Living in Emergency (2008) - full transcript

Millions of people have been,
have been affected.

The people need shelter,
some people need food.

They need clean water.

They need clothes.

They need blankets.

They need medication...

New fighting erupting today
in a civil war some call,

the most brutal in Africa,
in the Democratic Republic of Congo,

where millions have died.

How are you dealing with the people
who have been wounded?

Fourteen years of war
have left Liberia in ruins,



and a quarter of
a million people dead.

Warning: Some of the images
you're about to see are disturbing.

Monrovia's hospital has been
overwhelmed by casualties.

There are shortages
of food, water and shelter.

...earthquake along the border
between India and Pakistan.

It's estimated that as many
as 30,000 people were killed.

Close to the quake's epicenter,
almost everything is gone.

Entire villages
reduced to rubble.

So the situation here is
really getting worse by the hour.

Relief and rescue operations
are becoming visible,

but so too is the sheer
breadth of destruction.

We landed in Islamabad,
And we moved up to Abbottabad.

Two teams each fly by helicopter
into Kawai and Kaghan.

We are based here
in Mansehra.



When I say we are based
we just arrived, huh?

I work for
M?decins Sans Fronti?res.

We have a team of a doctor,
two nurses and a logistician.

Major, which is your aircraft?

We'll, we'll help you get loaded now.

So far nobody
has reached them.

You will be the first
one reaching them.

The beginning is always the why;
why are you there?

You could set-up MSF missions all
over the poor countries of the world.

The demand is
pretty much infinite.

It's just a question of being able
to choose what you can do.

So you make choices that
are tough choices to make,

but you have to make them.

The civil war in the very dangerous
West African nation of Liberia,

fierce fighting between rebel forces
and government troops,

in the capital of Monrovia.

This is where the frontline
was in December.

Where are the gloves man?

Nobody could possibly have any concept
of what it's like to work

in an environment like this.

When I first started, I had no idea
what, what I was getting myself into.

The second there is just a shadow,
here just a scratch.

I never could have imagined
what it means being the doctor.

Sometimes being the first doctor
that people has seen,

in the past twenty-seven years.

You're on here 24/7 which means
that I'm on-call all the time.

And, I mean, that's why
there's so much burnout.

Helping to stop
the suffering of people is

tremendously rewarding although
it also fucks you up a bit.

We have a 40-acre farm,
so it's felt pretty comfortable for me,

because I grew up
with my grandparent's dairy

and worked on it
actually up until...

till my first and second
year of medical school.

My grandfather
was a surgeon.

When I was a kid, I'd go to
the operating room with him.

I remember the first time I was in there
for an operation, watching him do one,

and I thought that it was
such a radical concept,

to cut people open
and work on them,

there was nothing else
that seemed like

it was going to be
quite so interesting.

So I practiced for
twenty years here.

I'm still kind of reflecting
and working through why it is

that I was tired of
what I was doing

when it was what I always
wanted to do with my life.

I have real problems with
the American health care system.

I think the whole system is
this big business now.

And I realized that, you know, in my
practice, that I really wasn't giving

of myself the way
I had wanted at one time.

Especially in, uh, African populations,
the peeling of the skin...

You know, it's hard when
you get started on a family

and you have all the responsibilities
to all of a sudden just say,

"Well I'm going to get off
and do something different."

That's why it's taken me twenty years
before I could do something like this

where I'd always
dreamed of doing it.

This emergency room of
a busy emergency hospital

where we get
all the complicated cases.

Alright, don't be scared,
you're in the hospital now.

We'll take care of you, okay?

Because of the war, the health system
was completely broken down.

Even now, the health
system is minimal.

Doc, doc,
good morning.

Here.

Okay, can I see his x-ray?

I don't actually see
any abnormality in there.

A young girl?

Electrocuted.

Yeah.

She fell in the water.

She fell in the water with
an electrical current.

What's this thing?

Osteomyelitis of his clavicle.

You don't see it on the x-ray, it's
looks fine, but uh, you can...

it's tethered
to the bone, you know?

You can't move it.

It was pretty much of a shock
when I got here.

I mean, if you're going to
talk to some of your friends

about some of the stuff you saw,
they'd, you know.

And you can't
describe the smells...

...the feeling of the heat
on your body

and the sweat
running down your back.

The smell of the puss
that hits your nose,

and of unwashed bodies in a closed
room, you know, no circulation.

And the smell of your own panic,
when you're not sure what to do.

You can't share that stuff.

This ulceration goes all the way
back to here, underneath there.

There's so much chronic
infection down there that,

going back to an older technique
that we've used on a lot of people

with really nasty feet is just
to do a guillotine amputation.

Just get the infection
off of him.

His only... his only recourse
is an amputation at this time.

