Taking a stand where others won't

Ann Silversides

CMAJ 1999;160:964

© 1999 Ann Silversides

MSF was founded in 1971 by physicians who had provided emergency relief in Biafra and Pakistan, and were frustrated by the obstacles to providing quick and effective medical relief. Today the organization has 2000 volunteers in 80 countries and is best known for providing medical care during high-intensity conflicts, but Orbinski stresses that about 40% of its work is in stable areas with limited access to care of any sort.

Orbinski, at age 38, has already made his way to the heart of some of the world's greatest miseries. He was MSF's chief of mission during the genocide in Rwanda (1994) and the civil war in Zaire (1996/97). He served as its medical coordinator for refugees during Somalia's famine in 1992/93 and in Afghanistan in 1994. He also worked in Peru during its 1992 cholera epidemic, and in Zambia. Quite simply, he's a Canadian physician who has made his name outside Canada.

Orbinski, a Montreal native, took a roundabout route to medicine. After receiving a psychology degree from Trent University, he spent 2 years working at a secure unit for juveniles in Alberta. "But I wanted more practical, in-depth understanding of what constitutes well-being and health," he said in an interview from his new home in Brussels. He applied to McMaster University and "fell in love with medicine during my first week there. . . . Being a doctor is an incredible gift and an incredible responsibility."

Dr. Victor Neufeld, his faculty advisor and director of McMaster's Centre for International Health, gave Orbinksi his first taste of international work during a year-long stint in Rwanda, where he provided clinical care and studied pediatric AIDS. "Until then I had planned to be a research-oriented academic, but my experience changed my understanding. . . . It became painfully evident that health and well-being are very much a product of social and economic circumstances."

He quickly realized the limitations and frustrations of clinical work in a country where the physician­patient ratio is 1:40 000 and the need appears endless. "When you realize that [your options] are limited, you either walk away or try in a different way," he said.

Orbinski chose the latter option and developed diagnostic and treatment algorithms that would allow nurses and others to address the most common pediatric ailments. "The kind of work I do is different," he explained. "MSF tries to address situations that arise because of inequity and social injustice. We're a humanitarian organization and our role is to provide medical action and advocacy."

Asked if advocacy ever jeopardizes the organization's field work, Orbinski acknowledged that it is "a very, very delicate balance that we have to strike . . . but there is no way you can stand by silently, administering palliative medical interventions." For MSF, humanitarian action is what Emmanuel Kant called a categorial imperative — it's self-evident that you must engage."

"No, it was not a surprise to me when James was made president," Neufeld said, explaining that he is "exactly the kind of person MSF needs" as it tries to centralize its operations and establish a single voice for policy. "He is a tough guy physically, mentally and emotionally. And he is spiritually based; he has a church background and translates all of that into his values."

Orbinski, who was awarded a Meritorious Service Cross by the Governor General for his work in Rwanda, mused for a while over his mentor's use of the word "tough."

The genocide in Rwanda "very deeply affected me," he said. "It is not simply a personal psychological trauma — I feel quite strongly about the political injustice I witnessed. So what do I do with that? I continue to work with this organization."

For more information about the work of Médecins sans Frontières, contact www.msf.org.

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