Infirmieres Sans Frontières
December 3, 2006 -- Recently, the Nobel Prize-winning Médecins Sans Frontières / Doctors Without Borders (MSF) launched a U.S. tour of an exhibit highlighting the global aid group's vital work in conflict zones. "A Refugee Camp in the Heart of the City" features MSF aid workers guiding visitors through a model of actual relief facilities. The exhibit explains the challenges MSF faces in providing care, nutrition, and decent living conditions. This is a perfect time to thank the group for its admirable work--and to note that its continuing use of the name "Doctors Without Borders" sends an inaccurate message about who is doing that work. We understand nurses are the most numerous health professionals among MSF workers, and they play a central role in the group's efforts. Yet when journalist Suzanne Gordon suggested to a physician MSF leader that the group consider adopting a name that did not slight its nurses, the leader said that she hoped MSF would never be so "stupid" as to do so. The Truth has tried to discuss the matter with MSF for two months, but we have gotten no real response. The group's name seems to reflect the undervaluation of nursing that is undermining health worldwide, particularly in the developing nations MSF tries to help. We doubt that MSF would suffer by phasing in a similar name, like "Soins Sans Frontières" ("Health Care Without Borders"). We urge MSF to give its own nurses the credit they deserve--and that nurses everywhere need to help their patients.
Read more below or go straight to our letter-writing campaign
In her important 2005 book Nursing Against the Odds, Suzanne Gordon, a Center board member, explained (at 52-53) that Doctors Without Borders
won the Nobel Peace Prize in 1999 for its courageous international work. What is less well known is that the majority of its members are not doctors but nurses. Yet the organization is not called Doctors and Nurses Without Borders...[which] would more correctly convey the role nurses and other nonphysicians play in the group. ...
Several years ago, I was talking with one of the leaders of the organization. When I politely asked this female physician leader about the choice of name, she became extremely annoyed. The organization now had "name recognition," she insisted. I suggested that a small change in its title would hardly jeopardize its renown. She responded angrily. "Well, I certainly hope we would never do anything that stupid." This medical confiscation of nurses' contributions assures, as one nurse put it, that "doctors get all the credit when something goes right. We get credit only when something goes wrong."
It's hard to avoid the conclusion that the MSF physician's dismissive attitude reflects a belief that the concerns of nurses don't matter much. As Gordon notes, a group with the prominence and resources of MSF could easily navigate a minor name change. We like "Soins Sans Frontières," proposed by Swiss Center board member Pierre-André Wagner, but it's just one possibility. (We understand "soins" roughly translates to "care," and can encompass medicine (soins médicaux) and nursing (soins infirmiers).) The corporate world is full of major companies that have changed their names completely in recent years as a result of mergers (e.g., Verizon, Novartis). We would be surprised to hear that MSF had done any actual research suggesting that any change to its name, even a minor one phased in over time with reasonable public notice, would harm its image or operations. Indeed, the name change itself could provide helpful publicity. We understand that MSF was founded long ago by several physicians. But that does nothing to alter the fact that its name sends an inaccurate message about what the prominent organization does around the world today.
There is precedent for large organizations changing the way they do things in order to fairly credit nurses for their work. In 2005, the U.S. Department of Health & Human Services (HHS) commendably agreed to change the name of its annual minority health campaign from "Take a Loved One to the Doctor Day" to "Take a Loved One for a Checkup Day." This public health campaign continues to prosper, and we are aware of no decline in its influence as a result of the change. MSF's current position resembles that of the nationally syndicated Tom Joyner Morning Show, a key partner in the HHS campaign, which appears to be virtually alone in steadfastly clinging to the name "Doctor Day." Our discussions with the Joyner show suggest that it has a vague belief that the old name has "capital," and that it may not grasp that nurses play a key role in providing primary care to minority populations. Of course, by contrast, MSF is well aware that nurses are vital to its operations.
But does it really matter what name Médecins Sans Frontières has? Yes. First, as we have sad cause to note virtually every day, physicians do not deserve credit for nurses' work, whether that credit comes from the government, hospitals, the news media, Hollywood, radio personalities, or globally influential aid groups. It's also clear that names and images that permeate modern culture--like "Doctors Without Borders"--have a significant effect on how people view the world and how they act. NBC recently decided to call the Iraq conflict a "civil war"; a media uproar ensued. Extensive public health research shows that the mass media affects the public's health care views and actions. If that were not the case, MSF would not care so much what name it uses. Nor would it be mounting the current media campaign about refugee camps. That exhibit's apparent goal is to increase understanding of MSF's work and financial support for its activities. The campaign included an extensive press kit, and the group has placed many links to media coverage of the exhibit on its web site. To claim that media image does not matter would be to reject everything MSF is doing in the campaign.
