"Millions of people have been, have been affected." "The people need shelter, some people need food." "They need clean water." "They need clothes." "They need blankets." "They need medication..." "New fighting erupting today in a civil war some call, the most brutal in Africa, in the Democratic Republic of Congo, where millions have died." "How are you dealing with the people who have been wounded?" "Fourteen years of war have left Liberia in ruins, and a quarter of a million people dead." "Warning:" "Some of the images you're about to see are disturbing." "Monrovia's hospital has been overwhelmed by casualties." "There are shortages of food, water and shelter." "...earthquake along the border between India and Pakistan." "It's estimated that as many as 30,000 people were killed." "Close to the quake's epicenter, almost everything is gone." "Entire villages reduced to rubble." "So the situation here is really getting worse by the hour." "Relief and rescue operations are becoming visible, but so too is the sheer breadth of destruction." "We landed in Islamabad, And we moved up to Abbottabad." "Two teams each fly by helicopter into Kawai and Kaghan." "We are based here in Mansehra." "When I say we are based we just arrived, huh?" "I work for Médecins Sans Frontiéres." "We have a team of a doctor, two nurses and a logistician." "Major, which is your aircraft?" "We'll, we'll help you get loaded now." "So far nobody has reached them." "You will be the first one reaching them." "The beginning is always the why;" "why are you there?" "You could set-up MSF missions all over the poor countries of the world." "The demand is pretty much infinite." "It's just a question of being able to choose what you can do." "So you make choices that are tough choices to make, but you have to make them." "The civil war in the very dangerous West African nation of Liberia, fierce fighting between rebel forces and government troops, in the capital of Monrovia." "This is where the frontline was in December." "Where are the gloves man?" "Nobody could possibly have any concept of what it's like to work in an environment like this." "When I first started, I had no idea what, what I was getting myself into." "The second there is just a shadow, here just a scratch." "I never could have imagined what it means being the doctor." "Sometimes being the first doctor that people has seen, in the past twenty-seven years." "You're on here 24/7 which means that I'm on-call all the time." "And, I mean, that's why there's so much burnout." "Helping to stop the suffering of people is tremendously rewarding although it also fucks you up a bit." "We have a 40-acre farm, so it's felt pretty comfortable for me, because I grew up with my grandparent's dairy and worked on it actually up until... till my first and second year of medical school." "My grandfather was a surgeon." "When I was a kid, I'd go to the operating room with him." "I remember the first time I was in there for an operation, watching him do one, and I thought that it was such a radical concept, to cut people open and work on them, there was nothing else that seemed like" "it was going to be quite so interesting." "So I practiced for twenty years here." "I'm still kind of reflecting and working through why it is that I was tired of what I was doing when it was what I always wanted to do with my life." "I have real problems with the American health care system." "I think the whole system is this big business now." "And I realized that, you know, in my practice, that I really wasn't giving of myself the way I had wanted at one time." "Especially in, uh, African populations, the peeling of the skin..." "You know, it's hard when you get started on a family and you have all the responsibilities to all of a sudden just say," ""Well I'm going to get off and do something different."" "That's why it's taken me twenty years before I could do something like this where I'd always dreamed of doing it." "This emergency room of a busy emergency hospital where we get all the complicated cases." "Alright, don't be scared, you're in the hospital now." "We'll take care of you, okay?" "Because of the war, the health system was completely broken down." "Even now, the health system is minimal." "Doc, doc, good morning." "Here." "Okay, can I see his x-ray?" "I don't actually see any abnormality in there." "A young girl?" "Electrocuted." "Yeah." "She fell in the water." "She fell in the water with an electrical current." "What's this thing?" "Osteomyelitis of his clavicle." "You don't see it on the x-ray, it's looks fine, but uh, you can... it's tethered to the bone, you know?" "You can't move it." "It was pretty much of a shock when I got here." "I mean, if you're going to talk to some of your friends about some of the stuff you saw, they'd, you know." "And you can't describe the smells the feeling of the heat on your body and the sweat running down your back." "The smell of the puss that hits your nose, and of unwashed bodies in a closed room, you know, no circulation." "And the smell of your own panic, when you're not sure what to do." "You can't share that stuff." "This ulceration goes all the way back to here, underneath there." "There's so much chronic infection down there that, going back to an older technique that we've used on a lot of people with really nasty feet is just to do a guillotine amputation." "Just get the infection off of him." "His only... his only recourse is an amputation at this time." "I bet my grandfather would have done a lot better here than I'm doing