Grumble, grumble

Well. I certainly have been Mr. Grumpy these last couple of days.

I’m inclined to believe that a lot of it is just the ebb and flow of energies across a project like this. At first, there is the excitement (fear?) about all the new stuff you are suddenly exposed to and asked to do; this gives you a bit of an “up,” tinged, perhaps, with anxiety. What may have been going on during this, week 2, is the subsequent settling in to a new normal, with its realizations and frustrations about things that don’t work so well.

That said, here are the more specific causes of my darker mood – some of which are, indeed, troubling.

The main one was having a patient – the mother of 4 young children – die on the operating room table about 6 minutes after we started doing surgery on her. In truth, no matter what had happened in surgery, it was very likely she was going to die (her colon had ruptured, spilling its contents into her abdomen – in other words, a horrid mess). But that doesn’t make the experience any less upsetting – it happened yesterday morning, and hung over the whole day.

The fact that certain limitations in the care we can provide here contributed to her death makes it even sadder, and points to another of the things bothering me this week: A sense of medical aid as a colonialist enterprise. Now, I recognize that that is quite an extreme phrase, to the point of being distorted. We unequivocally do manage to help individual people with real, sometimes life-threatening problems, and send them out better equipped, physically, to meet the challenges of their lives. I’m talking more about the background to what we do. On the one hand, it’s knowing that some aspects the care my patient received here would simply not have been tolerated in, say, the US, or France. So why are they tolerated here? Why is it okay here? That is exactly the question that Paul Farmer, the head of Partners in Health (the organization I went to Sierra Leone with) is continually asking, and I admire him greatly for it. I don’t know this, but my guess is that Partners might have made no pretense of offering any surgical services for years (thus leaving patients like mine to possibly die for lack of surgery), during which time Partners would have been building, and developing local staff for, something like a modern, well-equipped hospital with a full range of services (so that at the end of those many years, the people here could expect care at least resembling what a US person could expect). It’s a different model, and it seems to me a good one – but the cost of it is not treating people you could treat here and now. From what I’ve seen here, MSF has chosen to offer the care it can now, even if in some ways it doesn’t equal what you’d get in the west. Is one approach clearly better than the other? 

My bigger question about “colonialism,” however, has to do more just with impressions that rankle. We drive around in big SUVs; most people here walk. We have three big meals a day; most people here are not sure of getting enough calories. We make very little money (by Western standards, one of the things I love about MSF) – but it’s still WAY more than we pay our staff, and we get upset when they ask for more. We talk amongst ourselves about how you have to watch the local staff or they’ll just sit around all day, about how “hopeless” their skills sometimes are, about how we’ve warned them they could be fired if we find them on their cell phones when they should be working (NONE of us ever does that, of course) – etc. Is it really that different than the bwanas sitting around in their pith helmets tsk-tsking about the “natives”? Again, I don’t have an answer – most westerners would find how we live unacceptably Spartan, as it is; and it’s true, sometimes the local staff DOES seem to work slowly or reluctantly, and DOESN’T have what seem like basic skills. It’s just the whole setup seems – like something that should be questioned. My father once wrote a book about Albert Schweitzer; I know shockingly little about him, given this, but my impression is that he actually lived WITH the people he cared for, for YEARS. Is that the only acceptable model for “Western aid?” Or is it okay to be somewhat piggish and occasionally condescending outsiders, as long as we do some good in the process?

Okay – frustrations with care, frustrations with the enormous economic/class/power differences between us and the people we work with. What else was bugging me this week?

Well – um – how to put this – the fact that this kind of work seems to attract certain TYPES of people? With certain PERSONALITIES? As I’ve said again and again, I really admire (and often am in awe of) the skill and dedication of my colleagues. But, back at camp – well, a certain atmosphere prevails that reminds me of, I don’t know – freshman week? Summer camp? A fraternity? An image: “Movie Night” a few nights ago was Top Gun, a movie I find so repellent I really can’t even enjoy it as camp (I know – I’m a supercilious a-hole). The evening, fuelled by a great deal of alcohol, was roundly enjoyed by all (or most). Loud, joshing camaraderie seems generally to take precedence over quiet, thoughtful conversation. There is a French literary magazine lying around, but I seldom see people actually reading. The morning after the Nice attack, no one had anything to say about the world situation (or about the attacks at all), despite the fact that there are I think 6 French people here. I could continue, but I think you get the idea. Basically, the work seems to favor action over contemplation, and the group over the individual. There’s nothing wrong with this – I just happen to not be like that. Never have been, for as long as I can remember. I think I manage not to be too much of an insufferable prig, in response – I just kind of go my own way and enjoy those (many) interactions that I do over the course of a day. But I feel a bit like a sore thumb. Or, actually – like the new kid in high school. Amazing that I can still feel that way, at my age! Obviously, it doesn’t sting like it did back then, but – I guess on top of everything else, I’ve been feeling a bit isolated and lonely.

So there you have it, the sources of my ill-humor, from the sublime (or, well – the serious) to the ridiculous. For some reason, though (partly the writing it down here?) I’m already through this round of it. In terms of the more serious questions, about the care we provide and the sociopolitical context we provide it in, what it comes down to is it isn’t perfect but we do what we can, and we can (and I think most do) keep asking questions and noticing things and making choices that will help us do it better (or change how we do it). And in terms of the social situation – obviously, it’s a pretty minor concern in the scheme of things (though it may have some bearing on the choices I make around this kind of work in the future).

After all of which we are left with just – the state of the world! Oy vey. I don’t think I’ve ever in my life felt so worried about what I read in the newspaper every morning. But let’s leave that for another post, shall we?

I hope you’re all having good weekends, wherever you are!