But what do nurses actually do for MSF? We're glad you asked! One former U.S. board president of MSF is a nurse: community health expert Carol Etherington. Another notable MSF nurse is Mary Lightfine, a lecturer and media figure who has worked for MSF in nations like Somalia, Sudan, and Afghanistan. Lightfine publicizes her activities with the name "Nurse Without Boundaries"--which actually highlights the exclusion of nurses from the name of her organization.
As Suzanne Gordon demonstrates in Nursing Against the Odds (at 52, 187-88), nurses are generally missing from press accounts about MSF's work. They tend to be dominated by physician comment and suggestions that the group is composed only of physicians, which we suppose is somewhat understandable, given the name. However, in the last several years we have found a few media products that do give a sense of nurses' real contributions.
On September 16, 2006, Radio New Zealand ran a brief unsigned article headlined "NZ nurse calls for pressure over Darfur situation." It reported that Auckland nurse Lisa Blaker "from the group Médecins Sans Frontières" was urging New Zealanders to pressure political and diplomatic leaders "to make sure a United Nations peacekeeping force is sent to the stricken Sudanese province." The piece said that Blaker had just returned from Darfur. It also noted that the Sudanese government has said it will not allow the proposed force into the nation, and it provided a link to an Amnesty International petition in support of the force. In addition to being a good example of patient advocacy, Blaker's media outreach shows the key role that some MSF nurses play in building developed world support for the aid group's work.
In July 2005, the Guardian (U.K.) web site posted a powerful AP story by Nafi Diouf about efforts by MSF and the U.N. to cope with the devastating famine in Niger, where almost a third of the population was "in crisis." The MSF mobile health team profiled in the piece was led by Theodore Bitangui, a nurse from the Democratic Republic of Congo, and was composed of nine nurses, eight nutritional assistants, and two drivers. The mobile centers that such teams set up provide food and health care to threatened people in remote areas. The piece quotes Bitangui, who describes the team's work to assess and treat the severely malnourished, including weighing and screening for malaria, "as anxious mothers sitting under a blazing sun watched his every move." One mother interviewed marvels at the weight gain in her year-old daughter after a month on the program. The piece also quotes team member Balki Harouna, a nurse whose long hours for the mobile team "mean more than a secure job and enough food to feed her family": "[W]e are giving back to our society and these people who haven't had any luck."
In July 2004, a column by Carol Goar in the Toronto Star, "Miracles amid misery in Sudan," recounted the recent experience of nurse Nancy Dale as part of an MSF team in Darfur. There, government-backed militias had reportedly "slaughtered an estimated 30,000 men and raped and brutalized their wives and children," driving more than one million from their homes and creating a staggering humanitarian crisis. Dale, a 10-year ICU veteran, arrived in one of the camps surrounding a remote Darfur town to "run a medical clinic coupled with a feeding centre for severely malnourished children." Many of the children reached her clinic close to death: dehydrated and suffering from diarrhea, chest infections, and measles. Many of their mothers were traumatized, having been raped and having watched their relatives slaughtered. Dale worked 12 hour days for three straight months, caring for patients suffering from bullet wounds and sexual abuse, building trust and teaching 40 local staff (many refugees themselves) to change dressings, distribute medicines, and perform important clinic administrative tasks. This focus on capacity-building is a hallmark of good nursing--and good development work. The children, who at first "barely looked human," began to revive. Dale's team, which initially included only her, a physician, and a "logistician," grew to seven. She emphasizes its diversity, with members from France, Belgium, Austria, Italy and Japan coming together to get the job done. The piece notes that Dale and her team saved "[p]robably hundreds" of lives during her time there. We note that Dale and the column itself emphasize that the health care team saved lives--not one particular type of professional all by him or herself.
