From Publishers Weekly
This mostly admiring portrait of Doctors Without Borders/
Médecins Sans Frontières (aka MSF), the nonprofit that won the Nobel Peace Prize in 1999, emphasizes the inner workings of the organization and is animated by interviews with mid-level staffers and by site visits to MSF projects in Angola, Afghanistan and Pakistan. In between, journalist Bortolotti traces the history of the world's largest independent medical humanitarian organization, whose genesis was the Biafran horrors of the late '60s. Histrionic founder Bernard Kouchner (whom Bortolotti didn't interview) left the group in 1979 after disputes about tactics; not until the early 1990s did MSF spread to North America. Only about a quarter of field volunteers are, in fact, doctors, and most staff are local hires rather than foreigners. MSF volunteers resist being described as heroic ("It's not noble; it's an
attempt," one says) but acknowledge that the crucible of crisis does test character. Some stories (illustrated by stock-looking photos, including two color inserts) are grimly poignant: a middle-aged surgeon tells of relying on his lower-tech training to perform surgery in Sri Lanka and Liberia; a logistician describes how to negotiate with drugged-up child soldiers at a Sierra Leonian checkpoint. While Bortolotti could have been clearer, for example, on the mechanics of MSF's fund-raising apparatus, he notes that even critics of humanitarian aid admire MSF for attempting to intervene under seemingly impossible circumstances.
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From The New England Journal of Medicine
In 1971, I was 10 years old and growing up in Brooklyn, New York. I was never a good eater, and the summer of that year was no different. Every dinner at the small dinette was an interminable ordeal punctuated by my mother's insistent plaint, "Eat, Jerry. Don't you know there are children starving in Biafra?" Indeed, I did not know. Where was Biafra? Now, as I sit reading at my own dinette 33 years later, the Biafran crisis again rears its ugly head. It was partly in the flames of that conflagration that the humanitarian organization Doctors without Borders was born, a group that is the subject of Hope in Hell. The book describes the early history of Doctors without Borders, also known as Medecins sans Frontieres, and goes on to track the group's sometimes tumultuous internal political history as it developed into an organization that received the Nobel Prize in 1999 and became renowned for its accomplishments in numerous human disasters. Some attention is also paid to the mechanics of the association, from its organizational structure to its innovations in the field of disaster relief. These advances have allowed Doctors without Borders to respond faster and with more efficiency than do most other relief organizations. (Figure) The group's method of fund-raising -- primarily through private donations -- is contrasted with the methods of other organizations, which rely on large gifts from the United Nations or national governments. The different sources of funding in part explain the brash outspokenness and, some would say, self-righteousness of Doctors without Borders when the group decides that a certain situation is contrary to the accepted mores as it perceives them. Doctors without Borders uses the French word temoignage, or testimony, to describe such witnessing, and this advocacy has brought it into conflict with the various groups within the organization as well as with other relief organizations and sovereign nations. The criticisms that have been leveled at Doctors without Borders, partially as a result of temoignage, are discussed in Hope in Hell, although not in great detail. Nevertheless, Bortolotti's critique is consistent with his factual and objective portrayal of the group. There is very little hyperbole, which allows the reader to see the manifold ethical controversies inherent in war and charity. Most of the drama in the book appears in interviews with the group's field workers at various levels, including doctors, nurses, project coordinators, and can-do logisticians. These interviews describe life in the field well and bring out the complexities involved in human devastation and the response by Doctors without Borders. It is in the considerable space that Bortolotti gives to the emotions of the group's staff members that the book really shines. Having been on a mission to Afghanistan, I found Bortolotti's account, through his interviews, of the sentiments of volunteers while they were in the field and, even more importantly, after they returned to be authentic and inclusive. It was validating in a way that only confirmation of shared experience can be. The poignancy of the stories of volunteers, coupled with a revealing account of the inner workings of Doctors without Borders, makes this book informative and touching.
Jerry R. Dwek, M.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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