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For decades, Doctors Without Borders has been admired for bringing desperately needed medical care to crises around the globe and pioneering modern-day humanitarian aid. It’s an organization with radical roots, promising to do whatever it takes to deliver life-saving care to people in need. But now, it’s struggling to address institutional racism.

The organization, also known by its French acronym MSF, has about 63,000 people working in 88 countries. While foreign doctors parachuting into crisis zones get most of the attention, 90 percent of the work is being done by local health workers. 

In the summer of 2020, more than 1,000 current and former staffers wrote a letter calling out institutional racism at MSF. They say that MSF operates a two-tiered tiered system that favors  foreign doctors, or expat doctors, over local health workers. 

Reporters Mara Kardas-Nelson, Ngozi Cole and Sean Campbell talked to about 100 current and former MSF workers to investigate how deep these issues run. We meet Dr. Indira Govender, a South African doctor who in 2011 accepted what she thought was her dream job with MSF in South Africa, only to get a front-row seat to the organization’s institutional racism. Even though she’s officially the second-in-command of her project, she says it feels like a select group of European expats and White South Africans are running the show.  

Then, Kardas-Nelson and Cole take us inside the inequities MSF staffers experienced during the 2014 Ebola outbreak in Sierra Leone. While expat doctors had their meals together and socialized, local health workers were left out. But inequities ran deeper. If expat doctors got sick, they would be evacuated out of the country, while local workers didn’t get that care – they were treated at the same center where they worked. Kardas-Nelson and Cole reported the story from Sierra Leone in the Spring of 2021 and spoke to former National MSF clinicians.

Finally, we talk about what can change in humanitarian aid. Govender is part of a group of current and former MSF workers called Decolonize MSF. While she and others are pushing the organization to commit to changes that address racial inequities, some are skeptical about what will actually change. 

This week’s episode was created in partnership with the global news site Insider.

This is an update of an episode that originally aired in September 2021.

Credits

Lead reporter: Mara Kardas-Nelson | Reporters: Ngozi Cole and Sean Campbell | Editors: Queena Kim and Brett Myers | Lead producer: Katharine Mieszkowski | Producer: Pamela Kirkland 

Original score and sound design: Jim Briggs and Fernando Arruda, with help from Steven Rascón and Claire Mullen | Production manager: Amy Mostafa | Digital producer: Sarah Mirk | Episode photo: Ngozi Cole | Executive producer: Kevin Sullivan | Host: Al Letson 

Special thanks: John Cook at Insider, Ariya Ahrary and Daniel Gross.

Support for Reveal is provided by the Reva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Ford Foundation, the Heising-Simons Foundation, the Hellman Foundation, Democracy Fund, and the Inasmuch Foundation.

Transcript

Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal’s radio stories is the audio.

