The Good doctor: saving lives on the edge of world

Damien Brown and I are drinking tea at the Taj in Cape Town. It might be on the same continent, but the hotel’s neoclassical lobby is still a universe away from Mavinga, the dusty Angolan outpost where the Australian doctor had his first posting with Médecins Sans Frontières (MSF) in 2006. His work with the medical humanitarian organisation, which provides emergency relief in more than 70 countries, lasted a year, taking him from Angola to Mozambique and then to South Sudan. These experiences have been distilled into a riveting account, Band-Aid for a Broken Leg, which was published in the UK earlier this year, after hitting Australian bookshelves in 2012.

As a volunteer, Brown shared some of his experiences on his own blog. “I started to like writing doing that: I liked the idea of taking a complicated situation – like a messy encounter with someone – and just rendering that as a nice, neat narrative with a beginning, a middle and an end,” he tells me. Close friends and family kept telling him he should turn these experiences into a book. “I’ve discovered subsequently that everyone who sends group emails gets told that by their mum and dad,” he says wryly.

Returning to Australia after his last posting, he made use of a three-month break to start writing. He was convinced that he would get published – that a volunteer doctor’s view of rural Africa would be quickly snapped up. Instead the response was brutal – five publishers turned him down, some labelling his efforts as sophomoric. And so he tried again, writing new drafts, using feedback from manuscript appraisal agencies, and trying different tenses.

“I think the difficulty in the beginning was actually finding what the story was because I had far too much material,” he says. Of the 100 staff at his first posting, each one’s life could’ve been a book on its own.

After two years he decided to take a year off medicine, moving to Indonesia to work on the book. He “went back to square one”, trying to figure out main characters, and “why was I trying to do this”. “I was exquisitely aware of the narcissism of the memoirist – there was definitely a degree of that – [of] ‘oh my god, look at what I saw and did’ – in my initial motivation. The more the rewriting went on and I critically read other memoirs and books in general”, the less comfortable he became with the idea of writing his memoirs in his early 30s or of the idea that he was writing “his” story.

There “was a process of coming to realise why I did this work and what I actually wanted to tell about it. It wasn’t the suffering of the expats” – the pit latrines or lack of internet – he wanted to write about. Instead it was the resilience of the locals that inspired him – showing that despite their difficult circumstances, these weren’t the victims many in the first world assume rural Africans are.

Brown loved the process of writing; the book was an “immensely immersive, all-consuming challenge”, he says – “a giant jigsaw puzzle” which involved piecing together details from photos, emails home, medical reports and memories to form a coherent narrative.

He realised the book needed to focus on the moments that kept him in the field “no matter how jaded I was feeling”: the moments when kids in South Sudan were sculpting mini towns out of clay only minutes after a nearby gunfight, or when Roberto, a prickly Angolan medical orderly was insisting on coming into work despite having been injured with shrapnel from an exploded mine, or when Mozambicans, still haunted by their civil war, would shrug and say, optimistically, “We don’t have war.”

These incidents “would still give me a lump in my throat” after two-and-a-half years of redrafts, Brown says. He would tell himself “this is bigger than you – this isn’t your story”. Brown wanted the book to take readers beyond the cold mortality statistics and ratios that are so easily to glance over, and show the human stories behind preventable deaths. The book recounts a night in South Sudan when two children that had been hospitalised died of malnutrition, a common occurrence in the region. He was sick of people saying, “Really, does that still happen? I wanted people to be with that mum in that tragic moment.” Although the book is “not a guilt trip”, he felt a duty to show what a scenario like this “actually looks and feels and smells like” – something he does with gut-wrenching acuity. “These moments are happening all the time, and they’re lost otherwise – it’s an unremarkable event, it’s just one shitty night in a crappy town in South Sudan,” he says.

“I’ve had this existential crisis since the book came out and I’ve had to confront the idea of publicity because on one hand I loathe the idea of self-promotion; on the other hand I want the book to be ready by everyone,” he says. “I wanted it to appeal to people who wouldn’t have necessarily picked up a book on Aid or poverty in Africa – so, armchair backpackers,” for example, who think it looks like “a funny, interesting read.” It’s not for “the person who’s already giving money to MSF”. Although he’s not on a recruitment mission and wants his readers to have “a really good reading experience and adventure”, he also wants them to “not able to say I didn’t know”, and to have some understanding and “a sense of empathy, not pity” about conditions faced by the world’s most vulnerable. 