I bet my grandfather would
have done a lot better here

than I'm doing here...

because it was more like surgery
that he would have practiced

with limited facilities
and limited diagnostic measures.

Seeing things that should have
been fixed five or ten years ago.

They come in at the very
last moment, you know,

when they're at
the very worst.

That largest, the biggest, the hardest,
everything is super-sized here,

you know, in
terms of severity.

I hope, as it all goes through,
that there's not something that

comes to pass that
causes me to

feel bad about
my experience here.

I'm fearful it would be my own failing,
is I guess is what I'm saying.

I hope I'm up to it.

I'm going to visit him but I have
to get dressed to visit him.

Does he know this?

Yeah?

I can see myself
in my first mission.

When I got there, I was just so
scared about everything.

I was scared about the kinds
of diseases that I was seeing

I was scared about
the responsibility that I have,

because in our hospital
you're just not used to that.

Even as a doctor you always
share the responsibility with other

five or six or seven doctors
who knows their little, little part.

And when did
the fever start?

Thursday.

Thursday.

So do you
have pain here?

And then you go to Africa
and your responsibility just increases.

The beginning is like thirty beds and
all of these thirty patients are mine

and I have to save their life!

And it's very scary.

What else can it be?

So it can be Lassa fever,
it can be yellow fever.

You have seen Lassa fever,
what do you know about the timing?

Ten days maximum.

Ten days maximum.

So, I would... I would have
started Chlorophenicol...

When you decide to go on your first
mission it's because you want

to have your life in
what you're doing.

This division between what is personal
and what is professional here

is completely blurred.

There is no limit between what is
professional and what is personal

if you start working with MSF.

Mamba Point Hospital...
do you know that?

Mamba Point Hospital.

Do you know it?

MSF.

Yeah, you know that?

You come there?

If you are sick
you come there?

This is my
personal obsession.

This is West Point, the place
in which there are, like,

seventy-five thousand
people living, fifteen latrines,

the worst conditions in
Monrovia all put together.

This is considered
to be a 'no-go' area,

which is officially done
for security reasons.

But the result of that is that
nobody is working there

and the situation is just going
worse and worse and worse.

Today we own more than
seventy-five percent

of the hospital beds
in Monrovia.

MSF has actually more doctors
than the whole Ministry of Health.

Here, MSF is here in Foya
and here in Kolahun, right?

Up to the beginning of 2006
the whole rest of the country

was completely empty.

There were no other health centers,
even not health centers,

no nurses, no... nothing.

It's really just a huge level
of responsibility.

The doctors in the hospital are very
much cut in the situation of wanting

sort of, accepting everything
and then having to make choices.

Like, the fact of being faced
with cases in which you will

have to decide if you
can do it or not.

I think we all have the same question...
which is; what is our limit?

This lady came the other day
and wanted to get treatment

but this really was
not there when she came.

Sister, this one can come out
of your belly button, huh?

You start turning on your back for me,
and you will start feeling less pain,

and then we will slowly
try to push it in.

So for this hernia, we wonder
whether it's strangulated,

that means
the content is dying.

Unfortunately, in this setting
it doesn't matter.

Even if the bowel is dying,

all I can try to do is push it back,
and then tomorrow I'll find out

whether the bowel died
because she'll be sicker.

I mean, four doesn't really look like
enough but, it's... it's all I got.

I'm just going
to try to push.

It's gone, huh?

Sorry, sister.

We let her rest here for ten, fifteen
minutes then you put her on a bed,

and you do... be doing her observations
every two hours like I said, huh?

I have a desire to do medicine
that I think is really effective,

and for people who
need it more than others

and that takes you
to settings like this,

where the patients are
sicker but what you can do

makes more of a difference
life by life, person by person.

In 2001, when the war
hit here the worst,

overnight, everyone left, so both
hospitals were obviously deserted

since then and I'm the first doctor
who's lived here for fifteen years.

Alright, still swollen.

This illustrates a point that,
to do the dressings

for cases like we see here involves
a huge amount of SSD and gauze

and stuff that we
have never had.

Alright, well we'll
look at it later.

We don't have
a lot of cold pack.

You got them
this morning.

No, a patient did not receive
Gentamicin because it was not

in the cupboard
this morning.

But I sent
for it yesterday.

Yes, but it happens
often, huh?

I've spent six months here
and I reckon psychologically

I'm just tired at
the end of this mission.

Maybe I am wrong, but I thought you
ordered twenty and I gave you twenty.

The trouble is, here in Foya
there was never a regular contact.

Nobody really thought it was
their problem to make sure

that I feel supported here.

It's a lot, I know.

But, if you see that we're using that
much you're going to

have to be ordering
fifty/fifty then.

When you're trying from one end
to communicate something,

small gaps in what comes back
really piss you off

when you're sitting
by yourself in a bush.

It really pisses you off.