And in July 2003, the National Geographic Channel aired an episode of "Doctors Without Borders: Life in the Field," a cable television series about MSF's work. This episode, "Cool Hand Luc," focused on the work of nurses in Sierra Leone, Ivory Coast and Uzbekistan. Narrated by Kiefer Sutherland, the episode told the stories of four MSF workers: a veteran nurse running a health care system in an Ivory Coast prison with "tough love;" a young Belgian nurse in a race to get a child treatment for tuberculosis in the midst of a refugee crisis in Sierra Leone; a Dutch nurse on a mission to contain tuberculosis in a depressed region of Uzbekistan; and a British engineer also in Uzbekistan working to clear sewage from the lower level of a large hospital.
Despite the fact that most MSF health professionals are nurses, the Truth is not asking MSF to change its name to "Nurses Without Borders" or "Infirmières Sans Frontières"--even though that French name rhymes and would be catchier than the current one! Such job-specific names would have some of the same negative effects as the current one, excluding physicians and others who play important roles in the MSF team effort. All we're asking is that MSF consider a slight change that would eliminate the current suggestion--a demonstrably inaccurate one--that its work is overwhelmingly performed by physicians. When more people understand the value of nurses' work, it will be easier for nursing to get the clinical and educational resources it needs to resolve the nursing shortage and meet the challenges of 21 st Century health care.
Almost two months ago, the Truth contacted MSF's U.S. headquarters in New York, in the hope that we could begin a dialogue about a possible name change. On October 11, we sent MSF a letter explaining our concerns in detail. We have been told repeatedly that MSF will respond, but so far the group has failed to do so.
Now we're asking for your help.
Please click here to send our instant letter, or one of your own to Médecins Sans Frontières today Tell MSF that even Nobel Prize-winning aid groups owe nurses a fair account of their work. Thank you!
333 7th Avenue, 2nd Floor
Sandy Summers, Executive Director
The Truth About Nursing
203 Churchwardens Rd.
Baltimore, Maryland (MD) 21212-2937 USA
December 5, 2006
Dear Ms. Summers,
Thank you for your recent letter to Doctors Without Borders/Médecins Sans Frontières (MSF).
As you know, MSF provides lifesaving medical assistance to people caught in conflict and crisis throughout the world. This is a task that can only be performed by multi-disciplinary teams including physicians, nurses, midwives, lab technicians, pharmacists, logisticians, and administrators, among others. All professions working within MSF are highly respected, and nurses are no exception.
Nurses at MSF make a crucial contribution to our operations. They account for almost one-third of our international field staff, often occupying positions of great responsibility. In our field programs, nurses work as field coordinators, medical coordinators, and heads of mission, and in headquarters as directors of operations, directors of field human resources, and general directors. We also train locally hired nurses in our medical programs. In many of our HIV/AIDS programs, for example, nurses perform tasks routinely done by doctors in industrialized countries, ensuring that thousands of patients receive lifesaving treatment. Nurses, as part of our current and former field staff, are valued members of the organization and are often called upon for leadership roles. Nurses have been elected by their fellow MSF members to the Board of Directors and some, such as Carol Etherington, have held the position of President.
Médecins Sans Frontières (MSF) was founded in France in 1971 following the famine in Biafra, Nigeria. A small group of French doctors and journalists decided to create an independent emergency medical organization that could both respond and bear witness to atrocities around the world. MSF is now an international organization with offices in 19 countries and programs in more than 70 countries. Our medical teams run hospitals and primary health clinics, lead vaccination campaigns, conduct nutritional interventions, and provide other emergency medical care as needed.
Reaching people affected by conflict and crisis and providing them with much-needed medical services is always difficult and often dangerous. One of the most critical challenges we face is gaining recognition and acceptance for our presence and our work in volatile and insecure environments. This is why we have made such great efforts over the past 35 years to establish recognition for our name, logo, and ultimately our identity as an independent impartial medical humanitarian organization.
Recognition of our name, logo, and identity is crucial so that people wounded in conflict, seeking refuge in temporary shelters, or living in remote areas far from health services, understand that free and independent medical care is available. It is also vital so that local leaders, governments, belligerents, and others understand that MSF works independently of any political or military agendas. In these days of increasing threats to aid workers, this task is even more urgent. Our name and track record are critical in the ongoing and enormously difficult task of establishing our identity in volatile war zones in order to reach and assist millions of people at risk. Against the backdrop of the urgent lifesaving assistance our field teams provide, the consequences of changing our name could be far-reaching and potentially harmful.
