December 9, 2009

Living in Emergency: A Nationwide Screening and Discussion on Monday, December 14

Recently shortlisted for an Oscar, you have the rare chance to see the film and watch a live panel discussion moderated by Elizabeth Vargas

Soon after watching Mark Hopkins' award-winning documentary, Living in Emergency: Stories of Doctors Without Borders, I came across yet another talking heads debate on cable television about U.S. health care reform: blah, blah, blah, premiums, plans, policies, programs, and of course, the nefarious "public option". The irony was tragic considering I'd just learned that 2 billion people worldwide have no option, as in no access to essential medical care. This may not be news to many people with an eye on global issues, but Living in Emergency doesn't dwell on mind-boggling statistics like that because it's not really about the patients at all. It's about the doctors who volunteer to risk their sanity, careers, marriages, and even their lives to help alleviate suffering in the most dangerous environments on earth.

The four doctors profiled in Living in Emergency all work for Médecins Sans Frontières (MSF/"Doctors Without Borders"), the Paris-founded, Nobel Peace Prize-winning NGO that provides free medical care annually to 10 million people in more than 70 sites worldwide - most of them previously, or too often currently, ravaged by war.

These are the kinds of settings where doctors become chain smokers. Where doctors are encouraged to have sex frequently, because when you're losing patients day in and day out, sex represents life. Where doctors end up questioning their career choice and doubting their own sense of self-efficacy. Where the Hippocratic Oath is a quaint, tidy motto.

The film marks the first time MSF has given a documentary crew uncensored access to its field sites, however Living in Emergency was not produced by MSF, and it could hardly be considered a glossy recruiting video to show to idealistic medical students and public health professionals (they might not be excited at the idea of wearing headlamps to treat patients in the dark). But they are probably the first people who should see it, followed by Americans with any vested interest in international relations and/or our current health care debate. It is a hard film to watch (e.g., very graphic surgical scenes and war footage) but an important one, and its recent inclusion on the Oscar shortlist for Best Documentary Feature is deserved.

Next Monday, December 14, MSF will be teaming up with Fathom Events and ABC's Elizabeth Vargas for a nationwide screening and live post-screening discussion with the film's subjects. The one-night event will be held in New York City and streamed live in more than 440 participating theaters (click here for theaters in Minnesota). For this night, at least, we should be humbly grateful for the access to health care that we have in this country.

The limited medical care a small group of doctors can provide to a war-torn region is, in the words of one doctor, "a tiny, tiny drop in a sea of oceans." They know they are not there to solve all of the problems existing in developing countries; they are fully aware of their role as doctors, not diplomats, and anyway they hardly have the time to consider the root causes of these tragic situations (ironic considering their skill in diagnosis), let alone go about addressing them. At the end of one of many nights spent commiserating over (maybe one too many) local beers, one doctor somewhat contemptuously pokes a finger at aid organizations and agencies like UNICEF, dismissing the money and time spent theorizing in meetings and poring over research, when people like him are getting their hands dirty every day and meeting urgent needs.

While I personally have faith in the efforts of those international NGOs and development projects, it's hard not to sympathize with his attitude considering he and his colleagues are operating with extremely limited resources, extremely outdated diagnostic technology, and virtually no social or professional support. During their six-month assignments, MSF doctors are permanently on call and live in a constant gray area between their personal and professional lives; really their work is their life and their life is their work, all the time.

And as you would imagine it exacts a severe toll on the mental well-being of these doctors. Dr. Davinder Gill, an Australian in his late twenties, is quickly discouraged by the lack of support provided to him in the bush on his first (and ultimately last) MSF assignment. An MSF veteran, Dr. Christopher Brasher, is reaching his limit of tragedy and turmoil after nine years of MSF work, and he is not planning on taking on additional assignments.

An American, Dr.Tom Krueger, has gone on several assignments and is finding it increasingly difficult to maintain a positive outlook on the whole thing (Brasher and Krueger will both participate in Monday's panel discussion). And Dr. Chiara Lepora, an MSF staff member assigned as a kind of liaison and in-country medical director to these doctors, struggles with maintaining sustainable and consistent care while also delicately deciding how and when MSF should leave a country. While Hopkins uncovers some tension and distrust between MSF doctors and local communities, he doesn't explore whether this may be caused by their headfirst attitude and sometimes unsolicited "expertise" around local medical customs.

It's a small flaw in an imperfect film, but to Hopkins' credit the focus remains on the doctors involved and not the policies that brought them there, and by doing so he uncovers the complex personal challenges faced in this line of work. How do you remain motivated and encouraged when, even if you are making an incredible difference to the individuals you treat, your impact on a greater scale is often obscured by the horrible conditions surrounding you?

"In the beginning I felt very good about everything I was doing, and now I just...don't feel good anymore," admits one MSF veteran. You may not feel good watching Living in Emergency, either, but then it's not billed as a feel-good movie, and I admire MSF for providing what appears to be a very unfiltered look at their operations. Like an episode of Mike Rowe's popular show, "Dirty Jobs", Living in Emergency is a glimpse into the work that many of us cannot and do not want to imagine doing, especially considering that people's lives are on the line. And for that fact alone, I think it deserves our attention.