Okay, so we need three
hundred feet of steel rod.

Do you copy?

Is it alright if you lie down,
I press your stomach?

I press very...
no, please.

Okay, let him sit up.

It's alright.

It's okay, it's okay.

So this is one of
the interesting patients

I'm bringing Kiara
back to see after.

His condition is one of
just generalized swelling.

It could have been
something like e-coli.

Associated with
conditions like that,

you can have Renal
disease so, at least that

gives me a course for
current kidney disease

and why it's so
difficult to fix.

Yeah, I'm glad, I mean I'm,
you know, I'm not glad, but...

Yeah, I'm glad.

It gives me a cause, and it means
that there's nothing I can do

so at least I'm doing
what I can do.

I'll... I'll see you soon.

I'll see you and I'll
press your tummy after.

No one here that's trying
to die at the moment.

Lady last night,
she was really sick.

She died.

Nobody's that sick...
that they're going to die today.

How long will it take you to go to
Shella and come back?

Inside of ten minutes, fifteen.

Okay.

Then you can
carry the body there.

You go with Francis,
you carry the body, you come back.

I'm very sorry.

I didn't know her condition very well
but she was very sick, yeah?

So we tried.

It was really clear
to me from the beginning.

Patients would be dying
at night and I wouldn't be there.

They'd be dying during the day
and I'd have to be eating lunch.

I think the first two patients
who died were the hardest.

Those two cases stressed me
a lot at the beginning.

They stressed me
quite a lot.

But after that, I think appropriately,
I got more used to it.

It just becomes part of the work
and you just try your best.

I compare myself to others
and I wonder whether

another doctor in the same
setting would have had

the energy or whatever,
to spend longer with that patient,

sleep less that night,
and get more work done

the following day
than I got done.

And we need also a medical
visitor at the hospital.

...what about
the field coordinators?

Some of them been
there for a while?

In summertime, they're
always short in the field.

There's a call every summer for people
in the head office to go out to field.

They're always happy
to have one more person

because it's always
pretty... pretty heavy.

And also somebody who's
done that kind of stuff.

You know,
I've done it for a while.

I've been doing it
for nine years.

Everyone who joins MSF
as a volunteer has different motivation.

Some people do it just to
run away from where they're from,

and that's certainly my reason.

I've been away from
Australia for a long time

and when I go back
I feel a bit like a stranger.

I don't have a home
anywhere else really either.

So if I was looking to make myself
homeless I think I've succeeded.

I've been trying to sort of
digest and give some sense

to what I've been doing
the last nine years.

There's lots of stuff that really can
sort of eat away at you as well.

I've been sort of running
on empty for a long time.

I'm an anesthetist and...
and my career at MSF

involves war surgery, essentially,
and then emergencies in...

pretty much
exclusively in war zones.

So, basically the idea of
a medium term mission here

is that these sort of different
armed groups who are gonna

keep on clashing
and pillaging...

and people not being able to access
their food and their whole lives.

Yeah, and their fields.

So their children starve.

Security conditions are
not the best, that's for sure.

Two nights ago, there was some
gunshot right next to the MSF house.

Teams living under
a curfew, I presume.

Yeah, after six it's dark,
we don't go around by foot.

If we have a night like last night
or the night before, then nobody moves.

There's been all these security
incidents for the last six months.

Four or five MSF staff members have
been almost killed in this place.

It means they had a gun
to their head or shots fired at them.

Today, right now, it seems
to be alright, but by tonight,

we might be in a car driving like crazy
because the situation's gone bad.

He's got an entry bullet wound
here, an exit would here,

it's taken off his ear, and the question
is how much brain has gone with it.

It'd have to be some sort of local
collection of blood in his brain

for us to be able
to help him.

That's about all
we can do here.

But the chances of that
being the case are quite slight

and his coma's
getting deeper.

The armed men came to the house
at midnight and they said,

"Give us your money."

So then they shot the father at pretty
much point blank range in the head.

Well done, Mary.

He thinks it might have hit
the brain, he's not sure.

It'd be nice to have
a CT scan, but...

The usual drill bits used for
drilling into peoples brains

are sort of rounded, so you
can't, like, just sort of...

fall through and
into the brain.

In fact, it's not the best of
drill bits to use for that.

The question is how much
damage there is to the brain

and that we won't
really know.

Now we just have to wait and see
how he wakes up, and what he's like.

And work without oxygen in
the theater again, like yesterday.

It's tremendously frustrating here
because it's low-grade medicine.

It's low-grade medicine.

We... we compromise with
the way we do medicine.

It's not by negligence, it's by the
forces of the context, this violence.

We are able to do things,
but the things we are able to do

are not as good
as they could be.

When you decide as a doctor,
"I can't do what I'm meant to do,"

"I'm supposed to stop
the suffering but this I can't do it,"

Well, especially as a young bourgeoisie
from the wealthy countries,

you find it very
difficult to do.