Speaker 1:Hi, I’m Aura Bogado, a senior reporter at Reveal. My work focuses on migrant children confined in federal custody. I’ve investigated abuse, forced drugging, even tasing in government sponsored shelters. The stories I work on are told from the perspective of the people experiencing the policies and practices I’m investigating. In this case, migrant children. Support rigorous, ethical investigative reporting. Donate today at revealnews.org/donate.
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Al Letson:From the Center for Investigative Reporting and PRX. This is Reveal. I’m Al Letson.
Speaker 4:Médecins Sans Frontières, meaning Doctors without Borders is an international humanitarian aid organization that provides emergency medical assistance to people in crisis.
Al Letson:Doctors without Borders. If you’ve heard of this global aid organization, right now, you’re probably picturing foreign doctors parachuting into conflicts and crises around the globe to deliver desperately needed medical care.
Speaker 4:Doctors, surgeons, drivers, administrators, logisticians, nurses.
Al Letson:But a lot of that work, 90% of it, is done by locals or so-called national staff. And today in this show we first brought you back in September, we’re going to meet one of those staffers. A woman named Indira Govendor.
Dr. Indira Gove…:I was offered the job and was really excited.
Al Letson:It’s 2011. Indira is 30 years old, and going to be Deputy Medical Coordinator for Doctors without Borders mission in South Africa. She’s going to be their number two person in charge. Doctors without Borders pioneered modern day humanitarian aid, and is one of the most famous of these organizations. Today, it has about 63,000 people working in 88 countries, with an annual budget of $2.25 billion. Anyway, when Indira gets the offer, she’s already a doctor, just finishing up her graduate degree in public health.
Dr. Indira Gove…:I was going to leave my old job the next day and start this new job at MSF, which was really awesome that it kind of all happened together.
Al Letson:I should say, outside the US, Doctors without Borders is usually called by its French acronym, MSF for Médecins Sans Frontières. Working at Doctors without Borders is Indira’s dream job. For nearly a decade, she watched HIV spread across South Africa and fast. With drug prices so high, they’re out of reach for the vast majority of the population. And while the government fails to respond, millions of people are infected, and tens of thousands die each year. So MSF teams up with local activist groups and brings the drugs into the country.
Dr. Indira Gove…:People were then taking the antiretrovirals and experiencing what they call a Lazarus effect, where they would literally recover. So that really won a lot of support and changed mindsets. And it got this critical mass of people committed to fighting HIV.
Al Letson:They helped change the conversation around HIV across South Africa and the world. And this is exactly what MSF was founded to do back in the ’70s.
Dr. Indira Gove…:They transcended borders, they transcended race and nationality and ethnicity.
Al Letson:It’s an organization with radical roots that’s willing to offend governments and break the rules to deliver life saving care. These crusading doctors aren’t afraid to play hardball.
Dr. Indira Gove…:I was really wide-eyed and excited to be there. This is an opportunity of a lifetime.
Al Letson:Indira was born and raised in South Africa. She’s a person of color, and hiring her was a part of a larger movement within MSF.
Dr. Indira Gove…:I was part of a plan to bring in national staff as deputies to senior managers.
Al Letson:Around the world, MSF is trying to bring more national staff into positions of power. The organization is responding to criticisms that locals are stuck in subservient roles. And Indira is so ready to be a part of that change, but she keeps thinking about this strange moment at her graduation. One of her parents’ friends was there. He’s a bigwig, the former Dean of her medical school.
Dr. Indira Gove…:And so he had heard, obviously, that I was going to start this job at MSF and he didn’t really say much.
Al Letson:He didn’t seem excited for her, but he did say something that stuck with her.
Dr. Indira Gove…:So he just said to me that they will never allow a South African to manage that project. They will never let anyone from the country manage it. The boss is always from Europe.
Al Letson:But she doesn’t really let that bother her. And she launches into her work, caring for people with tuberculosis and HIV. They’re refugees and migrant workers living in abandoned buildings in Johannesburg, and people in the most remote, rural areas of Lesotho.
Dr. Indira Gove…:It was incredible work. And they were having amazing outcomes that were being applauded all over the world.
Al Letson:About eight months after Indira takes the position, a new staff member joins a team. He’s from Belgium, and he’s managing part of the Lesotho project. One day, he starts going off about this local staffer.
Dr. Indira Gove…:This man was just really speaking in a very insulting manner about her. Talking about how she’s lazy and she doesn’t work and she sits at her desk all day and they’ve seen her reading magazines. And I was like, “What?”
Al Letson:Because Indira has met this woman.
Dr. Indira Gove…:She was quite a smart young woman who was very dignified and conscientious in her work.
Al Letson:A few days later, in June of 2012, she flies to Brussels for a big meeting at one of MSF’s headquarters. There are photos of MSF’s work all around. Doctors helping babies, things like that. And this meeting is in a big boardroom overlooking the city.
Dr. Indira Gove…:I was the only South African and the only person of color in that room.
Al Letson:And they’re doing some planning for the South African mission. Talking about the staff they’ll need and how many hours the work will take.
Dr. Indira Gove…:And all of a sudden, this MSF doctor has an outburst. He just starts ranting about how lazy South Africans are and how none of us work, or we don’t like to work. We’re so lazy. All we want to know is what we are going to get out of it, how much we are going to get paid. I was just completely gobsmacked, if that’s the word. I think that incident was probably the fact time that I got hit in the face by the racist brick in the organization.
Al Letson:The man who Indira says made the disparaging remarks, well, he denies it. By the time they get back to Cape Town, Indira’s rose colored glasses have come off. Even though there are other national staff in positions of power, Indira is more aware than ever that it’s a select group of expats and white South Africans who are really running the show. And even though she’s officially second in command, Indira is left out of important conversations. She says many of those took place after hours, among expats who were friends with each other.
Dr. Indira Gove…:We were like tokens. We were just the black faces at the front of the shop, but we were not actually the owners of the shop.
Al Letson:When Indira brings up issues of race and equity with her boss, she says he doesn’t take it seriously. She remembers those conversations went something like…
Dr. Indira Gove…:“Why are you complaining? You’re not even oppressed.”
