Hope in Hell is a look into the world of Medecins sans frontieres, the renowned humanitarian agency focused on providing medical care in countries that lack the infrastructure to do so whether because of unrest, disaster or extreme poverty. Unlike many other aid organizations, MSF also takes on the role of advocate. Though they go in to countries as a non-partisan organization, they actively seek the attention of media, governments and the UN in acknowledging crises around the world. Most recently, MSF has been vocal about the costs of AIDS drugs in Africa (the subject of a previous Fourth-Rate Reader) and rape as a war crime in Darfur, Sudan.
Bortolotti's book looks into the lives of the doctors, nurses and non-medical volunteers who work with MSF in places around the world. The book debunks the idea that all volunteers are doctors (in fact, most aren't; the majority of volunteers work on administrative and logistical tasks), and deemphasizes the glamour of the work that is done by medical staff. Often, doctors do very little hands-on work, instead training local members of the community to provide the care, in the spirit of teaching a man to fish. In one case, a doctor stood by watching as local staff attempted, repeatedly, to insert an IV in the veins of a dehydrated baby. By the time the staff succeeded, the baby had moved from wailing to stoicism, but the doctor did not intervene, because local staff needed to be able to do this procedure.
For Western doctors, the pace of the work takes a toll. Accustomed to working in the controlled chaos of Western medicine, they find themselves plunged into uncontrolled chaos, without the luxuries of technology. Says one doctor:
General surgery training is famous for 120-hour weeks, every other night on call, but this was every day on call without relief, no backup, no blood, just the basics — and on top of that, the language barrier. Other things begin to wear on you as well — the food, the lack of sleep, the noise when you're trying to sleep. You end up being pretty ragged, and you're not as good as you could be.
Most of what MSF does is basic medicine, including immunizations and treatments for malnutrition and dehydration. There are also a plethora of diseases that have been eradicated in the Westbut still plague MSF-visited countries. Borolotti talks about the toll of these diseases, that are viewed by those in the developed world as diseases of "historical curiosity," particularly malaria.
SARS caused fewer than eight hundred deaths worldwide in 2003, while malaria kills about the same number every six hours.
Treatment options for these and other ailments (sleeping sickness, typhoid, etc) are limited because drug companies don't see profit potential in researching medications.
Article comments
1 - Natalie Bennett
Nice review, on an extremely worthwhile topic. Thanks!