Yeah.

Yeah, just be careful.

Let's go away.

Let's go back towards
the hospital.

Every war situation, you see
the civilians that are all terrified.

You see some people who
enjoy killing people.

Dr. Chris Brasher is an Australian
doctor with Med?cins Sans Fronti?res

who is in Monrovia.

I spoke to him a
short time ago.

In 2003 I was working with
MSF in Monrovia.

Basically all the people being
injured are civilians.

People ask me all the time "What
is the international community

doing about the situation..."

That time was sort of a
turning point for me.

People being carted around in
wheelbarrows with big holes in them,

blood all over the streets, no water,
no electricity, no food...

Pretty apocalyptic really.

Buildings getting peppered with stray
bullets and occasionally with mortars.

People just getting randomly
killed all the time.

Civilians.

Going to Monrovia in 2003, that was
kind of what decided that I didn't have

the stomach for it anymore.

So that was the beginning of me
getting out of MSF.

So I have decided that this is
my last go around at MSF.

Every situation MSF intervenes in is
really humanly abnormal and bizarre.

That's characteristic of
an MSF mission.

It's a crazy situation.

Here comes Chris, Giuseppe,
the heroes!

Hail! Oh yeah!

Mmhmm! Mmhmm!
Ahh, yes!

None of this kind of touchy-feely...

You're like, "fuck off" basically,
you know.

That's basically how it goes.

You know, it's like, "fuck off,"
you know.

And so you're an asshole,
an arrogant asshole.

So it is a question of making
a decision that we... we stop.

How long you think you need
to be there, first?

I think that's the first question.

It's not a rich area.

For the Ministry of Health to be able
to have the health facility in place,

they need man-power,
they need rehabilitation.

And this goes with, with, with time.

I think we need at least
one year and a half.

Hello, baby Harry.

How long has he been on Cipro?

Three days?

When there is no emergency
anymore, it is always like this.

It doesn't mean that there is
no health need anymore.

But MSF will not be able to
provide the same high standard

of care forever.

It will not be able to do it.

Does it hurt?

The fact that MSF is in some
situations which are overwhelming

is not because MSF is too small.

It's because the situation
is overwhelming.

Cooper.

Give gauze, please.

We need something to wipe always,
all the time we have to have

something on the field to wipe.

Do you understand?

I got it.

It's here.

Thank you.

When people is stressed and
here in the hospital,

it's very easy to get stressed.

They do not answer,
if you want, for the best.

They do answer with
a sort of stress answer.

When they get his x-rays,
can they...

When they get his x-rays,
can they keep them up here for me?

That is not for him.

Oh, it's not for him?

No, they are not his.

...Because you guys showed me this and
it was Babe and we thought it was

Bebe and it was Babe... remember?

So who is this?

For example, for the expat
is the fact of stepping back,

not trusting the others enough
because they don't know them,

because many times they don't
understand each other,

because they have different
backgrounds.

So, Mama.

Come and talk to me ma'am,
I'm not a foreigner.

I'm a Liberian.

Surgical abdomen.

Lot of troubles; vomiting, abdominal
swelling, terrible constipation,

three weeks without going toilet, and
now she's in this... in this condition.

And right now we have a case
that somebody else is saying

is a surgical case.

I say, "Yeah, maybe,
but I'm not sure."

She is stable right now and when
she came in she was in shock

and now I'm waiting for a surgeon's
screening to see what he thinks.

Tom?

You are arrogant.

You think you know what he has.

No, you are arrogant.

Why are you saying
that about arrogant?

You are arrogant.

This is why I can tell you
because I know what I'm talking about.

Why?

Why everybody think I'm arrogant?

I'm not arrogant.

What happened is I'm not happy about
the way people talk to me, okay?

So tell your doctors to talk to me like
a doctor and not like a small boy, okay?

And don't tell me... approach me
and say that I'm arrogant

because I disagree
with a diagnosis, okay?

I was informed
in the wrong way.

No, who informed you
that I was arrogant?

Who said I was arrogant?

Did I treat the patient arrogantly?

Did I insult anybody in the hospital?

Or did I say anything that is,
uh, out of place?

I was informed in the wrong way.

I'm sorry.

No, I don't want coffee.

I want to be treated
with respect, that's all.

She's such a high anesthetic
risk right now that it doesn't

look good for her either way.

If you did take her and put her
to sleep, you have to be

thinking about what it's going
to be like afterwards.

So, you know, I want to help
her but I don't want

to be her executioner either.

If she's got some, you know,
inter-abdominal catastrophe,

then she's not going to survive
without surgery.

There have been times where when
I'd made some wrong decisions

I became kind of paralyzed feeling like
my decision making wasn't good.

