MSF Mission In Rukum

Back in 2002, during the height  of the armed unrest in Nepal, a Frenchman by the name of Yves Lallinec could  be found wandering the hills of west Nepal, in the heart of the conflict area.  This was not a journalist looking for a scoop, a misguided tourist or a dedicated development worker, but a man on an assessment mission for Medecins Sans Frontieres (MSF- in English, ‘doctors without borders’).

Typical of this organization, it was a low-key trip which did not result in colorful reports and brochures and reams of paperwork. Rather, the result of this trip was simply MSF recognizing a need for its services in mid-west Nepal, and making an entry into the area to impart the services it could. MSF operates in many countries around the world where it sees a need for humanitarian work. In this case, MSF (represented by Mr. Lallinec, who later served as the first country director of MSF in Nepal) started to provide medical relief in this remote area of Nepal.

A very interesting and unusual aspect of MSF is that in this organization, at least eighty-nine percent of all expenses are directly related to fieldwork, with seven percent set aside for fundraising activities and the remaining four percent making up administrative and running costs. MSF has consistently met and often bettered this figure, serving as an example of responsible fund management to other international aid organizations. It is also a very independent organization in that it always tries to steer clear of political agendas or being manipulated in any way. It maintains this ability, in part, through insisting that at least eighty-nine percent of its revenues come from private sources and only the remaining eleven percent is allowed to come from institutional donors. Another aspect of MSF that contributes to its success is its unerring focus on its humanitarian role, and its unshakeable stand that it be allowed to carry out its medical mandate without any kind of interference.

In terms of its economic efficiency in carrying out its operations, Atul Gurung, Assistant Coordinator of MSF here, says that Lallinec and his team  operated with just the basic necessities and consistently focused on their work of providing relief, rather than on their own comfort.  Atul recounts that on their field trips, they are okay about sleeping in cowsheds (country director and all) and eating whatever food is locally available, as long as they can reach the people that need their services.  This is also true of the current country director Marie-Laure Le Coconnier and her team. Their office in Kathmandu is a simple setup with only the most basic necessities, with most resources being directed to the field. This he says is a rare quality in most international aid agencies in Nepal, or even the world over.

In 1999, Medecins Sans Frontieres was recognized for its outstanding work by being awarded the Nobel Peace Prize. It is one of the few institutions working in Nepal to have received  such an honor. In the presentation speech, Professor Francis Sejersted, Chairman of the 1999 Norwegian Nobel Committee, described MSF as an organization that “...has blazed new trails in international humanitarian work. The organization reserved the right to intervene to help people in need irrespective of prior political approval. The essential points for Medecins Sans Frontieres are to reach those in need of help as quickly as possible, and to maintain impartiality. They demand freedom to carry out their medical mandate, and to decide for themselves whom to help according to purely humanitarian criteria.” He went further to describe them, complimentarily, as  “…emergency aide rebels”.

Rebels they may be, but their work does stand out, not in terms of gross effect on the population of Nepal, but in terms of the methodology of their operation. Among the cases they took up was that of Govinda Bishwokarma, 9 years old, of Ganaghat in Rukum district, who had severe facial trauma and injury to his neck. His state reminds us of the plight of the people in rural areas living in abject poverty. Govinda fell from a tree while trying to pick some wild fruit. His fate could have been quite different had he not come across the “Amrikan” (for him any white person is American!) who rescued him by bringing him quickly to Nepalgunj Zonal Hospital and then to the Teaching Hospital for a major operation. Here he has received, as his mother says, a new life.

This, and the myriad other cases the small team of MSF has been able to provide succor to, may not represent quantitative gains, but they are important qualitative efforts.  Govinda’s widowed mother of six says, “I would never be able to manage this kind of treatment for my son had they not come in.” She is all praises and gratitude for what MSF did for her son.

Besides its humanitarian medical work, MSF also draws attention to humanitarian catastrophes and human rights violations when they come across such.  For this reason, the organization has often been unpopular among certain parties in various places, but its impartiality has won the organization respect across the world - including in every place they have worked.

