MSF’s next steps #2 Choose the battles

MSF’s work covers a wide range of activities in many countries. In OCG, we go from treating malnutrition in Niger to doing surgeries in Yemen, from providing health care in refugee camps in Tanzania to chronic situations in DRC to refugee populations in Athens, and from treating tuberculosis in Swaziland to treating Kala Azar in Sudan. We provide medicine to neonates moments after they are born and to the elderly as they suffer non-communicable diseases.

Yet, I doubt that any of us feels that we do enough. This feeling is a result of the ever-increasing commotion that seems to engulf our world leading to more complex crises and more needs everywhere. So we expand our programmes in scale and in scope.

Why not? Isn’t it good to expand our assistance to people suffering from crises who need it most? The answer is yes… but if we ask: is what we are doing most efficient? the answer might be different!

MSF’s strength is the people she helps and the courage she displays in reaching out to them. But this is not enough without a few “force multipliers”, things that allow us to exert influence bigger than only the size of our operations.

Those force multipliers include, in my opinion, our image, our focus, our research, and our voice..

Our image comes from others knowing and seeing that we will go beyond where anyone else deems acceptable to help our patients. The ebola crisis was a clear, although not a unique, example of where MSF displayed courage in going for a dangerous situation.

The focus is another facet that allows our operations to make impact beyond their size. This has been displayed by our focus on neglected tropical diseases, HIV and TB, NCDs, and forced displacement for example. The focus and operational investment we put into specific, and often neglected, crises raise them on the global agenda and leads to benefit to patients we are not reaching.

We elevate a topic through our image and focus, but we make it tangible through our research and voice. We have created new medical evidence through operational research on topics that ranged form HIV to rotavirus vaccine to Kala Azar. This evidence has changed the way those diseases are treated for our patients and within the global health landscape.

Finally, and significantly, our voice, through temoignage and through advocacy, is the second arm our medical humanitarian action. By speaking out loudly and by advocating directly we are able to make far reaching changes for our and other patients.

So, our operational choices can either consider these force multipliers and consciously expand our effect beyond our direct programmes and patients or ignore them and risk not being as useful and heard as we should and can be.

I am advocating more focus and careful choice in our operations. This, of course, does not exclude a diverse operational landscape that answers to the emerging crises and needs. However, it is important to make choices on specific issues that increase investment, knowledge, and voice on them.

Some examples of those include choices made by other OCs like war surgery and anti-microbial resistance by OCP and tuberculosis by OCA. Ohers yet include the choice by other sections to focus on forced displacement even when that has lead to unconventional operational choices like the search and rescue at sea.

OCG needs to make similar choices. I was hoping that our initiative to tackle the revision of the Refugee Health book would provoke OCG to invest more in forced displacement in line with the global crisis and the international associative motions. This has not been the case yet and while we continue to respond to traditional refugee crises like those in Uganda and Tanzania, we are not actively seeking a bigger role in responding to the global forced displacement crisis. I believe this is a wasted opportunity.

Another topic that will be of great importance in the future is palliative care. We have recognized this in our strategic plan but are yet to take the lead on it. Pain management is one of the topics that we have to tackle internally in MSF and externally with other actors. We cannot accept that many of our patients in agony cannot have access to simple medicines that will ease their pain for logistical or legislative reasons. This focus has started in the movement and we can be a leaders in the field.

Whether those are the topics that we will lead in OCG or whether we will discuss widely and take on other topics is not the main question, that question is whether we will increase our focus and make choices that take our effect beyond our operations and into a more active and effective role in the MSF movement and globally.

A father of twins, medical doctor, aid worker, parrhesiastes in the making.