廖滿嫦 埃博拉世界中的人類鬥士

In the rare free moments she has had this year between visiting Ebola centres in west Africa and pleading for support in front of the UN, Dr Joanne Liu, international president of Médecins Sans Frontières, reread The Plague by Albert Camus. Unsurprisingly, it had extra resonance this time. She was particularly struck by the narrator Dr Rieux’s statement that he keeps going because he has never managed to get used to seeing people die. Telling me this, she pauses. “I think today it’s one of our problems. Somehow we got used to death and then we dehumanised it. We account for conflicts in figures. Ebola is 13,500 infected, 5,000 people have died… People are losing their sense of empathy, their sense of wanting to do something.”

身爲無國界醫生組織(MSF)的國際主席，廖滿嫦醫生(Dr Joanne Liu)今年頗爲忙碌，她不時要前往西非的埃博拉疫區，還要赴聯合國(UN)請求支援，不過她還是忙裏偷閒重讀了阿爾貝•加繆(Albert Camus)所著的《鼠疫》(The Plague)。不出所料，這次閱讀讓她感觸更深了。她尤其被書中的敘述者李歐醫生(Dr Rieux)的自白所打動：他之所以能堅持下去，是因爲他始終不習慣看到人們死去。說到這裏，她停頓了一下，接着說道：“我覺得這是我們現在的一個問題。我們不知怎麼就習慣了死亡，在對待死亡問題上變得沒有了人情味。我們用數字來說明事故。埃博拉病毒已造成13500人感染，5000人死亡……人們正在失去同情心，沒有了想要做點什麼的心思。”

No one can accuse MSF or the woman who leads it of that. Since the current outbreak of Ebola was confirmed in Guinea in March, the organisation has worked with more than 6,000 patients, manning the front lines in west Africa for months before the world started to take notice. MSF realised this epidemic was different from previous ones almost immediately. “Our experience [with Ebola] is that it’s in a remote village and the chain of transmission dies very quickly . . . That’s it. It’s over in less than three months,” says Liu. “This was different because it was geographically spread.” But the international community didn’t want to know: “We were told that we were getting too excited and ringing the alarm when everything was under control.” Matters were complicated by the sheer number of global crises demanding attention this year. “There was South Sudan and the Central African Republic [CAR] . . . DRC . . . Ukraine . . . and then Gaza was a full-blown crisis in July.”

對於這種狀況，沒人能指責MSF或是這位女主席。自從3月份幾內亞證實爆發了埃博拉疫情以來，該組織已經接治了6000多名病人，在其堅守西非前線幾個月後世界才關注起這次疫情。MSF幾乎立刻就發現，此次埃博拉疫情不同於以往。“根據我們的經驗，埃博拉疫情一般發生在偏遠村莊，傳播鏈很快會中斷……就是這樣。疫情會在不到3個月內結束。”廖滿嫦稱，“而這次爆發的疫情並不一樣，因爲病毒能在地域間傳播。”然而，國際社會並不想了解其中究竟。“我們聽到的說法是，我們過於激動了，大驚小怪，其實一切都在控制之下。”今年國際上發生了太多需要關注的危機，這使事情變得複雜。“有南蘇丹內戰和中非共和國政變……剛果民主共和國……烏克蘭……接着是7月加沙地帶全面爆發的危機。”

MSF works in all of those places, with more than 32,000 staff in 67 countries last year. Founded in 1971 and largely privately funded, it provides independent humanitarian aid while bearing witness to what it sees on the ground.

MSF在所有這些地方都在運作。該組織成立於1971年，大部分經費靠私人捐助，去年成員總數超過32000名，遍佈67個國家。MSF提供獨立的人道救援，同時也現場見證各種災難。

Liu only became international president in October 2013. It seems an understatement to say it’s been a tough first year on the job. “It has hijacked all my life,” she laughs. When thinking about how best to describe it, three words keep coming back to her. Challenging — there have been so many places needing attention. Overstretched — the whole sector has reached its limits. And gap — a hole has been exposed in people’s ability to respond. “We’ve been running behind a train that is moving faster than the response has been in west Africa since the beginning,” she says.

