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Setting the Stage
We want to maintain our independence and neutrality Whenever we work. The focus is on the patients, regardless of where they come from, their gender, their ethnicity, their political affiliations, their sexuality. Anyone who’s a patient is a patient, is a patient. We do this by working on both sides of the front line if there’s a conflict situation.
JANE
I’m Jane McConnell and welcome to Imaginize World, where we talk with forward thinkers, pioneering organizations, and writers of speculative fiction. We explore emerging trends, technologies, world-changing ideas, and above all, share our journey’s, challenges, and successes. Today, I’m talking with Robin Vincent Smith of Médecins sans Frontières, or in English, Doctors Without Borders. Robin’s been working there for 20 years, and the first years were working in the field in Ethiopia, Congo, Chad, South Africa, Liberia, and other countries. Now, he’s based in Belgium at the center, and he’s officially Change and Knowledge Manager, but he dislikes job titles. His focus is how people work together. It’s important to say that Robin is talking with me today in a personal capacity and not as an official voice for MSF. We talked a couple of years ago on my Bold New Breed podcast about his work, and today we’re going beyond that. I want to know his views on a wide range of issues around and beyond the humanitarian world. His perspective is unique because it blends reality on the front lines with the big picture of how you can bring change, how you can share learning.
I want to talk with him about climate change, how it can be mitigated, if it can, how doctors and support staff can be neutral in conflict zones, how in general they can combat misinformation in places where there’s a lack of access to scientific information, which actually concerns a lot of us today. Another point is how can education for children be improved so that we are educating our children for their futures, not for our pasts, and does MSF work in this area? Above all, my final question to Robin will be how does he see the future? What does he think things will be like 20 years from now? Let’s find out.
From the field to the center
So Robin, it’s really, really nice to see you again after the last couple of years, which I think have been full of events for a lot of us.
ROBIN
Fun and games, fun and games.
JANE
I was wondering before we actually start, I know you’ve been with Médecins sans Frontières for what, 20 years? Something like that, at least. I wonder if you could just say a few words about what your work was before you actually worked from headquarters.
ROBIN
I was a logistician in the field with Médecins sans Frontières for 10 years. A logistician is like a jack of all trades and a master of none, providing the medics and the patients with everything they need to be looked after. It can be construction for shelter, transport, telecommunications, security, energy, water hygiene and sanitation, all these kinds of practical things. Maybe the closest equivalent in the European context would be a facilities manager or management team of a hospital. So I did that for 10 years in various different countries, including Congo, Ethiopia, Liberia, South Africa, and Chad. Then met, as many people do when they work as humanitarians, a partner in the field and came back to, well, to home, which happens to be Europe. She’s Belgian, I’m English, and to raise a family and then took up this position in headquarters at fiirst Training Logistics, having done it in the field for 10 years, and now since I think it’s 10 years now as Program Change and Knowledge manager, so working around projects, working around change, and working around information, knowledge, data, et cetera for the general director.
JANE
That’s really interesting because in my work with different organizations, very often the people in headquarters are completely out of tune, out of touch with the reality of what’s happening in the field.
ROBIN
I’m not sure I could argue to be in touch with the reality of the field. Now, it’s been 10 years since I’ve had a field position or an operations position, to put it in a business context. But I did work in operations for 10 years, and so I’ve got a solid background there. But there is always a risk, I think, that I lose touch with the reality of today that Médecins sans Frontières in the field today, and of course, we’re still providing healthcare, but the way we’ve provided healthcare is clearly evolving constantly and not to the point that I wouldn’t recognize it, but I think if I were to go back into the same role today, then that would be different.
JANE
What you say about evolving is really interesting because I looked at all the material you sent me and it broadened my understanding of what Médecins sans Frontières does. I like the idea, well, it’s easier to say in English, The Doctors Without Borders, I think you say. I like the idea of without borders because I think that Médecins sans Frontières is breaking a lot of borders, and not just geographical ones, but in terms of healthcare and disease control and things like that, and doctors, the role of a doctor, all that, Médecins sans Frontières has gone way beyond our traditional understanding of that.
