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An Imperfect Offering: Humanitarian Action in the Twenty-first Century [Hardcover]

James Orbinski
4.6 out of 5 stars  See all reviews (8 customer reviews)

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Book Description

April 4 2008
National Bestseller

“As Albert Camus wrote, the doctor’s role is as a witness–to witness authentically the reality of humanity, and to speak out against the horrors of political inaction. . . . The only crime equaling inhumanity is the crime of indifference, silence, and forgetting.”
—James Orbinski

In 1988, James Orbinski, then a medical student in his twenties, embarked on a year-long research trip to Rwanda, a trip that would change who he would be as a doctor and as a man. Investigating the conditions of pediatric AIDS in Rwanda, James confronted widespread pain and suffering, much of it preventable, much of it occasioned by political and economic corruption. Fuelled by the injustice of what he had seen in Rwanda, Orbinski helped establish the Canadian chapter of Médecins Sans Frontières (Doctors Without Borders/MSF). As a member of MSF he travelled to Peru during a cholera epidemic, to Somalia during the famine and civil war, and to Jalalabad, Afghanistan.

In April 1994, James answered a call from the MSF Amsterdam office. Rwandan government soldiers and armed militias of extremist Hutus had begun systematically to murder Tutsis. While other foreigners were evacuated from Rwanda, Orbinski agreed to serve as Chef de Mission for MSF in Kigali. As Rwanda descended into a hell of civil war and genocide, he and his team worked tirelessly, tending to thousands upon thousands of casualties. In fourteen weeks 800,000 men, women and children were exterminated. Half a million people were injured, and millions were displaced. The Rwandan genocide was Orbinski’s undoing. Confronted by indescribable cruelty, he struggled to regain his footing as a doctor, a humanitarian and a man. In the end he chose not to retreat from the world, but resumed his work with MSF, and was the organization’s president when it was awarded the Nobel Peace Prize in 1999.

An Imperfect Offering is a deeply personal, deeply political book. With unstinting candor, Orbinski explores the nature of humanitarian action in the twenty-first century, and asserts the fundamental imperative of seeing as human those whose political systems have most brutally failed. He insists that in responding to the suffering of others, we must never lose sight of the dignity of those being helped or deny them the right to act as agents in their own lives. He takes readers on a journey to some of the darkest places of our history but finds there unimaginable acts of courage and empathy. Here he is doctor as witness, recording voices that must be heard around the world; calling on others to meet their responsibility.

“Ummera, ummera–sha” is a Rwandan saying that loosely translated means ‘Courage, courage, my friend–find your courage and let it live.’ It was said to me by a patient at our hospital in Kigali. She was slightly older than middle aged and had been attacked with machetes, her entire body rationally and systematically mutilated. Her face had been so carefully disfigured that a pattern was obvious in the slashes. I could do little more for her at that moment than stop the bleeding with a few sutures. We were completely overwhelmed. She knew and I knew that there were so many others. She said to me in the clearest voice I have ever heard, “Allez, allez. Ummera, ummera-sha”–‘Go, go. Courage, courage, my friend–find your courage and let it live.’
—From An Imperfect Offering

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“Thoughtful and passionate.”
The Globe and Mail

“With vivid personal anecdote, Orbinski chronicles the struggle around humanitarian intervention in one hotspot after another across the planet. In a narrative of grace and power, he displays the intense components of his remarkable life: integrity, compassion and principle. He is undaunted in the face of the worst the world has to offer. He is determined to salve the wounds of humankind. He is a truly committed man, mind and soul throbbing with incandescent decency.”
— Stephen Lewis, Former UN Special Envoy

An Imperfect Offering is more than a memoir of life on the frontlines of disaster — it is a provocative and revealing meditation on what it means to be human. What do we do, and what should we do, in the face of unspeakable suffering.”
Ottawa Citizen

“James Orbinski has lived for years in the middle of the worst that humans can be, and somehow emerged with both his compassion and his desire to understand us intact. He is a marvellous storyteller, and the stories he has to tell are some of the most powerful I have ever read.”
— Stephanie Nolen, author of 28: Stories of AIDS in Africa

“In this complex era of massive abuses to human rights by governments in too many countries, it is suprising to read such a poignant book that describes, without fanfare, the constant ethical, moral, and even legal dilemmas that those in the field must confront hundreds of times a day. Clarity, compassion and commitment are presented in spades in this book about those who are fighting the lack of political will that too often fails to prevent man's inhumanity to man.”
— L.Gen. Roméo Dallaire, author of Shake Hands with the Devil: The Failure of Humanity in Rwanda

“The rich beauty of Dr. James Orbinski’s writing contrasts with the stark poverty and suffering of the people he has served…. This book exposes truths most of us would rather not know. Do not put it down…. See who you become after reading it.”
Canadian Medical Association Journal

“A powerful personal memoir from a courageous Canadian who has spent most of his adult life in front-line humanitarian work in the world’s worst conflict zones…. It’s also a hopeful story about the emergence of MSF as a new and independent agent of civil society, and the possibilities of making the world a better place.”
Edmonton Journal

“A highly personal and wrenching memoir.”
The Walrus

“Almost unbearably intense…. Orbinski’s writing is strongest and most compelling when he is recounting his actual experiences as a doctor.”
Winnipeg Free Press

“Orbinski pulls no punches…. With his vivid descriptions, Orbinski brings the stench of death and illness to his pages with unflinching realism, giving us detailed narratives of such shameful events as the ruthless genocide of over one million Tutsis in Rwanda, and the United Nations’ complicity in turning a blind eye to the horror.”
Toronto Star

"An essential text for our dire times. Orbinski plunges into the heartbreak, the maelstrom, the moral dilemmas of the genocide territories of the world — Rwanda, Kosovo, Sudan — and finds there enough courage and redemption for us all to feel that there is hope for our sad humanity."
— Ariel Dorfman

About the Author

Dr. James Orbinski is a past international President of Médecins sans Frontières (MSF). He is a Research Scientist and Associate Professor of Family and Community Medicine and Political Science at St. Michael’s Hospital and the University of Toronto. He is a founder of the Drugs for Neglected Diseases Initiative, a not-for-profit pharmaceutical research and development entity focused on the diseases of the South. He recently founded Dignitas, an organization focused on community based treatment, care and prevention of HIV in the developing world. Dr. Orbinski lectures internationally on humanitarianism and global health.