If you're paralyzed by indecision,
you can't do this job.

And so you have to be able to live
with wrong decisions.

That's really hard to do.

Yeah, I just don't see one specific
spot that's going to be benefited,

so we're just going to sew
a couple spots.

Is that the little girl?

Yes.

Did you find anything?

Yeah, she had, uh...

What is it?

A little antimesenteric border of the
bowel, you know, little perforations

in multiple locations.

Thank you, Tom.

Thank you, sir.

Thank you, Christelle.

To realize that in different situations
these are people that you could save,

and then to watch them die,
it takes a real heavy toll.

Take deep breaths.

Come on, breath in and out.

Put your tongue out.

Okay, bring it out.

Bring it out.

Wheel her into the ICU.

The odds are still a bit
stacked against her,

but at but least she's got
a fighting chance now.

All you can do is do the best
you can and hope for the best.

This is usually a simple perforation.

This is a complicated multiple
perforation that we've got here.

And this case is very typical,
you have a lot of, uh... uh...

I know, I find them in the book here,
I've been waiting for one...

You have many cases...

This is rather like being thrown
in with the lions in the coliseum.

I feel like I've still got
so much more to learn.

I want to say cautiously
that I'm enjoying it.

'Cause l... I feel good
about what I'm doing.

I'd like to do it better.

She's not going back?

Going back where?

To the surgical ward?

I don't understand.

She doesn't understand you.

Thanks, Pauline.

When did you get here?

Ten days ago?

You told me something like,
"Oh, I can stay here for six months."

Yes, I've changed my mind now.

Now I just want one night's sleep
now is all I want.

So my recommendation
on taking your time,

and staying at home sometimes...

Oh, and going to the beach
and socializing a little bit.

I didn't say that.

Like when?

Booth's looks pretty good
to me, yeah.

I say we... and then we can say
we didn't buy the cheapest one.

These are little groups and the social
dynamics can get pretty strange.

In my interview, my interviewer asked
me, "Well you know, sometimes,

on some missions, MSF you know,
they may like to smoke

a little marijuana.

Is that a problem?"

I was kinda like, "God I didn't know
there was any left when I finished

college at the University of Colorado."

I thought... I thought we had
depleted the world's supply.

When I was going back to Italy,
the people was asking me

'how can you work so much? '

Like, 'how can you work for so many
hours, for so many days? '

And it's just not a choice.

You take anyone, and put that
person in that situation,

and they will react in the same way.

It's the human answer.

It is not about being a good person.

It's not about that.

So what's the working diagnosis...
what does John think that he has?

Well John, uh, has more
than this, but, uh...

This is the wrong person's card.

This is the last time I'm saying it.

You come on duty.

You take hand of it.

You know all the patients.

You know all the patients.

Okay?

No.

I'm deadly serious.

Yeah.

Okay.

If I come here, and you don't
know the patients,

I'm gonna be really upset, okay?

We've had discussions
about stuff like this before.

And you know what I mean
when I say "really upset."

Let's go see the patients.

You know what the problem
with Davinder, I think.

When you are first mission... okay?...
you have no idea what

a mission should be.

Twenty-six years old, left alone,
managing forty national staff,

an entire hospital... in conditions
that are harsh in themselves.

All the members of the coordination
teams are supposed to go

on regular visits to the field.

There were a lot of communication
problems, and I'm the head of mission.

So it was necessary for me
to go to Foya.

Well the situation is that
OB wash and reuse gloves.

I do IV insertion, blood taking,
and dressings without gloves.

After asking all these things,
and all of this delay in communication,

problems I have with Eric,
problems that the rest of the team

has with Eric and the different
members of coordination,

you have worked in the field
and you know that there's a limit

where you just say,
"Forget it, I'm fed up, right?"

And maybe that limit for you is there
and that limit for me is there.

I've passed my limit...

What happened when you
passed your limit?

You just stop asking.

You just wash your gloves.

I'm sorry, I'm sorry,
but I really insist on this.

No one of us was aware
of this problem.

Which is logistical and medical.

I came to him to explain to me.

Now he say he doesn't want to do it.

You cannot say,
why don't you do something.

I say, "Fuck, why didn't you
do something?"

You know, sorry, I give
the whole bloody thing back.

But once, if it's not done, you don't
want to discuss again about that?

Yes, because you have
to do your job.

Otherwise go somewhere and do
your, do your inadequate job

somewhere else.

You come to the field.

You come to Liberia.

You do your job properly.

Why do we need coordination
if we just have to solve all of our

own problems then?

I do understand the anger.

The anger is good.

The anger is a part of the process.

But they are fighting the wrong thing.

If I am working in the middle
of the war and I get upset,

get angry at the war,

because that is the reason
for which you are there

and that is the reason for which
you don't have the surgical ward

that you are supposed to have.

