 First of all I should say thank you very much, I very much appreciate this opportunity for a whole host of reasons that would probably take more than 20 minutes to describe to you so I will simply say thank you to start. I also wanted to issue an apology before I began because I understand that the bar is very high for these talks and I will not be giving you a wrap today if that's what you were expecting from last year rather I will be committing the sin of PowerPoint but hopefully in a way that will be of use to you and help raise some questions and shift the field of focus somewhat for the rest of the discussion of this afternoon. As Kieran noted yesterday at the end in the summary remarks, anthropologists are not very good at giving short bulleted lists of suggestions or simply moving quickly rather they're slow and they ask questions and this is very much the mode in which I'll be operating today. So first of all I want to remind you of some obvious things these are things that you know we all know them but we tend to at times forget them. What is innovation? Innovation is a very complicated word it means lots of things it could be something that people all over the world do have done throughout history even when they didn't want to do it even when they were trying to produce exactly the same pot they don't always achieve it so things shift they change. It's also a reflection of how we imagine the future at the moment very much innovation has become an industry innovation is a buzzword innovation is something into which we place all kinds of hopes fears desires dreams it's a complicated reference and so I want to remind us of that and of the complicated nature of everything that might be going on today at the outset I also want to say something about anthropology since connecting innovation anthropology may not be immediately obvious to everyone why that might be something you want to do and in this case again being slow and without necessarily a good list of bulleted takeaway points that I'll be promising at the beginning suggests that there might be some value to what is the central move of anthropology methodologically historically which is to zoom in and out from things that are very very micro scale particular people particular places particular settings to large questions of the human and it's particularly that zooming out process that I'll be focused on today to try and recall what has MSF been up to this point before ever imagined having an innovation day and what a world might MSF be living in in which something like an innovation day might be happening and in doing so I'd be trying to hold up a mirror for you as an organization since most people in this room one way or another have a relation to MSF so the place I would start would be going back to when MSF was itself a startup it's not the language that people would have used in 1971 but I wanted to show you these iconic photographs and look at them for a second who are those people what do they look like how are they dressed what things do they carry with them what do they see as being essential they're mostly doctors there are few journalists and they all have interesting biographies and they have many ambitions if you read their particular histories and get a sense of who they are there lots of things going on in that room they're all white French men in suits and they are dressed the way that doctors in 1971 would dress if you're going to a meeting about starting an organization now if we move to 2017 and try to imagine what MSF would be like today if it were a startup you would get a rather different picture and you can look at this little group's a smaller group and obviously it's a fictional show that I'm referencing here but you can see that it's a very male world still in this case Silicon Valley is a very male world it's mostly white although somewhat Asian and it is very much a world in which a term like innovation is not simply a point of reference it's in the drinking water it's constantly there if you're not innovating you die that is the assumption of Silicon Valley which is rather different than what would be happening in 1971 in Paris and if we put these two things together which is presumably what's happening in this room today a culture of innovation with MSF as it actually exists in 2017 as a large organization working in many parts of the world with people who come from all different kinds of backgrounds have all carry all kinds of different stuff with them have all different kinds of interests and ambitions and thoughts and dreams you get a much more complicated picture and it's a picture which is going to have some tensions in it and it's a picture which is not necessarily simply going to leave us with one single path moving forward and just to illustrate this I thought I'd combine a slogan from that world of Silicon Valley and business and startups with the logo of MSF and I suggest you take this to the communications department and whatever group you're in whatever office you're in and suggest this would make a great poster going forward for the organization it'd be fabulous for fundraising and I think you could see relatively quickly and easily that it might generate some problems and indeed it might generate some problems from any medical organization because the concept of failure it rings a little bit differently failure rings differently if we're talking about health we're talking about life and death we're talking about people the stakes seem different and so the notion that you might try something out on three or four children and well maybe the fourth one survives and you can go somewhere that's a little bit different than the vision of what an entrepreneur is in Silicon Valley so there's no surprise that you would encounter areas of friction between the value systems of these two different gatherings around tables when people are trying to dream up a future there's also a difference in terms of the ethical framing of time that for MSF every day is an emergency somewhere in the world something is going on and while maybe things have changed but certainly a few years ago it was the case it's only a minority of projects in MSF that are technically speaking emergency projects nonetheless the organization itself views itself as an emergency organization several speakers today have already referenced that this morning as an emergency organization that is quite different than the vision of what the future is if you're trying to build a company if you're trying to expand what medicine would be for the future re-envision medicine for the future at a global scale or even something like the Gates Foundation which is somewhere halfway between the world of MSF of recognizing