Al Letson:In an email, he remembers them having “Vivid and interesting discussions on many subjects, including race relations in South Africa and beyond.” MSF’s grand plan had been for nationals like Indira to head its projects, but it becomes clear to her, that isn’t going to happen.
Dr. Indira Gove…:It just failed. It failed.
Al Letson:Eventually, she resigns. When Indira leaves, MSF replaces her with an expat. But Indira doesn’t make a clean break. She keeps thinking about this MSF doctor she met on one of her trips to Lesotho. She was giving out HIV meds from a mud hut on top of a mountain. Patients were lined up outside.
Dr. Indira Gove…:I was completely amazed at how she was able to do this. And MSF, with all their resources, had brought this doctor to Lesotho. I was quite inspired by that.
Al Letson:And Indira thinks, “Why not go back to my roots? Clearly I can’t make an impact in this organization as the manager, but maybe I can as a doctor. And maybe I’ll get more respect if I work overseas as an expat.”
Dr. Indira Gove…:There’s this literally cognitive dissonance in your own mind over how to make sense of this.
Al Letson:On the one hand, Indira beliefs in MSF’s mission. On the other hand, she knows what she experienced.
Dr. Indira Gove…:And it takes a while before you can reflect on it and articulate it and actually empower yourself to say, “Hey, this is what happened to me. And it was real to me. And it’s a problem.”
Al Letson:A big one. In the summer of 2020, current and former Doctors Without Borders staffers, more than a thousand of them, wrote a letter naming the problem. Institutional racism.
Speaker 6:Worldwide mobilization against racism has reached a Nobel Peace Prize winning aid organization, Doctors Without Borders. That organization provided critical care…
Al Letson:The letter says, “Despite grappling with this problem for years, racism and white supremacy still shape the culture and mindset at Doctors Without Borders.” It goes on to say that the organization remains defined by the white European expert and the distant other in need.
Al Letson:This problem isn’t limited to MSF. It plagues humanitarian organizations around the globe. MSF turned 50 last year, and to mark the occasion, we investigated how deep these issues run. We teamed up with the global news site Insider and with reporters, Mara Kardas-Nelson, Ngozi Cole, and Sean Campbell. They interviewed around 100 current and former staffers around the world and reviewed thousands of pages of documents during the course of their investigation. Mara and Ngozi worked in global health, and Mara even worked for MSF about a decade ago. She met Indira then.
Al Letson:When we come back, Indira goes to West Africa to help fight the world’s largest Ebola outbreak. That’s next on Reveal. From the Center for Investigative Reporting and PRX.
Al Letson:From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. Today, we’re bringing you an encore presentation of our investigation into Doctors Without Borders, and we’re taking you to West Africa. It’s October, 2014. And the region is in the middle of the biggest Ebola outbreak in history.
Speaker 7:There are dozens of new cases every day in Sierra Leone. Officials say so many people are dying of Ebola that dealing with their bodies is becoming a problem. A quarantine zone has been imposed around one area known as the gateway to the capital Freetown, but the disease is still spreading.
Al Letson:Ebola spreads through sweat, blood, and saliva, and the health systems in Sierra Leone, Guinea, and Liberia are collapsing. About a year before the outbreak Indira Govendor had left her job at Doctors Without Borders in her home country, South Africa. She was a part of the national staff there. That’s what the organization calls its local workforce. She quit because she felt disrespected, but Indira still really believed in Doctors Without Borders’ life saving mission, and she was impressed by its work on Ebola.
Dr. Indira Gove…:MSF was the only organization that had the know-how and the resources to go and build a treatment center in the middle of the jungle and save lives.
Al Letson:MSF, again, is the French acronym for Doctors Without Borders. And when the organization asked Indira to go to Sierra Leone, she said yes. Now she would be an expat, a foreign doctor going into a crisis zone. Reporters, Mara Kardas-Nelson and Ngozi Cole know a lot about this world. Mara is an American, and Ngozi is from Sierra Leone. Both of them worked in global health for years, including in West Africa. Mara even worked for MSF in South Africa about a decade ago. Mara starts us off.
Mara Kardas-Nel…:When Indira arrived in Sierra Leone, it was evening. The next morning, she was driven east to Kailahun, the center of the outbreak. Indira spent the whole day in the car. She remembers the vast jungles, these huge expanses of palm trees and snaking vines, and the sounds of birds everywhere.
Dr. Indira Gove…:Our ETC was literally carved out of the jungle.
Ngozi Cole:She’s talking about MSF’s Ebola Treatment Center. Sick people from across the country were taken there.
Dr. Indira Gove…:Patients would be packed into an ambulance and driven for hours on the dirt roads.
Mara Kardas-Nel…:Indira wrote in her journal that first day.
Dr. Indira Gove…:The team is wonderful. People are calm, collected, and serious. It’s good to be here.
Ngozi Cole:One of the people on Indira’s team was [Kini Musa].
Kini Musa:Kini means in our tribe, Mr. or elderly somebody that you have to acknowledge or respect. So in the Mende tribe, we call Kini as Pa, or Daddy.
Mara Kardas-Nel…:Kini had just graduated with what would be the equivalent of a physician’s assistant degree in the US, and he’d heard that MSF had opened an Ebola treatment center in Kailahun, his home district.
Kini Musa:So I decided to myself that I should help my people.
Ngozi Cole:But first, Kini needed to get to the treatment center. He’s 260 miles away in Freetown, and there’s a quarantine. Cars aren’t allowed on the road. You’ll hear him here, speaking in Krio, the main language in Sierra Leone.
Kini Musa:[foreign language] Emergency pass. [foreign language].
Ngozi Cole:Kini says he found a truck bringing rice from the capitol to the rural areas, and convinces the driver to pretend he’s helping out.
Kini Musa:[foreign language].
Ngozi Cole:When he finally arrives, MSF hires Kini. It’s his first big job out of university.
Mara Kardas-Nel…:Like most of the staff, Kini and Indira spent their days going in and out of the red zone, the area where really sick and really infectious patients are cared for.
Kini Musa:As we can see, he’s now taking off the apron.
Mara Kardas-Nel…:This is from a video one of their colleagues took on his phone. It’s at the treatment center. He’s recording them taking off their PPE safely.
Kini Musa:Take off your goggles.
Mara Kardas-Nel…:Because Ebola is so infectious, every inch of their body has to be covered.
Kini Musa:[inaudible]. Be careful, wash your hands, please. Take off your goggles.
Mara Kardas-Nel…:Kini and Indira often go into the red zone together, doing the same kind of work. Kini takes one side of the room, Indira the other. And sometimes Kini translates for her, since she can’t speak Krio. It’s the early days of the outbreak, and MSF is really worried about their staff getting Ebola. So some clinicians don’t feel comfortable giving IVs, even though patients can die of dehydration. But Indira and Kini Musa decide to do it anyway.
Kini Musa:As we see, Musa and [crosstalk].
