Motivations and Mentalities

I am really not convinced that I would want to work again with an international humanitarian organisation.  The subtitles on this photograph from a documentary on Vietnamese history explains why in a single brief sentence.

Vietnamese Inferior

Before I applied to Medecins Sans Frontieres, a friend told me of a mutual acquaintance who returned home to Australia unhappy with her MSF experience because “she had to live and work with French people who were horrifically arrogant”.  It sounded like a stereotype and I gave it little credence.

Five years on I have French friends, who were not arrogant and did not treat others as inferior.  I have visited France in that time and met friendly people and been welcomed into their homes and lives.

That aside, the general perception I developed from within a French-run international organisation is one in which a certain proportion of people who do consider themselves as superior, are able to travel to other countries for humanitarian reasons, at least on paper.  They are ensconced in positions of power and able to behave as colonialists over the local population and, to a lesser extent, non-French expatriates, who they perceive earnestly as their inferiors.  I expect this may not be specific to the French, but my experience was specifically French.

Some examples of the experiences I had include:

  • A doctor whose introduction included informing us repeatedly that her father was the mayor of her town.  This meant nothing to me until at least a year later when I watched a French comedy, The Belier Family and learned that French mayors have social status.  Part of her overt disapproval of me was highly likely to do with my lack of appreciation that to be the mayor’s daughter was to be someone important!
  • This same doctor, when informed by management that she was not entitled to the extra day off she had requested, informed me emphatically of her outrage which included, in the presence of a local colleague with fluent English, that “I am not just some local ‘oo ‘as no choice!  I am ‘ere as a ‘umanitaaaarian and they should look after me”!!
  • A young doctor who preferred not to speak to the non-French, non-medically trained expatriates and literally held her nose in the air at us whilst keeping her lips determinedly closed for some months.  This was quite some feat given our repeat attempts to engage with her over meals at the house we shared together or shared bicycle rides through villages.  I have one single memory of her speaking to me in more than a monosyllable, in which she informed me that her husband was a surgeon and her friends were dentists.  Arrogance does not make for riveting conversation, that’s for sure!
  • I have become passionately anti-selfie after watching so many expatriates take selfies alongside impoverished locals who often don’t know anything about social media, and have not given informed consent (or even any consent) to have their identities plastered over the internet.  This includes seeing expats put their cameras right into the face of complete strangers without even thinking about asking permission.
  • A nurse who spent a significant amount of time on an impromptu and lengthy lecture to a group of local doctors, some old enough to be her parent, of the ways in which patients can be spoken to in order to extract relevant medical information.  The humble locals sat in agreeable silence.  This nurse also sent an email to a group of doctors in which, to get her point across, she used capital letters by way of ORDERING A COMMAND.  This same nurse informed a local doctor who described a patient as being “in severe condition”, that the patient was in fact, not in severe condition at all.  The patient died within a few days.
  • A French doctor during a meeting offered to share a particular medical article to two doctors and a French, non-medical manager.  When I asked if he could also email it to me, he looked me up and down slowly, scoffed, and moved on to the next agenda item.  Suffice to say the article was never shared to me.
  • Another non-French expatriate I worked with was horrified to learn that a French nurse who had openly intimidated local staff, and been challenged a number of times on her unacceptable behaviour, left the Cambodian assignment and was promoted in her next assignment.  My colleague exclaimed that she couldn’t believe this person was able to remain employed, let alone receive a promotion.

In general, local staff are given no authority and are disciplined strictly should they get anything wrong.  Conversely, French staff can be significantly less qualified and experienced but will always hold higher positions within the organisation than their local peers.  Should French staff make mistakes or even significantly misbehave, they are perceived as being reasonably free from repercussions and in fact, able to climb the hierarchy.

I learned a lot about “humanitarianism” during my time with MSF.  It taught me about my own ego and the need to constantly self-reflect on my thoughts and behaviour in an environment where I have more power than local staff despite not having any contextual knowledge or insight.  Often my experience was limited in comparison to locals who were highly familiar with diseases of high prevalence and local management and issues, but which I had only learned about in books and study.

I could always return home and find work – which I since have.  Locals don’t have this privilege.  The prospect of long-term unemployment is a real and ever-present threat even to people with medical degrees, PhDs, multiple degrees and extensive skill and experience beyond anything most of us in the wealthy world can imagine aspiring to, because we don’t need to have such high aspirations for our mere survival or security.  The micro-economy of impoverished nations is a foreign phenomenon which those of us from wealthy nations can barely comprehend.  Even when we live in this micro-economy we don’t experience it because we have comforts and security external from it.  The impact this has on the power between locals and foreigners is difficult to describe.

At the same time as I was developing my own perceptions of the humanitarian world and it’s paradoxical complexities, a scandal erupted in Haiti where international staff with Oxfam were found to be exploiting locals.  The scandal has been identified by many as a predictable result of international staff not respecting locals in an environment of unequal power distribution between impoverished and vulnerable locals, and the “white saviours” who come to “help”.  Unsurprisingly it has also been shown as a widespread phenomenon across international aid agencies and across the globe.

MSF published a statement at that time, announcing an unequivocal commitment to fighting abuse and confirming that 19 staff across all of their projects had been dismissed on grounds of sexual abuse in the past year (2017).  Whilst this is a sound commitment to make, it does not address the underlying root of the problem, being an unspoken power imbalance which is easily embodied by both expatriates holding management positions and living in comfort in an impoverished environment; and locals who rely on the NGO for their employment prospects.  Counterbalancing this dynamic relies fully on the curiosity about local context, and the self-reflective inclinations, of the dominant foreigners.  Many have zero such inclination.

Afua Hirsch speaks for me when she says “I’ve seen for myself how agencies operate, and the toxic and exploitative relationships that can so easily develop“, in her article on the history of the aid industry’s white saviour mentality .

This short video How Not To Be a White Savior touches on the subject as well.


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