It’s hard to contemplate Bunia without MSF. Bon Marché (the MSF hospital) is truly an institution – everyone I meet has either worked there or been a patient there – usually both.  The community was initially devastated to learn that Bon Marché would be closing, and the fact that we will be here for some years supporting the General Hospital has softened that blow to some extent, even though no one in the community quite understands what that support will entail. And I have to acknowledge that we’re not all that sure either, because here we are being pulled out of our comfort zone – from responding to humanitarian crises – into the unfamiliar world of development aid.

Our disengagement strategy has evolved through a series of stages, governed (as these things are) by political, financial and cultural factors, as much as by experience as to what works in practice. The complexity of ‘integrating’ what are essentially a series of specific and focused MSF programmes (Paediatrics, HIV, Women’s health) into a very general health system is baffling, involving everything from assuring the availability of ink for printing surveillance charts, to advocacy at national and international level for provision of anti-retroviral drugs. To make matters more confusing, each of the numerous partner organisations has its own way of working, its own timetable, and its own agenda – and sensitivity to this is a prerequisite for effective collaboration.

The fact that I am reflecting on all this does not mean (unfortunately) that I understand it. I am only just beginning to get a feel for the landscape, and to identify the points where we may be able to have an influence.  As a doctor I feel like a fish out of water, knowing that there must be many people who could do a better job of this than me. But I remember my father saying that there’s always someone out there who’ll do a worse job of it, and this gives me some reassurance.

So, to return to the original question, can we conceive of life here without MSF? For Bon Marché is not just a structure, an employer and a community service; it implies a way of working, an ideology, even a particular relationship with the community –which won’t be possible to replicate as we move from one hospital to the other. This does not have to mean giving up on such ideals – but it means weaving those ideals into reality, such that the difference between the two ceases, eventually, to exist.

Kiran James Jobanputra has been working as a doctor with MSF in Somalia, Kenya, and Niger since 2007. He is currently project coordinator of the MSF Hospital (Bon Marché) at Bunia, DRC. This blog also appears on the MSF website.