This article addresses legacies of national origin within global forms. Focusing on tensions related to human resources, I consider the case of the humanitarian organization Médecins Sans Frontières (MSF or Doctors Without Borders). Since 1971, MSF has grown into a large, transnational NGO sponsoring a variety of medical projects worldwide. Amid recent efforts to “decolonize” its human profile, MSF has debated the appropriate role, motivation and remuneration of both international volunteers and local support staff it hires at mission sites. Given the different degrees of ease with which situated persons can travel, the organization’s conflicting impulses place it in a classic double bind: to remain mobile it must limit local attachments, while to achieve equality it must embrace them. The figure of the expatriate thus suggests a mundane but precise measure for the threshold of inequality.
Keywords: humanitarianism, expatriates, NGOs, globalization, Uganda
MSF IN THE FIELD
Cultural Anthropology has published a number of articles on NGOs, including Michael Hathaway’s “The Emergence of Indigeneity: Public Intellectuals and an Indigenous Space in Southwest China” (2010), Thomas Pearson’s “On the Trail of Living Modified Organisms: Environmentalism within and against Neoliberal Order” (2009), and Marina Welker’s ““Corporate Security Begins in the Community”: Mining, the Corporate Social Responsibility Industry, and Environmental Advocacy in Indonesia” (2009).
Cultural Anthropology has also published articles on humanitarianism. See for example, Erica Bornstein’s “The Impulse of Philanthropy” (2009), Didier Fassin’s “The Humanitarian Politics of Testimony: Subjectification through Trauma in the Israeli-Palestinian Conflict” (2008), and Ilana Feldman’s “Difficult Distinctions: Refugee Law, Humanitarian Practice, and Political Identification in Gaza” (2007).
ABOUT THE AUTHOR
Peter Redfield is currently an associate professor in the Department of Anthropology at the University of North Carolina at Chapel Hill. In his present work, he continues to extend a concern for spatial dimensions of science and technology outside the West, but focusing small technical systems and non-state actors along a shifting frontier of global health. His goal is to concentrate more directly on the complicated ethics and politics of intervention, and dilemmas of knowledge and action in modern life. To this end he embarked on a book project about the organization Doctors Without Borders/ Medécins Sans Frontières (MSF). He began active research on this project in the summer of 2000, and pursued fieldwork both at MSF's operational headquarters in Europe (especially sections in France, Belgium, Holland and Switzerland), and selected project sites in Uganda. His book on the subject will appear soon published by the University of California Press. He has also collaborated with Erica Bornstein on an edited volume on Humanitarianism and Anthropology in the SAR Advanced Seminar series, as well as other collective work addressing humanitarianism. His current and future research concerns humanitarian design, and the wider array of efforts to grapple with solutions in a box (examples include nonprofit pharmaceutical production as well as minimalist life technologies).
INTERVIEW WITH THE AUTHOR
Zohra Ismail Beben: In your article, you tackle a subject most anthropologists have not always focused on, the study of elites. How did you come to the decision to work on this topic? Why do you think anthropologists should study elites such as expats?
Peter Redfield: Around the same time that Médecins Sans Frontières first emerged, Laura Nader famously made a case for “studying up.” Although some of the language and references in anthropology may have since changed, the general significance of her observation about power and knowledge surely remains. Studying up (as well as many other directions) helps disrupt normative frames of common sense, while bringing larger patterns into view. That said I should stress two things. First, there are many degrees and conditions of being “elite” — for example the world of expat business displays far more conspicuous consumption than the particular NGO circuit I describe here. From the perspective of the university MSF is more “sideways” than up; these are people with degrees of privilege and constraint relatively similar to those of most anthropologists. Second, just because some people study up doesn’t mean everyone should. Indeed that would defeat the purpose! Personally I’ve never understood that form of conceptual myopia that assumes only one thing is ever worth doing. What matters in my view is finding a problem that fits one’s own particular set of abilities and opportunities, as well as commitments and interests. I came into anthropology as an undergraduate in the 1980s, amid lingering anti-colonial anxieties and a concern for examining power relations and one’s relation to them. Having partly grown up in expat settings, the world of traveling experts thus appeared both a legitimate object of study and a particularly appropriate one for me to pursue. But like every topic it remains only part of a larger story. One final note: in discussions of a more engaged or public anthropology, people tend to gloss over the details of transnational connection, circulation and collaboration, e.g. what exactly would be a “fair” wage across multiple economies? If nothing else I hope to suggest that such details loom large in actual practice.
ZIB: The idea of the volunteers and volunteerism is intriguing from an anthropological point of view. It brings in the notion of a gift economy operating outside of market exchanges and therefore is suffused with the moral. You suggest just this when you point out that volunteerism is an ideal driving MSF and creating the double bind because volunteerism is seen as essentially oppositional to material concerns. Volunteerism has also been talked about in literature as contributing to active citizenship and building of civil society within a nation-state or as having religious character and based in ideas of social justice. Where does MSF derive its specific ethos of volunteerism? Do you think that the notion of volunteerism espoused by MSF can be routinized or must it retain an exceptional character? Why do you think MSF fails to instill the volunteer ethos in the national staff? Is it a failure of expressing volunteerism in local terms?