here... because it was more like surgery that he would have practiced with limited facilities and limited diagnostic measures." "Seeing things that should have been fixed five or ten years ago." "They come in at the very last moment, you know, when they're at the very worst." "That largest, the biggest, the hardest, everything is super-sized here, you know, in terms of severity." "I hope, as it all goes through, that there's not something that comes to pass that causes me to feel bad about my experience here." "I'm fearful it would be my own failing, is I guess is what I'm saying." "I hope I'm up to it." "I'm going to visit him but I have to get dressed to visit him." "Does he know this?" "Yeah?" "I can see myself in my first mission." "When I got there, I was just so scared about everything." "I was scared about the kinds of diseases that I was seeing" "I was scared about the responsibility that I have, because in our hospital you're just not used to that." "Even as a doctor you always share the responsibility with other five or six or seven doctors who knows their little, little part." "And when did the fever start?" "Thursday." "Thursday." "So do you have pain here?" "And then you go to Africa and your responsibility just increases." "The beginning is like thirty beds and all of these thirty patients are mine and I have to save their life!" "And it's very scary." "What else can it be?" "So it can be Lassa fever, it can be yellow fever." "You have seen Lassa fever, what do you know about the timing?" "Ten days maximum." "Ten days maximum." "So, I would..." "I would have started Chlorophenicol..." "When you decide to go on your first mission it's because you want to have your life in what you're doing." "This division between what is personal and what is professional here is completely blurred." "There is no limit between what is professional and what is personal if you start working with MSF." "Mamba Point Hospital..." "do you know that?" "Mamba Point Hospital." "Do you know it?" "MSF." "Yeah, you know that?" "You come there?" "If you are sick you come there?" "This is my personal obsession." "This is West Point, the place in which there are, like, seventy-five thousand people living, fifteen latrines, the worst conditions in Monrovia all put together." "This is considered to be a 'no-go' area, which is officially done for security reasons." "But the result of that is that nobody is working there and the situation is just going worse and worse and worse." "Today we own more than seventy-five percent of the hospital beds in Monrovia." "MSF has actually more doctors than the whole Ministry of Health." "Here, MSF is here in Foya and here in Kolahun, right?" "Up to the beginning of 2006 the whole rest of the country was completely empty." "There were no other health centers, even not health centers, no nurses, no... nothing." "It's really just a huge level of responsibility." "The doctors in the hospital are very much cut in the situation of wanting sort of, accepting everything and then having to make choices." "Like, the fact of being faced with cases in which you will have to decide if you can do it or not." "I think we all have the same question..." "which is; what is our limit?" "This lady came the other day and wanted to get treatment but this really was not there when she came." "Sister, this one can come out of your belly button, huh?" "You start turning on your back for me, and you will start feeling less pain, and then we will slowly try to push it in." "So for this hernia, we wonder whether it's strangulated, that means the content is dying." "Unfortunately, in this setting it doesn't matter." "Even if the bowel is dying, all I can try to do is push it back, and then tomorrow I'll find out whether the bowel died because she'll be sicker." "I mean, four doesn't really look like enough but, it's... it's all I got." "I'm just going to try to push." "It's gone, huh?" "Sorry, sister." "We let her rest here for ten, fifteen minutes then you put her on a bed, and you do... be doing her observations every two hours like I said, huh?" "I have a desire to do medicine that I think is really effective, and for people who need it more than others and that takes you to settings like this, where the patients are sicker but what you can do" "makes more of a difference life by life, person by person." "In 2001, when the war hit here the worst, overnight, everyone left, so both hospitals were obviously deserted since then and I'm the first doctor who's lived here for fifteen years." "Alright, still swollen." "This illustrates a point that, to do the dressings for cases like we see here involves a huge amount of SSD and gauze and stuff that we have never had." "Alright, well we'll look at it later." "We don't have a lot of cold pack." "You got them this morning." "No, a patient did not receive Gentamicin because it was not in the cupboard this morning." "But I sent for it yesterday." "Yes, but it happens often, huh?" "I've spent six months here and I reckon psychologically" "I'm just tired at the end of this mission." "Maybe I am wrong, but I thought you ordered twenty and I gave you twenty." "The trouble is, here in Foya there was never a regular contact." "Nobody really thought it was their problem to make sure that I feel supported here." "It's a lot, I know." "But, if you see that we're using that much you're going to have to be ordering fifty/fifty then." "When you're trying from one end to communicate something, small gaps in what comes back really piss you off when you're