In vivid glimpses of diagnoses and surgeries, Living in Emergency illustrates the "tough choices" facing doctors in dire conditions.
Helping to stop the suffering of people is tremendously rewarding, although it also fucks you up a bit.
-- Dr. Arnaud Jeannin
"It was a pretty major shock when I got here," says Dr. Tom Krueger. "You can't describe the smells, the heat on your body, the sweat down your back, the smell of the pus that hits your nose. of unwashed bodies in a closed room, no circulation, you know, the smell of your own panic. You're not sure what to do. You can't share that stuff."
He's right. Despite his evocative language and visible exhaustion, you can't know the daily pain of working at Liberia's Mamba Point Hospital, the only free hospital in Monrovia (pop. 1 million). It's a typical project for Médecins Sans Frontières (MSF, or Doctors Without Borders), a facility opened in 2003 at the end of a 15-year civil war, conceived as a stopgap in crisis. Here needs are dire and possibilities are limited, a heartbreaking combination that is well known to MSF's team of volunteer doctors.
Their experiences are at the center of Living in Emergency: Stories of Doctors Without Borders. Mark Hopkins' remarkable film follows four doctors in Liberia and the Congo, in sequences at once grueling and inspiring. Handheld, tight frames of injuries indicate the urgency of each moment, while self-reflective interviews also suggest the ways time slows down, as choices are pondered. Italian toxicologist Kiara Lepora is now an MSF veteran, but she remembers her first mission, when "I was just so scared about everything." Looking out on a room full of beds, she realized the scope of her responsibility, so unlike working at a hospital where she was surrounded and supported by other doctors: "All of these 30 patients are mine, " she recalls, "And I have to save their lives." At the same time, she and other MSF doctors are practicing "low grade medicine" under dire conditions -- their equipment dated and resources scant, understaffed, undersupplied, and on call 24-7. "There is no limit between what is personal and what is professional if you start working with MSF," she says, drawing on a cigarette.
In vivid glimpses of diagnoses and surgeries, the film illustrates the "tough choices" facing doctors in dire conditions. In shot after shot, roads are muddy, rooms are small, and faces are strained. Observing that doctors volunteer for any number of reasons, some noble and some less so, Australian anesthetist Chris Brasher says, "I think some people do it to run away from where they're from." He smiles, sort of, when he adds, "As far as I was looking to make myself homeless, I think I've succeeded."
Working in Kayna, in the Congo, he's confronted daily with patients who come too late to be saved. After nine years in the field, on and off, he's aware of limits, however frustrating. "What happens is that we come and we just say, 'This is what we do,' and offer that. None of that touchy-feely 'What do you want?' None of that." Exhausted as he and his team take a rare break, he's disdainful of "some guy from UNICEF" who might come with plans for "these theoretical programs that might happen in the next three years." For MSF workers -- doctors and the local staff members they can hire during their temporary (usually six months) stays -- such abstractions are a luxury. They focus on immediate circumstances, what needs to be done now.
That's not say they don't have hope or ideals. They appreciate that they are appreciated, and they mean to do as much as they can. "The situations where people are less wealthy are often more human than situations where people are very wealthy," Brasher observes. As harrowing as each day is in a crisis zone, here, people work together to help each other, and "It's more rewarding than doing medicine in a country where people don’t give a shit about each other."
Amid grim pronouncements and valiant efforts, alongside graphic images of bloody surgery and horrific afflictions, the film also shows other tolls. One young doctor on a first mission to Foya, Liberia, Davinder Gill is aggravated by any number of problems, not least being the lack of supplies and apparent lack of effort by some workers. As he squishes a moaning patient's protruding belly back into place, he sighs, "Tomorrow I'll find out where the bowel died, because she'll be sicker."
His own limits exposed, Gill reflects the simultaneous impossibility and necessity of MSF's fundamental project. "It was really clear to me from the beginning that patients would be dying during the night and I wouldn’t be there," he says. "Patients would be dying during the day and I'd be eating lunch." He comes to this: "I compare myself to others and I wonder if another doctor in the same setting would have had the energy or whatever to spend more time with that patient than I did." But this misses the point, as Dr. Lepora sees it. Dispatched by MSF to sort out Gill's troubles, she says, "I think he's really Kurtz, Heart of Darkness. Davinder was all alone, left in his kingdom, he got crazy. If you put a reasonable person in an unreasonable situation, getting crazy is the most reasonable choice."
Because MSF faces unreasonable need and chaos at every turn, it's not always clear what's reasonable. Lepora tries to calm Gill, offering, "What can I tell other than that I am sharing at the hundredth percent the frustration you are feeling?" Where he finds fault with the system ("It's the French way the MSF works"), Brasher is more philosophical, noting, "You have to get used to it. You can't expect to turn up in a country where there's a lot of problems and be able to meet the needs of the majority of people."
The film doesn't smooth over what goes wrong and leaves unresolved the stories of its four primary subjects. Such messy narrative structure is to the point, exemplifying the disorder and difficulty of each day, however briefly. When a crisis is determined to be over, MSF must always leave one area in order to go into the next. Those left behind continue to struggle, with inadequate infrastructure and resources. "MSF has never been pretentious enough to think they're going to have an overall impact on health," says Brasher. "It's a tiny, tiny drop in a sea of oceans."