Challenging borders
Unfortunately, more and more borders are also being raised. I think humanitarian space is much less accepted now, and gone are the days where you can simply arrive and just look for interlocutors and start working. Now, we find as an organization, our humanitarian space is increasingly restricted to the point where we’re persecuted, hounded out of a country, et cetera, et cetera. So I’d say that over the years, the 20 years I’ve worked for the organization, there are more borders and so therefore, it’s even more important to be without borders. As regards to healthcare, yes, I think we are on the innovative edge of the spectrum. That’s clear. We’re in a position to try and test new protocols and certainly drugs as well. We’ve got some big drug tests going on at the moment linked to tuberculosis in third world settings. So yeah, there’s a lot of innovation going on, and I’d say we definitely challenge borders, that’s clear, but we also respect them.
I think we don’t want to come in and completely trash national protocols and national rules and regulations and things like this. We’re a law-abiding organization, and so there’s that as well. So we try to find a balance between respecting local customs laws, limits, whether it be social, cultural, legal, et cetera, et cetera, but at the same time, respectfully challenging them when we feel that the quality of patient healthcare could be improved. I’ll give you an example. In 2003, I was in Ethiopia, and the drug regime at the time for malaria treatment was one particular molecule, and we demonstrated through operational medical research that there was a… Sorry, there’s an amusing dog in the background playing with his toy.
JANE
No problem. That makes the whole thing real life.
ROBIN
Hang on, come here, dog. This is the problem. Problem solved.
JANE
If only you could solve all problems that fast.
ROBIN
Well, I say that. She’ll now go downstairs, bring up the toy and bring it back upstairs again and … Well, we’ll see. We’ll see what happens. So I was saying that in 2003 in Ethiopia, we were working in the malaria, in and around malaria, which is a big issue, still is a big issue. The Ministry of Health was using a particular molecule to treat malaria, which wasn’t necessarily the most effective. We argued through operational research that it would be interesting to try a new molecule and challenge the Ministry of Health a little bit and push the boundaries a little bit, and therefore work towards affecting a change in the choice that the Ministry of Health makes. So yes, indeed. So we challenge boundaries, we challenge borders, we challenge models of care, we challenge, yeah, we challenge. I think that’s absolutely our role.
Both sides in conflict zones
That’s interesting because one of my questions was it comes from one of the… Oh, I see where it comes from, a Smithsonian Magazine article about Médecins sans Frontières, about the need to remain neutral in situations in countries where there’s conflict, disagreement, political conflict. Do you find yourselves sometimes stuck between the need to provide the best information or the best care to people without becoming politically aligned in a country?
ROBIN
Yeah, yeah. Well, the first thing is how are we financed? We’re 99% financed by private individuals who give their funds with no political allegiance whatsoever. So that’s unlike, for example, the United Nations, which is absolutely politically financed.
JANE
Oh, absolutely, yeah.
ROBIN
Therefore, and with all the caveats that come with that. So that’s the number one. We defend that, and we’ve reduced our percentage of institutional funding. It was 6%, now it’s down to one or something. It’s getting smaller. For example, we started refusing EU funding since the European Union did a deal with Turkey regarding migrants, because we felt that went against our ethical stance. So that, we refused from then on. We thought, “We can’t take your money.” So for example, we want to maintain our independence and neutrality. So that’s one thing. Where does the funding come from? The funding absolutely allows us to be as neutral and impartial as possible. Secondly, whenever we work, the focus is on the patients regardless of where they come from, their gender, their ethnicity, their political affiliations, their sexuality, their anything. So anyone who’s a patient is a patient, is a patient, and we try and we do this by working on both sides of the front line if there’s a conflict situation. For example, in Sudan at the moment, as you know, there’s civil war in Sudan.
JANE
Yeah.
ROBIN
We’re on both sides, absolutely, in the areas where they control. We’re on both sides of the frontline, transparently so. Also, in terms of how we present our healthcare to try and make it as inclusive as possible and to ensure that no particular population feels in any way excluded. Then also when we do our witnessing, our témoignage, as we call it in French, then when we speak out, we speak out from the point of view of the patient, not from the point of view of any political affiliation, et cetera, et cetera.
