A World of Dif­fer­ence

Join­ing Médecins Sans Fron­tières taught me that hu­man­i­tar­ian work isn’t al­ways about sav­ing lives

The Walrus - - CONTENTS - by Sid­ney Coles

IN early Septem­ber 2015, I sub­mit­ted my re­sumé to the Toronto of­fice of Médecins Sans Fron­tières. Not long af­ter, the NGO’S hos­pi­tal in Kun­duz, Afghanistan, was at­tacked. The in­ter­na­tional hu­man­i­tar­ian-aid or­ga­ni­za­tion de­ploys in ar­eas marred by con­flict and dis­as­ter, and it had been tar­geted in the past. On this oc­ca­sion, US forces killed forty-two med­i­cal staff and pa­tients and in­jured more than thirty oth­ers via bombs and bul­lets sent from a war­plane. It was the dead­li­est at­tack the med­i­cal or­ga­ni­za­tion had suf­fered from a Western gov­ern­ment, and MSF gen­eral di­rec­tor Christo­pher Stokes quickly dis­missed the United States’s “fog of war” ex­cuse. Not long af­ter, Msf-sup­ported hos­pi­tals in Homs, Syria, were bombed by Syr­ian forces, and two fa­cil­i­ties in Ye­men were tar­geted by mem­bers of the Saudi Ara­bia–led coali­tion. In each case, many were killed and hun­dreds were left with­out ac­cess to med­i­cal aid. These at­tacks hor­ri­fied me. They also served as re­minders of why I wanted to work for the or­ga­ni­za­tion in the first place.

My in­ter­est in MSF be­gan in 1984, when I was fif­teen. From the yel­low couch in my fam­ily’s home in Oakville, On­tario, I watched news cov­er­age of the famine in Ethiopia. Against a back­drop of hol­lowed faces crawl­ing with flies and thin-legged chil­dren run­ning af­ter grain-de­liv­ery trucks, white-coated doc­tors work­ing with MSF made pleas for gov­ern­ments around the world to in­ter­vene. These im­ages roused in me a nascent po­lit­i­cal con­scious­ness, and my pas­sion was strength­ened a year later, when the or­ga­ni­za­tion an­nounced that it had been ex­pelled from Ethiopia for speak­ing out against Pres­i­dent Mengistu Haile Mariam’s forced re­set­tle­ment of hun­dreds of thou­sands of peo­ple from the antigov­ern­ment north to the gov­ern­ment­con­trolled south—an ac­tion that cost thou­sands of lives. I had the im­pres­sion that MSF work­ers were the rock stars of the NGO world. It’s an im­pres­sion that stuck with me as I grew older and fu­elled my decades long dream to join them.

When I sub­mit­ted my ap­pli­ca­tion to MSF, I was wrap­ping up my job as se­nior manager of of­fi­cial lan­guages at the 2015 Toronto Pan and Para­pan Amer­i­can Games. I am not a doc­tor—i ap­plied to the role of fi­nance-hr-ad­min manager in the hopes of us­ing my skills to sup­port the or­ga­ni­za­tion’s es­sen­tial work in the field.

Founded by French doc­tors and jour­nal­ists in 1971 as a re­sponse to the Bi­afran War, MSF, also known as Doc­tors With­out Bor­ders, has been the poster child for hu­man­i­tar­ian do-good­ism ever since. The or­ga­ni­za­tion has pro­vided med­i­cal aid to mil­lions of refugees and in­ter­nally dis­placed peo­ples. It has stemmed tides of mal­nu­tri­tion and epi­demics and co­or­di­nated mas­sive in­oc­u­la­tion cam­paigns un­der seem­ingly im­pos­si­ble con­di­tions. For these ef­forts, the or­ga­ni­za­tion won the No­bel Peace Prize in 1999. To­day, the non-profit has ap­prox­i­mately 8,000 in­ter­na­tional work­ers who are sent to seventy-two coun­tries around the world, where they work along­side 38,000 na­tional staff mem­bers. To fund this mas­sive ef­fort, MSF raises huge sums of money — more than 1.5 bil­lion eu­ros in 2017 alone — though it re­mains res­o­lute in its po­lit­i­cal neu­tral­ity and pur­suit of un­ear­marked fund­ing.

