- Doctors Without Borders: An Organization that celebrates 50 years
The date could not be more symbolic. In December of this year (2021), it celebrates 50 years of existence, carrying out humanitarian actions all over the world. They are the Doctors Without Borders (DWB), an organization primarily focused on health care, but which in more precarious cases offers assistance and preventive care, wherever in the world. Its intervention is mainly during global crises.
With the aim of providing the rod to teach how to fish, this Organization creates the necessary structures so that, after leaving, communities can continue to know how to do for themselves and on their own what they could not do in the past.
Represented by teams from 140 different nationalities and with more than 65,000 employees (2019 data), the Organization has been present in over 70 countries and 96.2% of its revenue comes from private donations. The impressive numbers do not end here. Over its 50 years of life, the Organization makes an average of 11 million consultations per year, treats more than 2 million and 600 thousand patients with malaria, helps more than 76,500 malnourished children, hospitalizes around 840,000 people and, of these, 100,000 undergo surgery. Altogether, DWB has around 500 projects running simultaneously around the world. For all this to happen, it always maintained the rule that acculturation, of those who arrive at each location, is essential, trying to adapt those who arrive to the existing structure and culture. This explains why 83% of workers at DWB are recruited locally in the countries where the humanitarian projects take place.
They react to major global emergencies and intervene in the acute and severe periods of the humanitarian crisis, reacting to urgent response situations such as the massive displacement of refugees, armed conflicts, epidemics, situations of exclusion from access to health care, or bad weather. All situations that increase the morbidity and mortality of populations.
The Doctors Without Borders (Médecins Sans Frontières) organization was created in France in 1971 by young French doctors and journalists, led by French physician Bernard Kouchner. All of them acted as volunteers in Biafra (Nigeria), while volunteering for the Red Cross. At that time, when they experiencing a civil war, they realized the difficulties of the victims of war and the bureaucratic obstacles that made international aid difficult. DWB thus appeared driven by a desire to reverse the greatest difficulties, bringing humanitarian aid to the weakest. It was for the projection and help they gave to the needs of the world that, in 1999, DWB was awarded the Nobel Peace Prize.
Despite the name and purpose unequivocally pointing to medical help, the fact is that DWB goes far beyond it. Of the total number of DWB workers, 49% are non-medical professionals, 26% are nurses, nurses and paramedics, and 25 % are doctors.
In 2020, DWB realized that it should take a stand in the face of the medical and humanitarian consequences of climate change. It entered into the new Environmental Pact, in order to minimize its own environmental footprint, never neglecting the medical and humanitarian assistance it has always provided. It attended COP26. The moment could not have been more relevant for us to get to know the organisation, through its representative in Portugal, João Antunes, with whom we spoke to understand how the planet's diseases interfere in human health.
He joined the team in 2005 and stayed until 2017 in the first phase. In these 12 years, he has been involved in 18 humanitarian missions, covering numerous countries and trying to provide answers to the global crisis. Nervousness is a characteristic that he assumes, because whoever goes to the field, knows that it is an integral part of the process of interaction with reality, no matter how much experience is gained. João also explains that the necessary basis is to add qualification and competence to the motivation to help.
As of 2018, João Antunes embraced a new challenge within the Organization, opening a delegation in Portugal, trying to get the message out about what it means to provide medical consultations in cultures and realities as different as Yemen, Syria, Afghanistan, or the Central African Republic. Currently focused on recruiting people for the structure of the Portuguese Organization, João creates some initiatives with the Faculty of Medicine, where he divulges the objectives and needs to consolidate teams for humanitarian aid. The requirements cannot be just the willingness of our students to go as future doctors. They must have a specialty and at least two years of professional experience. Afterwards, all undergo training, so that each person can adapt to the culture with which they will interact, fostering an increasingly integrative culture. There is also an adaptation of each culture to the health system, ensuring as much as possible that the Western bases are not perpetuated in different cultures, such as Muslims or Asians.
“All this requires time to prepare, adapt and analyse each place. The purpose is to better empower each location, bringing medical expertise and benefiting everyone's knowledge, in order to create the structure and only then design the health strategy”, explains João Antunes. Each person receives training for two weeks, the minimum time for learning and training. In the first mission, they stay 3 to 6 months to receive the best learning. "We can't depend on just one person, those staying for 6 months must take their breaks and rest. As much as they want to help, the way they dedicate themselves has to be reasonable, because it's always the team's work that counts, not the isolated action of each person, because dedication also wears out”. This means that each local team knows how to work in a balanced way, without being dependent on a single command voice. Nothing is left to chance. This is the way to prepare whoever stays there to be able to act when “left” by the organization. Once the action structures of the teams that stay, often in a hospital environment, have been created, the exit strategy phase is worked on, when the teams leave, within an expected exit logic.
Always with three grounded premises, the organization acts based on religious, political and social impartiality. Even so, it knows that to enter certain geographic areas, it needs to negotiate its presence with different political actors, some of them involved in armed conflicts. The authorization must be explicit and involve several times more than one party. DWB's allegation, ultimately, is an allusion to Humanitarian Law, but this consecrated foundation is not always enough to ensure what they intended. Security is, therefore, an essential point to safeguard, but it is increasingly fragile, since authorization for them to intervene humanitarianly may be denied, running the risk of counter-terrorism strategies. In that case, they don't take on the mission.
Attentive to the various parts of the world's reality, João knows that the organization is adapting to the passage of time and how to go about it. "We do not strictly look at medicine in isolation, we follow the times and trends that arise, climate actions, or the new movement Black Lives Matter. That was why, at the end of 2020, the organization launched an action plan on Diversity, Equity and Inclusion. The closing of international borders itself, another one of the consequences of Covid-19, prevented the normal routines of exchanging teams involving doctors, nurses, technical specialists and other professionals of the organization. And if all these points weaken the most vulnerable groups and those in need of help, then there is also the possibility of looking at new solutions and action plans.
Time and experience showed these humanitarian support teams that the health provided to people is always associated with environmental health. One part has effects on and damages the other. As they come into contact with various countries in Asia, the Middle East, or Central Africa, they are well aware that, at the base of epidemics, cholera, dengue fever, or malaria, there is always the vulnerability of populations due to the environment in which they live. This was the topic they addressed at COP26, allowing for the testimonials of victims of climate change, resulting in the need to assess how they will reduce their own environmental footprint. “Our health depends on the planet's well-being, and the planet's well-being depends on how we act”, they stated.
João Antunes also developed the idea that “people's lack of access to water, as well as the impossibility of cultivating the land, are some of the causes of human conflicts in some parts of the planet. But this is not the only reason for the large population migrations. Many of them are forced to abandon their land because it is flooded by sea water, as is the case of many residents in the slums of Dhaka in Bangladesh”. A reality that mirrors the lives of people forced to migrate due to climate change, which further aggravates the precarious health of these groups, exposing them to hunger, the spread of more infectious diseases, violence and consequent malnutrition, and total loss of immunity, which ultimately leads to their death.
In 2020 alone, the Doctors Without Borders Organization conducted health activities in 88 countries. More and more needed, more and more attentive to the world, they promise to continue to reach needy populations. Therefore, they need to mobilize more teams that do not all need to be doctors to provide health support.
The challenge is open to anyone who wants to collaborate with the organization. On the part of the Faculty, the invitation for another reunion has already been made, itself without borders.
Credits: All photos belong to the Doctors Without Borders Organization or to João Afonso