JANE
But doesn’t that put you in danger?
ROBIN
It’s difficult.
JANE
Doesn’t that put your doctors in danger sometimes?
Making choices in dangerous places
Yeah, absolutely. Yeah, yeah, absolutely. So choices have to be made. Not saying it’s easy, but we stick to it. If we’re given a choice, if our neutrality and impartiality is compromised to such an extent that we are in danger ourselves, we put our medics and our [inaudible 00:12 :05], not only there’s not only medics there, doctors, nurses, midwives, et cetera, but also all the support staff of which I was part, logisticians, administrators, coordinators, et cetera, et cetera, then we have to measure those risks and take decisions accordingly. Sometimes the choice is to leave because it’s too risky. A recent example is Gaza, where it’s no longer… In fact, that’s less to do with the neutrality.
It’s more to do with, it’s just incredibly dangerous wherever you are in Gaza. So we’ve had to pull out or reduce our activities massively because of the war. It’s as simple as that. So that’s a bad example. I’m trying to think of an example where we’ve had to pull out, because I can’t really off the top of my head like that. But yes, indeed, it’s a constant ongoing debate about maintaining our integrity as an organization, our neutrality, our impartiality, our independence, and at the same time, providing open access to healthcare for free for the patients, and at the same time, not placing our staff or our patients indeed at risk.
Bring help to where patients are
Somewhere, I’ve read a number of things about MSF the last couple of days getting ready for our conversation, and somewhere, you provided in an area where there was a lot of flooding, in fact, pretty much permanent flooding, you had canoes that you made available. You had medical facilities along the river, I believe, along the side of the river, and you had canoes that would take patients to those facilities.
ROBIN
Yeah, that’s a good example of innovative use of transport options that are locally available. So our standard ones are the Toyota Land Cruiser. That’s the tool of humanitarians everywhere, but there are places where that doesn’t go. So for example, in Ethiopia, rainy season challenges. So I engaged a fleet of donkeys for ambulance transport because at the time we were dealing with nutrition, malnourished children, and most of the cases weren’t time critical for the transport from the outreach centers to the local, the centralized hospital. In other words, the patients could comfortably bumble along at donkey pace for six hours. That was okay because we sheltered from the sun and the elements and it was reasonably comfortable. That was in fact a more comfortable and easy way of transporting patients from diverse different areas out in the rural community towards a more centralized therapeutic feeding center.
So innovative, it’s not that innovative to use donkeys. People have been using donkeys for millennia, but you see what I mean? I mean, it’s a change of the usual way of doing things. Along with that came, of course, welfare of the animal was very important to us in the same way that welfare as the car is important when you’re using cars. I built, it sounds silly, but a logbook for donkeys. I engaged a local vet, et cetera. So as much care and thought went into the management of that fleet of donkeys as it went into the management of the fleet of vehicles that we had as well. So yeah, so I think access, you talked about neutrality and impartiality and independence. Access is a very important part of that. If the patients can’t get to the healthcare facilities, then we go to where the patients are and if they need transport and if the transport can’t happen in Ministry of Health ambulances, then we start running transport services as well, absolutely.
Climate change priorities
I imagine, and from what I’ve read in the materials that you sent me and that I searched out myself on the internet, the climate change…
ROBIN
Absolutely.
JANE
… criticality right now is forcing you to deal with a lot of issues that you didn’t have to deal with so much before. Or maybe it’s a question, I read some interesting stuff about how situations endure in an ongoing way. You can’t go and fix something and then move on to the next one because the situation itself is permanent.
ROBIN
I think climate change has been around for obviously a very long time, but what we’ve seen in recent years is that it’s intensified and its impact has intensified, and therefore we see more patients who are impacted by environmental degradation as a result of climate change. So this means we do three things. Firstly, we change our operational priorities to be present in places where people are vulnerable for the impact environmental degradation as the impact of climate change, and particularly a lot more emergency preparedness because we know that there’s going to be a high chance of, or we can no longer call them natural disasters because they’re manmade.
JANE
Manmade, yeah.