It's not MSF.

MSF is nothing within this.

You let me know
what the problem is

and I do my best in order
to solve the problem,

and we solve the problem together.

This is my solution
and I don't have a better one.

And this is not a good ideal solution
because we are not working

in an ideal situation.

What else can I tell you?

Other than telling you that
I am sharing at 100 percent

the frustration
that you are feeling.

This is peace, love, happiness.

I'm really convinced that one
of the problems for which people

needs to have so much sex
when they are on a mission

is because they are facing
very difficult situations

that they are not used to.

Five, six, ten patients dying each day.

And sex is life.

He's telling me I shouldn't smoke.

Situations where people are less
wealthy are often more human

than situations where people
are very wealthy.

And it kind of fits in that going to do
medicine with people that are actually

trying to help each other... is in some
ways more rewarding than doing

medicine in a country where people
don't give a shit about each other.

Apparently five people died,
little girl was shot in the arm.

So it just needs to be cleaned.

Her arm will work.

It doesn't seem to have hit any blood
vessels or nerves.

So she was lucky in terms
of her injury...

not so lucky in terms of her family.

Most of the missions I've done have
been in places where a lot of people

you couldn't help,
and you have to get used to that.

You know, you can't expect
to turn up in some country

where there's a lot
of problems

and be able to address the needs
of the majority of people.

And that's why in some ways
there are limits that MSF gives.

MSF makes sort of decisions
about what the priorities are,

and in some ways
that's kind of reassuring.

But, it's really hard to swallow
the first time you go out.

But Davinder, can you understand
the difference between

a shortage of one antibiotic
among ten antibiotics choices,

and the shortage of gloves.

I mean, this is a medical...

When were gloves invented?

What does that mean?

Ahh, it means people...
you can practice without gloves.

Sure, you can practice without
gloves and you can take

a lot of diseases without glove.

Davinder I think, he is really Kurtz;
The Heart of Darkness.

Davinder was all alone,
left in his kingdom.

He got crazy.

If you put a reasonable person
in front of an unreasonable situation,

getting crazy is the most
reasonable choice.

I think this is what
he has done.

Are you going to do a second
mission after your first mission?

Oh, uh, not soon.

And...

And why not?

Well, it's... it's the French,
it's the way that MSF works.

There are lots
of good things about it,

and there are frustrating
things as well.

I'm still very vague about
what l... I'm planning,

and, you know,
I might come back to MSF

for years and years and years
or I might never do another

mission with MSF or any
other NGO, I don't know.

I'm still thinking about it...

You're sick, Davinder.

You will come back for sure.

About two weeks ago,

first his eyes got swollen,

uh, his belly got big,

and then he couldn't walk.

So he sat here and I've
just scratched my head.

The swelling of the face looks like it
could be related to the salivary glands,

you know, your lacrimal,
your parotid.

Maybe.

Brother, she'll just be examining
you a little bit, uh?

And if you look in the mouth,
there's nothing?

No.

I think I would start Prednisone.

Not because I'm convinced
about the diagnosis,

but because I don't
have any other idea.

Alrighty, sounds good.

Thank you.

I'm sorry.

No, don't be sorry.

Well I don't... I don't know.

Okay, explain her now that they
are going to do a procedure

because he cannot breathe now.

Because his belly is getting too big
and he is not able to breathe.

So it's important to take away
some of the liquid

so that he can breathe better.

Yeah, it's me, go ahead.

Okay, thanks.

So what do you want me to do?

Alright, thank you.

Um, see you tomorrow.

Even if I thought he was
going to die tonight,

putting a needle into a tympanic gut
is just going to kill him quicker.

But, I think he's absconded and he's
never coming back, that's why...

He's what?

Absconded, left.

His mom has taken him
and left and said,

"Well, okay, if the doctor thinks
the condition is this grim,

and I don't want the doctor
to put a needle in the tummy,

then I'll take the child
and go somewhere else."

And so she left?

Yeah, she left.

I mean, that's what
Juliana just said.

Well, it's... it's bad, but,
you know I mean, let them go.

Like, I'm not offering them a lot.

No, but, really, ivermectin.

I could give them ivermectin...

It takes a lot to surprise someone
after six months here,

so I wasn't really surprised.

The baby was just as likely to
be there as it was not to be there,

and I wasn't really going
to be surprised either way.

Um, I was very glad and...
I was very glad to see the baby.

It's gone.

What happened?

When did it go down?

How did it go down?

The belly went down.

You've been farting.

You fart and you fart and...

you'll feel more comfortable.

You, you've had so many
more missions

and so much more
experience than me,

and if you really think that
that patient can be helped in Monrovia,

then that's fine.

Yes but why do you get upset?

It's because I'm at
the end of my mission,

it's because yesterday you stood up
and left after discussing a patient...

in a huffy sort of fashion...

and didn't explain after...