廖滿嫦於2013年10月纔出任MSF國際主席。如果說任期第一年是艱難的，似乎有些輕描淡寫。“這份工作綁架了我全部的生活，”她笑着說。當她思考如何形容這份工作比較恰當時，腦海中不停地閃現三個詞。挑戰性——始終有太多地區需要關注。超負荷——這一領域已經達到了極限。差距——人們做出反應的能力暴露出了不足。她稱：“我們就像一直跟在火車後頭跑，與我們在西非做出反應的速度相比，它要快得多。”

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Liu was born in Quebec, Canada to Chinese immigrant parents. For her, MSF is a calling. As a teenager she read a book by a French doctor about his time with the organisation and that was that. “I remember reading that when I was young and saying, ‘Oh my god, this is a real life,’” she says. AFTer her medical training she volunteered with the organisation repeatedly, spending time in the field from Darfur to Haiti and heading the Canadian branch. The opposite of self-promoting, she shows little interest in her own achievements: “I find myself a bit boring because I somehow always wanted to be MSF.”

廖滿嫦出生在加拿大魁北克一個華裔移民家庭。對她而言，加入MSF是受到了感召。她年少時讀過一本法國醫生寫的書，講述他在該組織工作的經歷。“我記得讀那本書時我還很年輕，我說‘我的天啊，這纔是真實的生活’，”她說。在接受過醫療培訓後，她多次成爲該組織的志願者，在達爾富爾、海地等多個地方工作過，後來還負責加拿大分支。對於個人取得的成就，她非但沒有誇誇其談，反而顯得不太樂意提起：“我覺得自己有點無趣，總是想着要當個無國界醫生。”

Boring is not the word most would use to describe someone whose work, this year alone, has seen her travel to Syria, the CAR, Myanmar, the DRC and Sierra Leone among other countries, not to mention multiple trips to the UN and Montreal, where much of her life remains. Liu is a force to be reckoned with: the words flow out of her, punctuated only by the occasional “how you say” as she pauses to allow her French-English translation skills time to catch up with her brain.

因爲這份工作，她僅今年內就去過了敘利亞、中非共和國、緬甸、剛果民主共和國和塞拉利昂等等許多國家，更別提還多次前往聯合國和蒙特利爾（她主要生活的地方），對於這樣一個人，多數人都不會用“無趣”來形容。與她交談需要集中精神認真應付：她侃侃而談，只是偶爾插句“你怎麼說”做個停頓，給點時間讓自己法譯英的技巧趕上大腦思考的速度。

This is a woman who, while based in Switzerland, planned to spend her August holidays doing shifts in the Canadian hospital with which she remains associated as a paediatric emergency physician — “to keep a clinical hand in”. Ebola put a stop to that but she is determined to find somewhere to practise in Geneva. She laughs when asked how she fits it all in. “I feel that [in] any position of this kind of exposure and commitment, you have to accept that you won’t be as balanced as you would like. I always think of it as a privilege, an honour.”

常駐瑞士，卻計劃着利用8月份的假期在加拿大醫院（她仍然是該院的兒科急診醫生）輪班——“要保持臨牀的工作”，她就是這樣一個女人。埃博拉終止了這一計劃，但她決定在日內瓦找個地方繼續執業。當被問到如何適應這一切時，她大笑起來。“我覺得，處在這種要面對公衆、肩負着使命的職位上，你就得接受一個事實，你沒法做到像你希望的那樣，各個方面都兼顧到。我總是把它看作一種殊榮，深感榮幸。”

Her relentless travel schedule has also served up some difficult insights. “Our humanitarian aid system is sick and needs to be fixed. It needs to get a reality check and get back humanity,” she says. She recounts with disdain a supposed DRC success story about a displaced woman with the resilience to support herself. It turned out she had become a prostitute. “I can’t believe that you’re giving me that . . . That’s resilience for you?” she says, then mentions another visit to a displaced persons camp in the CAR. “People were talking to me with their two feet in mud. And I said, ‘This is not possible, that in the 21st century we still have to see that.’ And that for me is really a call for how can we do better? . . . Can I stand on a spot where I don’t have my two feet in water?”

