No matter how self-obsessed you are, you would have heard of Doctors Without Borders. Officially known as Medecins Sans Frontieres, or MSF, they are, like Marvel’s Avengers, superheroes who tread where devils have no fear of going either. They might even make you think of the Steinbeck story immortalised by Henry Fonda in Grapes of Wrath: fill-in-the-blanks, and they’ll be there.
Dr Unni Karunakara has been with MSF since 1995 and has just stepped down as its International President. As he begins a 5,000 km cycle tour of India on October 12, 2013 to fundraise for MSF and “speak to medical students about medical humanitarian action in more than a dozen colleges across the country”, his own story best exemplifies what MSF is all about: It’s about individuals.
The official Bio will tell you that Dr Karunakara started his career with MSF by setting up a tuberculosis control programme in Jijiga, Ethiopia and then did the kind of thing that socially-inclined people dream of with the same kind of yearning that Kim Kardashian has for another Hermes Birkin: He handled health issues from Azerbaijan to Nagorno-Karabakh; focused on health care for Brazil’s indigenous population in the Amazonas province, and oversaw a programme dealing with sleeping sickness in the Republic of Congo.
In 2002, Dr. Karunakara joined the Public Health Department of MSF in Amsterdam, advising country programmes in the Middle East, southern Africa and South and Central America, before becoming Medical Director of MSF’s Campaign for Access to Essential Medicines. In 2007, he was part of the medical emergency response team that treated victims of cyclone Sidr in Mathbaria, Bangladesh.
Since 2008, Dr. Karunakara has worked at Columbia University, USA, as Deputy Director of Health for the Millennium Villages Project at the Earth Institute, and is an Assistant Clinical Professor at the Mailman School of Public Health. He was appointed MSF President in 2010.
In other words, fill-in-the-blanks and he was there.
Dr Karunakara’s unofficial history is equally compelling. MSF is, perhaps reassuringly, not always God-like and more like most organisations worldwide: Approach them and they’ll ignore you, until serendipity intervenes.
Dr Karunakara recalls, “While in medical college, in 1984 or so, I heard about MSF on the BBC World Service. I was very impressed and intrigued by their work in Ethiopia and other parts of the world. It seemed an ideal way to practice medicine, combining my desire to discover the world and experience new cultures. In fact, I wrote to BBC for MSF’s address. I then wrote to MSF expressing my interest in being a ‘Doctor Without Borders’ but never heard from them. Ten years later, I met an MSFer at the airport in Brussels and soon I was on my way to set up a TB control programme in the Somali province of Ethiopia. Nothing I had done until then prepared me for that year in the Ogaden desert. The utter lack of human resources coupled with immense health needs made our presence absolutely essential. In many places we were often the only providers of health care. It contrasted sharply with the situation in Manipal where I had been a student.”
The world MSF operates in is not the world we know. They recently shut their Somalia office after 22 years during which time staff were killed, abducted and abused. What kind of person would continue to work under conditions like that? And actually for the sake of humanity, a phrase as alien to the hoi polloi as it is to politicians. The way Dr Karunakara explains it, with a mixture of honesty and objectivity, gives you a startling perspective.
“I consider our withdrawal from Somalia after 22 years a failure,” he says. “Sure, we tried our best to deliver healthcare in some of the most difficult parts of the country. In the final analysis, however, we were unable to convey the principles of our actions, our independence from international political actors, our neutrality and impartiality in a way that stopped political and criminal elements in the Somali society from manipulating or even targeting us. Over the years, we had accepted more and more compromises in the way we worked in Somalia. Perhaps, we should have left sooner. For all of us in the MSF movement, it was an extremely emotional and difficult decision to make as we are very aware of the immense humanitarian needs in Somalia and consequences of our withdrawal to hundreds of thousands of Somalis.”
It isn’t the only country that has proved difficult.
“In Syria today the delivery of humanitarian assistance is an extremely challenging and dangerous enterprise. Doctors, hospitals and ambulances are being targeted across the country, making it difficult for civilians caught in conflict to receive life-saving health care. Having said that, all countries pose challenges in the delivery of health care. If not conflict, then dysfunctional health systems, the corruption, the lack of capacity or the lack of health workers all make it difficult to provide health and humanitarian assistance.”
