Living in Emergency: Stories of Doctors Without Borders (2008)

Director: Mark N. Hopkins

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By Marilyn Ferdinand

I don’t know who Manny the Movie Guy is, but he had this to say at a link on the IMDb page for Living in Emergency:

How could this be? Michael Moore’s Capitalism: A Love Story was snubbed by the Academy Awards! Moore’s new documentary was largely favored by critics, including me, but apparently, it’s not good enough for the Academy. It’s this year’s highest-grossing documentary (it has made $10 million so far), and Overture Films even opened it on Sept. 23, in time for the Academy’s Sept. 30 cutoff date. Moore won an Oscar before in 2002 for Bowling for Columbine.

I must say that I’m a little flummoxed, too. I didn’t realize that winning an Oscar (and for an undeserving film at that), having a film company smart enough to follow a simple AMPAS rule, and being popular with the public were sufficient to guarantee an Oscar nomination. Although this is, in fact, often the case, there does still seem to be a minimum threshold of quality involved. Moore’s film about a system that has benefited him heartily and that he could have scripted by cribbing a few blog posts from Firedoglake, represents everything that is wrong with the state of documentary inquiry—the docusnark. Living in Emergency, which had Moore made it would have looked like the pandering, pathetic human relief commercials (with laugh track) that pepper late-night television, represents everything that’s right with documentaries. It presents in intimate and unflinching detail the compelling story of the humanitarian efforts of Médecins Sans Frontières, aka Doctors Without Borders, an international organization that provides emergency medical care to people afflicted by armed conflict, epidemics, healthcare exclusion, and natural or manmade disasters. I’m deeply pleased that it was singled out for Oscar consideration over the popular choice.

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I’ve long been a supporter of MSF, which acts as a small oasis in a desert of misery. Doctors are deployed on six-month missions to serve under some of the worst conditions human beings have to endure. In MSF aid zones, diseases that have long been eradicated in developed countries, such as cholera and tetanus, are commonplace, and driving down a road to deliver aid might mean negotiating with a dozen different warring factions—indeed, where driving down a road could cost an aid worker his or her life, as it did two aid workers in Pakistan early this year. As a supporter, I was keen to view Living in Emergency for an unprecedented chance to see MSF in action. The documentary follows four doctors—three in Liberia and one in the Democratic Republic of Congo.

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In the desperately poor country of Liberia, 27-year-old Australian doctor Davinder Gill is on his first mission in the rural town of Foya. He is a one-man clinic, frustrated to breaking by a lack of supplies and by his local workers who do not operate like a well-oiled hospital staff. He has almost no time for sleep or recreation—we first see him at night, tending to a patient with an enormous hernia with only a miner’s helmet light by which to work in the electricity-free village—and he constantly doubts his decisions and working style. In the Liberian capital of Monrovia, Tom Krueger, a seasoned surgeon from Kentucky also on his first mission, tends to the sick and hurt at MSF’s Mamba Point Hospital, the only free and functioning hospital in the entire country. Chiara Lepora, an Italian national who is the head of the Liberian operation, not only tends to patients at Mamba Point, but also travels to other missions in the country, including Gill’s, to troubleshoot, manage problems, and lend a brief helping hand. After a 15-year presence during the ravaging Liberian civil war, MSF must decide whether to pull out now that the war has ceased and a Ministry of Health has been established to restore the country’s collapsed healthcare system.

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War continues in Congo, and most of the patients MSF treats have been attacked or caught in the crossfire. Christopher Brasher, an Aussie doctor now on staff with MSF, is compensating for the shortage of volunteer doctors that always occurs in summer by deploying to Congo. He’s surprised to find himself in another war zone after being so traumatized by the Liberian civil war in 2003 that he almost quit. After nine years with MSF—he jokes that he has managed to have a career being homeless—he is thinking about moving on so that he can finally settle down. Brasher seems matter-of-fact about walking near the MSF facility among armed soldiers and frightened, scurrying civilians, but we’ll see that he’s anything but blasé to the traumas he has witnessed as the film progresses.

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Hopkins and his camera crew do an excellent job of taking us close to the doctors and their staff as they go about their work, which at times requires them to improvise as best they can. For example, a man has been brought into Brasher’s facility by his family. Soldiers came to their home to rob them and shot the man in the head. Brasher points to the entry wound above the eye and the exit wound at the side of his head—his ear has been blown off. His coma is deepening, but as there are no CT or MRI machines around, there is no way to know what’s going on in his skull. The team finally decides to drill in and take a look, but they don’t have the right-size drill bit. They take a large chance of killing him if they use what they have, but he’ll probably die anyway if they don’t. Luckily for him, the drilling relieves the pressure on his brain, and in a few hours he is alert, with his memory intact. The operation is wince-inducing to watch, but how he got onto the surgical table in the first place is even more unsettling. “Some of them (soldiers) just like to kill people,” Brasher says.