不停出差也使她得以深入瞭解情況。她稱：“我們的人道救援體系出了問題，需要被修復。這需要進行一次現實檢查，重新回到人道主義的宗旨上。”她以不屑的口吻講了一個發生在剛果民主共和國的故事，一個無家可歸的婦女，堅強地自力更生養活自己，被視爲一個成功的援助案例，結果發現她已經當了妓女。“我不敢相信你就拿這個回報我……這就是你的堅強？”她稱，接着又提到了在中非共和國一次探訪難民安置營的經歷。“人們跟我說話時，兩隻腳還踩在泥裏。我說，‘這不可能，都21世紀了我們還能看到這種情況。’這使我認真思考，我們怎樣做得更好？……我能站在一個不用把雙腳踩在水裏的地方嗎？”

MSF is not necessarily the popular kid in the humanitarian aid playground. For one thing, it is unusual in having financial autonomy: 89 per cent of its funding comes from individual and private donors. The flexibility that such independence brings also ushers in critics. “Some people say that sometimes we’re a loner, and I accept that. And some people say we’re arrogant and it happens and I’m quite aware of that,” says Liu. “But it’s important to be self-sustaining because that’s what gives you the capacity to respond quickly.” In the case of Ebola, this meant arriving on the spot while others were still having meetings.

在人道救援圈子中，MSF未必是受歡迎的。擁有財務自主權是該組織與衆不同的一個地方：其89%的資金來自個人和私人捐助者。這種因爲財務獨立而具有的靈活性也招致了批評。“有些人說，有時我們是孤單的，我同意這個說法。還有人說我們是傲慢的，確實是這樣，我也相當清楚這一點，”她說，“但是自給自足很重要，因爲這才使你擁有迅速反應的能力。”以埃博拉疫情來說，這意味着，在其他人還在開會討論時，MSF便抵達了疫區。

Once in the thick of something, MSF stresses the importance of staff sharing what they see. So Liu stood up repeatedly in front of the UN and begged for boots on the ground, rather than mere promises. “I think that when people heard MSF say we were losing the battle, it was a bit of a shock for everybody.” Still, she feels it was the return home for treatment of two infected American missionaries in August that really woke people up. “All of a sudden it was knocking at our door . . . these were our neighbours, these were our colleagues, these were our people . . . And when it changed from them to us, then it got traction,” she recalls.

每到形勢最緊張的時候，MSF會強調成員們分享各自見聞的重要性。因此，廖滿嫦反覆向聯合國請求採取實際行動，而不僅僅是口頭承諾。“我覺得，當人們聽到MSF說我們正在輸掉這場戰爭時，每個人都有點震驚。”然而，她認爲，直到8月份兩名受感染的美國傳教士回國接受治療時，人們才真的醒悟過來。“突然間，它就敲響了我們的家門……這些人是我們的鄰居，我們的同事，是我們的同胞……而當‘他們’變成‘我們’時，才引起了關注，”她回憶稱。

For Liu, the effect of such proximity was not surprising. Indeed, she thinks the closeness that most MSF workers have to situations propels them to act. For these doctors, it’s not just nameless people in a far-off country who are dying but the cousins of the nurse who has been with them since the beginning of the epidemic. MSF employs a ratio of about 10 national staff to every international member and Liu believes they are the true heroes. “To do it for four weeks [the average international staff placement] is straining but to be living with Ebola for the last eight to nine months, it’s really, really hard,” she says. “Most of our staff have either lost family members or friends, as well as living in the constant potential fear of being exposed.” Thirteen have died so far.

