates both the logic and the tensions of casting humanitarian medicine into a leading role in international affairs.

    eISBN: 978-0-520-95518-9
    Subjects: Anthropology

Table of Contents

  1. Front Matter
    (pp. I-VI)
  2. Table of Contents
    (pp. VII-VIII)
  3. List of Figures
    (pp. IX-X)
  4. ACKNOWLEDGMENTS
    (pp. XI-XIV)
  5. Introduction
    (pp. 1-7)

    The prospect of “saving lives” now serves as a common point of moral reference. Variations on the theme figure prominently in fundraising appeals, suggesting that donations to aid organizations can transmute into rescue. Politicians and corporations, with varying degrees of sincerity, seek to validate their actions through an accounting of potential protection or harm. As a moral precept the preservation of human life offers the allure of simplicity: whatever else holds in the complexity of human affairs, surely helping others live should be a good thing.

    Beyond rhetorical appeals to virtue, what would it mean to build a framework for...

  6. PART ONE. TERMS OF ENGAGEMENT
    • 1 A Time of Crisis
      (pp. 11-36)

      On October 15, 1999, the Norwegian Nobel committee announced the last Peace Prize of the twentieth century. It would go, the committee proclaimed with customary fanfare, to the organization Médecins Sans Frontières. Known in English as Doctors Without Borders and in the acronym-friendly aid world as MSF, this group was, strictly speaking, focused on medical humanitarianism rather than peace. Nonetheless, the committee noted the distinctive independence MSF brought to disaster settings. By intervening swiftly and calling public attention to abuses of power, it suggested, MSF’s action inspired at least a glimmer of a brighter future. “In critical situations, marked by...

    • 2 A Secular Value of Life
      (pp. 37-66)

      The photograph shows its age now, black-and-white details fading into the distance. A group of men sits around an oval conference table in a large office. Drapes frame the window behind them and a bookcase guards one wall. The men wear jackets, most with ties, although a few sport turtlenecks and unruly hair in keeping with fashion of the times. Details of skin, style, and dress suggest urban Europeans on a reasonably cold day. They appear to be in animated discussion as they sit, several gesticulating with their hands. Each has papers spread before him, and several grasp pens or...

  7. PART TWO. GLOBAL AMBITIONS
    • 3 Vital Mobility
      (pp. 69-97)

      On my initial trip to an MSF field site, I experienced the minor drama of a flat tire. The Land Cruiser was carrying a full complement of patients as well as staff members, though I was the only non-Ugandan aboard. When the tire blew we lurched and began to bump. Mohammed, the driver, quickly slowed down and pulled to a stop. I leaned out the window and confirmed that the left rear tire looked flat. A staff member clambered out, peered glumly at the wheel, and assured Mohammed it was indeed to blame. One by one the rest of us,...

    • 4 Moral Witness
      (pp. 98-123)

      A Spanish doctor once told me a different story about MSF ’s Nobel Peace Prize. Some members of the group, he said, had fantasized about using the prize money to sue the UN Security Council for failing to intervene in the Rwandan genocide. He had been working in the region at the time, and the prospect of such an action clearly resonated deeply. Nearly a decade after the events, passion still flickered in his eyes recalling the moment, and his voice constricted when referencing the country. Aid organizations had inadvertently turned civilians into bait there, a horror that would live...

    • 5 Human Frontiers
      (pp. 124-152)

      On a visit to one MSF field site in Uganda, I had to travel in and out of the country to get there. The project, run by the Swiss section, was located in a relatively remote region on the Kenyan border, home to nomadic peoples considered quite wild by many in Kampala. Due to road and security concerns at the time, MSF vehicles regularly detoured through Kenya, favoring the known complications of the border over less predictable hazards. Their cars departed early, so on the appointed morning I set out in darkness to reach the meeting place in Kampala. Already...

  8. PART THREE. TESTING LIMITS
    • 6 The Problem of Triage
      (pp. 155-178)

      What place might death have within an ethic of life? Among secular inheritors of religious tradition the answer is not always clear, given that funerary rites, afterlife, and relations with ancestors all fall within the personal realm of belief rather than public action. Working across lines of culture and language only increases the uncertainty; once life stops, assumptions about human commonality grow harder to sustain. When Henry Dunant offered succor to wounded soldiers, it included the act of accompanying the dying as an expression of Christian duty and love. If largely forgotten in later retellings of Red Cross mythology, the...

    • 7 The Longue Durée of Disease
      (pp. 179-204)

      The patient is an older man, skin taught across his skull, eyes darting here and there. He wears a light-colored dress shirt, frayed but clean and carefully buttoned. We are sitting in a small room—too small now with my extra chair wedged into it—at MSF’s AIDS clinic in the northwest of Uganda. Together we wait for the French doctor in charge to return. It is a busy day at the clinic, full of interruptions, and staff members are juggling several different demands and a full waiting room. The patient’s eyes turn to me. He has been told that...

    • 8 The Verge of Crisis
      (pp. 205-228)

      In the summer of 2003 Idi Amin lay dying. The symbol of Uganda’s period of crisis, once the very embodiment of postcolonial excess, now clung to a final thread of life in his Saudi Arabian hospital room. Uganda’s media outlets blared updates in breathless type, along the lines of “Still in a coma! … Doctors give up hope!” Some also turned a suspicious eye on the dictator’s old home district in the country’s northwest: “Arua Gripped by Amin Nostalgia.”¹ Rumors flew about the possible return of his body, dead or alive, to the land of his birth. In Amin’s native...

    • 9 Action beyond Optimism
      (pp. 229-244)

      It has become difficult to discuss a problem without offering a solution. Our era prizes the idiom of problem solvers, no matter how often or how spectacularly they might fail. Nowhere, perhaps, is this truer than in the contemporary United States, where goodwill and earnest effort remain deeply held articles of faith, and the suggestion that they might not ultimately prevail nears heresy. When faced with unpleasant questions or facts related to values they hold dear, people often react with predictable dismay. Sometimes they simply dismiss those questions or facts. At other times they resort to a more sweeping form...

  9. EPILOGUE
    (pp. 245-248)

    Over the years I spent slowly writing this book, MSF continued to evolve. The period after the La Mancha meeting saw some retrenchment, with sections both reorganizing their operational structure and renewing their fundamental commitment to emergency response.¹ On that front there was always plenty to do. The group’s updates chronicled a steady stream of human suffering due to disaster and war. Although the crisis in Uganda may have eased, many of the same countries continued to occupy the annual top ten list of crises, with the Democratic Republic of the Congo, Sudan, and Somalia all seemingly assured a permanent...

  10. NOTES
    (pp. 249-272)
  11. REFERENCES
    (pp. 273-290)
  12. INDEX
    (pp. 291-298)