Policy without Borders: Insights from Bruce Lampard

Bruce Lampard is an Emergency Physician and the current President of the Canadian section of Medecins sans Frontieres, or Doctors Without Borders, an organization which won a Nobel Peace Prize in 1999 for their pioneering work in humanitarian medical assistance on several continents. Dr. Lampard has worked with Doctors Without Borders in South Sudan, Nigeria, Afghanistan, Democratic Republic of Congo, Chad, Central African Republic, and Somalia. He represented the organization at the 2012 Nobel Summit in Chicago.

The Chicago Policy Review’s Gunner Hamlyn spoke with Dr. Lampard to discuss Medecins sans Frontieres and the organization’s important work. 

When Medecines sans Frontiers (MSF) tries to enter a country, what is the most important part of the process?

The most critical component of what we do as an organization is to maintain our independence. We’re fortunate enough that, financially speaking, we can make our own decisions, carry out our own programs, and carry out our own projects where we see they’re needed the most. We supply whatever we need, we stay as long as we can, or as long as we need to.

It’s our own decision-making that goes in to all of this. The independence is critical, so from there it gets in to how do you work. So certainly, with the ministries of health in any country, we’re trying to work with them, meet them, because of course if there’s some way that we can figure out the best way to collaborate with them in that region, if there is such a ministry of health, we do our best to try and make that happen – but sometimes there just isn’t one Ministry of Health.

Typically, is the motivation for MSF to enter a country based on your own awareness of a public health issue, a request from a country, or both?

There are two ways we hear about things: One is that we already work in 60 countries, and so if you’re already working in a country, and your projects are in regions A, B, and C, you may hear that in region D there’s a problem brewing. You just hear about it, though newspapers, through the local staff over there, so you send someone to investigate. And maybe if you’ve got the resources to open up a new program or new projects, you do it.

Or in a neighboring country you hear that something is going on, and you’re close to it because you’re working in their neighbor, then you’ll send somebody across the border to check out what’s happening, and make your assessment. So, that’s the most common way that we have to get involved with new projects.

Another way is that we read the papers – if there’s an earthquake or a tsunami, as soon as it happens, we’ve got the mechanisms where you just press the green button and things start.

But obviously, it all begins with, do we have the resources to start sending people? Our most precious resource is always people, but for things like the Haiti earthquake two years ago, we got lots of people who were able to help out on very short notice. When we talk about short notice, we mean 48 hours. Not many people can free themselves up from their job for a month or two on 48 hours’ notice, but there certainly are some people out there who can do it.

A few years ago the country of Niger asked MSF to leave because they thought that their presence was giving them bad publicity. Does that happen frequently? Or is it rare to get push back from a host country government, even when an investigation indicates a country is not running things well?

It’s not rare… but it is rare that it goes so far as to either us getting kicked out, or us making the decision that we don’t have enough independence to make the decisions and carry out the work we want to do.

But nevertheless, everything is about negotiations. Whether it’s with the national Ministry of Health, or other aspects of the national government, we’re always getting in to different discussions about how we work and where we work. But as I said, the most critical part of what we do, and why we do it, is the ability to assess where the needs are, what the needs are, figure out what we’re going to do, and then monitor the quality of our work. If we find that we’re not able to do that, which is something we call “carving out humanitarian space,” and make our own decisions in there, then we will try to negotiate to be able to get what we need. It may work or it may not – but then we have to make the decision of whether we’re going to be able to stay.

In those negotiations, do you typically work with a partner organization or with the ministry of health to get policy changes that you need? Or do you toe the line of your independence, especially if there’s a humanitarian crisis that might also have human rights abuse aspects to it?

When we talk about negotiations, it’s important to differentiate between gaining access to work and advocacy or lobbying for policy change.  I have addressed the issue of access above.  Regarding lobbying around policy change, we tend not to work through partners, although we do work with partners.  If there are messages we want to get across, then we do it ourselves, and as directly as possible. So it’s not just us wanting to represent ourselves, it’s the need to interact directly with decision-makers. We will try and make sure that we get meetings or get our message across to the highest level possible.  Hopefully to affect some change.

For example, we have addressed optimum treatment for malaria infections in the past, especially in Africa. Some national guidelines continue to use outdated therapy, such as chloroquine, which is often not much different than using a placebo. It was important for us to advocate for better national guidelines, and through extensive lobbying, our strong recommendation was to use newer combination therapy. We even went so far as to conduct field studies proving resistance patterns and effectiveness of the various regimens, to further support our recommendations.

In some cases, our lobbying is successful, in some cases it is not. And the list of global health issues to address is long. Who will pay for HIV drugs in the setting of a weak global economy; the inadequate treatment of drug resistant TB; and the growing problem of global antibiotic resistance, to name a few.

Feature photo: cc/Jesper2cv