ROBIN
There we go. So floods, extreme weather conditions, et cetera, et cetera. So we’ve invested heavily in analysis about extreme weather conditions. Where are we likely to see them? Sudan, South Sudan in particular, is another obvious one, but not only Mozambique, I mean, it’s all over the world, but even in Europe, indeed with the fires last summer in Italy. So there’s the operational response, which has definitely evolved much over time, but certainly the last decade, a lot more. The second is speaking out about what we see. We see on the ground, the impact, the environmental degradation and the impact this has on people’s lives and their wellbeing and the quality of their health. So we work together with, for example, The Lancet Countdown, Lancet’s British Medical Journal, et cetera. We’ve done a report on what we’ve seen because we’re in places that others aren’t.
Giving voice to patients
So we’re in a position to witness things that others can’t necessarily and giving the voice to the patients and so they can speak out about what they’re experiencing. So that’s the second act of it. The third is our own carbon footprint as an organization. We’ve invested heavily in not only analyzing our carbon footprint, we signed up also to the Environmental Charter and the Paris Agreement to reduce our carbon footprint by 50% by 2030, and we’re making progress on reducing our own footprint as an organization. So those are the three axes on which we’re working on that front.
JANE
I understand it’s a challenge in some places to reduce your footprint. In order to provide aid quickly in certain areas, you’re still using fossil fuels.
ROBIN
Yep.
JANE
You can’t do everything with solar or wind energy. Today, it’s not possible. Is that right?
ROBIN
Yes, but it’s the scale, of course. You can certainly do a lot more than you could in the past. The technology is… I mean, when we first started looking into solar pumps, for example, 20 years ago, I mean now, and look at the quality of the technology, there’s no comparison. 10, 15 years ago, having an electric vehicle was blue sky thinking, but now it’s a reality. We’ve got electric vehicles in many of the contexts we work, for example. But I think there’s often a lot we’ve done with our supply chain because if you can forecast the goods, because we import a lot of our medicines and our material from abroad, but if you can forecast what you’re going to need, you can send it by boat instead of sending by plane, which has a much lower carbon footprint, for example, you can increase local and regional procurement, which we’ve got hubs out in Kenya and Dubai to be able to help us to do that.
So you reduce the carbon footprint there. You can make choices about the kinds of products that you use. For example, instead of single use plastic products, go for multiple use products, and so you can reduce the consumption. There’s an awful lot you can do, and we are doing to change that. Is it possible to go to completely zero today? No, and why I say no is because we don’t also really want to invest in carbon offsetting because we feel that’s cheating. So…
JANE
You feel that’s cheating?
ROBIN
… we’d rather just concentrate…
JANE
In what way?
ROBIN
Well, I mean, it’s just shifting the project problem to somewhere else…
JANE
Oh, right.
ROBIN
… and not addressing it yourself.
JANE
Yes.
Reducing our footprint
We’d rather address our energies. Instead of donating, for example, large amounts of cash to an organization to go and plant a load of trees somewhere, well, we’d rather plant trees ourselves and work on reducing our carbon footprint ourselves rather than… I think I wouldn’t go as far as to say as greenwashing, and cheating is a strong word, and this is my personal opinion, by the way. All of this is my personal opinion.
JANE
Of course.
ROBIN
JANE
Of course, that’s your qualifier. Yes.
ROBIN
But yeah, I personally think it’s more interesting to invest in reducing one’s own carbon footprint. Yes, perhaps you hit a wall at a certain point and then you have have to start considering carbon offsetting if you want to go for zero. But certainly, it’s too easy just to go and go straight, take the carbon offsetting route. I think the hard work is to be done internally, and that’s really what we’re doing is what we’re doing the hard work. We’re really critically looking at our organization to find out where we can make the difference.
Nobel Peace Prize
Little side issue, a side point rather, is the fact that I didn’t realize that MSF had won the Nobel Peace Prize back in 1999.
ROBIN
Correct, yeah, yeah.
JANE
I read the description on the website for the Nobel Peace Prize, and the description corresponds very much to what you’re saying about the way you work and what your goals are. That’s a major accomplishment. That was a long time ago, 1999.
