By Matt Whiteman
Last night, the UBC Chapter of Engineers Without Borders held a screening of Dr. James Orbinski’s harrowing documentary “Triage“. If you haven’t already seen it, do. To my disappointment, only six or seven people showed up to watch, four of which were members of EWB. Quel dommage.
[youtube]https://www.youtube.com/watch?v=TMPCjy_Arbo[/youtube]
There were indeed many insightful moments, but one in particular stuck out for me that will likely never happen again in quite the same way, so I feel the need to record it here. The film began with Dr. Orbinski explaining the awful process of triage he went through – deciding who lives or dies – during the genocide in Rwanda. This is a process which can only be described as “the ultimate humanitarian nightmare”:
“So we labeled them 1, 2, or 3… put a little piece of tape on their forehead
and ‘1’ meant that they should be treated right away…
a ‘2’ meant that they needed to be treated within 24 hours.
And a ‘3’ meant that even though they were alive, they were irretrievable.”
Imagine this was your decision.
As he spoke, someone in front of me was fiddling with the remote control, trying to bring up subtitles. Immediately after Orbinski said “and a ‘3’”, the picture froze and the words “Cannot Operate” appeared in the centre of the screen.
It was just the DVD player’s way of telling us it didn’t like button-mashing, but there was something hauntingly poetic about this small, perfectly-timed apparition. It wasn’t quite irony; just a simple coincidence with a lump of double entendre. Maybe it’s not even all that interesting. But for me, it set the mood for the rest of the film, which – believe me – was not easy to watch. Even for someone who has never themselves glimpsed the complexity of the things witnessed by Dr. Orbinski, the mood is unmistakably one of pathos.
Among other things, Triage sparks an interesting debate about the role of doctor as political actor. My room mate poignantly noted this morning on the bus that doctors are among the only professionals who are essentially “licensed to be apolitical”. The rest of us aren’t allowed to be, ethically speaking anyway. We have a choice to be apathetic or ignorant, but as human beings, should we be allowed to be?
If you work for Doctors Without Borders (MSF) as a physician, you can’t get involved in the politics of the region. Your job is to treat the sick. Although I am not a doctor, the modern hippocratic oath, along with the spirit of MSF, seem to imply that all human life is equal, and that – like the law – a physician’s compassion should be blind.
Triage examines just how difficult it can be to remain apolitical when the people you are treating are victims of (often infuriating) political circumstance. “Famines,” one man comments “are never simply natural occurrences.” The same truth is reflected in the staggering number of casualties of the recent earthquake in Haiti.
After the genocide in Rwanda ended and 2 million Hutus fled to Uganda and Zaire, the refugee camps were run by the very genocidaires who killed close to a million people. They appropriated emergency food aid and sold it with a tax markup, allowing them to sustain themselves during a conflict that is ongoing to this day. Humanitarian workers operating in these camps had a choice: work with the genocidaires, or let people starve. But not for Orbinski. MSF had to remain politically neutral, and Orbinski decided that it could not do that while supporting murderers. It left Rwanda in 1997 and has not returned since. The flak that you risk facing in a circumstance like that is that what gets televised is the doctors leaving the camp – not the complex reasons for doing so.
You can just as easily not get involved out of sheer political ignorance too. But the difference between political neutrality and political ignorance is that the former requires a conscious understanding of the politics involved in such a situation so that you can make the right decision. But many physicians, as Ernest Boyer would say, experience a “divorce of conscience from competence” – they retreat into their technical training when they don’t understand a socio-political situation well enough.
This same schism is often characteristic of anyone who wants to help – which is where many of the ethical problems with international engagement begin. I’ve said it so many times I feel almost self-conscious saying it again here, but reliance on good intentions – even with a certain competence – is not enough. Some people have neither conscience nor competence, and yet somehow still show up to “help”.
Sometimes you have to ask tough questions: Are there people who don’t deserve to be helped? It is dilemmas like this that are the subject of Orbinski’s book “An Imperfect Offering”, which Triage documents him writing. The role of doctor as health advocate suggests that physicians must be political creatures, that they must include social and political circumstances in their calculus.
Orbinski understands this and is himself torn by it – he knows that you have to understand the politics before you can step outside them, and that’s why he (representing MSF) was awarded the Nobel Prize in 1999.