I knew all about MSF’S his­tory and ac­com­plish­ments, and I saw my­self as one of their “type”—a risk-tak­ing ide­al­ist. When I went for my in­ter­view, my re­cruiter asked me why I wanted to work with the or­ga­ni­za­tion. I gave the pre­dictable an­swer: “Be­cause I want to make a dif­fer­ence.” The re­sponse seemed to make him ner­vous. He de­lib­er­ated, then rolled his chair back a few inches and looked me in the eyes.

“Okay,” he said, “but you know we’re not re­ally about sav­ing the world, right?”

MSF’S Ori­en­ta­tion pro­gram, called Wel­come Days, quickly dis­abuses one of any naive as­sump­tions about life in the field. The pur­pose of the in­tense two-day ses­sion I at­tended at the Toronto of­fice in Novem­ber 2015 was to help shape “re­al­is­tic ex­pec­ta­tions” about our fu­ture roles.

My co­hort was made up of about two dozen peo­ple from across the coun­try, a mix of med­i­cal and non­med­i­cal per­son­nel. None of us were young­sters. The or­ga­ni­za­tion seems to rec­og­nize that life ex­pe­ri­ence and level-head­ed­ness are good in­di­ca­tors of suc­cess in work­ing con­di­tions where com­pas­sion and calm are in high de­mand.

On the first day, I met Anna (whose name has been changed to pro­tect her pri­vacy), a psy­chol­o­gist from Toronto who sat at the ta­ble be­side mine. She was in her early thir­ties and ap­peared to be the youngest of our group. Her smile was in­fec­tious, but the ques­tions she asked of our in­struc­tors were sober­ing. She was itch­ing for ad­ven­ture and a new con­text in which to ap­ply her skills. I liked her im­me­di­ately.

Dur­ing our day­long ses­sions, we learned about MSF’S char­ter prin­ci­ples of neu­tral­ity

from all po­lit­i­cal, eco­nomic, or re­li­gious pow­ers. We dis­cussed op­er­a­tional pro­to­cols and the men­tal and phys­i­cal chal­lenges that we might encounter on mis­sions. Dur­ing our se­cu­rity ses­sion, we dis­cussed how to be­have in the event of a com­pound breach, a car­jack­ing, and a kid­nap­ping.

“Don’t run,” warned our se­cu­rity trainer, a tall, thin man with re­bel­lious brown hair. “Most kid­nap­pers are ner­vous, so don’t make them more jumpy then they al­ready are. They’re more likely to kill you if you run.” “Oh,” he added, “and make sure you fill out your proof-of-life form. It has ques­tions on it that no one else knows the an­swers to. This way we’ll know you’re alive when we make con­tact with your kid­nap­pers.”

A Van­cou­ver emer­gency nurse who was head­ing to Pak­istan right af­ter train­ing raised her hand. “Wait, I’m sup­posed to fill out a form while I’m blind­folded in a trunk?”

We all laughed—the forms are typ­i­cally filled out and sub­mit­ted as a pre­cau­tion be­fore a mis­sion starts—but it was ev­i­dent from the look on her face that she had said it in earnest.

The trainer as­sured us that MSF has a host of ne­go­ti­at­ing pro­to­cols that it re­lies on should such an event come to pass. “We’ll ne­go­ti­ate,” he said, “as long as there is some­one will­ing to ne­go­ti­ate with.”

“Je­sus,” I whis­pered.

As an or­ga­ni­za­tion, MSF deftly nav­i­gates the ten­sion be­tween per­sonal risk and so­ci­etal re­ward, and it re­quires the same of its staff. It’s com­mon for MSF staff to come down with malaria, and many have suf­fered the ef­fects of one par­a­site or an­other. Then there are the less quan­tifi­able in­juries, in­clud­ing the psy­cho­log­i­cal ef­fects of field­work. Staff are ex­pected to work six days a week—long days that of­ten go un­til around eight at night. And the work is drain­ing: MSF teams can be small, their re­sources are tight, and the need that they see can feel end­less.