ROBIN
Yeah, yeah, yeah, yeah. Why the messages haven’t changed since 1999 is because we have a charter since 50 years, which has been slightly updated to make sure it fits with the time, but it remains a one-page document, the MSF charter, which is still as relevant today as it was 50 years ago when it was written. We stuck to that over time. It’s really our mission statement and it’s very useful. So we stick to that and it’s all good.
Helping migrants and refugees
That’s good. One thing that we see a lot in the press and on TV these days is refugees around the world. We even look at that because I was born in the United States, but I’ve been in France now for well over 50, over 50 years, that’s over half my life. I see the refugees arriving and trying to get across the border into Texas and so on, and then they get put on buses and they get shipped off to cities. That’s just a small example, I think. There are many bigger movements of refugees around the world. I presume you come into contact with this quite often, is that right?
ROBIN
Absolutely. Yeah. We’re very heavily involved in support to migrants and refugees all over the world. I mean, will it be, for example, now in Chad because of the Civil War in Sudan, people crossing the border from Chad into Sudan again, as they have been doing in the past. I was there myself in 2005 and saw it happening then. There was a war going on back then, but not only, also in Europe, there’s obviously the whole route that people take traveling out from Africa and Asia up into Europe, often heading to England. Often, we see people along the route because we’ve got multiple projects along the way. We’re heavily operational in Italy, Bosnia, Serbia, France, in the UK as well. We’re busy, we’re operational in the UK to try and ensure that these people have healthcare because they often don’t. Because they’re excluded from the national healthcare systems, intentionally or unintentionally.
JANE
Intentionally, I think, usually.
ROBIN
Very often, yeah, very often. Or at least it’s made the bureaucratically too difficult for them to get access to healthcare. So it’s access to healthcare. That’s what we’re there to provide. Here I am in Belgium and we have operations here in Belgium specifically to work with that population of patients.
The Climate Hub
Going in a slightly different direction, you sent me a link to your climate hub, and that is an amazing website. Amazing.
ROBIN
I’m happy to hear. It is quite new, and so I’ve not had much feedback on it yet, so it’s good to hear that you think it’s useful.
JANE
Oh, it’s very interesting because it’s interesting to people like me. Even if I weren’t talking to you today, I would still find it interesting in the content on it because it talks about things that most people are not aware of. The thing that struck me the most, well, I didn’t spend hours on it, but I spent a good hour going through it. The thing that really struck me was the one that you call fighting misinformation. I found that fabulous, your, what do you call it that’s on the, that was on your science portal. The idea of having a science portal within the climate hub is “génial” as we would say in French, and could you talk a little bit about, what do you call it, the, what was it? The climate, the misinformation, I guess it’s just the misinformation on the science portal and you have ways of dealing with it.
Fighting misinformation
There was a lot of misinformation about vaccinations, for example, that people were spreading the word that vaccinations were going to kill you, that they were lethal, and so on and so on. That’s a pretty common thing that’s being talked about in a lot of different countries. You said it’s fairly new, the website’s fairly new, but have you had any feedback yet on the conclusions, not conclusions, but the observations your people made about fighting misinformation? Because I think it’s such a big problem today.
ROBIN
It is definitely gotten worse. Social media is an intensifier of disinformation, misinformation, and so I’d say that’s how it’s got worse. I think there’s been a breakdown in trust in general in all kinds of different areas, but also towards doctors. I mean, the position of your average doctor in society has, there’s less trust, put it that way, but not only in doctors, also in teachers, in other professions as well. So we’ve got a whole project, we call it the DisMis project, Disinformation, Misinformation Project. Yes, we’ve got communications departments and teams to work and counter and put out the message as we have for years. But I think what it really comes back to is we want to maintain our integrity about the information that we communicate. There’s two ways of doing that. The first is to let the patient speak for themselves and give them a platform to speak, and so it comes directly from the source as opposed to speaking on their behalf or having “portes parole” or spokespersons on their behalf. So we try to do that.