problems generally that are out there and the world of Silicon Valley where the money came from for the Gates Foundation which is trying to rethink disrupt and innovate an endeavor like medicine worldwide quickly as a reminder I have to watch my time to make sure they leave room for discussion which would hopefully be the most important part of this as a reminder MSF has gone a long way from being a group of men in an office in Paris and I think I like this particular graphic that comes from it was in the newsletter of MSF USA recently because it shows a larger picture and it fits MSF into that and it's very clear that if anything you're not a startup you know you're the establishment and so you should be thinking not simply in terms of of what you might gain from changing things in the future but also what you might lose you already have major investments you have a lot of people who are working very hard on problems even as we speak and so it's not a playing field which is a blank slate from which you might want to reimagine things and then I always like to show this graphic to remind us we're going to talk about money in the world and where money is really going that there's a lot more money going towards death than there is towards life internationally and that's a larger political framing for the whole world of global health various different kinds of endeavors and the whole world of humanitarianism so you're a significant slice of the pie when you look at humanitarianism but it gets much much smaller when you zoom out and you take into account the larger frame I then want to remind you quickly again very all too quickly that MSF has been innovating for a long long time it just was not called innovation and it didn't necessarily have a day dedicated to it but within the humanitarian world as I came to know when I started looking at you as an anthropologist you're well known for having good logistics I mean it's not completely unique there's the history of military logistics in the background etc etc there's there's things you can unearth beneath this but in the 1980s MSF developed a very good logistical kit system and indeed that's one of the things that is a hallmark of MSF interventions emergency interventions especially where does it come from and this is the words of one of the creators of this system Jacques Pinnell basically it's what you would do as a human being if you're repeatedly engaging in the same activity which involves travel that's the basic idea behind the kid the kid has been very successful so I just want to point that connection out to you the kid is now everywhere everything is a kid in humanitarianism and that means it also becomes a danger once it establishes a form of doing things because it becomes a problem when you start treating people only as visible if they fit into a kit and you can't see them if they don't fit into a kit or the kit begins ordering your relations rather than the kit is there to solve a problem which you are in control of and can define now technology is very hard to talk about in any kind of way that would be a balanced and I like to use this image for thinking about this because everyone in this room now has something like what is being imagined at the beginning of the 20th century as a piece of boys adventure science fiction you can tell stories of technology as a love story and there are many things to say about cell phones which are love stories we've heard some of them and we'll hear more of them and experience them in their lives you can also tell it as a horror story certainly when the president of the United States has twitchy fingers and is connected to Twitter suddenly there are a whole new host of problems which can emerge which didn't exist in the past but among everything else I want to recall that Silicon Valley the way I'm using that term is tied to a form of business enterprise it can shorthand is gadget capitalism and a lot of it is about making money and speculating about making money in the future and that is a bit different than humanitarianism it may cross over in certain places but it's end goal of profit and speculative profit for the investment for the future is also a bit different I also want to recall that there have been great innovations of the past at the very micro scale the band aid is one of my favorite or sticking plaster in UK parlance and there is a history of using surplus it comes out of a moment where somebody who is being innovative use surplus gauze and surgical tape to create a small solution to an everyday problem and it became general universal I mean everyone in this room no doubt has experienced this particular little innovation and seen it as a good thing at the same time it's a metaphor we use to talk about a kind of response that is not satisfactory it's merely a band aid it's merely a temporary response it's not addressing deeper underlying problems and in many ways everything that is being discussed here today is in one form or another a band aid and I think that's important to recall it could be wonderful could have benefits it could be very useful but it may not be addressing the deeper underlying problems that MSF faces on every on an everyday basis I also want to suggest to you that it's important to recognize use through time if you visit any medical facility in the world you can find waste you can find surplus you can find things which can no longer be maintained I know number of people are actively thinking about it but you can never do that too much even things that are magic bullets which are wildly successful like ready to use therapeutic food they have effects once they become a norm once they start being used repeatedly in a number of different ways they are not in and of themselves the best answer to a global food system for example they are very specific kinds of interventions and they also I'll just note the one thing that keeps this makes this a miracle the hygienic wrapper becomes waste once you've opened it and we live in a globe that's full of waste and I also want to say something very quickly about ethics and recognize while procedural ethics are important and valuable and I'm very glad that there's an ethical framework for innovation at MSF and I think it's looking at it and reading it it seems like a good one to never forget the difference between ethics in life as they're being practiced between human beings and ethics as a set of rules and even if you look at the charter of MSF which is quite interesting in part because it's very simple it was modeled on the Red Cross Charter and it's very similar to parts of it I mean it's modeled on the Red Cross tradition but it's open-ended and it's been used in an open-ended way and it's been debated