Brown is upfront about MSF’s perceived flaws and makes it clear, both in the book and in his promotion of it, that he is just a former volunteer, and doesn’t represent the NGO officially. He laments the high turnover rates of volunteers (exacerbated by missions sometimes being short-staffed). Recounting a memorial service for three employees murdered in Somalia, he also questions whether volunteers are able to make decisions about their involvement without a fuller understanding of their posting’s security implications. He also questions the expense involved in missions that are not necessarily sustainable. In South Sudan, vast sums were being spent on charter flights to allow rival clan members to be treated in separate hospitals, for example – and he felt that the money could be better spent on initiatives with a much broader impact – such as HIV education.

In short, many of his frustrations centred the fact that MSF provides a quick fix, not a lasting cure – and that their interventions do little to promote a long-term improvement in the standards of healthcare in the countries they operate in.

But he is aware that how and where the NGO operates is “hotly contested and vigorously debated” inside the organisation and amongst its volunteers. While writing he grappled with the dilemmas the organisation faces on an ongoing basis: by rushing into provide assistance in corrupt regimes like Angola, is it tacitly condoning incompetence and malfeasance?

At the same time, though, Brown knows that MSF’s involvement in these “very flawed, difficult contexts” – whether treating cholera in Angola or HIV/Aids in Zimbabwe – is saving thousands of lives. He senses a “moral obligation” to treat these people, particularly as MSF has the money and the means to do so. He feels “this is where the thinking must end” – “the rest is just beyond what we need to address”: humanitarian medical organisations’ role is to save lives, not to create a political incentive to change policies or improve healthcare.

“I don’t think I have any answers in the book and I don’t know that throwing more money here or more money there or everyone volunteering is going to change or fix anything but I still believe an organisation like MSF has an important role: it’s a safety net, it’s definitely not the solution – but they don’t ever pretend it is,” he says.

By the end of his year of volunteering, Brown was exhausted and disillusioned. He was thinking, “I don’t even know if I want to be in Africa anymore; I’m just going to run around from one shitty village to the next shitty village trying to treat a kid. For how long and at what personal costs – where’s the end point?” But writing Band-Aid, has given him the opportunity to digest his experience; it’s been “immensely” therapeutic and given him perspective on both the role of MSF, and also his contribution as a volunteer. “I’m convinced, having thought about it retrospectively and hopefully critically, that it’s an important and worthwhile pursuit. I’m equally convinced it’s not the solution.”

Brown hopes to return to the field with MSF soon. “I know what I’m in for now and I think I’ve made my peace that this is what I am: I trained as a medical doctor and that means treating the person in front of me. That’s an incredibly satisfying thing most of the time,” he says. “I really enjoy being at the bedside and I really enjoy the interaction” – being a clinician was what attracted him to medicine, a field he’s been drawn to since high school. But while he loves treating patients, he also wants to “look at the bigger picture” and “do something a bit more lasting”. He recently completed a master’s degree in international health in London, which combines tropical medicine with epidemiology – an ideal gateway into public health. Knowing how former clinicians working on public health initiatives often lament the loss of patient contact, even if what they’re doing is worthwhile, he hopes that somehow he’ll be able to combine both patient care with public health.

How he will achieve that may still be uncertain, but what is definite is that he would like to carry on writing. “I feel like medicine is just such a wonderful passport – people bring you into facets of their lives that you wouldn’t otherwise have access to,” he says. It’s a lens through which some of the world’s greatest social and cultural complexities can be witnessed up close, and in a way in which few other fields allow. Brown feels that often people get defensive around journalists – believing they have an angle or agenda, whereas people “assume you’re coming from an angle of empathy” if you’re a doctor.

“This sounds really corny but I feel like I’ve been given the opportunity to lend a voice to some people and an audience to do that to,” he says. “That’s no small thing.”

Band-Aid for A Broken Leg is published by Allen & Uwin, R240.

This first appeared in the October 2013 issue of Business Day WANTED.

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