Spreading scientific knowledge
The default situation is that when you look at the MSF website, what I hope you’ll see is you hope you’ll see patients speaking out about what they’re experiencing rather than MSF staff interpreting what they think the patients are thinking. So that’s the first thing. The second thing is certainly to look at the science behind situations that we have massive internal operational research units, and we publish regularly with the British Medical Journal, the Lancet, et cetera, et cetera. We built our own science portal where we list all the different medical publications, but not only medical, but peer-reviewed publications that we’ve published out. So that’s really important to us too and quite successful, I hope. It’s through those… Obviously, it’s also not only publishing, but socializing these publications at conferences.
So our staff are constantly going to conferences all over the world, World Health Organization, but not only to share what we are learning in the field, and it can be anything from feedback on a particular molecule that we’ve been using in the field to treat something or a treatment protocol or the use of a particular type of equipment or a treatment model or a programmatic model. It can be all different areas. Yeah, we have even run every year an internal thing called MSF Scientific Days where we, it’s an in-house, there’s 300 people, and online 10,000, and we share the best of MSF operational research, operational scientific discovery, scientific operational research with the world. So yeah, it’s an important part we do. So I think that’s my perception. It’s really the patient voice is really important and the scientific research to empirical research to back up what we do.
JANE
I read some of the content on what’s called MSF Listen, and that was, I wouldn’t say back and forth, but people’s experiences, I think MSF people, sharing their experiences in situations where they encountered misinformation. It was fascinating and distressing, I mean, distressing to hear about the misinformation and the degree of danger in the misinformation.
ROBIN
Indeed. But I think we can also say that from a very personal and Eurocentric perspective, that it’s equally scary, the kind of stuff that gets published in what one would consider respected news outlets and all comes out of politicians’ mouths and et cetera, et cetera. That’s equally scary, I think. As a Brit, I just cite Brexit as an amusing example of dis and misinformation. I mean, I think an awful lot of people are now learning the reality of what Brexit really means, and then were wondering whether that was what was sold to them when they were offered the vote, for example. It’s not my opinion, it’s just what I read in the press, for example. So I think it is harder. It’s really the social media and social media can be a very powerful tool for change, but it can also be a very powerful tool for dis and misinformation as well.
Using social media
I was just going to ask you about social media. I presume that your people are very active on social media?
ROBIN
Very active, absolutely.
JANE
In all the different platforms, I imagine.
ROBIN
Yeah, professionally, not personally. So that’s the thing…
JANE
Professionally, I mean, yes.
ROBIN
Yeah, absolutely. Yeah.
JANE
Do you think that makes a difference?
ROBIN
Does it make a difference? You are asking the wrong person. Again, all of everything I’m saying here, you’re asking me on subjects that are outside of my area of professional responsibility, but I’ll just give you my opinion.
JANE
Yes.
ROBIN
Absolutely, we must be present on social media where everybody else is or it’s where a lot of other people are.
JANE
Yes.
ROBIN
But not exclusively. I think there’s still, everybody consumes news and information in different ways, and there are those that go looking on websites like you did, and there are those that read books, and so we publish books regularly. There are those that look at peer-reviewed journals. There are those that listen to audio podcasts. We’re very present on the media, orally and also… So I think you need to be present everywhere, and also face-to-face. I mean, we leverage our network of alumni, we leverage our network of staff to speak as often as possible. Here I am speaking to you today as an example, but there’s thousands of us doing this all the time, and I think every single MSF staff member has a prerogative to share the values of the organization, the charter of the organization at whatever opportunity they can get in order to keep things on the line. What helps, as I said earlier, is our charter is very short. It’s one page, and so it’s a half-page even. So it’s very simple to stick to.
JANE
Well, the fact that it hasn’t changed over the years is very important.
ROBIN
Indeed.
JANE
Most organizations I know have a mission statement that changes every few years. The mission statement, in fact, there’s a hilarious website where they say, “We can build your mission statement for you.” They have three parts of the sentence and choose any one in column one and then one in column two, then anything in column three, put it together with another selection, and you end up with things that literally sound like mission statements. So I mean, that’s obviously not your case, but…
ROBIN
No, we’ve made tiny changes, but really more to make sure it reflects the original core values because words and the meanings of words change over time. So we’ve updated small words here and there just to make sure that it remains true to our core values as they were, yeah, described 50 years ago at our foundation.
