Témoignage: the action to testify, to report what we saw, what we heard, and what we now know.

This is a term that has been adopted by MSF, Doctors without Borders, as one of their core principles. I personally adopted this as one of my own principles for international medicine and humanitarian work although I do not work with MSF. According to MSF’s principles, it is important to bear witness in order to better understand our humanitarian responsibilities, rather than reducing them to strictly charitable actions. This gives meaning and weight to the work, individualizing it when a face is placed with a story.

Humanitarian work is about the people. The medicine is important – but the people and their stories are paramount. I promised myself when I started doing this work that I would always remember to bear witness.

---

A 2.5-year old with developmental delay is brought in by her mother. She has been unable to eat after a long stretch of untreated seizures a few months ago. She appears as though she has rickets, likely secondary to severe vitamin deficiency, and her tiny body is riddled with scabies.

A 29 year old presents with pain in his testicle. After an incident, he was dragged out of bed in the middle of the night and beaten until he was unconscious. His testicle was ruptured. He doesn’t dare to contradict any of the inmate-elected officials anymore.

A 35 year old fell two weeks ago and appears to have a displaced fracture of the proximal humerus. Unable to get surgery, this is likely to result in chronic pain.

A 39 year old is worried because of a recent TIA. This has led to severe anxiety. He tells me that his wife has left him since he has been imprisoned and she didn't come to visit on his birthday which was last week. His extended family has also refused to contact him even when he was hospitalized. He felt quite alone and depressed. He has only been in prison for two months, for what he tells me was a misunderstanding over the Bolivian drug laws. He is likely involved in the well-connected cartels and is confident that he may be released soon.

A 42 year old with a nasopharyngeal mass asks me if I have anything to help him breathe through his right nare. The mass is growing and he feels as though his voice is becoming affected. He saw a surgeon last year, who told him that he would need surgery to remove the mass. But the surgery costs $500, which is much more than he could ever hope to afford. His monthly rent for his room in the prison is $40. A seven-day rigorous work schedule barely pays enough to allow him a place to sleep. Others, either too old to work, or less fortunate in their connections, sleep outside on the dirt.

A 54 year old with uncontrolled diabetes begs me to help her control her blood sugars. She cannot afford medications since moving into the prison with her husband. She lives mostly on bread and rice supplied during the once-daily meal from the prison that often comes with some sort of soup ladled out from a large metal pot as a community meal. She tells me that more vitamin-rich foods such as fruits and vegetables are more dear in the prison - she could never afford them even if she wanted to try to buy them. She is now at the mercy of her environment.

A 68 year old breaks down in tears telling me his story. He and his wife lived in their home for 25 years. They paid taxes, owned their property, and had good careers. One day, a stranger knocked on their door, laying claim to their home. After some bribes to the judges by the accuser, both husband and wife were sentenced to three years in prison for unlawful ownership of property. They are segregated and placed into the men’s and women’s prison, allowed only to see each other on Saturdays. The husband cries most nights, worried about his wife and what will happen to her. He worries about what will happen when they are released. This, too commonly, occurs to elderly people in Bolivia, who become a target to those who are more well-connected and influential.

---

I treat their ailments, but I also ask their stories. I want to bear witness, to tell the world what may otherwise be forgotten: that these people are humans, too. At the end of the day, I bounce a 10-month old on my knee as she giggles and bats at a balloon. Her father asks me what he can do to help her as she grows. He is looking forward to her first steps. I give him a toothbrush for her tiny teeth and talk about love. Even in an environment such as this, children can thrive. After all, flowers can grow in a sidewalk if they are nourished properly, even despite the harsh conditions.

---

I bear witness to these stories and the stories of so many others. I cannot change their circumstance, but I can offer them an ear and a shoulder, and let them know that the world will not ignore them. We will not stay blinded, we will not stay silent - we will recognize their humanity.

Comment