Mara Kardas-Nel…:Here’s that video from their colleague again.
Kini Musa:… Just coming from the treatment center. I think they went for IV infusion. Now they’re here as we can see. A South Africa dynamic lady. Yeah, yeah. They do two IVs. Yeah.
Mara Kardas-Nel…:They were taking a risk, but Indira thought it was worth it.
Dr. Indira Gove…:So I went in and I started putting up drips, and it made a small difference. At least people were not dying of dehydration.
Mara Kardas-Nel…:For the most part though, patient care is limited. There’s only so much they can do. Kini and Indira give patients food and water, keep their fevers low, and make them as comfortable as possible. Indira says sometimes all they can do is move two beds closer to each other.
Dr. Indira Gove…:So that the two relatives that were lying on those beds dying of Ebola could hold hands or something.
Mara Kardas-Nel…:In the red zone, Indira and Kini are living the same experience, but outside of that zone, after they take off their PPE, that changes. Indira’s life in Sierra Leone revolves around the guest house. MSF rented out the best lodging in Kailahun. All of Indira’s meals come from there. Breakfast and dinner are served before and after work. Even her lunch is delivered to the treatment center. When it arrives, the national staff noticed that the expats go off and eat together. Indira says, yeah, that happened.
Dr. Indira Gove…:And that was never addressed. And maybe it was just something that happens with people in groups and that everyone just kind of gravitates towards their community.
Mara Kardas-Nel…:Because Ebola is so infectious, MSF has a strict no touch policy. Staff members aren’t supposed to touch anyone without PPE.
Ngozi Cole:But while workers like Indira are living in their expat bubble, Kini and other national staff aren’t. Kini has to find his own lunch, and that often means leaving the treatment center. It’s a hassle, and it also puts him in a situation where he might have to touch people. That’s a huge infection risk. He complains to MSF a few times, but he says they tell him there’s a small stipend in his salary to cover it. One day, Kini is so hungry after working in the red zone that he eats a plate of food from the center. And he says, an expat started yelling at him.
Kini Musa:I said, “For God’s sake, [inaudible] a human.”
Ngozi Cole:Kini remembers saying, “For God’s sake. I’m a human.”
Kini Musa:Very, very hot. You get for sweat a lot.
Ngozi Cole:He says it gets so hot inside the PPE that he sweats a lot and it burns energy. And he gets really hungry. Kini says the expert threatened to fire him.
Kini Musa:I said, “So if I eat this thing, even [inaudible] they will sack me.”
Ngozi Cole:One of Kini’s colleagues, Gloria Bunda, remembers that even the water supply was separate. When she asked an expert if she could drink some of the water in the fridge, she was told that…
Gloria Bunda:This is not for you [inaudible] patient and for us [crosstalk].
Ngozi Cole:Gloria says, “She told that the water is not for you. It’s for us.” Meaning experts and the patients.
Gloria Bunda:[inaudible] Prepared, you guys. Why you are coming to work and don’t come with water?
Ngozi Cole:Indira, who is now an expat, doesn’t remember it the same way.
Dr. Indira Gove…:So there was a fridge, but it was not filled with drinks for expats. We brought our water from the guest house.
Ngozi Cole:Since she’d been a national staff member, Indira understands how a divided workplace colors everything, even the water.
Dr. Indira Gove…:That’s an example of where a perception exists and nobody addresses it, and it takes on a life of its own.
Mara Kardas-Nel…:Pay is also an issue. Kini, who’s basically a physician’s assistant, is making around $360 a month. Indira, who’s an MD, is making four times as much for doing the same kind of work. That’s significant. In the US, doctors typically make about twice as much as PAs. And as an expat, Indira also gets a daily allowance on top of her salary. Expats live totally different lives than national staff. At the end of the day, when Indira gets off work, she gets into a big white land rover to be driven home. Indira says some evenings, she would sit in the courtyard and have a drink. Kini remembers popping by the guest house once. He noticed the expats were hanging out, barbecuing chicken. It was like a completely different world.
Kini Musa:They should have invited some of us, but they never did that one. So I felt left out.
Mara Kardas-Nel…:Indira had left Sierra Leone by then, but she doesn’t think the expats were trying to be exclusive or anything. It’s just that the guest house was closed to anyone who didn’t live there because of that no touch policy. But it’s not lost on Indira that Kini’s being left out. Indira remembered that feeling when expats in South Africa would socialize after hours and end up making work decisions without her.
Ngozi Cole:When national staff got off work, there was no land rover. They had to find their own way home. Kini usually took a motorcycle taxi, despite MSF’s no touch policy. When he got home, like many of the national staff, he was shunned. People assumed he was bringing Ebola with him.
Kini Musa:Some of us lost relationship because of our job. Some of us, we lost good friends.
Ngozi Cole:Kenny was one of those who lost his relationship. Other national staff were kicked out of their apartment.
Kini Musa:Even the family members. They were so scared. The rate at which our colleagues were dying, dying. So because of this, it created a lot of stigmatization for us.
Mara Kardas-Nel…:And if the workers at the treatment center did get sick, they would be treated differently. If Indira got sick, MSF would evacuate her out of the country, where her chances of survival would be good. National staff who got Ebola were treated in the same center where they worked. I asked Kini about this.
Mara Kardas-Nel…:Was that a good thing that they were admitted to the same facility?
Kini Musa:For me, it was actually the motivation. Because the segregation was there, clearly.
Mara Kardas-Nel…:Kini helped to treat national staff who got sick with Ebola at MSF’s facility. Some of them died. In a written response, MSF says they offer medical care to national staff based on national laws and availability of care in country. And that they have a different level of responsibility to people on international assignments.
Mara Kardas-Nel…:We’re focusing on MSF because it’s one of the biggest players in global health, and because more than a thousand current and former staff signed that letter last summer demanding change. But this two-tiered system is baked in into a lot of global health organizations, and some say it’s directly linked to colonialism. Many of the early Western hospitals in Africa were set up by missionaries. That language has endured. Even though MSF is not a religious organization, it sends out expats on “missions”.
Ngozi Cole:MSF says it’s mandate is to provide medical care where it’s needed most. And it says national staff are paid according to minimum pay requirements for the countries where they work. But critics say that MSF is exploiting labor conditions in these countries.
Mara Kardas-Nel…:And look, it’s really complicated. Foreign doctors already take pay cuts to work for MSF. If they made local salaries and had to live like locals, they might not come to Sierra Leone at all.