At the end of Wel­come Days, my group stood proudly be­hind MSF’S leg­endary red-and-white flag for a photo. Anna and I ar­ranged to meet for cof­fee the fol­low­ing week, and as I made my way to leave, I ex­pressed my ex­cite­ment to one of our train­ers. “Well, you’ll ei­ther love it or you’ll hate it,” she said, grin­ning.

Then came the wait for a post­ing. Mis­sions tend to be six- to twelve-month com­mit­ments, and I had to stand by un­til I was needed on a project. I be­gan binge watch­ing MSF Youtube videos from the Cen­tral African Repub­lic and South Su­dan, which showed staff re­spond­ing coolly to the horrors of con­flicts, epi­demics, and droughts. I won­dered whether I had the req­ui­site met­tle.

My fam­ily was proud of my new job. “That’s re­ally amaz­ing, Mom!” said my daugh­ter, who had spent one sum­mer work­ing for the Cana­dian Coast Guard and had her eye on a ca­reer in wilder­ness search and res­cue. My son was more re­served when we spoke over Skype. He asked a lot of ques­tions, in­clud­ing about how quickly MSF staff could be evac­u­ated if some­thing went wrong. When I sent an email to my sister ex­plain­ing what I wanted for my memo­rial ser­vice if the worst should hap­pen, she phoned me in tears. “You’re be­ing dra­matic,” I chided. “It’s just a pre­cau­tion.”

At the be­gin­ning of De­cem­ber, I re­ceived the call: an ad­min-fi­nance manager post­ing had opened in Pe­shawar, Pak­istan. I gave no­tice at my con­sult­ing job, packed up my cher­ished apart­ment near Toronto’s Trin­ity Bell­woods Park, and put al­most ev­ery­thing I owned into stor­age. The rest — sum­mer clothes and what­ever else I thought I would need on my post­ing—i crammed into a seventy-litre back­pack. Ten days be­fore my an­tic­i­pated de­par­ture, how­ever, I re­ceived a call from my pool manager: the MSF desk had de­cided that they needed some­one with more ex­pe­ri­ence and lin­guis­tic and cul­tural fa­mil­iar­ity with the re­gion. I was dis­ap­pointed, job­less, and home­less. I knocked on my ex’s door and asked for a bed.

The waiting game for MSF’S non­med­i­cal staff is of­ten taxing, as staff are only paid while in the field. Doc­tors and nurses tend to have a prac­tice or a clin­i­cal po­si­tion that they can re­turn to be­tween mis­sions, but ad­min man­agers and lo­gis­ti­cians usu­ally leave jobs and scram­ble for new ones once a place­ment ends. The desta­bi­liz­ing ef­fect of the wait, as well as the loss of my apart­ment and in­come, had me de­spon­dent. Emer­gency relief doesn’t fol­low a sched­ule.

It took an­other four months, and one other can­celled as­sign­ment, be­fore I re­ceived my long-awaited post­ing. On April 10, 2016, I de­parted from Toronto for Lulingu, a small town of fewer than 30,000 lo­cated in the jun­gle of the Demo­cratic Repub­lic of Congo.

Over the past three years, MSF has spent more money in the DRC than in any other coun­try. In 2017 alone, 102 mil­lion eu­ros were in­vested into the pro­gram there, much of which went to in­fra­struc­ture, staffing, and med­i­cal sup­plies. The coun­try faces on­go­ing vi­o­lence and po­lit­i­cal chaos, lega­cies of its colo­nial past as well as the war in Rwanda in the early nineties, which oc­curred just across the bor­der and led to the ar­rival of nearly 1 mil­lion Hutu refugees. Gov­ern­ment forces are now fighting mili­tia fac­tions, and mili­tia fac­tions are fighting one an­other. Eth­nic mas­sacres, sex­ual as­saults, and the forced re­cruit­ments of child soldiers are com­mon.

The Lulingu project that I was as­signed to had been es­tab­lished in May 2013 as a re­sponse to a deadly malaria out­break in the area. The mis­sion later widened af­ter more than 100 women in the area were raped by mil­i­tants in a sin­gle day. By the time I re­ceived my post­ing, the

At our morn­ing staff meet­ing, we learned that a two-car con­voy had been at­tacked. One of the driv­ers had been killed.

con­flict had moved into the north­ern part of the re­gion, and MSF’S fo­cus had ex­panded to in­clude treat­ing mal­nu­tri­tion and re­duc­ing in­fant mor­tal­ity rates, which were the high­est in the coun­try in 2014.

