A Look at the Activities of Humanitarian Organizations and MSF—Akonolinga and Yaoundé, Cameroon
Jean de Dieu Fosso
In its inception, humanitarian action was viewed as a specific necessity that would compromise a return to normalcy if not performed. It was considered to be absolutely essential for victims of natural disasters or epidemics and less important for those who had been spared by the catastrophe. All humanitarian organizations aimed to remain free, independent, and impartial. How these organizations are viewed today has changed, due to their complex connections to biopower, biopolitics, and biosociality, which extends their reach beyond troubled zones and their direct contacts. Within this research perspective, we conducted a survey with MSF in 2007 on the perception of humanitarian organizations in general and MSF in particular in Akonolinga, a town outside of Yaoundé, the capital of Cameroon. In 2008 we resumed this same study in Yaoundé, Cameroon, but added a few variables to the subject being explored. The reason MSF was present in these two locations was to provide care and assistance to people in Akonolinga suffering from a disease known as Buruli ulcer. Public hospitals in the area treating the disease were powerless under the scale of the outbreak and the damage it inflicts on the human body. The situation was so dire that some doctors quickly diagnosed the disease as having metaphysical causes. The symptoms are generally not described in doctors’ usual reading material—the disease is said to be neglected or forgotten by public health system authorities. In Yaoundé, the activities of MSF focus on HIV/AIDS. The survey was meant to gather data on the perception of humanitarian organizations deployed in Yaoundé, on MSF, and on the perception of AIDS.
This research is part of a group of recent studies on perceptions in the humanitarian aid sector, and particularly on international development in general. With the two teams in Akonolinga and Yaoundé, MSF set up a shared system to collect data, which was then used by researchers in the field to compile information on events concerning each of the studies. The project required numerous training sessions to ensure that all researchers had a shared understanding of the elements involved. The use of a common framework helped to collect comparable information for each case setting. To conduct this study, we relied on a qualitative method based on group conversations or focus group discussions and in-depth, individual interviews. We analyzed the results according to themes.
The starting point of this study is centered on the concept of perception, which is widespread in social and cultural anthropology and is also used in the management of local policies of organizations. Admittedly, it was difficult for us to assume the attitude of an impartial observer in this study. We were sometimes faced with patients in agony, and all that we could do was to ask them if they regularly received their antiretroviral medicine from MSF personnel or an affiliated organization combating HIV/AIDS.
We became involved in this work, even though our contribution started after the initial planning phase and the development of the survey tools. We were present at meetings and field training and have performed an analysis of the compiled data. We were struck by the presence and influence of lobbying by management personnel from MSF in Cameroon.
Humanitarian Aid Perceived as Western Domination
From a thematic analysis of the data, we see that survey respondents had much to say on the subject of image. Six respondents emphasized rather clearly that, in general, humanitarian aid is the “showcase” for Western domination of Africa, the symbol of poverty. However, what is also surprising is that respondents rated the West’s superiority as being the most important goal for humanitarian organizations. This perceived goal was rated higher than impartiality, transparency, neutrality, and independence—all values cherished and espoused by humanitarian organizations. In the two contexts that were studied, the notion of dominance is hardly a pejorative connotation. In fact, it was shown that poor countries take full advantage of this international aid.
To adapt an expression of Arthur Rimbaud, everything takes place as if the poor were an “other,” practically reduced to the state of animals, their destitution being viewed as something radical and unthinkable. This distancing through “exotic accentuation” of the other’s suffering seems to be a mechanism that strongly resembles those used in other distress situations (Boltanski, 1993).
Survey participants have difficulty grasping the concepts of humanitarian aid and humanitarian organizations, both in the capital of Yaoundé and in the countryside near Akonolinga. They associate it with a few things seen on television, or it is synonymous with the big cars that drive through the cities and countryside. In light of this, the effectiveness of MSF is only perceived by persons who by chance have had the opportunity to stay informed on the organization’s activities. Yaoundé is a large city. Here MSF is almost lost among the multitude of other organizations, whereas Akonolinga has a smaller population, and other organizations such as Plan-Cameroun or Emicam are dwarfed by MSF. This situation means that the results from Akonolinga offer a better assessment of the organization.
One idea that plays an important role in this study comes from Norbert Elias and John Scotson. It involves the opposition between the “established” and the “outsiders” within an organization such as MSF. Within such an organization, actors or employees are not blocked by an objective factor such as qualification or salary. Rather, obstacles come from the fact that the “established” belong to this culture and to a well-defined ethnic group, whereas the “outsiders” only manage to penetrate this culture with difficulty and are portrayed negatively. The study’s data shows that this practice exists within the organization in Yaoundé and must be eliminated. It creates a situation where one group, recruited through connections and privilege, dominates the other, and leads to many operational problems.
Influence of Context on Perception
In Akonolinga, sociocultural beliefs and practices strongly impact the actions of MSF in its effort to provide care to patients suffering from Buruli ulcer as well as HIV/AIDS. Traditional treatment is often the first step for persons suffering from these diseases. For Buruli ulcer, even though MSF pays for the expensive surgical treatment, the fear of operations and concerns about scars and possible amputation influences patients’ behavior. Patients often delay a medical examination as they are concerned about their appearance and are afraid of being ostracized. As a result, patients often go first to a county hospital located in the same premises as MSF, where treatment is expensive and a lack of infrastructure and trained professionals jeopardizes recovery.
Influence of MSF on the Public Health System
In this region, MSF is seen as a benefactor not only because of the care its doctors and nurses provide to victims of Buruli ulcer. Their service extends beyond this domain. Many activities contribute to the public perception of MSF: schooling for some sick children, distribution of food parcels, clothing for the neediest, small presents for patients. It turns out that MSF’s role is much greater than we think. MSF’s image in the public eye is all the more important because the organization came to solve a medical problem whose etiology the local residents ascribe to witchcraft. Thus, since MSF has been in Akonolinga, the organization’s work has succeeded in demystifying how the disease is viewed. The government and the only school of medicine in Cameroon have already started to show interest in training young doctors to provide clinical care to patients suffering from Buruli ulcer.
The conclusions of the surveys conducted in Akonolinga and Yaoundé are rather important in this regard. Subsequently, in 2007 and 2008, MSF had the good sense to intervene in situations for illnesses that were not part of a public health problem, even if politically the contrary could be shown. Both the full support given to persons suffering from Buruli ulcer and the distribution of antiretrovirals to HIV/AIDS patients at a time when triple therapy was not yet available to most people had a major impact. In fact, MSF was very well viewed by the people who were aware of the organization’s actions, despite a few internal logistical problems.
A Transparent Organization?
In light of the analysis, it appears that the organization operates with transparency and that its annual reports are accessible to the public. MSF is credible to the people of Akonolinga and, to a lesser degree, to residents of Yaoundé due to its rigorous management of funds. For example, our survey revealed that everyone is familiar with the employee pay scale.
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