From Bunia

It’s hard to contemplate Bunia without MSF. Bon Marché (the MSF hospital) is truly an institution – everyone I meet has either worked there or been a patient there – usually both.  The community was initially devastated to learn that Bon Marché would be closing, and the fact that we will be here for some years supporting the General Hospital has softened that blow to some extent, even though no one in the community quite understands what that support will entail. And I have to acknowledge that we’re not all that sure either, because here we are being pulled out of our comfort zone – from responding to humanitarian crises – into the unfamiliar world of development aid.

Our disengagement strategy has evolved through a series of stages, governed (as these things are) by political, financial and cultural factors, as much as by experience as to what works in practice. The complexity of ‘integrating’ what are essentially a series of specific and focused MSF programmes (Paediatrics, HIV, Women’s health) into a very general health system is baffling, involving everything from assuring the availability of ink for printing surveillance charts, to advocacy at national and international level for provision of anti-retroviral drugs. To make matters more confusing, each of the numerous partner organisations has its own way of working, its own timetable, and its own agenda – and sensitivity to this is a prerequisite for effective collaboration.

The fact that I am reflecting on all this does not mean (unfortunately) that I understand it. I am only just beginning to get a feel for the landscape, and to identify the points where we may be able to have an influence.  As a doctor I feel like a fish out of water, knowing that there must be many people who could do a better job of this than me. But I remember my father saying that there’s always someone out there who’ll do a worse job of it, and this gives me some reassurance.

So, to return to the original question, can we conceive of life here without MSF? For Bon Marché is not just a structure, an employer and a community service; it implies a way of working, an ideology, even a particular relationship with the community –which won’t be possible to replicate as we move from one hospital to the other. This does not have to mean giving up on such ideals – but it means weaving those ideals into reality, such that the difference between the two ceases, eventually, to exist.

When you are accustomed to living in closed compounds, you develop a long-distance stare; a meditative gaze you adopt automatically when left to yourself. This abstracted state serves two purposes – it allows you to take a little break, to escape for a moment without physically leaving the property; and it helps you overlook the razor wire that charmingly adorns the walls of this and other MSF compounds around the world. This time round, though, my view is a little different – beyond the wire, climbing roses and clumps of deep-green foliage adorn a backdrop of billowy hills.

Perhaps Congo is the closest thing there is to that romanticized image of Africa we have created in the west – tropical forests, gorillas (and guerillas, of course), exploitation, civil wars, dusty road, and lots of dancing. I have numerous preconceived notions of the Congo, all based on novels or historical accounts written by westerners who came here to conquer, enslave or make their name through ‘adventure journalism’.  Then there are those (such as King Leopold) whom we associate with the Congo but who never actually set foot here; and those (Conrad) who experienced the cruelties of the Belgian Congo so vividly that they could only write about what they witnessed in metaphorical terms.  I’m trying to be conscious of these preconceptions so I can let go of them at some point.

Here, for the first time, I will be leading a project. Although there is nothing inherently intimidating about this role, I find myself thinking wistfully about the solid simplicity of the medical roles I have taken on up until now.  We will be closing down Bon Marché, the flagship MSF hospital in Bunia, and transferring all activity to the regional MoH facility. This will involve a lot of negotiating, HR management, and security assessment – and yet I will still be heavily involved in the medical aspects of the programme, in terms of quality assurance before and after the transfer. The role is something of a poisoned chalice, as such changes – with all the HR implications – are inevitably demoralizing for the staff. The next 6 months will undoubtedly be taxing and stressful, but could nonetheless be satisfying. I think.

Thankfully my office is in the hospital grounds, and when I step into the hospital wards I breathe a (paradoxical) sigh of relief, as if somehow I am coming home.  Instead of slippers I put on my stethoscope, and suddenly everything feels familiar and logical. The children are thin and frightened, the mothers care-worn and tired, the nurses are eating their lunch….and all’s right with the world. But then a voice whispers in my ear that the budget revision is due tomorrow, and I reawaken rudely to the reality that I am now a bureaucrat, albeit in doctor’s clothing.

Since 2007 I have been working as a doctor with MSF in Somalia, Kenya and Niger, and am currently Project Coordinator of the MSF Hospital (Bon Marché) at Bunia, DRC.

I am writing this blog for family and friends, for those interested in the work of MSF (or in working with MSF), and for myself, to help me process everything that’s going on here. I’m sure there are many who would identify with the feelings I’ve expressed here, and I would be happy to hear from anyone who has any reflections to share.

Please note: the opinions expressed in these pages are my own, and do not necessarily reflect those of Médecins Sans Frontières.