I jour­neyed via Ki­gali into the DRC. When I saw the white ve­hi­cle with the iconic MSF logo parked just across the bor­der, I cried. My wait was over, and ev­ery lin­ger­ing doubt I’d had about my de­ci­sion to go on a mis­sion evap­o­rated.

Lulingu is lo­cated 140 kilo­me­tres west of Bukavu, the cap­i­tal of South Kivu prov­ince. The town is iso­lated, set into misty hills that are blan­keted by dense jun­gle, and as I entered, dirt bikes, goats, and men push­ing bi­cy­cles strapped with enor­mous loads all com­peted for space along the main road. The town had a school, a tex­tile mar­ket, and a soc­cer pitch. Chil­dren were ev­ery­where. This was to be my home for the next year or so.

The MSF hos­pi­tal, a com­pound about the size of a high-school cam­pus, was made up of red-brick colo­nial rem­nants. It sat on the hill­top at the edge of the village. Small wards were de­mar­cated by hand-painted signs above their doors, and there was a court­yard where women with rel­a­tives in care of­ten cooked over open fires. The stark­ness of the space — the paucity of equip­ment and sup­plies — was strik­ing to me as a per­son who had just ar­rived from Toronto. In the ma­ter­nity ward, women had to share beds, and though there were power lines around the com­pound, the grid was un­re­li­able and generators were ex­pected to kick in through­out each day.

Within a few days of ar­riv­ing, I had got­ten into the rhythm of life in the field. My work­day be­gan at eight in the morn­ing with a staff meet­ing called a point info (the lin­gua franca on many MSF projects re­mains French). Dur­ing these gath­er­ings, we re­ceived news from the HQ in Bukavu, op­er­a­tional plans for the day, and a se­cu­rity-sta­tus brief­ing.

Eleven of us—a mix of med­i­cal and non­med­i­cal staff, both ex­pat and na­tional — worked in a cramped, swel­ter­ing of­fice that was at­tached to our sleep­ing quar­ters. Chick­ens wan­dered in and out of the space, and huge waxy bee­tles that flew with the grace of garbage trucks fre­quently landed on our cloth­ing and in our hair while we worked. My tasks in­volved over­see­ing the project bud­get and staff salaries and pay­ing lo­cal ven­dors. I man­aged HR records, ben­e­fits, and the oc­ca­sional em­ployee griev­ance.

Pens and pa­per were at a pre­mium— all our sup­plies, in­clud­ing med­i­cal equip­ment and food, had to be flown from Bukavu to a nearby airstrip and then trans­ported by dirt bike through the jun­gle. The pen­cil I used to check my ledger was one of the few pen­cils in the of­fice, and I kept it in the locked cabi­net be­hind my desk. I whit­tled it each morn­ing with a long knife bor­rowed from our cook, Zaina.

I soon found that my in­ter­ac­tions at the ac­tual hos­pi­tal across the road from my of­fice were lim­ited, and the work I did could feel ut­terly dis­con­nected from the hu­man­i­tar­ian im­pulse that had brought me to the DRC. My ser­vice, it turned out, was not al­ways di­rectly re­lated to the pa­tients be­ing served but rather to the na­tional staff who worked on the

mis­sion. I tried to sup­port them in any way I could, whether it was get­ting ad­di­tional re­sources for the house­keep­ing work­ers or ex­hort­ing the ex­pats to be more re­spect­ful of their labour. I did an au­dit of our kitchen sup­plies to de­ter­mine what needed re­plac­ing; I wa­ter­proofed the se­cu­rity doc­u­ments of the mo­tards — the dirt-bike-taxi driv­ers who were es­sen­tial to our mis­sion and drove for us in all man­ner of weather. These ac­tions were small and did not save lives, but they made me feel use­ful in prac­ti­cal and im­me­di­ate ways.