Education for young people
Something that interests me a lot, and you’re going to tell me it’s outside your professional area of specialization, but I’d like your opinion anyway, and that’s about education, especially for young people. Everyone I’ve interviewed so far, I’ve asked the question about what is your opinion about, I know it depends on what the country is, but in general, in the way children are educated today and what can you envisage changes? Someone I talked to, in fact, the last person I talked to was Sugata Mitra. Do you know him? He’s the one who did the Hole in the Wall project where he made a…
ROBIN
Okay, I’m not familiar with it.
JANE
… put a computer in a stone wall in India and tied it down, I mean, locked it down, whatever, and little children could come up and play with it. Within a few days, children who didn’t speak English and had no education really were able to figure out the computer and they were online playing games, and they had figured out how to use the computer within a few days. So then, his name is Sugata Mitra, he then moved it to different places, tested it in different places, including in England, and every time, the children figured it out and got into really interesting topics without any adult supervision, and he gave several TED Talks. In 2013, every year, TED gives a million dollars to someone who has a wish that they want to realize, and he got the million dollar prize in 2013 to build what he called Schools in the Cloud.
The idea being you give young people the means to learn themselves and they will learn. I mean, you can have teachers who guide them, who ask questions and so on, but children need to be given greater responsibility for their own learning. I find that idea very interesting. He said, “Today, we are educating our children for our pasts, not for their futures.” I wondered if from the viewpoint of medical scientific knowledge, the area in which you do work, what do you think about that?
ROBIN
Well, half of our patients are children, and so half of the patients that come through our doors into the health structures where we work are children.
JANE
Right.
ROBIN
A very big element of what we do besides providing physical healthcare and also let’s say mental healthcare as well, let’s be clear, there’s that too, is what we term health promotion. So this is giving messages about how to live a healthier life, and these messages are aimed at the patients and the caregivers of the patients. So typically, obviously if children come into our healthcare centers, then they’re going to come accompanied usually by a family member. So there’s messages about nutrition, there’s messages about hygiene, there’s messages about, well, all kinds of things. It’s very context specific, and it’s almost, I mean, always done by locally hired people in local languages, according to the local custom. There’s a multiplicity of different media which are used. It can be just a simple explanation with a flip chart, or it can be all the flip cards or it can be videos, or it can be, we worked a lot with the influencers, for example, everything around HIV/AIDS [inaudible 00:36 :04]. We worked with local influences in Congo who were present on TikTok, Instagram, social media, et cetera, to pass messages.
We filmed a great song. It’s really good fun and people dancing. There’s healthcare messages, et cetera, around messages, the healthcare messages around HIV/AIDS. So a lot of theater. There’s an awful lot of theater groups where in Liberia, I hired a local theater group to spread a message about if you are a victim of sexual or gender-based violence, come to the clinic. The medium for which we use are designed to be accessible to all of our patients, and as 50% of our patients are children, to them too, absolutely. It’s true that when you’re talking about young children, you’re really aiming the carer that comes with the child as well as the mother, the father…
JANE
Yes, of course.
ROBIN
… the uncle, the aunt, et cetera, et cetera, but children as well. We’re trying to create an environment where children feel welcome and where have opportunities, depending on the condition, et cetera, to certainly play, but also indeed to absorb healthcare messages as well. So yes, it speaks to me. Then beyond that, when you look beyond children to young adults and teenagers, we’ve been training for years, healthcare professionals, but now we’ve taken it to a next level in the last seven or eight years, and we’ve opened the MSF Academy for Healthcare, which not only provides training, but also provides certification. We work with local universities. For example, we took 50 midwives from Sierra Leone and they went to Ghana because there’s no midwifery school of the particular type we were looking for in Sierra Leone. There was a better offer of education in Ghana. So they went there for two years, graduated and then came back to the hospital in Sierra Leone where they’d been recruited and started working there.