and it's been constantly a focus of elastic interpretation over the course of the history of MSF in part because it leaves open the possibility that you as an actor respond to it as a human being in given circumstances in a given situation to the best of your ethical understanding and you can see this collectively I think in MSF and part of what I'm trying to do is remind you as an organization of things that you may have forgotten that you yourselves have done MSF is excellent at amnesia there's one thing I learned over the course of studying you as an organization you're very very good at forgetting the things you already know the things that you did not that long ago in a particular setting there is the wonderful speaking out series which addresses complicated ethical moments in MSF and it doesn't have a simple list of takeaway points it has a lot of debate it has a lot of complicated history it has a lot of painful moments for which there is no simple solution at least not at the level of a band-aid or at the level of a humanitarian organization it are deeper deeper political problems in this globe and you are but a palliative response to that and I know everyone in this room knows that but I think it's important not to forget it on a continuing basis if we're going to talk about ethics we should remember that they're interpersonal and they're relational and it's always the quality of the relations you have with people as to whether or not you can convince them of anything including doing things that you think are beneficial for them but also want to remind you that you have done some wonderful work in beginning to recognize that people around the globe have different world views they have different cosmologies not everyone thinks that life is the only important thing for some people how you die matters and what happens to you after you die matters and that might matter more than any medical treatment you might receive that doesn't mean that people don't care about the medical treatment it just means that they have other values that they care about as well that's one of the things as an organization you discovered by doing perception studies and so I think it's useful to always remember translation to recognize that your real end users are not people in the field they're the people you're trying to reach in one way or another and you only reach them through translation even if you speak the same language you're reaching them through translation to the best of your abilities you have connections those connections are never perfect and they require a constant a constant relational exchange in order to achieve any ethically meaning and meaningful and worthwhile end so I did my best and here are four my effort to give you four points last and the keynote yesterday there were five so I'm very proud that I'm only giving you four I've gotten it down to four as things that I see as being obvious but important to always recall recognize the difference between a scale of effects versus aspirations in order to get people into room often what they want to respond to is a big problem like climate change even if what you're actually going to be working on is never going to have an effect at that level so there's constantly going to be a tension between the things that we might want to do and the things that we have capacity to do recognize use through time that just because something happens at a given moment doesn't mean that that activity that object or activity or procedure doesn't have a ongoing biography and it can change through time and it may generate waste and may require maintenance that maintenance is at least as important as innovation recognize that ethics are lived as well as procedural and it's a question of what kind of person you are at any given moment in relation to other persons that will determine the success or failure ethically of most engagements and finally think through translation and recognize that any exchange you have even if your best friend ever in the same language is always going to be subject every now and then to slippage mistranslation forgetfulness something that gets lost between the thing that you wanted to say and the thing that was heard and finally what I wanted to leave you with this is still one of my favorite cartoons of MSF ever and I try to use it for these purposes of summarizing the organization she's asking how do you do it at MSF he's saying oh not like that not like that not like that he's this stereotyped grizzled MSF doctor of course she says so how do you do it not like that but that but better you have another question and it is that kind of critical ethos that I think is central and important in an organization to never forget MSF only exists in the world because the world is terribly screwed up you should want a world that doesn't need MSF and that's important I think when thinking about innovating in a domain such as humanitarianism humanitarian action is with us for the foreseeable future but that's not certainly the world that we would want or the world that we would design or the world that we would seek in an absolute sense of innovation so I'll stop there and thank you and very happy to answer any questions. Thank you Peter that was some that was fun but definitely some sobering thoughts there wasn't it we want a world where MSF doesn't exist. I should have warned you that anthropologists can also be downers also they're necessarily uplifting and inspirational. Yeah we are but a band-aid and a palliative response but nonetheless we plod on. So questions from the floor we'll take them in clusters, comments even. I was is that an online one of I lost it online person. Okay no one from Peter I was a little bit lost through that sort of lived versus procedural ethics. It's actually really the first time I've come across that so can you just expand on that a tiny bit for me? Sure absolutely I was doing a number of things at high speed watching my watch out of the corner of the eye in order to make sure not to use up all the time. It's the difference between having a code of ethics and what you actually do it's the difference between having say an institutional review board and being a good person when you're engaging with other people and I do think there was a comment there's there's laughter in the room and earlier there was a mention of a project which was reviewed by five different boards and I suggest that that might be an indicator of a problem if you have five boards reviewing something that might itself be an issue. The IRB system came into being when MSF first came into being when MSF started there wasn't no such thing as the IRB. The IRB came into being in the 1970s in response to specific famous