There were few com­forts on the com­pound, and pri­vacy was all but nonex­is­tent. In the con­joined shower-bath­room stall, the doors came up to just above my shoul­ders. At night, even the size­able rats that scratched and scur­ried in the walls oc­ca­sion­ally peered out at me from holes in the ceil­ing of our bed­room quar­ters.

Our se­cu­rity grid—our des­ig­nated perime­ter of move­ment — was lim­ited to the ring of a rust-coloured dirt road that cir­cum­nav­i­gated the village cen­tre. We were given two hours af­ter work—be­fore sun­down—as well as Sun­day af­ter­noons to walk be­yond the com­pound gates. There were a few shops where we could buy soap, fab­ric, and warm beer. The edges of the cir­cu­lar road fell away to open san­i­ta­tion ditches, along which were houses con­structed of ochre-coloured wad­dle and daub, with low, thatched roofs, on which cloth­ing of­ten was spread to dry.

The peo­ple who lived be­yond our com­pound’s bam­boo fenc­ing were cir­cum­spect but friendly enough. We ex­changed greet­ings with them in Swahili when­ever we passed each other on the road. And wher­ever we walked, throngs of chil­dren fol­lowed us smil­ing and shout­ing, “Mzungu” — the col­lo­quial term for “white per­son” in Swahili. Some wanted their pic­ture taken. Oth­ers wanted to hold our hands or to prac­tise their French. The more aloof stood back and watched.

At Our point info staff meet­ing on May 19, we were told that a twocar MSF con­voy had been at­tacked in Kouki, in the north­west of the Cen­tral African Repub­lic. The oc­cu­pants — which in­cluded staff and pa­tients—had been made to exit the ve­hi­cles and lie face down on the ground. The at­tack­ers fired rounds into the dirt near their heads. The lo­cal driver of one of the ve­hi­cles was killed. Na­tional hu­man­i­tar­ian staff — the lo­cal work­ers who live in the trou­bled re­gions—are killed much more of­ten than in­ter­na­tional work­ers and tend to be more at risk in ar­eas where fighting is eth­nic­ity based.

All around me, my col­leagues’ heads bowed and their tongues clicked. I tamped my sad­ness and fear into my chest and wor­ried my­self with thoughts of a mili­tia at­tack on our com­pound. Now that I was in the field, I had a real un­der­stand­ing of our col­lec­tive vul­ner­a­bil­ity—hear­ing about this at­tack on my co­work­ers felt noth­ing like be­ing back home and watch­ing news reports of far­away bomb­ings.

While this event hit close to home, it wasn’t the worst in­for­ma­tion we re­ceived that month: not long af­ter, we learned that in Beni, near the Drc’s bor­der with Uganda, Con­golese women and chil­dren had been hacked to death with ma­chetes by uniden­ti­fied as­sailants. Later, I re­ceived an email from Anna, my psy­chol­o­gist friend from Wel­come Days. She was also work­ing in the DRC, about 150 kilo­me­tres south­west of Beni, where she was coun­selling women and men who had been sub­jected to ex­treme vi­o­lence that in­cluded rape and sodomy with sharp ob­jects, tor­ture, mu­ti­la­tion, and, in some cases, forced can­ni­bal­ism. I fell in­vol­un­tar­ily to my knees as I read her ac­counts on my phone. She wrote that she was do­ing her best but was reach­ing the end of her own psy­cho­log­i­cal rope.

My col­leagues in Lulingu had all walked with death, and their ex­pe­ri­ences seemed to have be­come a part of them. Nuria, an emer­gency-re­sponse nurse who had worked in the camps on the bor­der be­tween Rwanda and what was then Zaire in 1994, re­called the Kagera River run­ning with blood. Our lo­gis­ti­cian, Ja­mal, slight in build and soft in tem­per­a­ment, told me at din­ner one evening that he was in Ban­gui, Cen­tral African Repub­lic, at the height of fighting be­tween Mus­lim and Chris­tian forces in 2014. He said that he still could not get the sight and stench of hun­dreds of rot­ting bod­ies left in forty-de­gree heat out of his head. Marta, a vis­it­ing fi­nance co­or­di­na­tor who smoked from wak­ing un­til sleep, had also been in Ban­gui that same year. She told us a story about how, dur­ing one out­break of gun­fire, she and the other staff had spent days hid­ing in a tiny safe room on her project while most of her team waited to be evac­u­ated.