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17 of 17 people found the following review helpful
4.0 out of 5 stars Other Peoples' Tomorrows May 14 2008
Just finished Dr. James Orbinski's new book, An Imperfect Offering: Humanitarian Action for the 21st Century. For those of you who don't know him, Orbinski is one of Canada's global health heroes. He accepted the Nobel Prize for Doctors Without Borders while he was its international president and has since worked on developing MSF's Access to Essential Medicine's Campaign and establishing Dignitas International, an organization that provides community-based HIV/AIDS treatment in Malawi.

I've heard Orbinski speak a couple of times, including at the Hope in the Balance forum last November. His talks provoke the idea of thoughts and a world view constantly evolving. This makes him especially human, despite his almost super-human committment to justice and health. One of his strongest messages is the world's need to create what he calls "humanitarian space," unobstructed by politics and military. Orbinski's experiences in Somalia, Kosovo, Afghanistan and elsewhere have made clear the problems of military co-option of humanitarian action. The classic example is the dropping of both bombs and food packets within Afghanistan; in several cases children have confused the two and were harmed rather than fed.

Orbinski's book is part memoir, part call to action. He takes the reader through some of the most devastating humanitarian disasters of the past 20-odd years, from the Rwandan Genocide to New York on September 11, 2001, when Orbinski worked in triage at Ground Zero. It struck me that on several occasions Orbinski has had a relationship with the countries he visits beyond their experience of humanitarian emergency, allowing him to describe the harsh differences between the time of acute crisis and normal daily life.
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18 of 19 people found the following review helpful
5.0 out of 5 stars A ray of Hope April 26 2008
It really is difficult to find words to describe the hope that this book gives. Although it describes deeply disturbing and difficult to comprehend suffering, it is written by a man who continually describes himself as 'a man' but describes situations in where his behaviour and devotion come straight from heaven. "A human perspective on suffering" just doesn't do this book justice. this book provides the decidely un-human (meaning more than human) perspective and unbelievable willingness to accept hope in the face of evidence that there should be none. It should be mandatory reading.
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4.0 out of 5 stars When Medicine Has No Cure... April 26 2012
Format:Hardcover|Verified Purchase
James Orbinski stays true to his profession even when writing the book. As a true doctor, he is honest and compassionate as he gives his account of the atrocities he witnessed/survived at the end of the 20th - beginning of the 21st century. Unfortunately, this is not the first nor the last book about ongoing genocides and mind-blowing ignorance. There is currently no cure for genocides. They still happen and they will continue to happen again and again. It can happen anywhere as modern-day genocidaires manage to find new "causes" for hatred and extermination...

Like any human being, the author of the book tries to restore the sanity in the mid of this chaos and impose an order on this depressing, pitiless, and ruthless natural world with no rules. In the book, James Orbinski tries to avoid the inescapable truth, that speaking out against genocide, acting against it, imposing the rules on it cannot prevent this inexplicable, but deliberate "human choice" (pp.163-164) from being made again and again. However, he believes in "human rights" and "humanitarian action" as if not solution, but, at least, the treatment for the tragic choice each of us makes. The belief that all people should share the same human values in this increasingly interconnected world is a wishful thinking. It is a sweet self-deception of the medicine, as well as law and politics, to think that there is some kind of collective cure for our epidemic desire to exterminate those who don't share our values. It is always hard to face our inability to control ourselves and the world around us. In this light, humanitarian action is truly "an imperfect offering"...
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3 of 4 people found the following review helpful
4.0 out of 5 stars Moving Aug. 1 2008
Format:Hardcover|Verified Purchase
An Imperfect Offering is a deeply moving, captivatingly told story of one man's lifetime of humanitarian efforts that border on the super human. It is hard not to retain hope for our future even in the face of the horrors intimately described in this book when we have people around with the depth of care for the human condition shown by Dr. Orbinski.

Briefly covering his early upbringing including the seeds of his exceptional compassion Dr. Orbrinski moves to his assignments with Medicins Sans Frontieres (MSF) in Somalia, Afghanistan and Rwanda. His narrative is intensely personal and disturbing. The Rwandan genocide was particularly difficult and is the subject of a lengthy and graphic chapter. Later Dr. Obrinsky describes his term as president of MSF during which he accepted the Nobel Peace Prize awarded to MSF in 1999 and his pivotal roles in; founding Dignitas International to "harness the natural compassion of communities," launching the Campaign for Access to Essential Medicines to bring life saving drugs to millions living in poverty and creating the Drugs for Neglected Diseases, a company to develop drugs with insufficient profit potential to interest big Pharma. One wants to cheer with each of Dr. Obrinski's successes and can't help sharing his tears.

Throughout Dr. Obrinski delves into the global political milieu, it's affect on humanitarian actions and MSF's responses which often forge a new and timely direction for NGOs. It is a useful addition to the book but is done from a typically Canadian left wing position resulting in a rather one-sided perspective. For example, he dismisses all of Bush's (the second) actions following 9/11 with scant thought or understanding.
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