sitting by yourself in a bush." "It really pisses you off." "Okay, so we need three hundred feet of steel rod." "Do you copy?" "Is it alright if you lie down, I press your stomach?" "I press very..." "no, please." "Okay, let him sit up." "It's alright." "It's okay, it's okay." "So this is one of the interesting patients" "I'm bringing Kiara back to see after." "His condition is one of just generalized swelling." "It could have been something like e-coli." "Associated with conditions like that, you can have Renal disease so, at least that gives me a course for current kidney disease and why it's so difficult to fix." "Yeah, I'm glad, I mean I'm, you know, I'm not glad, but..." "Yeah, I'm glad." "It gives me a cause, and it means that there's nothing I can do so at least I'm doing what I can do." "I'll..." "I'll see you soon." "I'll see you and I'll press your tummy after." "No one here that's trying to die at the moment." "Lady last night, she was really sick." "She died." "Nobody's that sick..." "that they're going to die today." "How long will it take you to go to Shella and come back?" "Inside of ten minutes, fifteen." "Okay." "Then you can carry the body there." "You go with Francis, you carry the body, you come back." "I'm very sorry." "I didn't know her condition very well but she was very sick, yeah?" "So we tried." "It was really clear to me from the beginning." "Patients would be dying at night and I wouldn't be there." "They'd be dying during the day and I'd have to be eating lunch." "I think the first two patients who died were the hardest." "Those two cases stressed me a lot at the beginning." "They stressed me quite a lot." "But after that, I think appropriately, I got more used to it." "It just becomes part of the work and you just try your best." "I compare myself to others and I wonder whether another doctor in the same setting would have had the energy or whatever, to spend longer with that patient, sleep less that night, and get more work done the following day than I got done." "And we need also a medical visitor at the hospital." "...what about the field coordinators?" "Some of them been there for a while?" "In summertime, they're always short in the field." "There's a call every summer for people in the head office to go out to field." "They're always happy to have one more person because it's always pretty... pretty heavy." "And also somebody who's done that kind of stuff." "You know, I've done it for a while." "I've been doing it for nine years." "Everyone who joins MSF as a volunteer has different motivation." "Some people do it just to run away from where they're from, and that's certainly my reason." "I've been away from Australia for a long time and when I go back I feel a bit like a stranger." "I don't have a home anywhere else really either." "So if I was looking to make myself homeless I think I've succeeded." "I've been trying to sort of digest and give some sense to what I've been doing the last nine years." "There's lots of stuff that really can sort of eat away at you as well." "I've been sort of running on empty for a long time." "I'm an anesthetist and..." "and my career at MSF involves war surgery, essentially, and then emergencies in... pretty much exclusively in war zones." "So, basically the idea of a medium term mission here is that these sort of different armed groups who are gonna keep on clashing and pillaging... and people not being able to access their food and their whole lives." "Yeah, and their fields." "So their children starve." "Security conditions are not the best, that's for sure." "Two nights ago, there was some gunshot right next to the MSF house." "Teams living under a curfew, I presume." "Yeah, after six it's dark, we don't go around by foot." "If we have a night like last night or the night before, then nobody moves." "There's been all these security incidents for the last six months." "Four or five MSF staff members have been almost killed in this place." "It means they had a gun to their head or shots fired at them." "Today, right now, it seems to be alright, but by tonight, we might be in a car driving like crazy because the situation's gone bad." "He's got an entry bullet wound here, an exit would here, it's taken off his ear, and the question is how much brain has gone with it." "It'd have to be some sort of local collection of blood in his brain for us to be able to help him." "That's about all we can do here." "But the chances of that being the case are quite slight and his coma's getting deeper." "The armed men came to the house at midnight and they said," ""Give us your money."" "So then they shot the father at pretty much point blank range in the head." "Well done, Mary." "He thinks it might have hit the brain, he's not sure." "It'd be nice to have a CT scan, but..." "The usual drill bits used for drilling into peoples brains are sort of rounded, so you can't, like, just sort of... fall through and into the brain." "In fact, it's not the best of drill bits to use for that." "The question is how much damage there is to the brain and that we won't really know." "Now we just have to wait and see how he wakes up, and what he's like." "And work without oxygen in the theater again, like yesterday." "It's tremendously frustrating here because it's low-grade medicine." "It's low-grade medicine." "We... we compromise with the way we do medicine." "It's not by negligence, it's by the forces of the context, this violence." "We are able to do things, but the things we are able to do are not as good as they could be." "When