Not ev­ery­one re­sponds to the stresses of field­work the same way. Ex­po­sure to trauma, lack of sleep, in­se­cu­rity, and long hours all have an im­pact on a per­son’s re­silience. Dur­ing my mis­sion, my col­leagues and I com­bat­ted the te­dium of our con­strained ex­is­tence by do­ing tough phys­i­cal ex­er­cises in the evenings. “In­san­ity” work­out videos are com­mon on per­sonal lap­tops and usb sticks on most MSF projects. For those who can with­stand it, the pu­n­ish­ing com­bi­na­tion of in­ter­val train­ing pro­duces a pow­er­ful en­dor­phin rush — a salve for the emo­tional and psy­cho­log­i­cal de­mands of the job. One day, I was told that there had been an at­tempted hang­ing of a young boy from our village and that the per­pe­tra­tor had been sub­se­quently stoned and beaten not far from our com­pound gates. That evening, I worked out for nearly two hours be­fore fall­ing into bed. You can’t sweat out trauma, though; I started sleep­ing more and eat­ing less. Af­ter a time, the work­outs stopped work­ing.

I had thought hu­man­i­tar­ian work was straight­for­ward: you see a cri­sis, you re­act. But in prac­tice, that prin­ci­ple be­comes com­pli­cated.

Sto­ries like these don’t end up in the MSF donor news­let­ters. Peo­ple need to be­lieve that their dol­lars make a dif­fer­ence and that, with their help, change for the bet­ter can hap­pen. And change does hap­pen, but the jour­ney there is of­ten not tidy or re­demp­tive. As a re­sult, MSF work­ers tend to be care­ful about which sto­ries they tell.

It’s no se­cret that some MSF lif­ers have sim­i­lar prob­lems to what some mem­bers of the mil­i­tary ex­pe­ri­ence when re-en­ter­ing “civil­ian” life. Wit­ness­ing things that are be­yond the ken of most peo­ple back home can make re­turn­ing dif­fi­cult. As a re­sult, many staff sim­ply don’t go home — or, at least, they don’t go home for long. This is what Anna did. From her mis­sion in the DRC, she trav­elled to Syria. Later, she was posted to the is­land of Les­bos in Greece to work in the mi­grant camps. She’s spent only a few weeks in Canada be­tween her mis­sions, and each time we saw each other in Toronto, I thought she seemed more hope­less and alien­ated from her life here.

Anna’s lat­est post­ing was in Mo­sul, Iraq, the for­mer stomp­ing grounds of Is­lamic State mil­i­tants. This sum­mer, two years and three con­ti­nents af­ter our first meet­ing, we talked over What­sapp. Against the echoes of the af­ter­noon call to prayer, she told me how, for women in Syria and Iraq, even a sin­gle hour­long coun­selling ses­sion with her can have a pos­i­tive im­pact. She ex­plained that the women she had spo­ken with seemed grate­ful that their feel­ings were be­ing heard—they were fi­nally safe to talk about their ex­pe­ri­ences.

“But how are you do­ing?” I asked. An ex­tended si­lence fol­lowed. “I am hear­ing the most hor­ri­ble sto­ries ever, and I know it sounds ter­ri­ble, but I just don’t care any­more. I’m to­tally numb,” she replied.

In the field, the brain sup­presses, im­mu­niz­ing it­self against over­whelm­ing trauma. It’s a pro­tec­tive shield, but it has con­se­quences. In 2012, the Antares Foun­da­tion, which pro­vides men­tal-health train­ing and sup­port to aid or­ga­ni­za­tions, funded a study on de­pres­sion and anx­i­ety among hu­man­i­tar­ian work­ers. It found that chronic stress dur­ing de­ploy­ments can in­crease the risk of emo­tional burnout for work­ers af­ter they re­turn.