But the difference is that they’ve not only got the learning, which they would’ve got anyway because we train on the job, but they’ve got the formal recognition and the formal certification, so that allows them, that empowers them. Also, the quality that you get when you take people out of context and put them into, obviously full-time midwifery school in Ghana, it’s going to be higher than if you could do it on the job as well. So yeah, so we’re heavily investing in that too.
JANE
So those are all very interesting ways of, I would say, providing education. When I say providing education, it sounds a bit top down, but you are providing opportunities and materials so that people can learn.
ROBIN
Absolutely.
JANE
That’s really, really interesting.
ROBIN
Absolutely. Yeah.
Vision of the future
Yeah. Robin, I want to ask you one final question, and that is how do you see the future, say 20 years from now? I did this survey that I call Future 2043. I got amazing results from around the world, and I won’t go into the results right now. I can send you a link. If you have time, you can look at it. But I’d be curious to know how you see the future in particular in the world, not for MSF specifically, but the world that MSF functions in, which is pretty much the world in general. How do you see the future, say, 20 years from now?
ROBIN
Well, right now, it’s not great. We’ve never been busier as an organization, and us being busy is not good. Us being redundant, that’s good. I mean, the day when MSF leaves your country, that’s a good thing. The day when MSF opens operations in your country, that’s not good. So for example, particularly sad that for the first time in my 20-year career, MSF has felt the need to open operations in England, my country of birth, because the government is neglecting the health of migrants to such an extent that we feel it’s necessary to start operations in the UK. So that’s going the wrong way. I think in terms of conflict, that’s going the wrong way too. Yemen, Sudan are the ones we talk about less, even though Yemen’s obviously been in the news very recently because…
JANE
Right now, yeah.
ROBIN
… the events are overnight right now, but Sudan, I mean Congo, I can go on, but obviously Ukraine and Gaza and the scale, many staff, including those have been with us for a long time, and were around during Grozny, for example, say that even this is worse than Grozny. So I think that that’s all going the wrong direction. Then you add climate change and environmental degradation, and that’s all going the wrong direction too. So the future is really not bright. If you add all those together, the direction of the politics and the impact on the patients and the increased exclusion of more and more populations are excluded, and therefore MSF has to intervene. So that’s all going the wrong way. I don’t see a turning point in the short term I have to say. So the future is, from my perspective, not bright.
The younger generation
That was the conclusion of a number of my respondents in the survey. I had 15 different questions, and there were certain questions where the overall idea was what I call dark. I’d broken them into dark, light half on, and lights on. So I broke down the… Statistically, I looked at the numbers and there was a surprising amount of darkness in the results that I got. Perhaps there’s a glimmer of hope with young people today. A number of people said that we are counting on the younger generation. I read a thing just very, very recently, which big major oil companies are having trouble hiring young people. They can’t find enough young people who want to work with them. I saw that as a good sign. Now, that’s a small indication, and maybe it’s not a very operational indication, but I would like to think maybe it’s just wishful thinking on my part that the younger generation will be able to make a difference. I’m not convinced. I don’t know.
ROBIN
Well, I don’t think that’s new. I think the younger generation has always made a difference, and I don’t think they’re particularly doing so more today than they were before. The oil companies will just pay more money, and so that won’t change much there. Yeah, I think that young people have always, since the inception of time, brought change to the world and the way we think. Perhaps it’s more observable these days because of social media and because, I mean, Greta Thunberg is a good example. I mean, it is rare that somebody so young had such an influence worldwide. That’s an example of someone very young having a very big influence. But I’m sure there’ve been Greta Thunbergs in the past. Perhaps we’re just less aware of them because there wasn’t these social media platforms, which, like I said, intensifies of communication. So I’m sure there have been, but I also don’t think it’s good to put it on the young generation.
It’s our responsibility. We’re the ones that made the mess. So I think I would love for our generation to take more responsibility, allowing the young generation to have a childhood with free of worry and strife, and you only have to read the news to see how mental health in the younger generation is an increasing issue. So yeah, no, I think it’s on us. Of course, us, when I say us, it’s on everybody. But wouldn’t it be nice to leave the younger generation to have a decent childhood?
JANE
Like we did.
ROBIN
A bit more carefree like we did, indeed.