Ngozi Cole:But 90% of their workforce is national staff. And people in the global health community are asking, should organizations like MSF and others reinforce existing inequalities or be part of changing them? Something happened in Sierra Leone during the Ebola crisis that brought all of these issues to a head.
Speaker 14:The worst Ebola outbreak in history continues to rage in West Africa, and the chief doctor in the area has contracted the deadly disease .
Ngozi Cole:That chief doctor was Sheik Umar Khan, a legend in Sierra Leone. He was one of the first doctors to treat Ebola patients in the country. When Ebola broke out, he trained hundreds of clinicians, including Kenny and many other national staff who later worked for MSF. He was kind of like Dr. Fauci of Ebola, one of the key leaders fighting the epidemic.
Dan Bauch:He was kind of excited to do things and very decisive, and he really wanted to do it. He really wanted to plunge in.
Mara Kardas-Nel…:Dan [Bauch] is a doctor and a leading expert in global health. He worked alongside Dr. Khan in Sierra Leone. When Dan found out that Dr. Khan tested positive and that he was being seen at MSF’s treatment center, he and other giants in global health sprung into action. They asked the World Health Organization to medevac Dr. Khan out of Sierra Leone. That was routine for international medical staff. At first, the WHO said no, and by the time the organization agreed, it was too late. They also pushed MSF to give Dr. Khan an experimental and promising treatment called ZMAP. But MSF said no. They said it wouldn’t be fair.
Dan Bauch:What they termed equity and social justice. That you had many, many people every day who were coming down with Ebola who were not getting offered an experimental therapeutic.
Mara Kardas-Nel…:Dan didn’t buy it. He says doctors make decisions about who should live and die all the time.
Dan Bauch:To be very frank, if it was an MSF worker who had fallen sick, someone who had come into the country from outside-
Mara Kardas-Nel…:Meaning an expat.
Dan Bauch:I think that that person would have been offered the drug.
Ngozi Cole:That’s basically what happened. A few days after Dr. Khan died, another organization, flew ZMAP from Sierra Leone to Liberia. It was used to treat two white American relief workers. Both lived.
Mara Kardas-Nel…:Dan says that Dr. Khan’s death was a watershed moment. It’s become a textbook example of inequality in global health.
Dan Bauch:And so I think in many ways, that is his legacy.
Mara Kardas-Nel…:It’s been almost six years since the Ebola outbreak ended. And we went to Kailahun to see how Kini and other national staff are doing.
Kini Musa:The road is still bad as the way it used to be.
Ngozi Cole:We drove to the site of MSF’s old treatment center.
Kini Musa:We are now close to the camp,
Mara Kardas-Nel…:A few miles outside of town, the paved road turns into gravel, and we enter a jungle. Bushes and trees reach towards us from all sides.
Kini Musa:I think we are here. We can get out of the vehicle.
Ngozi Cole:You can still see some concrete slabs, old latex gloves, but really it’s just forest.
Mara Kardas-Nel…:Kini and some other former MSF staff show us around. He points to where the ambulances and the land rovers would park.
Kini Musa:We have a very big space for car park.
Ngozi Cole:And where the expats ate lunch.
Kini Musa:Place where the expats take their lunch.
Ngozi Cole:Gloria Bunda, who was a nurse at the treatment center, teases him.
Gloria Bunda:What about you? Did you take a lunch there?
Kini Musa:I was not part of them.
Mara Kardas-Nel…:They’re excited to show us where they worked and what they did every day. They know they helped to save many lives.
Ngozi Cole:But they also say they feel left behind and forgotten. At the end of the Ebola outbreak, national staff say they were finally invited to the guest house. They hoped after a year of grueling work with low pay, MSF might reward them. Workers, tell us the hopes they might get a severance check. Instead, they say they were each given a certificate and a big white bucket. Gloves and soap.
Kini Musa:I’m saying this. If Ebola enter Sierra Leone today, we are not pushing for that.
Mara Kardas-Nel…:Kini says that if MSF were to come back to the country to fight another Ebola outbreak, he won’t join them.
Kini Musa:Because looking at the risk that we took, we are left with no compensation.
Mara Kardas-Nel…:He says, look at the risk that we took, and we didn’t get compensated for that. That’s why if Ebola happened again…
Kini Musa:Nobody would tap into my knowledge to work again. I would not do that.
Ngozi Cole:At the old treatment center, they tell us they want to look for a colleague’s grave. He was a nurse who worked there and died of Ebola.
Kini Musa:So we are heading now to the cemetery where we buried the patients who died.
Ngozi Cole:Because dead bodies were highly infectious, everyone, except for Dr. Khan, was buried in a cemetery down the road.
Mara Kardas-Nel…:Today, there are rows and rows of big, brown mounds, and a few wooden placards. A lot of them have fallen down or cracked in half.
Gloria Bunda:I feel sad. I’m really discouraged if I see those graves, if I can remember those days.
Kini Musa:So it’s not really easy for us. These are Sierra Leonians.
Mara Kardas-Nel…:Kini says it’s hard to see all these graves. So many Sierra Leonians from across the country died from Ebola and are buried here.
Ngozi Cole:They look for a while, but they aren’t able to find their colleague’s grave.
Al Letson:Kini, Gloria and other former national staff tell us that MSF promised to pay into their social security program, or [NASIT], but the money never showed up in their accounts. We’ve seen NASIT statements for five former MSF workers, and there’s no record of these payments. We asked MSF about this several times. The organization did not answer those questions. We spent a lot of time trying to get to the bottom of this. NASIT is a big government bureaucracy, and it’s possible that the problem is on their end. But the bottom line is, after MSF closed the treatment center, former staff say there’s no one they can talk to fix the problem. When we come back and Indira Govender is torn. She’s proud of the work she did during the Ebola outbreak.
Dr. Indira Gove…:There is no doubt that what MSF did was life saving, and I think everyone will be forever grateful for that.
Al Letson:But she thinks MSF is deeply segregated, and she’s trying to figure out where to go from here. That’s next on Reveal.
Al Letson:I may sound biased here, but I think our stories are pretty great. And if you’re listening to this, I have a feeling that well, you might agree. But have you ever been left wanting even more? Reveal’s newsletter goes behind the scenes. Reporters describe how they first found out about these stories, and the challenges they face reporting them. Plus recommended reads and more. Subscribe now at RevealNews.org/newsletter.
Al Letson:From the Center for Investigative Reporting and PRX. This is Reveal. I’m Al Letson. Today, we’ve been telling you about Doctors Without Borders and how the global organization is deeply divided. Staff members say the organization is plagued by a two-tier system that favors foreign staffers, also known as expats. They make up a tiny fraction of the workforce, just 10%. They’re paid based on French salaries, where the organization is based. Food, lodging, transportation, and daily spending money are also routinely provided. And sometimes Doctors Without Borders throws in cushy benefits like private school for the kids. National staff who make up 90% of the organization’s workforce, are paid local wages, often a fraction of what expats make. But the issues the organization faces run much deeper than that. Doctors Without Borders acknowledges that bias, inequality, and institutional racism are problems they need to wrestle with.