The reason for which I was
so upset is that to me,

listening to a doctor saying,

"It is better for the patient
to leave than to stay with me."

This is something
I cannot accept.

Either you are too tired
or frustrated

or you faced too difficult
a situation or whatever,

but you have lost the confidence
in your being a doctor

and this to me
is not acceptable.

Okay, there's... there's obviously
a difference between how we

feel about things and how
we practice medicine.

Which is good, and you...

It's fine, yeah.

It's a shame that you thought that
I had such an extreme view last night

and I think that it was because
you were tired, I was tired,

and because you jumped
at conclusions way too fast and...

Sorry.

Well, it doesn't bother me,
I'd just feel embarrassed if I was you.

L... I would say I was sorry for walking
away and not bringing it up,

and Davinder it is good that even
you brought it up now because...

I'm bringing it up...

No, I brought it up.

And Davinder it is good
that you brought it up,

you were still the first
person to bring it up

even though it was
twelve hours later,

you were still the first person
to bring it up,

and I should have
brought it up first.

That's how I would have said it.

But, you don't have
to say it that way,

it's just how I would
have said it.

I mean that's how I think
I would have said it,

I probably wouldn't have
said it that way...

but, I think I would have
said it that way.

Sir, how are you?

How are you sir?

I'm Davinder, the doctor.

And you can cough?

No.

What are you thinking Victor?

Can I call this kid, um,
typhoid or not really?

Is that stretching it a bit?

What do you think he has?

This one?

This man?

Yes.

MSF wants to keep a minimum
of fifty percent of first mission.

To me what's so frustrating
is the fact that

when I spoke to you the first time,
you kept me awake

until 2 o'clock in the morning
making me questions

about HIV treatment
and why don't we do this

and why we do that
and it was so good,

it was terrible obviously...

You were laughing at me.

I was laughing, but as much
as I was laughing,

I was so glad inside about the fact
of having someone with that talent,

that can give so much input
in what the mission is

and wants the mission to evolve
and wants things to be changed.

The fact of seeing
this innocence spoiled

and maybe by me as...
as well in part is...

Is very...
is very upsetting.

This is just to let you know
that I would like you not to

lose the reason for which
you've done the first mission

because the first mission
was not a good one.

And I don't think you have
to worry about that.

I haven't lost that...

I mean... I don't think
I've lost that reason.

We'll see.

Basically all the emergency
operations we did this week,

all those people would have
died without surgery.

Those war-wounded
patients would be dead.

The women who had cesareans,
they'd be dead.

So would Dada,
she would have died of infection.

And similarly in the wards,

it's all the people who got
good treatment for malaria,

all the malnourished people in
the therapeutic feeding center...

They would have all died.

Yeah, they...

Good results, good results.

Basically if he's not breathing we can't
keep ventilating by hand forever.

So we're giving him, well it'll be
an hour in total of resuscitation.

If that doesn't work
then we'll stop.

So it's not really nice combining
futile resuscitation and patients

coming in to the theater and other
one's waking up from anesthesia.

I forgot to have breakfast.

I said how's it going,
he said fine.

He's actually breathing a bit.

Hopefully the oxygen will keep up
the oxygen level in his blood

and I feel he might survive,
which would be a minor miracle.

Just hang in there.

I mean it's not everywhere
we do that in MSF

but, uh, here we can reanimate him,
intubate him because we have

the anesthetist.

The guy that we were
resuscitating died.

Did he?

Yeah.

He was breathing a bit better and
we just put an oxygen mask on him

and then he basically had
another arrest and died.

He lived for a lot longer
than I expected.

It made life very difficult
not having any oxygen

for the anesthesia
for the whole day.

He's a chronically sick patient.

He's been sick all his life.

Yeah.

Good morning, chop chop.

Dr. Gwenigale.

Going?

Yes I'm going unfortunately.

How are you doing?

So you're tired of Liberia already?

No I'm not actually.

I would really like to stay
for much longer.

But MSF has limits
and problems as much as...

At the Mamba Point facility,
many people go there for treatment

and we know that they are
doing a good job there.

So we hope that will continue,
we thank you people for it.

We really feel the need at this point
to have an exit strategy

that would allow both to
the governmental structure

to be able to take over
and... for example...

to MSF to be able to leave
without leaving any vacuum.

Mamba Point Hospital
will close down.

There is no way they are
going to keep it open.

It's terrible because as a doctor you
never want to refuse a patient

who needs care.

It is unfair.

Refusing someone is unfair.

The problem is an entire country
with no health system whatsoever.

And here in West Point,
it is the major issue today.

My frustration is the fact
of thinking that...

not intervening in a situation
in which you need to intervene,

it's a criminal mistake.

To me it was not acceptable...