Soon af­ter our con­ver­sa­tion, Anna’s con­tract in Iraq ended. This time, rather than go­ing back into the field as a psy­chol­o­gist, she moved into an HR po­si­tion with MSF in western Europe, where she re­ceived a lengthy de­brief­ing and sought coun­selling. Where MSF de­mands “flex­i­bil­ity with­out bor­ders” of its staff, its re­spon­sive­ness to its work­ers’ needs is also un­stint­ing. On some projects, psy­choso­cial sup­port is ac­ces­si­ble 24/7 via Skype. Ex­ten­sive pre-mis­sion brief­ings and post­mis­sion de­brief­ings are de­signed to prepare staff for what lies ahead and to help them de­com­press when they reach home. These re­sources, along with time, can be ef­fec­tive heal­ers.

Three weeks into my mis­sion in the DRC, I suf­fered a con­cus­sion. In tor­ren­tial rain, I was run­ning head down and at full tilt from the kitchen to the small gazebo at the back of the com­pound. I hit my head against a jut­ting roof beam and fell back­wards, hit­ting my head hard against the ground. I got up, dizzy and nau­se­ated. I wor­ried about what those symp­toms might mean.

I didn’t say any­thing to any­one, though, be­cause it had taken so much time and ef­fort to get pre­cisely where I was— work­ing for MSF was what I’d wanted to do since I was a teenager. But over the fol­low­ing three weeks, I re­al­ized that I was strug­gling with tasks that were once sim­ple. I could not fol­low ver­bal in­struc­tions eas­ily, count money, or rely on my mem­ory. I had to tell some­one.

Straight away, the project co­or­di­na­tor ar­ranged for an air­lift to Bukavu, where I was taken to the hos­pi­tal for an Mri and a Cat scan to rule out the pres­ence of a blood clot. Through a Skype ses­sion with the MSF psy­choso­cial unit in Barcelona, I took a range of tests to as­sess my cog­ni­tive func­tion. It was de­ter­mined that I had to go home. I had been in the DRC for six weeks by that point; my mis­sion was only just be­gin­ning. I was given a few days in Bukavu to de­com­press and come to terms with the sad end­ing be­fore fly­ing home. I felt no sense of ac­com­plish­ment, only tremen­dous guilt.

Be­fore join­ing MSF, I had thought that hu­man­i­tar­ian work was straight­for­ward: you see a cri­sis, you re­act. But, in prac­tice, that prin­ci­ple be­comes com­pli­cated, and help­ing of­ten means do­ing what is needed. On the same day I se­cured the rape reports of three women over the age of sixty, I also recorded staff va­ca­tion days and changed the of­fice printer pa­per. Af­ter the con­cus­sion, my be­ing on the project had be­come a risk for the team; maybe the no­blest thing that I did in Lulingu was ad­mit that I needed to go home.

Since re­turn­ing to Toronto in 2016, the call to do hu­man­i­tar­ian work re­mains strong. Go­ing back to MSF as an ad­min no longer makes sense for me, though. Af­ter my ex­pe­ri­ence in the DRC and all my con­ver­sa­tions with Anna, I de­cided that I wanted to do more to di­rectly help par­ents and chil­dren who are cop­ing with war. I entered a doc­toral pro­gram in the Depart­ment of Ap­plied Psy­chol­ogy and Hu­man De­vel­op­ment at the On­tario In­sti­tute for Stud­ies in Ed­u­ca­tion, and I am now de­vel­op­ing a com­mu­nity-based sup­port­ive par­ent­ing pro­gram for fam­i­lies liv­ing amid ex­treme vi­o­lence or in dis­placed-per­sons camps. My goal is to sup­port the well­be­ing of par­ents and small chil­dren who have ex­pe­ri­enced the trau­matic ef­fects of war.

I now un­der­stand what my re­cruiter meant when he told me that MSF is not about sav­ing the world. But I do know that the world needs peo­ple will­ing to do what­ever they can to make it a bet­ter place, in big ways and small. I still think of my hard-work­ing na­tional and ex­pat col­leagues in Lulingu, and I jeal­ously fol­low the paths of those friends, like Anna, who re­main with MSF. I still have the red-and-white T-shirt I was given dur­ing my mis­sion. I keep it neatly folded in my dresser, just in case it’s

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