you decide as a doctor, "I can't do what I'm meant to do,"" ""I'm supposed to stop the suffering but this I can't do it,"" "Well, especially as a young bourgeoisie from the wealthy countries, you find it very difficult to do." "Yeah." "Yeah, just be careful." "Let's go away." "Let's go back towards the hospital." "Every war situation, you see the civilians that are all terrified." "You see some people who enjoy killing people." "Dr. Chris Brasher is an Australian doctor with Medécins Sans Frontiéres who is in Monrovia." "I spoke to him a short time ago." "In 2003 I was working with MSF in Monrovia." "Basically all the people being injured are civilians." "People ask me all the time "What is the international community doing about the situation..."" "That time was sort of a turning point for me." "People being carted around in wheelbarrows with big holes in them, blood all over the streets, no water, no electricity, no food..." "Pretty apocalyptic really." "Buildings getting peppered with stray bullets and occasionally with mortars." "People just getting randomly killed all the time." "Civilians." "Going to Monrovia in 2003, that was kind of what decided that I didn't have the stomach for it anymore." "So that was the beginning of me getting out of MSF." "So I have decided that this is my last go around at MSF." "Every situation MSF intervenes in is really humanly abnormal and bizarre." "That's characteristic of an MSF mission." "It's a crazy situation." "Here comes Chris, Giuseppe, the heroes!" "Hail!" "Oh yeah!" "Mmhmm!" "Mmhmm!" "Ahh, yes!" "None of this kind of touchy-feely..." "You're like, "fuck off" basically, you know." "That's basically how it goes." "You know, it's like, "fuck off," you know." "And so you're an asshole, an arrogant asshole." "So it is a question of making a decision that we... we stop." "How long you think you need to be there, first?" "I think that's the first question." "It's not a rich area." "For the Ministry of Health to be able to have the health facility in place, they need man-power, they need rehabilitation." "And this goes with, with, with time." "I think we need at least one year and a half." "Hello, baby Harry." "How long has he been on Cipro?" "Three days?" "When there is no emergency anymore, it is always like this." "It doesn't mean that there is no health need anymore." "But MSF will not be able to provide the same high standard of care forever." "It will not be able to do it." "Does it hurt?" "The fact that MSF is in some situations which are overwhelming is not because MSF is too small." "It's because the situation is overwhelming." "Cooper." "Give gauze, please." "We need something to wipe always, all the time we have to have something on the field to wipe." "Do you understand?" "I got it." "It's here." "Thank you." "When people is stressed and here in the hospital, it's very easy to get stressed." "They do not answer, if you want, for the best." "They do answer with a sort of stress answer." "When they get his x-rays, can they..." "When they get his x-rays, can they keep them up here for me?" "That is not for him." "Oh, it's not for him?" "No, they are not his." "...Because you guys showed me this and it was Babe and we thought it was" "Bebe and it was Babe... remember?" "So who is this?" "For example, for the expat is the fact of stepping back, not trusting the others enough because they don't know them, because many times they don't understand each other, because they have different backgrounds." "So, Mama." "Come and talk to me ma'am, I'm not a foreigner." "I'm a Liberian." "Surgical abdomen." "Lot of troubles; vomiting, abdominal swelling, terrible constipation, three weeks without going toilet, and now she's in this... in this condition." "And right now we have a case that somebody else is saying is a surgical case." "I say, "Yeah, maybe, but I'm not sure."" "She is stable right now and when she came in she was in shock and now I'm waiting for a surgeon's screening to see what he thinks." "Tom?" "You are arrogant." "You think you know what he has." "No, you are arrogant." "Why are you saying that about arrogant?" "You are arrogant." "This is why I can tell you because I know what I'm talking about." "Why?" "Why everybody think I'm arrogant?" "I'm not arrogant." "What happened is I'm not happy about the way people talk to me, okay?" "So tell your doctors to talk to me like a doctor and not like a small boy, okay?" "And don't tell me... approach me and say that I'm arrogant because I disagree with a diagnosis, okay?" "I was informed in the wrong way." "No, who informed you that I was arrogant?" "Who said I was arrogant?" "Did I treat the patient arrogantly?" "Did I insult anybody in the hospital?" "Or did I say anything that is, uh, out of place?" "I was informed in the wrong way." "I'm sorry." "No, I don't want coffee." "I want to be treated with respect, that's all." "She's such a high anesthetic risk right now that it doesn't look good for her either way." "If you did take her and put her to sleep, you have to be thinking about what it's going to be like afterwards." "So, you know, I want to help her but I don't want to be her executioner either." "If she's got some, you know, inter-abdominal catastrophe, then she's not going to survive without surgery." "There have been times where when I'd made some wrong decisions" "I became kind of paralyzed feeling like my decision making wasn't good." "If you're paralyzed by indecision, you can't do this job." "And so you have to be able to live with wrong decisions." "That's