Based in France, MSF was formed in 1971 by a small group of doctors and journalists. At that time, nobody, not even its founders, had ever dreamt that it would spread out to more than seventy countries across the globe. Rising above political, religious or profit motives, MSF reaches out wherever and whenever there is need, providing medical services and logistical support as well as food distribution and rehabilitating the displaced. MSF has operated in areas hard-hit by conflicts, famine, natural calamities and epidemics. It now stands among the most revered humanitarian organizations in the world.

“What we believe in is pure service. No political or religious motivations have any room in our mission,” says Marie-Laure Le Coconnier, current MSF country director to Nepal. Marie is of the view that MSF is an organization with a difference. Unlike many other INGOs, MSF does not accept donations from governments and political organizations, hence is not beholden to their interests. MSF medical staff, who for the most part join the service on a purely voluntary basis, work with the minimal benefit the organization can afford to provide.  From African famine-hit areas to war zones in the Middle East, MSF has been fighting a battle of its own kind - which is to provide medical assistance to people trapped in situations of crisis.  Not only the service they provide, but an unbending dedication to their profession and  a willingness to shoulder physical risks have won them high accolades. “MSF volunteers are qualified personnel familiar with the requirements of the job, and the risks involved,” says Marie (who served in the conflict zones of Angola before she came to Nepal) with pride. She also notes that though they are all volunteers, the are all given a very basic stipend to compensate for the work they leave in order to serve with MSF.

Why did they choose Rukum in Nepal? Marie says it was one of the most conflict-affected districts and the problems were many (some caused by the Maoist conflict, others endemic) that called for urgent proactive measures. “We have noticed that there are many districts which in no way can be called better off than Rukum, but we can only reach out to limited areas. As of now, our understanding and knowledge of the needs are limited to that area, so we decided to base ourselves in that district for now,” Marie says.

Reeling under poverty and neglect exacerbated by the Maoist conflict, the people of Rukum have been deprived of many basic facilities. To date, the government has been unable to address the major problems facing the people, including a high illiteracy rate and lack of access to medical care. For the last two years no doctor has stayed in the district hospital irrespective of the fact that the district hospital is allocated doctors and they are sent to Rukum, forthe job. Forty-three health posts exist in the district, but hardly any of them are equipped with health workers and necessary medical supplies. People are unable to afford the costs of going to Nepalgunj hospital or other cities for better treatment. Many times, minor diseases take a heavy toll, not to mention the suffering (including injuries) of innocent people, who are mostly women and children, due to the recent conflict. Epidemics are a common phenomenon as well.  MSF has been providing unbiased assistance to anyone who comes to them, regardless of political or other affiliations. “If anything can make a difference, howsoever little, it is the MSF,” says Man Bahadur KC, a college student from Rukum.

Altogether one doctor, two nurses and a logistician administrator have been deployed in Rukum by the MSF. A pediatric doctor, a nurse and the logistician administrator are stationed at the Rukum District Hospital working in close association with the health ministry officials, and they also plan in the future to visit the health posts in the far-off villages of Rukum. “They are doing their utmost to improve the health condition in the area and provide food and logistic support to the needy,” reports Atul Gurung. He describes the MSF team as working like a family, and says that unlike in large hospitals and government health care centers, the MSF staff genuinely get close to their patients and manage to give a personal touch to all their work – something that the patients appreciate as much as, if not more than, the medical care.

“We do not claim that whatever we have done is big enough to make a significant change in the overall health scenario in the district, but whatever little service we can provide we are proud to do that,” Marie maintains with frank sincerity.

MSF states that there has been no obstruction to working in Rukum from any side. “As we provide service to all without reservations, neither the Maoists nor the government forces are opposed to our modus operandi. In fact, we have received support from all quarters,” Marie says, happy to be serving this beautiful but troubled country.  She hopes that MSF will be able to continue its humanitarian mission for the people of Rukum and Nepal.