Human being =========== * Barbara Sibbald, BJ * © 2008 Canadian Medical Association ***Triage: Dr. James Orbinski's Humanitarian Dilemma*** A documentary directed by Patrick Reed; White Pine Pictures, National Film Board of Canada: 2007 88 min. English Dr. James Orbinski is one physician who doesn't mind raising your blood pressure, provided he raises your awareness at the same time. In the documentary, *Triage: Dr. James Orbinski's Humanitarian Dilemma*, the Canadian physician journeys back in time to the civil war in Somalia, the genocide in Rwanda and the displaced persons camps in the Democratic Republic of the Congo to present harrowing scenes and scenarios that adroitly perform both functions — and, in the process, he issues a challenge. Propelled by the narrative device of Orbinski's memoir writing (see page [1192](http://www.cmaj.ca/lookup/volpage/178/1192?iss=9)), Director Patrick Reed follows the renowned Canadian physician as he revisits these places and ruminates on what has been and what lies at the heart of humanitarian efforts. ![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/178/9/1191/F1.medium.gif) [Figure1](http://www.cmaj.ca/content/178/9/1191/F1) *In Triage*, Dr. James Orbinski was overwhelmed by the smell of lime-preserved bodies at the Murambi Genocide Memorial in Gikongoro, Rwanda; a testament to the travesty. Image by: Steve Simon Using graphic historic footage and, more poignantly, Orbinski's stories, the documentary strikes first at the emotional level, but it does not succumb, and this is its strength. So many of these efforts end up preaching to the converted, *Triage* offers an approach that broadens the appeal. Informed by emotion — by what it means to be human — the documentary is predominately about our intellectual response to our world, replete with genocide, starvation and all. We have to feel those emotions, Orbinski says, “it's absolutely vital to who we are as human beings, but it doesn't stop there, that's my point.” The corollary is the moral imperative to retain hope in the face of hopelessness and to engage in the world: to act, be it through a vote or performing surgery. The documentary begins in Baidoa, Somalia, where Orbinski worked with Médecins Sans Frontières in 1993. In the “epicenter of the famine” 150 000 people waited for food, up to 400 died every day; in the end 40% of the adults and 70% of children under 5 were dead. Fifteen years later, the internally displaced person camp is still there: 950 huts filled with people who have no where left to go. Orbinski laments that so little had changed, but then again, 80 000 were helped. Was it worth it? “You're damn right it was worth it,” he says. He sees hope in the children, the “seeds waiting to grow,” and in the people who won't turn their back on their country. Orbinski is a remarkable contradiction of cynic and optimist, of what he knows to be the record and what he hopes for. His attempt to synthesize these incongruent ideas drove him to write his memoir, to simplify the complexity. Similarly, the documentary, without dumbing-down the complexity, leaves the viewer with a feeling and the sense that above all else, we must try to be decent human beings. The documentary continues in Rwanda, where 800 000 people were murdered in 100 days in 1994. Orbinski worked in the hospital in Kigali, where 6000 people stayed. “This wasn't a medical safari, this was a fucking genocide.” People just outside the fence were being killed, and dogs would come at night and eat them, he recounts. Orbinski doesn't let anyone off the hook: “The genocide was a collective act made possible by the absence of others…” The most poignant moment in the film is the story he recounts about when he was operating on a young woman whose breasts and ears had been cut off, whose Achilles tendons had been severed. A pattern had been carefully cut into her face with a machete, and she had dried semen on her thighs. As Orbinski sutured, he accidentally pinched her with the forceps and she touched his arm. In a flash, his objectivity, his doctor's mask, was gone. This was a woman. He turned and vomited. In another scene he recounts a young girl who stayed with her wounded mother on the streets amidst a mass of “shit and blood and corpses,” pleading for help. Orbinski took them to the hospital, where the mother died, but he can't shake the image of the girl. As he silently contends with those feelings in the film, his voice-over continues: “It wasn't heroic, it's decent, it's normal. It's the human choice and it's the right choice.” Such insights, which occur several times in the documentary, afford a glimpse into Orbinski's heart, and by extention, the heart of humanitarianism: our capacity for decency. Not surprisingly in a world that often belies belief in the depths of its depravity and seeming indifference to human suffering, *Triage* raises more questions than it answers. But they are important questions about religion, politics and power, and also about our responsibility as citizens' of this world. What is our role? “Humanitarianism is not about a perfect system, 7 litres of water a day … it's about solidarity,” says Orbinski. ## Footnotes * Barbara Sibbald has been writing about the activities of Médecins Sans Frontières since 1998.