really hard to do." "Yeah, I just don't see one specific spot that's going to be benefited, so we're just going to sew a couple spots." "Is that the little girl?" "Yes." "Did you find anything?" "Yeah, she had, uh..." "What is it?" "A little antimesenteric border of the bowel, you know, little perforations in multiple locations." "Thank you, Tom." "Thank you, sir." "Thank you, Christelle." "To realize that in different situations these are people that you could save, and then to watch them die, it takes a real heavy toll." "Take deep breaths." "Come on, breath in and out." "Put your tongue out." "Okay, bring it out." "Bring it out." "Wheel her into the ICU." "The odds are still a bit stacked against her, but at but least she's got a fighting chance now." "All you can do is do the best you can and hope for the best." "This is usually a simple perforation." "This is a complicated multiple perforation that we've got here." "And this case is very typical, you have a lot of, uh... uh..." "I know, I find them in the book here, I've been waiting for one..." "You have many cases..." "This is rather like being thrown in with the lions in the coliseum." "I feel like I've still got so much more to learn." "I want to say cautiously that I'm enjoying it." "'Cause I..." "I feel good about what I'm doing." "I'd like to do it better." "She's not going back?" "Going back where?" "To the surgical ward?" "I don't understand." "She doesn't understand you." "Thanks, Pauline." "When did you get here?" "Ten days ago?" "You told me something like, "Oh, I can stay here for six months."" "Yes, I've changed my mind now." "Now I just want one night's sleep now is all I want." "So my recommendation on taking your time, and staying at home sometimes..." "Oh, and going to the beach and socializing a little bit." "I didn't say that." "Like when?" "Booth's looks pretty good to me, yeah." "I say we... and then we can say we didn't buy the cheapest one." "These are little groups and the social dynamics can get pretty strange." "In my interview, my interviewer asked me, "Well you know, sometimes, on some missions, MSF you know, they may like to smoke a little marijuana." "Is that a problem?"" "I was kinda like, "God I didn't know there was any left when I finished college at the University of Colorado."" "I thought..." "I thought we had depleted the world's supply." "When I was going back to Italy, the people was asking me 'how can you work so much?" "'" "Like, 'how can you work for so many hours, for so many days?" "'" "And it's just not a choice." "You take anyone, and put that person in that situation, and they will react in the same way." "It's the human answer." "It is not about being a good person." "It's not about that." "So what's the working diagnosis..." "what does John think that he has?" "Well John, uh, has more than this, but, uh..." "This is the wrong person's card." "This is the last time I'm saying it." "You come on duty." "You take hand of it." "You know all the patients." "You know all the patients." "Okay?" "No." "I'm deadly serious." "Yeah." "Okay." "If I come here, and you don't know the patients," "I'm gonna be really upset, okay?" "We've had discussions about stuff like this before." "And you know what I mean when I say "really upset."" "Let's go see the patients." "You know what the problem with Davinder, I think." "When you are first mission... okay?" "..." "you have no idea what a mission should be." "Twenty-six years old, left alone, managing forty national staff, an entire hospital... in conditions that are harsh in themselves." "All the members of the coordination teams are supposed to go on regular visits to the field." "There were a lot of communication problems, and I'm the head of mission." "So it was necessary for me to go to Foya." "Well the situation is that OB wash and reuse gloves." "I do IV insertion, blood taking, and dressings without gloves." "After asking all these things, and all of this delay in communication, problems I have with Eric, problems that the rest of the team has with Eric and the different members of coordination, you have worked in the field and you know that there's a limit" "where you just say, "Forget it, I'm fed up, right?"" "And maybe that limit for you is there and that limit for me is there." "I've passed my limit..." "What happened when you passed your limit?" "You just stop asking." "You just wash your gloves." "I'm sorry, I'm sorry, but I really insist on this." "No one of us was aware of this problem." "Which is logistical and medical." "I came to him to explain to me." "Now he say he doesn't want to do it." "You cannot say, why don't you do something." "I say, "Fuck, why didn't you do something?"" "You know, sorry, I give the whole bloody thing back." "But once, if it's not done, you don't want to discuss again about that?" "Yes, because you have to do your job." "Otherwise go somewhere and do your, do your inadequate job somewhere else." "You come to the field." "You come to Liberia." "You do your job properly." "Why do we need coordination if we just have to solve all of our own problems then?" "I do understand the anger." "The anger is good." "The anger is a part of the process." "But they are fighting the wrong thing." "If I am working in the middle of the war and I get upset, get angry at the war, because that is the reason for which you are there and that is the reason for which you don't have the surgical ward" "that you are supposed to have." "It's not MSF." "MSF is nothing within this." "You let me know what the problem is and I do