在廖滿嫦看來，近距離接觸疫情所產生的這種影響並不令人意外。事實上，她認爲，多數MSF工作人員因爲接近疫情，驅使他們採取行動。對這些醫生來說，將死的不是在遙遠國家的無名人氏，而是自疫情開始一起做事的那位護士的表親。MSF從每個國際成員國聘請約10名醫生，廖滿嫦相信他們都是真正的英雄。“連續做4周工作（國際員工的平均安排）的強度很大，但在過去8-9個月裏面對埃博拉，這真的很難很難，”她稱，“我們多數人員不是失去了家人，就是失去了朋友，還要生活在可能暴露在病毒中的恐懼中。”目前爲止，已有13人死亡。

Liu is fiercely protective of the people that she works with: “What makes MSF, the strength of us, it’s our people.” In April, the organisation lost four staff in an attack on hospital grounds in CAR, and the question of how best to work in increasingly dangerous contexts — Syria, Libya, South Sudan, Somalia among others — remains unresolved. “Hospitals being targeted, patients being targeted, ambulances being targeted . . . the last spot that was supposed to have a minimum of respect has been violated in 2014,” she says. She believes it critical that MSF maintains a hands-on presence. How precisely that can happen will be one of her focuses in 2015.

廖滿嫦對一起共事的人有強烈的保護欲：“是什麼成就了MSF，我們的力量，是我們的人。”4月，中非共和國的醫院遭受襲擊，該組織失去了4名員工，而在越來越危險的環境——敘利亞、利比亞、南蘇丹、索馬里等等——如何更好開展工作的問題仍然沒有解決。她稱：“醫院成爲襲擊目標，病人成爲目標，救護車成了目標……這些原本應受到最起碼尊重的僅存之地，在2014年被侵犯了。”她認爲，MSF保持親臨現場是至關重要的。如何確實做到這一點，將成爲她2015年的工作重點之一。

And what about that Ebola train? Are we still running behind? “I think that what is happening now in some places is we’re jumping in the train and trying to get hold of the brake,” she says. “What has been the hampering, the hindering factor is fear . . . People are scared to deploy, scared of being infected.” Her hope is that the episode will teach the international community that someone needs to take responsibility before such a crisis escalates again in the future. “We all know that if the world had woken up in the spring, we wouldn’t be where we are today.”

那麼“埃博拉列車”怎麼樣了？我們仍然跟在後面跑嗎？“我想有些地方的情況是，我們跳上了火車，並試着控制剎車，”她稱，“一直以來的障礙，造成阻礙的因素是恐懼……人們害怕採取行動，害怕被傳染。”她希望這件事將使國際社會明白，有人需要擔起責任，以防未來這樣一場危機再次升級。“我們都知道，如果世界在今年春天能警醒，我們就不會處在今天這種局勢。”

When we talked, Liu was about to get back on a plane to west Africa to reassess the situation. MSF is hosting trials there and she is determined to make sure that any new treatment will be accessible to those on the ground. (On her return she will speak out about the potential for a double failure, both initially and now in adapting the response.) For her, the most crucial thing is keeping the world’s attention. “It’s like when you’re sick and you have pneumonia and you’ve been given antibiotics for 10 days and then you start to feel better after three days and would like to stop taking your antibiotics,” she says. “We’re just getting ahead of the game. We need to finish.”

我們談話時，廖滿嫦準備乘機返回西非，對埃博拉疫情進行重新評估。MSF在那裏組織試驗，她決心確保任何一種新治療手段將能被用於處在疫情中心的人。（回去後，她將闡述雙重失敗的可能性，包括最初的應對措施和現在的對策調整。）對她來說，最重要的事情是讓全世界的人繼續關注疫情。“就好像你生病，得了肺炎，醫生給你開了10天的抗生素，剛治了3天你感覺有所好轉，就想停了抗生素，”她說，“我們剛要在遊戲中佔得優勢。我們要完成它。”

Alice Fishburn is the deputy editor of FT Weekend Magazine

本文作者爲《FT週末雜誌》(FT Weekend Magazine)副主編