"Living in Emergency: Live with Elizabeth Vargas" will be broadcast via satellite from the Skirball Center for the Performing Arts at NYU, on Monday, December 14, 2009 at 7:30 p.m. Eastern / 6:30 p.m. Central / 5:30 p.m. Mountain/ 8:00 p.m. Pacific (Tape Delayed). Tickets are on sale at more than 440 participating movie theaters nationwide. (Click here for additional information)

Become a fan of Living in Emergency on Facebook to keep up with the latest news and to watch deleted scenes from the film.



  1. I appreciate your thoughts on this film --- this is a film that because it's real & doesn't have much of a filter on the presentation opens itself up very well to be discussed.

    Obviously easy to talk from ivory towers, but I think an organization like MSF does the best it can, but clearly does not claim to have the world medical crisis and issues of the developing world "figured out." But it's glimpse into there world might help and encourage others as well as awareness of these types of issues.

  2. Right, that's what I appreciated most about it, RC. It's not a neatly packaged sales pitch and there aren't slow motion close-ups of children's faces to overwhelm you with pity. Not that you shouldn't feel pity for innocent people suffering in war-torn regions, but too often the "cure" for that pity is for you to write a fat check and forget about it.

    MSF and these doctors know that people actually need immediate, hands-on help in these places, and they're going to go and do it for as long as that need exists. It was interesting to see the challenges that come along with that mission, and I imagine the discussion on Monday night might help inform the greater conversation about international engagement.

  3. MSF is my number one charity and has been for a long time. There have to be some forces of peace in war zones, and these folks need all the help they can get.

    I have tickets to the national showing on Monday, and I can't wait.

  4. That's great, Marilyn. This is a really major opportunity for MSF and I hope it results in some support and greater awareness among the American public. I don't know if you remember a few years ago they had a touring refugee camp that they took from city to city as part of a public education campaign. It had to have gone through Chicago at some point. It was really well organized and I still remember it vividly.

    Also, just to give fair warning to people seeing this on the big screen for the first time - there are some fairly graphic scenes, including limb amputation and even drilling a hole into a skull. Standard surgical stuff and the camera doesn't get too close, but some viewers might not be prepared for the idea of it anyway.

    Then again, Saw VI just came out, so maybe people really enjoy that kind of thing. If so they'll be disappointed that these patients are being helped, not harmed.

  5. I got a press release at work about the traveling exhibit, but I didn't go. I had just been to the Amnesty International national convention, and they had some great speakers from MSF talking about Sudan and neighboring countries that were being destabilized by the massive uprooting of Sudanese. It was sad, but very informative and gave direction toward prevention.

  6. Interesting - that truth about the MSF doctors getting an inside look at the roots of conflict isn't really discussed here. As I said, from the film it seems like they are way too busy treating people (through no fault of their own; that's the nature of their job) to have any involvement in preventing the underlying causes that bring them to these places. Not that they wouldn't have an opinion, of course, because they are really operating at the ground level. So they probably have a much different perspective than the diplomats.

  7. @ Daniel, I agree -- the film shows that they are way too busy to do anything other than treat the immediate needs around them - the film really seemed to show how little support they had.

  8. Makes it all the more impressive that they've grown to an annual group of nearly 30,000 strong.

  9. Saw the film and discussion last night. Great, great movie. I couldn't catch my breath during the scene with the girl who was shot in the arm; it still haunts me.

    Elizabeth Vargas was a terrible interviewer, but the panelists overcame her considerable shortcomings. They had the Liberian Minister of Health on, an articulate, surprisingly candid gentleman; unfortunately, the executive director of MSF had to refer questions Vargas asked her to him because Vargas seemed to avoid questioning him like the plague. I think it was because she couldn't pronounce his name...

  10. Thanks for checking back in, Marilyn. I had a prior obligation and couldn't attend the event last night, but I was glad to see it get a lot of attention (at least here locally) over the weekend.

    That's really sad to hear about Vargas, particularly if she was stepping around him so as not to embarrass herself. Of course, I tend to think discussions like this are largely scripted beforehand anyways, but who knows. For that matter I'm curious as to why a medical reporter - even the famed Dr. Sanjay Gupta - wasn't chosen as the moderator.

  11. No idea. While Vargas clutched sheets of paper in her hand, she seemed surprisingly awkward questioning these folks. After the initial, organized questions, she fell back on the blithering "how did you feel" kinds of questions that are such a blight on journalism. She seemed positively nonplussed when she mentioned the healthcare debate in the U.S. and Dr. Brasher called the whole thing "pathetic." When she started talking about where the beach scene was filmed and how great the water looked, Shane and I left.

  12. What?! I can't believe that's where the questioning led!

    I like that Brasher guy - a real straight shooter. Maybe he would have been entertaining anyway. Also, I see you've just posted a review and I look forward to reading it shortly...

  13. @Marilyn I agree with your criticism of the interview, I got up and left as well. I think it might have been a bigger issue than not being able to pronounce the minister's name though: like many, Vargas seemed to have much more faith in foreign NGO workers than local African officials. An unfortunate end to an otherwise wonderful film.

  14. Thanks for stopping by, Mike. And you touch on an underlying message in the film, too - I'm reminded of the Liberian doctor who was frustrated because he felt disrespected by the foreign doctors on-site.


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