Al Letson:Throughout the show, which first aired last year, we’ve been following Dr. Indira Govender. She’s worked on both sides of the organization. At the beginning, it was her dream job, but Indira has grown disillusioned. Reporter Mara Kardas-Nelson worked with Indira at Doctors Without Borders in South Africa about a decade ago, and has the rest of her story.
Mara Kardas-Nel…:Indira still thinks about her experience fighting Ebola in Sierra Leone.
Dr. Indira Gove…:That experience was one of the most incredible experiences of my life. That has not changed.
Mara Kardas-Nel…:But she also sees how local staff members felt disrespected, undervalued, and stuck in subservient roles.
Dr. Indira Gove…:The worst part, it was this amazing life saving intervention, but they felt dehumanized after they were part of it. So that’s a paradox that shouldn’t exist, in my opinion.
Mara Kardas-Nel…:The paradox, it does exist. And it’s one Indira has to wrestle with. In the end, she decides…
Dr. Indira Gove…:I just don’t think that I would feel comfortable going as an expat. I don’t want to be part of this institution until I see radical transformation.
Mara Kardas-Nel…:For a couple years after she left Doctors Without Borders, Indira didn’t really talk about everything that had happened. She still had this trickle of doubt, like maybe she had just seen the worst of it, or maybe her experience wasn’t normal, and she was just unlucky. Mostly though, she was ready to get on with her life. She got married, had kids. Indira got a research job that she loved. But she kept in touch with people who worked for Doctors Without Borders, and so it kept coming up.
Dr. Indira Gove…:So I saw other people come through the organization and have the same experience and leave feeling disempowered.
Mara Kardas-Nel…:And the more people she talked to, the more Indira thought, “You know what? All those experiences, it isn’t just me. It might just be Doctors Without Borders.”
Dr. Indira Gove…:MSF is unfortunately on the wrong side of decolonizing global health.
Mara Kardas-Nel…:In our investigation, we spoke to about a hundred current and former staff from Ukraine, to Egypt, to Canada, the stories we heard were strikingly similar. We’ve already heard how local staff in Sierra Leone made a small percentage of what expats made, and they got way fewer benefits. This is true in many of the 88 countries in which Doctors Without Borders works. In 2020, on average, MSF spent six times more on each expat than each local staffer. National staff we spoke to also say they routinely heard expats disparaging them. In Egypt, employees say they heard expat colleagues use almost the exact same language Indira heard in South Africa years before. That local staff are lazy, that they just want money. One African staff member at a different site shared a report with us where he claimed his white colleagues referred to a fellow African staff as a “chimpanzee, gorilla, and monkey.” Indira says these stories speak to a larger truth.
Dr. Indira Gove…:The wellbeing of national staff often seen to be secondary to the wellbeing of international staff.
Mara Kardas-Nel…:We learned of several instances of national staff being left behind in dangerous situations, often with little or no warning. For example, when a conflict threatened to spill into part of the Democratic Republic of the Congo, one expat staffer told us that international staff were evacuated, overnight. She said that national staff had no idea what was happening. They just woke up one morning, and their colleagues were gone. The staffer says she still thinks about it to this day. She told us it’s just heartbreaking. It’s wrong.
Speaker 17:We have gathered here in order to raise our voice. We are workers of MSF, Afghanistan.
Mara Kardas-Nel…:And in late August, just as the US troops were leaving Afghanistan, national staff posted a video on Facebook asking MSF to help get them out.
Speaker 17:We went to the main office of MSF and they say that we will help you, but they didn’t.
Mara Kardas-Nel…:In the video, about two dozen men and women are seen protesting in Kabul, holding signs that say, “Our lives matter.” The speaker says that they’ve worked for the organization for years. We asked Doctors Without Borders if they had plans to evacuate national staff. In a written statement given to us in early September, a spokesperson said no. They are offering to provide national staff with certificates proving they were employed with the organization, and Doctors Without Borders said it is giving national staff accurate information about the possibilities for evacuation and other immigration pathways. Doctors Without Borders stressed that as of early September, it was still providing care at five sites in Afghanistan, with some 2300 national staff and 50 expats. Doctors Without Borders also told us it was negotiating with the Taliban and assured national staff they would be safe. In a written statement, the organization said that it bears specific responsibility towards staff who relocate to danger zones as part of their work with the group. And I should add that Doctors Without Borders is not alone here. Other organizations, including the UN, have also been criticized for not doing enough to get local staff out of Afghanistan. And in the end, evacuations of Afghan nationals have proven extremely challenging and often impossible.
Mara Kardas-Nel…:Indira and the majority of the people we spoke to say the underlying problem here is who gets to make decisions. 50 years after it was founded in France, five of the organization’s six main operational centers are still based in Europe. They decide its priorities and assign staff to missions.
Dr. Indira Gove…:Those attitudes are very much colonial attitudes and colonial ways of doing things.
Mara Kardas-Nel…:Doctors Without Borders says it’s confronting the hard truths about how racism and colonialism are embedded in the organization. To begin addressing the problem, they say they opened an operational center in West Africa. But Doctors Without Borders has acknowledged these issues for almost 15 years. In 2006, the organization pledged to give all staff fair opportunities. Over the next decade, it held meeting after meeting issuing one mea culpa after another, and pledging to do better. But more than a thousand former and current staffers have come out publicly to say nothing has changed.
Sam Bomicho:Looking back from 2006, and now we are in 2021, that’s quite a long time. Of course, we need to work towards delivering change faster.
Mara Kardas-Nel…:Sam Bomicho is the vice president of Doctors Without Borders’ international board. It guides the organization, but doesn’t supervise day to day operations. Sam Bomicho is a physician from Kenya.
Sam Bomicho:Of course, there’s still white and Western over-representation in our top management. And this is something that we need to actively and more robustly address.
