At its inception, my sociological quest to know and understand Doctors Without Borders / Médecins Sans Frontières (MSF), out of which this book grew, was given intellectual and moral impetus by three inspiring individuals: Willy De Craemer, Jonathan Mann, and Ernest Drucker. Albeit in differing ways, each of them had been involved in firsthand humanitarian action to which he was strongly committed, while remaining keenly aware of the dilemmas it posed, its limitations and imperfections, and the unintended harm it could cause.
Willy De Craemer, a fellow sociologist and a Jesuit priest, was the one with whom I had the closest professional and personal relationship. In a missionary capacity, he had been a teacher and the director of a center for sociological research in Congo/Zaïre, where he initiated me into the social and cultural worlds of Africa south of the Sahara, and of the Catholic Church–affiliated personnel who worked there.1
Jonathan Mann was a physician, renowned for having uncovered the existence of an epidemic of HIV/AIDS in sub-Saharan Africa (from a base in Zaïre), for his international battle (as first director of WHO’s AIDS program) against the pandemic it became, and as a leading figure in linking AIDS and global health with social problems and human rights issues. He was also a founder of the American branch of Doctors of the World (the humanitarian organization that resulted from a schism in Doctors Without Borders).2 We became acquainted through these links, our respective publications, and our Harvard connections. (After his term with WHO he returned to the Harvard School of Public Health, where he was director of the International AIDS Center, and of the Bagnoud Center for Health and Human Rights.)
For twenty-five years, the psychologist Ernest Drucker was director of Public Health and Policy Research at the Albert Einstein College of Medicine’s Montefiore Medical Center in New York City. Throughout his career his policy-and human-rights-oriented research, conducted in Africa as well as the United States, has centered on drug addiction, the reduction of drug-related harm, and the relationship between drugs, crime, HIV/AIDS, and “mass incarceration” (which he regards as an epidemiological, plaguelike phenomenon.)3 In the first phase of my research when I was considering making a comparative study of Doctors Without Borders and Doctors of the World, it was Drucker, at that time a member of the board of Doctors of the World, USA, who arranged for me to become a participant observer in its New York City office.
Willy De Craemer died from complications of Parkinson’s Disease in 2005. Jonathan Mann perished in 1998 in a Swissair crash, en route to Geneva to participate in global strategy sessions on HIV/AIDS, sponsored by WHO and the UN. Ernest Drucker, an emeritus professor, is still involved in humanitarian action and advocacy. I shall always be thankful to each of them for encouraging and aiding me to undertake a study of MSF, and for infusing it with added meaning through their example.
I am profoundly grateful to the members of MSF for the unreserved access they gave me to their lived experiences within their organization/movement—including to their questions and disputes about the humanitarian action in which they are ardently engaged. They are likely to say there was nothing exceptional about what they willingly shared with me—that it was in keeping with MSF’s culture, its commitment to transparency and critical selfexamination, and its conviction that “ideas matter for action.” Nevertheless, I hope this book will demonstrate to readers how remarkable, and in many ways admirable, these attributes of MSF’s culture are, as well as how vital to the research I was able to conduct.
I am especially grateful to members of MSF who have been important teachers, exemplars, providers of key information and documents, and sources of emotional and moral support. They include Eric Goemaere, James Orbinski, Jean-Marie Kindermans, Alex Parisel, Jean-Hervé Bradol, Ulrike von Pilar, Unni Karunakara, Nicolas de Torrente, Revka Papadopoulou, Sharon Ekambaram, Hedwige Jeanmart, Alexei Nikiforov, Andrei Slavuckij, Kenneth Tong, Stephanie Short, Fiona Terry, Rony Brauman and, through the medium of his brilliant cartoons, Samuel Hanryon (“Brax”). The parts that some of these persons have played in MSF are chronicled in the body of the book.
In addition, along with other MSFers, some of these individuals performed crucial roles in reading, commenting on, and when necessary correcting, the contents of the book’s chapters. All of its chapters underwent this kind of scrutiny and review by the principal persons who appear in or are relevant to them.
In a number of ways writing this book has been a collective process. Throughout its course, I have not only been surrounded by members of MSF, but by a bevy of friends and colleagues, and also some of my former students, who were indefatigably interested in the book, and in how it was progressing. Among them were Peggy Anderson, Isabelle Baszanger, the late Robert Bellah, Evelyn and Solomon Benatar, Harold Bershady, Judith Brown, Pamela Bump, Nicholas Christakis, Anne Fadiman, Tovia and William Freedman, Gail and Allen Glicksman, Mark Gould, Jonathan Imber, Jan Jaeger, Carole Joffe, Robert Klitzman, Gail Kotel, Victor Lidz, Kenneth Ludmerer, Mary Ann Meyers, Keith Robinson, Olga Shevchenko, Neville Strumpf, Judith Swazey, Emiko Ohnuki-Tierney, Jan Vansina, Lydwine Verhaegen, Renée Waissman, and Yves Winkin.
Several persons in this local, national, and international entourage carried out tasks that were indispensable to the development and production of the book. Foremost among them was Olga Shevchenko, who coauthored the chapters that deal with MSF’s missions in Russia, and who played a capital part in collecting and analyzing the field data on which they are based. Nicholas Christakis helped me to comprehend the cultural meaning of the existence of a section of MSF in Greece and to conduct interviews in Athens with members of its staff. He also enabled me to climb the hill to the Acropolis, from whose panoramic summit I contemplated the import of Greece’s ancient history. Judith Swazey, my companion in much of the medical sociological research that I have conducted since we first met in 1967, made several journeys into the field with me: to MSF’s “La Mancha” meeting in Luxembourg, to its fortieth anniversary meeting in Paris, and, once, to its HIV/AIDS program in Cape Town, South Africa. She brought the astute observations that she made in those settings, along with her usual combination of intelligence, candor, and kindness to her reading of the penultimate drafts of most of the book’s chapters. In addition, her “wordsmithing” helped me to craft the book’s title. And notwithstanding the arduousness of checking the book’s references and bibliography, obtaining permissions for the inclusion of certain materials in it, proofreading its text, and constructing its index, Judith Watkins was enthusiastically insistent about taking on these assignments, to which she unrelentingly applied her consummate skills as an information specialist.