We appreciate your concern for the welfare and recognition of nurses in our international medical work. Should you be interested in sharing information with your membership about the work that nurses do at MSF, we would be more than happy to arrange an interview with one of our field nurses, or provide links to our website where your members could learn more about the significant and lifesaving work done by MSF nurses and their colleagues around the world.
Nicolas de Torrente, Ph.D.
Executive Director, MSF-USA
Darin Portnoy, M.D.
President of the Board, MSF-USA
December 8, 2006
Dear Drs. de Torrente and Portnoy:
Thank you for your letter of December 5 in response to our request that Médecins Sans Frontières (MSF) consider modifying its name slightly, in order not to exclude the contributions nurses and others make to its vital work around the world.
You note that you are replying to my "recent" letter. Of course, as you know, my letter was sent on October 11. Despite my repeated efforts to obtain a response from MSF since then, your letter only arrived two days after the Truth asked its supporters to express their concerns to you.
We do appreciate that you have now made an effort to address our concerns. I note at the outset that you do not even try to argue that MSF's name is a fair or accurate representation of what it does today. Instead, you suggest that MSF cannot change its name because it would undermine recognition of the group's identity and role among various constituencies around the world, including in volatile conflict zones.
However, your letter vastly overstates what we are seeking and its likely effect. We have asked for no change in your "logo," your "identity," or your "track record." All we have suggested is that you consider changing the first of the three words in your name. In particular, we suggested changing " Médecins Sans Frontières " to "Soins Sans Frontières." In French, that would mean changing the first five letters of the first word to two new letters. The word would actually become shorter, and arguably catchier. In English, the first word would change.
It seems unlikely that such a small change would cause significant confusion, especially if accompanied by a modest effort to explain it. There would be no change in any aspect of your actual operations. We have trouble picturing a refugee wondering whether the MSF worker who last week gave them health care, and who has now returned in a truck that is identical except for five letters on the familiar side logo, is representing the same group. It is hard to imagine residents of a camp being baffled about whether this is still your group's food tent because one word on the side logo has changed. We are also confident that political, military, and non-governmental entities are capable of recognizing MSF after a one word change in its name.
Moreover, your absolute position on the name suggests that MSF would not consider changing any aspect of its current image for any reason, because any change could potentially cause some confusion. Is that really MSF's position? Would that be its view if MSF discovered that some small aspect of its name or logo caused offense in a particular region or culture? It's hard to believe that MSF's position relates solely to a commitment to never change any aspect of its image. It seems more plausible that it has to do, at least in part, with MSF's view of how important our request is.
We again urge you to consider how not changing MSF's name may undermine its work, and the work of millions of nurses. We appreciate your description of the important things nurses have done with MSF and the respect they receive there. But this simply underlines how unfair it is when such professionals are not accorded adequate public recognition for that work, which in turn inhibits the poorly understood profession's ability to get clinical and educational resources. This is a significant factor in the nursing crisis that is taking lives worldwide. We note also that your group might have more appeal to potential nurse volunteers with a more inclusive name.
We appreciate your offer to put us in touch with MSF nurses so that we can share their achievements with our members. In fact, our web site's lengthy analysis of this issue serves that very purpose. In addition, as that analysis made clear, we have been making our members and the public more aware of the work of MSF nurses for years, highlighting the relatively few major media pieces we can find that discuss it. We have also, in analyzing media pieces about health care "heroes," suggested that nurses like Ms. Etherington deserve wider recognition. In general, however, we do not have the resources to engage in firsthand reporting on issues other than nursing in the media. So we encourage you to make similar overtures to media entities that do. We will be pleased to analyze and publicize the resulting coverage, as we always have.
Frankly, we realize that some view MSF as effectively immune from criticism because they believe it to be so virtuous. Your letter's lengthy description of the importance of your work will do nothing to discourage that view. However, we believe that the perceived moral authority of a speaker actually serves to amplify any negative effects of its speech. Those who revere MSF are even more likely to form strong misimpressions about who its heroic "doctors" are.
I urge you and the leaders of MSF International to consider whether the first five letters of the group's current name are really worth the damage caused to nurses and other vital workers every time the world's population sees or hears about the good work of "Doctors Without Borders."
Thank you again for your consideration.
Sandy Summers, RN, MSN, MPH
The Truth About Nursing
203 Churchwardens Rd.
Baltimore, Maryland (MD) USA 21212-2937