On the New Film "Living in Emergency"

Has anybody out there seen the new documentary on Medicins Sans Frontieres called “Living in Emergency: Stories of Doctors Without Borders.?” If you haven’t, do and then write a letter to MSF as well as to the producers.  The film is both impressive, depressing and appalling.  To spotlight the work of what is an incredible organization, it focuses on four physicians — three men and one woman.  All have gone on tours to truly agonizing places to Liberia and the Congo at the height of their wars.  All are overwhelmed by the level of suffering, grief, lack of health care services, poverty and violence.  And so are we, as viewers.  Choices in these countries and outposts have to be made between procuring anti-biotics and surgical gloves.  You choose the latter and the patient dies of an infection.  You choose the former and the patient gets an infection.  The doctors have a terrible time because they were all trained in high tech medical systems — trained to use the latest gizzmos and there are no gizzmos where they are.  Not even enough paid meds, or basic supplies.  For them, care is a constant triaging and for each patient they rescue hundreds — no thousands — go untended.   The film eloquently captures their anguishing daily dilemmas.

That is the good part of the film What is truly astoudning is that the film and film makers, and by extension MSF itself, depicts this organization and the effort to help deliver medicine to war torn countries as a doctors only enterprise.  The majority of MSF volunteers are in fact not doctors but nurses and statisticians and others.  There is not a single depiction of a nurse or other health care professional in the film.  We see people working with the surgeons who probably are nurses, but who knows.  What is even worse is that the relationships of the physicians in the film and at least to the local professionals and staff who are stuck in these terrible places is almost entirely disdainful.  Do MSF doctors get any training in dealing with local people?  You wouldn’t know it by watching this movie.  They berate the locals, speak scornfully of their work and there are no local people who play a prominent role in the film — except as objects of derision.  I was really shocked watching the movie.

The film has serious implications for health care.  We now know that health care must be delivered in a team, with decent team relationships and team commuication, if it is to be safe and effective.  But the media consistently depicts health care — medical treatment — as a doctors only affair.  This film is a perfect — quintessential –example.  Any young person wanted to do good in medicine who watches it will get the impression that its the heroic doctor who counts — now sometimes a female — but always flying solo. Anyone becoming a doctor, who could potentially understand the value of real teamwork, will learn all the wrong things seeing this film.  They will never learn to ask the right questions about health care delivery or how to improve their practice and communication as doctors by watching material like this.

When will the media get it.  When will doctors get it?  When, will MSF get it.  Okay — so its called Medicins San Frontieres, not Medicine Sans Frontiere (Doctors Without Borders not Medicine without Borders) that doesn’t mean the organization should legitimize as it does here the total exclusion of other non-physician members of the team.  See the film. Write to MSF.

As I sat in that darkened movie theatre, in Berkeley,California, watching the film with all the progressive Berkeleyites in the cinema with me, I wanted to shout out — hey guys, this is not how it is either out there, or back home here.  It takes a village to deliver this kind of care –whether high tech, or low tech, in war zones or back here at home.  And that village is a complex entity, in which lots of people who are not physicians do a lot of important and mindful work.  When are we going to learn about them?

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