What may help anyone working in this arena nullify the bleakness of their landscape can come in different ways. For Dr Karunakara, “It is invariably the patient in front of you that makes it worthwhile to do this work. A child today does not have to die of measles. A woman today does not have to die giving birth. Very often, as the only health care provider in remote locations, an MSF doctor or a nurse can help to make the difference between life and death. We often serve as a catalyst for change by providing care to people that are neglected and ensuring that innovative therapies are available for diseases that are neglected. It is particularly gratifying to see governments change policies for the better. For instance, provision of free treatment to those affected by HIV in South Africa or the implementation of a new therapy for sleeping sickness in the Congo.”
At the end of the day, though, how optimistic can anyone be about the human condition when they see the worst of it? It probably takes an unblinkered vision, to start with.
“Humans can be incredibly generous and kind and at the same time be greedy and cruel,” says Dr Karunakara. “As humanitarians we do not have the answers or profess to have solutions to political and economic situations faced by various societies. Our presence is often a symbol of failure. A failure of security, a failure of systems and often a failure of humanity itself. As a humanitarian, the most I can hope for is to be with people or communities when they are going through a crisis, provide them with health care so that they live through the crisis, and occasionally speak on their behalf to raise awareness of their plight. We prescribe medicines but not solutions for ills that face the human condition.”
A day in the life of the good doctor..
“As President, I chair MSF’s International Board as well as represent the organization. The board is tasked with ensuring that all MSF operations are implemented in a principled manner. As the face of the organization for the past few years, I have had to position MSF in complex humanitarian crises and lead certain advocacy efforts. A typical day may involve meetings with MSF teams inside and outside Geneva, and high-level advocacy meetings with heads of international agencies and states. I travel a fair bit to visit field missions, to support the work our colleagues do and to see and hear first-hand the challenges they face in carrying out MSF’s social mission. In addition, I spend a fair amount of time catching up on unfolding events and new developments in the field of health care, and talking to students and journalists about our work, and the challenges we face in doing it.”
And later..
“Somewhat like Hotel California, one can check out anytime one likes from MSF but one can never leave. I will continue to remain an active member of the MSF movement and may at times travel on a field project. I am hoping that the long cycle tour across India will help me figure out what I want to do next.”
What is it about the MSF that has caught the public imagination unlike say, PETA, whose militant stance against anyone disagreeing with their worldview merely puts one off their agenda? “MSF embodies the humanitarian spirit of a global civil society,” says Dr Karunakara. “Not everyone is able to get on a plane and go to Africa or take time out of their lives to express solidarity with people across the world (and at home) who are going through a difficult time. MSF volunteers are ordinary people that respond to extraordinary situations and in some way carry the aspiration of our 4.6 million supporters around the world. Moreover, we try our best as a medical organization to be ethical in the way we deliver health care and as a humanitarian organization, to provide care solely based on need without any political or religious considerations. In doing so, we often challenge the status quo, highlighting political and structural barriers that prevent people from being healthy.”
The India bike tour takes Dr Karunakara back to his roots in more ways than one. “Cycling across India was always something I had wanted to do. I see cycling as a great way to meet people and feel the pulse of the country. In addition, I find the act of cycling long distance through different terrains and conditions incredibly contemplative. A great time to think about life, really. As I thought more about the trip, I remembered my days as a medical student and how inspired I was by the story of MSF and how this spurred me to practice medicine in a different way. Talking to medical students along the way from Srinagar to Trivandrum is my humble attempt to inspire students to be humanitarians and good doctors. It so happens that MSF has set up an office in India with the express purpose of raising human and financial resources. Along the way, I intend to put the spotlight on various humanitarian issues in India and elsewhere with a view to raising awareness about medical humanitarian action and to raise funds for MSF’s work. MSF has very kindly agreed to support my bike ride. A young engineer from Berlin has built and generously donated a cycle for this trip. We are looking for sponsors to underwrite the cost of the trip as well as to contribute to our humanitarian efforts.”
Dr Karunakara will be in Bangalore on January 9, 2014. For updates, follow him on Twitter. You can also donate to his effort at http://www.justgiving.com/unnicycles.
Sheba Thayil is a journalist and writer. She was born in Bombay, brought up in Hong Kong, and exiled to Bangalore. While editing, writing and working in varied places like The Economic Times, Gulf Daily News, New Indian Express andCosmopolitan, it is the movies and books, she says, that have always sustained her. She blogs at http://shebathayil.blogspot.com/