Continental Conflict Zone Roulette

So it begins.  Since my MSF application was first submitted nearly a year ago the process has rumbled along while the daily activities of life and work provided distraction from the pending reality.  There were moments where it really hits home.  This past week has been full of them.  In the context the changing locations and dates I bid farewell to my little family twice.

I’ve left home many times before but the destinations were always more touristic. This won’t be the longest time I’ve been away from my very understanding wife.  Five weeks away is nothing in the context of most MSF missions.  I’m only special because I’m an anesthesiologist we along with surgeons are treated a little different due to the intensity of the work. This goodbye for many reasons is different. The biggest is that we now have a little boy, 9 months old and that changes everything.  He’s not crawling yet.  He’s damn good at sitting and eating but still rather stationary.  But he’s on the verge.  I installed the stairway gates the week before I left with the expectation that he’ll take off while I’m away.  The good news is that he (seems) to recognize me on video chat. Or perhaps like all humans he is simply mesmerized by a bright interactive digital screen and any figure making faces and noises is enough to capture his attention. I’ll have to ask him when he’s older.

Spin the globe, where it stops no one knows. Yemen, Gaza, Nigeria, Haiti, Central African Republic.  The last couple of weeks have been a blur of continents, countries and conflicts.  My MSF human resources handler/broker/torturer/agent in Montreal has guided me though the process with an expert hand.  That being said his threshold for declaring a region stable is rather relative.

How did I finally end up en route to CAR of all places? It is a matching process based on availability and need run out of OCP- Operation Central Paris, the central bureau that runs 80% of MSF surgical missions worldwide. They take my skill set, available dates and do their best to find a suitable mission in the context of global upheaval.  Unfortunately for those back home who would prefer very stable conflict free locales MSF tends to operate based on need and surgical missions are often associated with some level of instability (read: violence).  This doesn’t always hold true but is often the case.  

My first option was northern Yemen inside the Houti rebel controlled northern province of Amran.  It was supposed to be a safe location and a good candidate for a first time mission.  At the time of selection in January the poorest country on the Arabian Peninsula was not in the news but as winter progressed the news reports became increasingly concerning. The Houthi rebels overthrew the government and placed President Hadi on house arrest before he escaped to Aden and eventually fled to Saudi Arabia. The ensuing confusion and power vacuum allowed Al-Qaeda to increase its presence and resulted in a mass casualty suicide bombing at a mosque in the capital city of Sana’a killing 142 and injuring hundreds more.  Every time I inquired and received a reassurance of stability another non-reassuring event would create a headline.  To say the least family and colleagues were rather concerned particularly when the Saudis and Iran got into the mix and a bombing campaign against the Houthis ensued.

Eventually the faceless name at the Paris desk who was playing continental conflict zone roulette with my life agreed that Yemen wasn’t the place for a newbie like me.  Over the next couple weeks the list of options are various times included Gaza (a pediatric reconstruction project), Nigeria and Haiti.  I would have liked Haiti mostly due to my perception that the risks of kidnapping and aerial bombardment were both considered to be rather remote.

Then one day the wheel landed on exotic Central African Republic (CAR).  As it turns out I was needed to replace the anesthesiologist who is now headed to Yemen. Oh my! The most common reaction I heard when CAR was mentioned as the destination du jour was 1) Is that a country? And the follow up 2)What was it called before?  The answers to which are 1) Yep 2) Central African Republic.  It certainly isn’t on the radar or the map for most Canadians outside the humanitarian space. 

So after bumping my dates around and getting some support from my rather understanding colleagues in Ottawa I was off to Paris for a brief briefing where I was able to meet face à face with my handler’s handler.  Most importantly I had one free day to get lost again in the city of lights.  I also got my MSF jersey (read: T-shirt).  Made of heavy cotton and slightly poorly fitting, I slipped into a cramped OCP washroom to try it on.  It may not have been the same spectacle as getting my name called in the NHL draft but for me, in that dimly lit water closet it was the same feeling.  I felt as though I’d finally made it. This is my big league and as a Canadian, hockey and the NHL is the best reference.  I’ll stop shy of asking mom to stitch my name across the back.

This journey has been over a decade in the making.  As soon as I was in medical school in Winnipeg I was engaging the local MSFers to speak to the student body about humanitarianism.  When asked about how my spouse accepted the notion of my departure for a far off land my response was simple. She knew for ten years this was coming.  We were last in Africa/mother continent in 2005 as wide-eyed medical students on a rotation in Uganda.  I’ll concede it was part education, part medico-tourism.  But I loved it. There was something very grounding about the experience.  It certainly provided us with a sense of perspective about the world we live in.  My only regret is that it has taken this long to return. 

This mission is no tourist safari.  This is real.  In MSF parlance, this is my first rodeo.  I hope I don’t get bucked off.