Dr. Natalia Nikolayevna Vezhnina does not fit neatly into any of the foregoing groups of persons to whom I am indebted; but in common with them, she made an essential contribution to the book. She is a Russian physician who is a central figure in the chapter on MSF’s tuberculosis project in the prison colonies of Siberia. The detailed oral history of the project and of her relationship to it that she generously and courageously related to Olga Shevchenko and me was indispensable to writing that chapter.
This book had a master editor—Jack Beatty. He had been described to me by those who knew him as a highly “admired editor,” who was very “smart,” “talented,” “well-informed,” “sophisticated,” and “deep.” He brought all these qualities to bear on the editing of my book, along with personal warmth, gusto, and vigorous, forthright opinions about my writing that were also flexible and open-minded. I had been told that he had only one “imperfection”: his notoriously “terrible handwriting.” This proved to be true. But I did not have much trouble reading the valuable notes that he scrawled all over the pages of my manuscript.
I would be remiss if I failed to mention that my author-editor relationship with Jack Beatty was made possible by another outstanding editor—William Whitworth—whom Beatty considers his mentor, and on whose staff Beatty worked as a senior editor during Whitworth’s distinguished tenure as editor-in-chief of the Atlantic Monthly.4 Whitworth edited my autobiography. He was the first editor, and the only editor—other than copy editors—I ever had for the books I previously published.5 He was not free to undertake the editing of this book, he told me when I consulted him about it; but he recommended a short list of alternative editors to me. At the top of that list was Jack Beatty, whom he contacted on my behalf, and with whom he said he would “put [me] in touch when the end of [my] book was in sight”—which he did. I am sure that having William Whitworth as my intermediary was a determining factor in Jack Beatty’s assenting to become the editor of this book. And so it is to both of them that I express my appreciation for this good fortune.
The sorts of contributions that two other persons made to writing this book and readying it for publication should not be underestimated. Initially, I was overwhelmed by the volume of field data and documents about MSF that I had amassed during the years of my research. How to organize them in a way that would make it easier to find the material I needed at specific points in the writing process was a daunting challenge. It was Yizhar Gilady, a personal assistant, who helped me create a set of files that enabled me to do this, to consolidate the books in my library that had bearing on MSF in particular and humanitarian action more generally, and to locate the files and books together in a small room in my apartment designated for them. The results of his efforts were so impressive that I felt it entirely appropriate to affix a special sign to the door of that room reading: Archives.
Jeff Katz, an information technology (IT) specialist, did more than keep my computer in working order as I typed the pages of this book, communicated via e-mail with MSF informants and respondents, and searched on the Internet for additional data and to fact-check some of the data I already had. He also set up a system on my computer to file and safeguard the unfolding chapters of the manuscript and to store the photos and cartoons I had collected as potential illustrations for the book. He accompanied these tasks with supportive therapy for an anxiety-ridden, marginally competent computer user like myself, who has little understanding of how computers work. And at one crisis-ridden juncture he rescued me, psychologically as well as technically, from a computer crash that had imperiled the entire manuscript of the book.
Kenneth Ludmerer took the initiative of informing Jacqueline Wehmueller, executive editor at Johns Hopkins University Press, that this book was in an advanced stage of being written, and suggested to her that it might be of interest to the Press. She, in turn, contacted me, and with alacrity set the process in motion that eventuated in the book being accepted for publication by the Press. In a continuous, hands-on way, she accompanied the book and me throughout all the stages of its being reviewed and readied for publication—bringing to the manuscript meticulous, astute attention to detail, her literary craftsmanship and artistic sense of design, and, most important, her deep understanding of its wellsprings. Working with her, and with senior editorial assistant Sara Cleary, was one of the most gratifying publishing experiences I have ever had.
I am indebted to all these persons for whatever merits this book may possess. I hope that it will be judged to be a worthy portrayal of MSF, and of the medical humanitarian care and assistance that, in the words of its Charter, MSF provides to people “in distress, to victims of natural or manmade disasters and to victims of armed conflict … irrespective of race, religion, creed or political convictions.”
1. I have written extensively about Willy De Craemer’s background, professional career, my relationship to him, and my years of research and teaching in Congo/Zaïre (now the Democratic Republic of Congo) in my autobiography, Renée C. Fox, In the Field: A Sociologist’s Journey (New Brunswick, NJ: Transaction Publishers, 2010).
2. For more details about this schism and the foundation of Médecins du Monde/Doctors of the World, see chap. 2 of this book.
3. I was introduced to Ernest Drucker by Robert Klitzman, who is presently a professor of clinical psychiatry at the College of Physicians and Surgeons, and in the Mailman School of Public Health at Columbia University, and director of the Master of Science in Bioethics Program in Columbia’s School of Continuing Education. Klitzman has extensively studied and written about ethical, social, and psychological issues in medicine and psychiatry.
4. Whitworth, currently editor emeritus of the Atlantic, was its editor- in- chief from 1981 to 2001. Prior to that, beginning in 1966, he was a member of the staff of the New Yorker, first as a writer and then as associate editor.
5. On this experience, see Renée C. Fox, “‘Dear Mr. Whitworth / Dear Professor Fox’: Ode to an Editor and to Editing,” Society 48, no. 2 (March–April 2011): 102–111.