At Mamba Point, Krueger examines a man with a seriously infected foot, a typical case of a treatable problem left to go until it becomes life-threatening. Krueger is forced to use a ligature saw—basically piano wire—to saw the man’s foot off. He comments that he is practicing the kind of medicine his father would have been comfortable performing in Depression-era Kentucky. This kind of medicine, he says, is hard for modern physicians to adapt to.

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All of the doctors voice their concerns about their psychological health, the relative futility of the good they can accomplish in the face of severely overwhelming need, the absolute necessity of making hard choices about who to treat and who to let go. Brasher examines a teenage boy in cardiac arrest. He does CPR to get the boy’s heart going and then says he’ll let his aide force air into his lungs with a blue balloon for an hour. If the boy doesn’t start breathing on his own, they’ll let him go. Fortunately, the boy does revive and tells Brasher he’s feeling ok. Later that day, Brasher and we are crushed to learn the boy has died after all. At a wild party where Gill and other MSF field staff are dancing and getting drunk, Lepora says in voiceover that MSF workers have a lot of sex: “We’re faced with so much death. Sex is life.”

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In the end, MSF staff in Paris decide it is time to close Mamba Point and leave Liberia. Lepora’s going-away party is sweet but also bitter, as one of her nurses complains that they will be left behind without MSF resources. This is always the case, and in fact, only 10 percent of MSF’s work is done by foreign recruits. Still, MSF is designed for emergency assistance. When the emergency has passed, each country must come to rely on its own resources. Liberia’s health system is still in critical condition, but they have managed to reopen John F. Kennedy Hospital in Monrovia, and Mamba Point staff are needed there. Brasher returns to Monrovia at the end of his mission in Congo and testifies that things are better: “It’s nice to see people going about their business, no guns on the streets.” He and Gill won’t be back. Lepora and Krueger continue the work. And Hopkins and crew have helped us to bear witness in a clear, compelling way that, though difficult to watch and contemplate, I could have kept watching for hours.

A live panel discussion moderated by TV personality Elizabeth Vargas was shown after the film in theaters across the country. Vargas, schooled in the “how do you feel” brand of “journalism,” was fine on the intimate questions she posed to Krueger and Brasher, who attended along with MSF-USA executive director Sophie Delaunay, Liberian Minister of Health Walter Gwenigale, MD, and American journalist and war correspondent Sebastian Junger. Vargas avoided speaking with Dr. Gwenigale as much as possible, to the point where Delaunay actually had to ask him a question and defer questions from Vargas to him. It was an embarrassing performance to say the least, which ended for me and the hubby when she asked where the beautiful beach scene that ends the film was shot, in deference, I suppose, to the adventure travelers in the audience.

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Nonetheless, the panelists managed to be eloquent, informative, and real. When Vargas wondered about whether Dr. Gill should have been given the mission he was, Delaunay could only say that MSF is needs driven, and that they choose an available doctor with the most appropriate skills and background. Only about 2 percent of applicants are accepted into the program in the first place, and there is a high attrition rate, so many doctors simply don’t have a choice of mission. The highlight of the discussion for me came when Brasher called the current healthcare reform debate in the United States “pathetic.” Indeed it is, and given the criteria of natural disaster and healthcare exclusion that MSF applies to its work, parts of the United States could qualify.

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Krueger, quiet and reflective, mature enough to process a lot of what he has seen, seemed to stumble when he ruminated on witnessing what cruelty human beings can inflict on each other. MSF wouldn’t have to exist if we could just cure that disease.

  • Rod spoke:
    15th/12/2009 to 7:56 pm

    Stop reading IMDb comments. Now!

  • Marilyn spoke:
    15th/12/2009 to 8:00 pm

    Sorry. It just…happened! How can I pass on someone who calls himself a film critic saying something like that. That’s an inhuman expectation.

  • Daniel spoke:
    16th/12/2009 to 4:57 pm

    I like your last line here, Marilyn, because in the context of all of the tragedy discussed in the film, that greater human potential is never explored, except of course in the examples of the doctors who sacrifice so much for this kind of work.
    And I forgot to mention in my review that idea that Tom Krueger brings up about how much more suited his grandfather would be for this work. It’s a thought that kind of takes you aback, and puts into perspective not only how much medical technology has advanced in the last century, but how much the developed world has come to depend on it.

  • Marilyn spoke:
    16th/12/2009 to 6:03 pm

    It’s nice to be able to have advanced medical techniques; they simply should be available to all. Sadly, we can’t even make that happen in the US of A.

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