my best in order to solve the problem, and we solve the problem together." "This is my solution and I don't have a better one." "And this is not a good ideal solution because we are not working in an ideal situation." "What else can I tell you?" "Other than telling you that I am sharing at 100 percent the frustration that you are feeling." "This is peace, love, happiness." "I'm really convinced that one of the problems for which people needs to have so much sex when they are on a mission is because they are facing very difficult situations that they are not used to." "Five, six, ten patients dying each day." "And sex is life." "He's telling me I shouldn't smoke." "Situations where people are less wealthy are often more human than situations where people are very wealthy." "And it kind of fits in that going to do medicine with people that are actually trying to help each other... is in some ways more rewarding than doing medicine in a country where people don't give a shit about each other." "Apparently five people died, little girl was shot in the arm." "So it just needs to be cleaned." "Her arm will work." "It doesn't seem to have hit any blood vessels or nerves." "So she was lucky in terms of her injury... not so lucky in terms of her family." "Most of the missions I've done have been in places where a lot of people you couldn't help, and you have to get used to that." "You know, you can't expect to turn up in some country where there's a lot of problems and be able to address the needs of the majority of people." "And that's why in some ways there are limits that MSF gives." "MSF makes sort of decisions about what the priorities are, and in some ways that's kind of reassuring." "But, it's really hard to swallow the first time you go out." "But Davinder, can you understand the difference between a shortage of one antibiotic among ten antibiotics choices, and the shortage of gloves." "I mean, this is a medical..." "When were gloves invented?" "What does that mean?" "Ahh, it means people..." "you can practice without gloves." "Sure, you can practice without gloves and you can take a lot of diseases without glove." "Davinder I think, he is really Kurtz;" "The Heart of Darkness." "Davinder was all alone, left in his kingdom." "He got crazy." "If you put a reasonable person in front of an unreasonable situation, getting crazy is the most reasonable choice." "I think this is what he has done." "Are you going to do a second mission after your first mission?" "Oh, uh, not soon." "And..." "And why not?" "Well, it's... it's the French, it's the way that MSF works." "There are lots of good things about it, and there are frustrating things as well." "I'm still very vague about what I..." "I'm planning, and, you know, I might come back to MSF for years and years and years or I might never do another mission with MSF or any other NGO, I don't know." "I'm still thinking about it..." "You're sick, Davinder." "You will come back for sure." "About two weeks ago, first his eyes got swollen, uh, his belly got big, and then he couldn't walk." "So he sat here and I've just scratched my head." "The swelling of the face looks like it could be related to the salivary glands, you know, your lacrimal, your parotid." "Maybe." "Brother, she'll just be examining you a little bit, uh?" "And if you look in the mouth, there's nothing?" "No." "I think I would start Prednisone." "Not because I'm convinced about the diagnosis, but because I don't have any other idea." "Alrighty, sounds good." "Thank you." "I'm sorry." "No, don't be sorry." "Well I don't..." "I don't know." "Okay, explain her now that they are going to do a procedure because he cannot breathe now." "Because his belly is getting too big and he is not able to breathe." "So it's important to take away some of the liquid so that he can breathe better." "Yeah, it's me, go ahead." "Okay, thanks." "So what do you want me to do?" "Alright, thank you." "Um, see you tomorrow." "Even if I thought he was going to die tonight, putting a needle into a tympanic gut is just going to kill him quicker." "But, I think he's absconded and he's never coming back, that's why..." "He's what?" "Absconded, left." "His mom has taken him and left and said," ""Well, okay, if the doctor thinks the condition is this grim, and I don't want the doctor to put a needle in the tummy, then I'll take the child and go somewhere else."" "And so she left?" "Yeah, she left." "I mean, that's what Juliana just said." "Well, it's... it's bad, but, you know I mean, let them go." "Like, I'm not offering them a lot." "No, but, really, ivermectin." "I could give them ivermectin..." "It takes a lot to surprise someone after six months here, so I wasn't really surprised." "The baby was just as likely to be there as it was not to be there, and I wasn't really going to be surprised either way." "Um, I was very glad and..." "I was very glad to see the baby." "It's gone." "What happened?" "When did it go down?" "How did it go down?" "The belly went down." "You've been farting." "You fart and you fart and... you'll feel more comfortable." "You, you've had so many more missions and so much more experience than me, and if you really think that that patient can be helped in Monrovia, then that's fine." "Yes but why do you get upset?" "It's because I'm at the end of my mission, it's because yesterday you stood up and left after discussing a patient... in a huffy sort of fashion... and didn't explain after..." "The reason for which I was so upset is that to me, listening to a doctor saying," ""It