PR: MSF’s version of volunteerism derives from a secular form of humanitarian concern, within which “saving lives” effectively constitutes a sacred good. It takes shape against a background of the professional vocation of medicine — the original idea envisioned doctors temporarily donating their skills and time during an emergency. So the key things to understand are that the “sans frontières” claim exceeds the nation state — if citizenship this is a global, cosmopolitan sort — and that the sense of social justice concentrates on meeting medical need, not development, let alone building any utopian society. Unlike say Cuban medical brigades, or Partners in Health, or even the Gates Foundation, at its core MSF doesn’t imagine it will build anything at all. In practice its activity creates all kinds of aftermaths of course, from active spinoffs to messy absence. But in emergency thinking the goal is simply to try and stabilize the situation and then allow people to make their own future. So rather than a failure to translate this ethos “into local terms,” the real disconnect with national staff arises from a more fundamental tension: they remain more focused on everyday needs of living in a project site, and less on an exceptional endeavor of saving lives there. I should add that related tensions pervade most forms of nonprofit work, which by definition claim values other than self-interest or money. So MSF’s expats are subject to similar pressures from an inverse position. Being volunteers, they should not think too much about a career, even though they might need to when away from the field.
ZIB: You allude in the article to a kind of crisis-based model followed by MSF and the trouble they have had in instituting long-term projects for example in order to combat HIV/AIDS because of a mindset based in crisis, emergency, and mobility. Can you elaborate on this relationship between the notion of humanitarian or other kinds of emergencies and cosmopolitan mobility? Does this notion of mobility thrive on ideas of a crisis-filled world?
PR: MSF’s tradition is one of emergency response, along the lines of the ambulance and battlefield medicine. When facing slower crises, like HIV/AIDS it confronts the quandaries of everyday life in impoverished settings. I should clarify two things: that the tension of “development” has been with the group from the outset, and that it has put more long-term projects in place as a result of AIDS. (Indeed it’s providing 170,000 people with anti-retroviral medication in 19 countries; see the MSF Access page for more detail: http://www.msfaccess.org/our-work/hiv-aids). But this commitment runs against the grain of the emergency tradition, changing the organization. In settings like South Africa the organization developed a more regional vision around AIDS. Yet at the same time even the new South African section has also sent a few volunteers to emergencies elsewhere. A conception of a crisis-filled world certainly encourages mobility (not just of journalists or aid workers, but also the refugees whose migrations they often follow). It’s by no means the only form of cosmopolitan engagement — classic ethnography, for example, embodies another mode of displaced connection through cultural difference. But to be “without borders” is clearly to have global ambitions, and so accept potential movement in multiple directions.
ZIB: You are writing a monograph based on your work with MSF entitled Life in Crisis: The Ethical Journey of Doctors Without Borders. What are the larger arguments you make in that book and how do they fit in with what is presented in the article?
PR: In the book I follow the story of this organization as a sort of collective Bildungsroman, examining what it means to pursue a minimalist value like “saving lives” over the time and space of its experience. Thus it crosses questions of what it means to link ethics with crisis, how MSF actually learned to go global at a technical level, its tradition of witnessing, its quandaries with selection, its involvement with AIDS and so on. This article derives from one piece of this larger narrative, examining what borders look like in human practice. In the manuscript I likewise try to argue largely through description, casting MSF’s technical project as one of “minimal biopolitics” — but unmoored from the nation state and directed toward an ethic of care. Having declared itself “without borders” (symbolically sovereign, if formally apolitical), being relatively financially independent and refusing to accept justifications for letting people die, MSF continually faces the ethical problem of defining its own limits. It also faces the problem of acting without optimism, or any utopian vision of a happy ending. And that’s the central story I wanted to tell, since our era seems to feature more NGOs than utopian dreams, if sometimes confusing the two. In any case the volume should be out soon with the University of California Press.
ZIB: What research project/topic do you hope to tackle next?
PR: I’ve become increasingly interested in what for now I’m calling “humanitarian design.” By that I mean efforts to create technical fixes to enhance human survival, magic bullets and solutions in a box, ranging from nonprofit pharmaceuticals to clever market oriented inventions to supply life needs in an absence of working infrastructure. This is partly an outgrowth of being influenced by STS and following MSF, which has a whole technical side. But I also see the phenomenon as embodying contemporary perceptions of “social problems” (in the classic sense of social welfare), within potentially shifting understandings of states, markets and aid. In any event examples are appearing all over the place, and some may prove productive in unexpected as well as expected ways. Here’s a link to an article in Public Culture where I try to sketch some of the potential terrain: http://publicculture.dukejournals.org/content/24/1_66/157.abstract
This official video offers an overview of the activities, philosophy and structure of the international humanitarian organization Doctors Without Borders/ Medecins Sans Frontieres (MSF).
Humanitarian Practice Network: http://www.odihpn.org/
Bornstein, Erica, and Peter Redfield, eds. 2011. Forces of Compassion: Humanitarianism Between Ethics and Politics. Santa Fe, NM: School of Advanced Research Press.
Fassin, Didier. 2012. Humanitarian Reason: A Moral History of the Present. Berkeley: University of California Press.
James, Erica Caple. 2010. Democratic Insecurities: Violence, Trauma and Intervention in Haiti. Berkeley: University of California Press.
Ticktin, Miriam. 2011. Casualties of Care: Immigration and the Politics of Humanitarianism in France. Berkeley: University of California Press.
Wendland, Claire. 2010. A Heart for the Work: Journeys through an African Medical School Chicago: University of Chicago Press.
QUESTIONS FOR CLASSROOM DISCUSSION
1) What does the author mean by the part of his article’s title “the unbearable lightness of ex-pats”?
2) According to the author, in what ways is MSF typical of nonprofit agencies and how is it atypical?
3) What is the double bind and what are some ways in which the double bind manifests itself for MSF?
4) What are the differences in motivations of the ex-patriates and the local personnel? How does MSF as an organization understand and value (or not value) those motivations?
5) How are the issues of mobility and proximity to be understood within the organizational structure and ethos of MSF?
6) How does the colonial history play a role in the debates and conversations within MSF?