Mara Kardas-Nel…:Sam was once a national staff member, and was elected to the position several weeks before we spoke. He says the issues we’re raising aren’t isolated incidents.
Sam Bomicho:I worked as a national staff for more than 10 years, so I’m familiar with this frustration. I’m very familiar with it. I’ve lived it, I’ve experienced it.
Mara Kardas-Nel…:Sam says Doctors Without Borders’ staff have rightly highlighted the problems of structural racism within the organization for years. And he says people must keep raising their voice to make change. I pushed him on this point.
Mara Kardas-Nel…:People have been saying these things for a really long time, and have been coming out for decades. So you’re still putting the burden on staff to say what they’ve already said.
Sam Bomicho:I’m not putting the burden on the staff, but we need information. Where do we get this information? We go out to the field. We need to speak to the people.
Mara Kardas-Nel…:But Sam, you have that information. I mean, that information has come out four decades from thousands of people at this point.
Sam Bomicho:We need to engage. We need to have this conversation without staff and colleagues feeling that it’s a burden to them. We need to have a constant conversation. We need to continue engaging.
Mara Kardas-Nel…:This spring, six years after leaving Doctors Without Borders, Indira says national staff in South Africa asked her to run for one of Doctors Without Borders’ governing bodies. They wanted her to push for change. She turned them down.
Dr. Indira Gove…:I’m just so fed up because I just don’t think that there’s ever going to be any change here.
Mara Kardas-Nel…:But she kept thinking about it. A few months later, she decided to run.
Dr. Indira Gove…:Instead of saying no, I thought, let me just go in there and say what I think. And if they don’t like me, they don’t have to vote for me. So that’s what I did. I went in and I told them that I don’t like the way MSF is run. It’s not representative. It’s old. It’s stale. This white male patriarchy needs to go.
Mara Kardas-Nel…:In May of 2021, Indira went on Zoom to give a speech. She was running to become a representative of something called the Movement-wide Association. It’s one of the many bodies for current and former staff, and advises the greater organization.
Dr. Indira Gove…:… That I stand for here is the commitment to anti-racism. And yes, dealing with that in MSF.
Mara Kardas-Nel…:She won. She was shocked.
Dr. Indira Gove…:Because my experience 10 years ago was of being ostracized and sidelined because of my opinions. And now I’m voted into the Movement-wide Association, basically for those same opinions.
Mara Kardas-Nel…:Indira is part of a growing wave of people pushing for change, including a group that formed just over a year ago, called Decolonize MSF. In the summer of 2020, Decolonize published The Letter, calling on the organization to commit to immediate, tangible changes. After news outlets covered the rebellion, Doctors Without Borders issued public statements acknowledging they’ve failed to tackle institutional racism. And Indira told me something that surprised me. Even after her own experience with racism at Doctors Without Borders, she continues to make a monthly donation to them.
Dr. Indira Gove…:And I think it’s because as much as I have my personal opinions and my own experience, I cannot deny the fact that they do reach some of the most vulnerable people, and they do save lives, and they do also speak out against those atrocities.
Mara Kardas-Nel…:Indira says some people are so mad that they want to burn it all down, but she’s not with them. She says there’s too much at stake. What would happen to all those patients who rely on Doctors Without Borders’ care?
Dr. Indira Gove…:People sometimes want us to choose one or the other, like you can’t love MSF and have these attitudes towards them. You can’t say you had this amazing experience, but then also talk about the fact that you witnessed racism or you experienced racism. It’s very much a theme in all of this, is this cognitive dissonance.
Al Letson:Indira’s discomfort with that in-betweenness of loving and hating Doctors Without Borders, that’s what’s pushing her to keep going. She’s now an active member of Decolonize MSF, a group she thought would never exist.
Dr. Indira Gove…:I am a bit more optimistic, because I think that the more people talk about these things, the more courage it gives everybody to talk about it.
Al Letson:Another point of optimism. Today, 50% of expats come from outside Europe and North America. That’s up from 25% just 10 years ago. They are also more national staff in leadership positions around the world. Doctors Without Borders representatives tell us they’re also reviewing pay structure, but say the changes don’t mean that local and foreign staff will have the same contract, pay, or benefits. The organization says it’s impossible with a global workforce. And to meet this moment, Doctors Without Borders has launched an initiative called The MSF We Want To Be. The organization is asking thousands of current and former staff about its culture and its diversity inclusion efforts. Initial results are expected in 2023.
Al Letson:Today’s show was created in partnership with Insider, the global news site. You can read more at insider.com. It was reported by Mara Kardas-Nelson and Ngozi Cole, and Sean Campbell. Katherine Meskowski and Pamela Kirkland produced our show. Queena Kim edited today’s episode with additional editing from Brett Myers. Special thanks to John Cook at Insider, as well as Aria [Ahrari] and Daniel Gross. And shout out to our former colleagues Chris [Coneely], Jen Chien, and Laura [Sarchevsky] who helped us get this project going. If you’ve worked in global health and have a story to tell about your experience, reach out on Twitter to Mara Kardas-Nelson. She’s @MaraJennKN. That’s @M-A-R-A J-E-N-N K-N.
Al Letson:Victoria [Berenetsky] is our general counsel. Our production manager is Amy Mustafa. Score and sound designed by the dynamic duo, Jay Breezy, Mr. Jim Briggs and Fernando ma man yo Arruda. That helped this week from Steven Rascon, Najib Amini, Claire C-note Mullin, Katherine Styer Martinez, and Jess Alvarenga. Our digital producer is Sarah Merck. Our CEO is [Kazar Campwalla]. Sumi Agarwal is our editor in chief, and our executive producer is Kevin Sullivan. Our theme music is by Camarado, Lightning.
Al Letson:Support for Reveal is provided by the Reva and David Logan foundation. The John D and Catherine T MacArthur Foundation, the Jonathan Logan Family Foundation, the Ford Foundation, the Heising Simon’s foundation, the Hellman foundation, the Democracy Fund, and the In As Much Foundation. Reveal is a co-production of the Center for Investigative Reporting and PRX. I’m Al Letson. And remember, there is always more to the story.
Al Letson:If you like what we do and you want to help. Well, it’s pretty simple. Just write us a review on Apple Podcast. It’s easy and only takes a few seconds. Just open the Apple Podcast app on your phone, search for Reveal, then scroll down to where you see “Write a Review.” And there, tell them how much you love the host. Your review makes it easier for listeners to find us, and well, it really does make a difference. And if you do it, you will get a personal thank you from me. Like right now. Like thank… Not him. Not, no. You. Yes, you. Thank you so much. Thank you. Thank you. Thank you. Thank you. Thank you. All right.
Speaker 20:From PRX.