is better for the patient to leave than to stay with me."" "This is something I cannot accept." "Either you are too tired or frustrated or you faced too difficult a situation or whatever, but you have lost the confidence in your being a doctor and this to me is not acceptable." "Okay, there's... there's obviously a difference between how we feel about things and how we practice medicine." "Which is good, and you..." "It's fine, yeah." "It's a shame that you thought that I had such an extreme view last night and I think that it was because you were tired, I was tired, and because you jumped at conclusions way too fast and..." "Sorry." "Well, it doesn't bother me, I'd just feel embarrassed if I was you." "L..." "I would say I was sorry for walking away and not bringing it up, and Davinder it is good that even you brought it up now because..." "I'm bringing it up..." "No, I brought it up." "And Davinder it is good that you brought it up, you were still the first person to bring it up even though it was twelve hours later, you were still the first person to bring it up, and I should have brought it up first." "That's how I would have said it." "But, you don't have to say it that way, it's just how I would have said it." "I mean that's how I think I would have said it," "I probably wouldn't have said it that way... but, I think I would have said it that way." "Sir, how are you?" "How are you sir?" "I'm Davinder, the doctor." "And you can cough?" "No." "What are you thinking Victor?" "Can I call this kid, um, typhoid or not really?" "Is that stretching it a bit?" "What do you think he has?" "This one?" "This man?" "Yes." "MSF wants to keep a minimum of fifty percent of first mission." "To me what's so frustrating is the fact that when I spoke to you the first time, you kept me awake until 2 o'clock in the morning making me questions about HIV treatment and why don't we do this" "and why we do that and it was so good, it was terrible obviously..." "You were laughing at me." "I was laughing, but as much as I was laughing," "I was so glad inside about the fact of having someone with that talent, that can give so much input in what the mission is and wants the mission to evolve and wants things to be changed." "The fact of seeing this innocence spoiled and maybe by me as..." "as well in part is..." "Is very..." "is very upsetting." "This is just to let you know that I would like you not to lose the reason for which you've done the first mission because the first mission was not a good one." "And I don't think you have to worry about that." "I haven't lost that..." "I mean..." "I don't think I've lost that reason." "We'll see." "Basically all the emergency operations we did this week, all those people would have died without surgery." "Those war-wounded patients would be dead." "The women who had cesareans, they'd be dead." "So would Dada, she would have died of infection." "And similarly in the wards, it's all the people who got good treatment for malaria, all the malnourished people in the therapeutic feeding center..." "They would have all died." "Yeah, they..." "Good results, good results." "Basically if he's not breathing we can't keep ventilating by hand forever." "So we're giving him, well it'll be an hour in total of resuscitation." "If that doesn't work then we'll stop." "So it's not really nice combining futile resuscitation and patients coming in to the theater and other one's waking up from anesthesia." "I forgot to have breakfast." "I said how's it going, he said fine." "He's actually breathing a bit." "Hopefully the oxygen will keep up the oxygen level in his blood and I feel he might survive, which would be a minor miracle." "Just hang in there." "I mean it's not everywhere we do that in MSF but, uh, here we can reanimate him, intubate him because we have the anesthetist." "The guy that we were resuscitating died." "Did he?" "Yeah." "He was breathing a bit better and we just put an oxygen mask on him and then he basically had another arrest and died." "He lived for a lot longer than I expected." "It made life very difficult not having any oxygen for the anesthesia for the whole day." "He's a chronically sick patient." "He's been sick all his life." "Yeah." "Good morning, chop chop." "Dr. Gwenigale." "Going?" "Yes I'm going unfortunately." "How are you doing?" "So you're tired of Liberia already?" "No I'm not actually." "I would really like to stay for much longer." "But MSF has limits and problems as much as..." "At the Mamba Point facility, many people go there for treatment and we know that they are doing a good job there." "So we hope that will continue, we thank you people for it." "We really feel the need at this point to have an exit strategy that would allow both to the governmental structure to be able to take over and... for example... to MSF to be able to leave without leaving any vacuum." "Mamba Point Hospital will close down." "There is no way they are going to keep it open." "It's terrible because as a doctor you never want to refuse a patient who needs care." "It is unfair." "Refusing someone is unfair." "The problem is an entire country with no health system whatsoever." "And here in West Point, it is the major issue today." "My frustration is the fact of thinking that... not intervening in a situation in which you need to intervene, it's a criminal mistake." "To me it was not acceptable..." "The... responsibility of having MSF committing a criminal mistake." "In the beginning, I felt very good about everything I was doing." "And now I just don't feel good