The...

responsibility of having MSF
committing a criminal mistake.

In the beginning, I felt very good
about everything I was doing.

And now I just don't
feel good anymore.

When we decide to end
the mission we leave the people

we've come to help
in the worst situation.

It has to happen.

It's not there forever.

It has to happen one day.

It's never easy but you
get more used to the idea.

The first time you do it,
like the first time you go on a mission,

you think it's, you don't think
about those kinds of things.

You think, you think it's...
secretly, that it's forever.

But it can't be.

Once a crisis has abated,

what are you actually
trying to achieve?

Are you trying to fix
the normal?

So you make choices that are
tough choices to make, but...

you have to make them.

You have to say sorry
to all these people all the time.

They're going to go back to the
life of the average sub-Saharan

African existence
which is pretty hard.

Normal's not good but MSF has
never been pretentious enough

to try and think they were going
to have an overall impact on health.

It's a drop, tiny, tiny drop
in a sea of oceans.

So, dependant on...
on the context

and the general sort of...

wealth in society and
the political stability that,

you know, those are things
that you can't fix.

Or I can't fix anyway.

I'm very honored for having
been a part of this until now.

Unfortunately I will have
to leave soon

and I hope I will see
all of you at the party.

I don't have a question but I just
want to compliment...

Before you compliment,
I would just like to say

in this public manner;

thank you to the entire staff
that I have been working with

for the past three years.

Now we will be getting
a new head nurse.

I think I was supposed to have
been consulted to say

who I felt in the supervisor group
will take my position.

That's the right procedure.

I was not.

Do any of you think
that I've been consulted

in order to decide who will take
the place of head of mission after me?

You are an expat.

So you're position is different
from my position.

It's all together different.

This is my home.

I am not going to go
to any other place.

I am not an expat.

You come for a certain time,
then you leave.

But with us, it's different.

You always have choices, no?

I mean, Paris called me
and they told me to come back,

and I could have said, "Fuck you."

"I don't take that plane."

I knew my level of energy and I knew
that I could have stayed longer.

Well it's nice not to see
anybody with any guns.

It's nice.

Well, it looks a lot better than it did.

Looks a lot better than it did.

But what's really nice is
just seeing all this activity

and people going around,
and they're not scared.

It's not how things were
during the war, obviously.

I'd say that I'm happy about the
decision of having worked with MSF

despite the sacrifices
and the costs of that decision.

Well, I missed, you know,
important things,

you know people dying,
people getting married

in my family and friends.

And it's a real priority
for me now,

leaving MSF to re-anchor
myself somewhere.

And maybe its just
phases in life.

Working with MSF forever
in the same place?

No, that doesn't work.

But, I've been living in that place
for more than fourteen months,

committed myself so much
that it sounds very unnatural

the fact of just stopping.

It doesn't sound right.

Tomorrow night, you will
come to the party?

Yes.

Yeah.

Okay, good.

See you then.

Thank you.

Isaac, you come to
the party tomorrow night, yeah?

I don't want to see you
leaving this place.

I don't want to leave either.

So how is everything?

Not bad.

Not bad?

You are going to the party?

Well, it's my party.

We'll have to have you dancing.

Okay, you'll have me dancing.

Thank you.

Bye.

Okay, thank you again.

I like it a lot.

And, I will go back
to Europe

and I know people will be very jealous
about this, so thanks a lot again.

There are two mixed levels.

One level is the attachment
that anybody will have

towards a place in which you've been,
and the other is the nonsense of...

of not doing something once you know
that something needs to be done.

You're driving somewhere and you have
a car crash happening in front of you,

you have the duty of stopping
and doing something.

And Liberia is
a huge car crash.

Big, big car crash.

And once you get rest,
you know that it's not about Liberia.

It's about Congo, Sudan,
Pakistan, Darfur...

wherever, lots of places.

Car crashes everywhere.

But still...

Am I going to do this forever?

I think I wanted to prove to myself
that the conflicts are real

and the people are just
normal people.

They just no different
to you or I.

And, and that most of the people
in the world have a pretty

rough time getting through
the day and the week

and the month and the year.

And I couldn't really be sure how
real that was until I lived with it.

And now I have.

And my attitude's very different
than what it would have been

if I had stayed at home.

So I won't be exactly the same.

I won't have the same
priorities

as I would have,
if I hadn't of done it.

I think sometimes you have
to leave what you're doing

in order to find out
what it is that's missing.

I would like to do more,

and I'm ready for more
and more of a commitment.

And I realize that this stuff still
comes out to being a very selfish thing.

Somehow fixing other people
seems to fix yourself.

That's what I found out,
so, it's how I fix myself.

I can't solve the world's problems,
and they're not going to be solved.

So, you have broken people,
just put them back together...

...that makes sense to me.

Subtitle Rip; TheHeLL