Katharine Mieszkowski

Katharine Mieszkowski is a senior reporter and producer for Reveal. She's also been a senior writer for Salon and Fast Company. Her work has appeared in The New York Times, Rolling Stone, Mother Jones, Slate and on NPR's "All Things Considered."

Her coverage has won national awards, including the Alfred I. duPont-Columbia University Award two years in a row, an Online News Association Award, a Webby Award and a Society of Environmental Journalists Award. Mieszkowski has a bachelor's degree from Yale University. She is based in Reveal's Emeryville, California, office.

Queena Sook Kim

Queena Sook Kim is a senior editor for Reveal. She was previously at KQED, where she supervised the weekend desk. Before that, she headed the Silicon Valley desk and hosted a statewide daily news show, The California Report, for the station. Kim was also a senior reporter covering technology for Marketplace and covered homebuilding and toys at The Wall Street Journal. She has spent much of her career starting up shows and editorial projects for local public radio stations. She most recently edited an eight-part documentary, “The Political Mind of Jerry Brown.” Kim is also the head of audio at the UC Berkeley Graduate School of Journalism. Her stories have appeared on NPR, WNYC’s The Takeaway, Here & Now, BBC’s Global Perspective and The New York Times’ multimedia page.

Brett Myers is an interim executive producer for Reveal. His work has received more than 20 national honors, including a George Foster Peabody Award, four nationalEdward R. Murrow Awards and multipleThird Coast/Richard H. Driehaus Competition awards. Before joining Reveal, he was a senior producer at Youth Radio, where he collaborated with teenage reporters to file stories for "Morning Edition," "All Things Considered" and "Marketplace." 

Prior to becoming an audio producer, Myers trained as a documentary photographer and was named one of the 25 best American photographers under the age of 25. He loves bikes, California and his family. Before that, he was an independent radio producer and worked with StoryCorps, Sound Portraits and The Kitchen Sisters. Myers is based in Reveal's Emeryville, California, office.

Jim Briggs III is the senior sound designer, engineer and composer for Reveal. He supervises post-production and composes original music for the public radio show and podcast. He also leads Reveal's efforts in composition for data sonification and live performances.

Prior to joining Reveal in 2014, Briggs mixed and recorded for clients such as WNYC Studios, NPR, the CBC and American Public Media. Credits include “Marketplace,” “Selected Shorts,” “Death, Sex & Money,” “The Longest Shortest Time,” NPR’s “Ask Me Another,” “Radiolab,” “Freakonomics Radio” and “Soundcheck.” He also was the sound re-recording mixer and sound editor for several PBS television documentaries, including “American Experience: Walt Whitman,” the 2012 Tea Party documentary "Town Hall" and “The Supreme Court” miniseries. His music credits include albums by R.E.M., Paul Simon and Kelly Clarkson.

Briggs' work with Reveal has been recognized with an Emmy Award (2016) and two Alfred I. duPont-Columbia University Awards (2018, 2019). Previously, he was part of the team that won the Dart Award for Excellence in Coverage of Trauma for its work on WNYC’s hourlong documentary special “Living 9/11.” He has taught sound, radio and music production at The New School and Eugene Lang College and has a master's degree in media studies from The New School. Briggs is based in Reveal's Emeryville, California, office.

Fernando Arruda

Fernando Arruda is a sound designer, engineer and composer for Reveal. As a multi-instrumentalist, he contributes to the original music, editing and mixing of the weekly public radio show and podcast. He has held four O-1 visas for individuals with extraordinary abilities. His work has been recognized with Peabody, duPont-Columbia, Edward R. Murrow, Gerald Loeb, Third Coast and Association of Music Producers awards, as well as Emmy and Pulitzer nominations. Prior to joining Reveal, Arruda toured as an international DJ and taught music technology at Dubspot and ESRA International Film School. He worked at Antfood, a creative audio studio for media and TV ads, and co-founded a film-scoring boutique called the Manhattan Composers Collective. He worked with clients such as Marvel, MasterClass and Samsung and ad agencies such as Framestore, Trollbäck+Company, BUCK and Vice. Arruda releases experimental music under the alias FJAZZ and has performed with many jazz, classical and pop ensembles, such as SFJAZZ Monday Night Band, Art&Sax quartet, Krychek, Dark Inc. and the New York Arabic Orchestra. His credits in the podcast and radio world include NPR’s “51 Percent,” WNYC’s “Bad Feminist Happy Hour” and its live broadcast of Orson Welles’ “The Hitchhiker,” Wondery’s “Detective Trapp,” MSNBC’s “Why Is This Happening?” and NBC’s “Born to Rule,” to name a few. Arruda also has a wide catalog of composed music for theatrical, orchestral and chamber music formats, some of which has premiered worldwide. He holds a master’s degree in film scoring and composition from NYU Steinhardt. The original music he makes with Jim Briggs for Reveal can be found on Bandcamp.

Amy Mostafa (she/they) is the production manager for Reveal. She is a UC Berkeley School of Journalism alum, where she focused on audio and data journalism as a Dean's Merit Fellow and an ISF Scholar. She has reported on science, health and the environment in Anchorage for Alaska Public Media and on city government in Berkeley and San Francisco for KQED. Her work also has appeared on NPR, KALW and KALX. Mostafa holds a bachelor's degree in English literature and public policy. She has most recently reported on housing and aging in the Bay Area. She is based in Reveal’s Emeryville, California, office.

Steven Rascón (he/they) is a production assistant for Reveal. He is pursuing a master's degree at the UC Berkeley Graduate School of Journalism with a Kaiser Permanente Institute for Health Policy Fellowship. His focus is investigative reporting and audio documentary. He has written for online, magazines and radio. His reporting on underreported fentanyl overdoses in Los Angeles' LGBTQ community aired on KCRW and KQED. Rascón is passionate about telling diverse stories for radio through community engagement. He holds a bachelor of fine arts degree in theater arts and creative writing.

Claire Mullen worked at The Center for Investigative Reporting until September 2017. is an associate sound designer and audio engineer for Reveal. Before joining Reveal, she was an assistant producer at Radio Ambulante and worked with KALW, KQED, the Association of Independents in Radio and the San Francisco Bay Guardian. She studied humanities and media studies at Scripps College.

Kevin Sullivan is the executive producer of Reveal’s public radio show and podcast. He joined Reveal from the daily news magazine show “Here & Now,” where he was senior managing editor. There, he helped lead the expansion of the show as part of a unique partnership between NPR and WBUR. Prior to radio, Sullivan worked as a documentary film producer. That work took him around the world, with stories ranging from reconciliation in Northern Ireland to the refugee crisis during the war in Kosovo.

Following the 9/11 terrorist attacks, Sullivan launched an investigative unit for CBS in Baltimore, where he spearheaded investigations on bioterrorism and the U.S. government’s ability to respond to future threats. He also dug into local issues. His exposé of local judges found widespread lax sentencing of repeat-offender drunken drivers. Other investigations included sexual abuse by Roman Catholic priests, and doctors who sold OxyContin for cash. Sullivan has won multiple journalism awards, including several Edward R. Murrow awards, a Third Coast / Richard H. Driehaus Foundation Competition award and an Emmy. He has an MBA from Boston University.

Sullivan is based in Reveal's Emeryville, California, office.

Al Letson is a playwright, performer, screenwriter, journalist, and the host of Reveal. Soul-stirring, interdisciplinary work has garnered Letson national recognition and devoted fans.