anymore." "When we decide to end the mission we leave the people we've come to help in the worst situation." "It has to happen." "It's not there forever." "It has to happen one day." "It's never easy but you get more used to the idea." "The first time you do it, like the first time you go on a mission, you think it's, you don't think about those kinds of things." "You think, you think it's..." "secretly, that it's forever." "But it can't be." "Once a crisis has abated, what are you actually trying to achieve?" "Are you trying to fix the normal?" "So you make choices that are tough choices to make, but... you have to make them." "You have to say sorry to all these people all the time." "They're going to go back to the life of the average sub-Saharan" "African existence which is pretty hard." "Normal's not good but MSF has never been pretentious enough to try and think they were going to have an overall impact on health." "It's a drop, tiny, tiny drop in a sea of oceans." "So, dependant on..." "on the context and the general sort of... wealth in society and the political stability that, you know, those are things that you can't fix." "Or I can't fix anyway." "I'm very honored for having been a part of this until now." "Unfortunately I will have to leave soon and I hope I will see all of you at the party." "I don't have a question but I just want to compliment..." "Before you compliment, I would just like to say in this public manner;" "thank you to the entire staff that I have been working with for the past three years." "Now we will be getting a new head nurse." "I think I was supposed to have been consulted to say who I felt in the supervisor group will take my position." "That's the right procedure." "I was not." "Do any of you think that I've been consulted in order to decide who will take the place of head of mission after me?" "You are an expat." "So you're position is different from my position." "It's all together different." "This is my home." "I am not going to go to any other place." "I am not an expat." "You come for a certain time, then you leave." "But with us, it's different." "You always have choices, no?" "I mean, Paris called me and they told me to come back, and I could have said, "Fuck you."" ""I don't take that plane."" "I knew my level of energy and I knew that I could have stayed longer." "Well it's nice not to see anybody with any guns." "It's nice." "Well, it looks a lot better than it did." "Looks a lot better than it did." "But what's really nice is just seeing all this activity and people going around, and they're not scared." "It's not how things were during the war, obviously." "I'd say that I'm happy about the decision of having worked with MSF despite the sacrifices and the costs of that decision." "Well, I missed, you know, important things, you know people dying, people getting married in my family and friends." "And it's a real priority for me now, leaving MSF to re-anchor myself somewhere." "And maybe its just phases in life." "Working with MSF forever in the same place?" "No, that doesn't work." "But, I've been living in that place for more than fourteen months, committed myself so much that it sounds very unnatural the fact of just stopping." "It doesn't sound right." "Tomorrow night, you will come to the party?" "Yes." "Yeah." "Okay, good." "See you then." "Thank you." "Isaac, you come to the party tomorrow night, yeah?" "I don't want to see you leaving this place." "I don't want to leave either." "So how is everything?" "Not bad." "Not bad?" "You are going to the party?" "Well, it's my party." "We'll have to have you dancing." "Okay, you'll have me dancing." "Thank you." "Bye." "Okay, thank you again." "I like it a lot." "And, I will go back to Europe and I know people will be very jealous about this, so thanks a lot again." "There are two mixed levels." "One level is the attachment that anybody will have towards a place in which you've been, and the other is the nonsense of... of not doing something once you know that something needs to be done." "You're driving somewhere and you have a car crash happening in front of you, you have the duty of stopping and doing something." "And Liberia is a huge car crash." "Big, big car crash." "And once you get rest, you know that it's not about Liberia." "It's about Congo, Sudan, Pakistan, Darfur... wherever, lots of places." "Car crashes everywhere." "But still..." "Am I going to do this forever?" "I think I wanted to prove to myself that the conflicts are real and the people are just normal people." "They just no different to you or I." "And, and that most of the people in the world have a pretty rough time getting through the day and the week and the month and the year." "And I couldn't really be sure how real that was until I lived with it." "And now I have." "And my attitude's very different than what it would have been if I had stayed at home." "So I won't be exactly the same." "I won't have the same priorities as I would have, if I hadn't of done it." "I think sometimes you have to leave what you're doing in order to find out what it is that's missing." "I would like to do more, and I'm ready for more and more of a commitment." "And I realize that this stuff still comes out to being a very selfish thing." "Somehow fixing other people seems to fix yourself." "That's what I found out, so, it's how I fix myself." "I can't solve the world's problems, and they're not going to be solved." "So, you have broken people, just put them back together that makes sense to me." "Subtitle Rip;" "TheHeLL"