infamous ethical lapses in the world of medical research and has since expanded to address a whole range of issues and concerns and things. I'm not saying that IRBs are bad by any means I think they're important and they're good but they don't absolve you from ethical questions simply because someone said especially if you took an online training module which is what we do at my university everyone we take all kinds of online training modules and afterwards are you an ethical person because you clicked you know on the right bubble multiple times my answer is that's the difference between these two things not to forget that that the real ethics starts afterwards real ethics isn't in the clicking and the clicking might be helpful to remind you that these are some things you'd want to think about or things to avoid but the real ethics is what you do after that certification you're not absolved in that sense that's why I'm trying to say none of us are absolved. Questions on the floor yes down here Claudia sorry just a mic down here please. Thank you very much I was pleased that you focused on the ethical issues there and I think you're absolutely right about the difference between using ethics for strategic purposes to get things done and to be allowed to do them as opposed to actually feeling it and living it and there's often a gap but I you also mentioned the difficulties of flipping from innovation for doing good to innovation for making money and the challenges that brings and I wondered if you could reflect on that little more. Certainly it's not that I think you can't do both I think there are a lot of interesting things going on at the moment in the intersection between the borderlands between those impulses the impulse to try and act in the name of some good and the impulse to try and do well I mean there are slogans that put these things together all the time and universities love these slogans because it's a way to justify all kinds of activities especially around things like health but we should not forget that health you can make money at health but your goal may not be making money your goal might be the well-being of a patient and some patients might be costly some patients might not ever make you any money and that is a place where these things would part ways and the profit motive is a very powerful and also a very dangerous thing and I could go on and on about this so I'm trying to be succinct for this moment in this setting I would just want to recall that MSF has been very wary of money that's why you want most of your money not to come from governments but governments are not the only powerful agents out there with money at this moment in time of course there are corporations and corporations have a lot of money and corporations want to make more of it that's what they exist for and that's that's their their central case on death and one should not forget that that's what that would be the beginning of my longer spiel yes gentlemen in the check shirt right in the middle here anybody else to follow that okay enjoyed it and my name is John Pringle I'm from the MSF ethics review board but that's not what my question is about so recently MSF passed a motion to promote safe moral space within the organization in part to reduce the moral distress of our field workers along the line of innovation in an organization such as MSF how might you envision creating a safe moral space oh it's a hard question yeah that's a simple one I was trying to be provocative and I guess this is the hazard that you run into when you do that I would first say that I think it's interesting to hear that because I think perhaps the safe moral space is the utopian dream of our times one of them that that's one of the things we would desire we would like to be someplace where we could feel safe and same time address difficult moral quandaries in life I think it's very difficult to find those spaces fully or completely I do think that there if you work for MSF that is part of the hazard of confronting how painful it can be in this world and these second-hand distress that you can experience by knowing too much about things you can never forget their standard modalities in social science not so much anthropology but domains in social science therapeutic forms of social science which come up with different modes of attempting to achieve a safe moral space maybe if I'm understanding correctly what the desire is there but I think what could be good for an individual psyche may or may not be good for a collective or good for a world moments like the profit motive there'd be moments of tension there as well because for an individual psyche the best thing might be for certain things to go away say or for there be a lot of discussion about that individual perspective for a collective I do think the speaking out series is in a way what has performed a therapeutic function for MSF for some of the difficult moments in the organization's history and I encourage all of you because I don't think it gets nearly enough readership especially within MSF I encourage all of you to look at some of those volumes and I encourage people who want it's not a safe moral space except this contained you know in pages or in you know online I mean in a form that's that's contained so you can respond to it but it will give you a point of comparison and reference and for me at least that has had therapeutic functions reading can serve that purpose as well to feel less alone and feel that there is a larger sweep of history and the particular moments may not be the only moment of trauma around I know that's not an uplifting kind of statement again and but that's where I'll come to close brilliant and a short short question if you can answer short it'll be tricky but I'll try it'll be the last in MSF we're very fond of saying that somebody or some organizations behaved unethically when we disagree with them forgetting for the moment that they may be acting according to a code of ethics that are in conflict with our own but quite ethical through seen through another lens such as theories of justice going up against utilitarianism or the like so one's choice of an ethical framework says something about the organization and I was wondering if you might comment on your perception of MSF's ethical character not in the face of what we could all agree is bad but the positions we take in the face of what others might see as good yes I'll try to be very brief so I just say that while you're more similar to the Red Cross the ICRC then has historically been imagined nonetheless historically MSF has always been much more flexible in its interpretation of its own ethical precepts things like neutrality have come and gone and we have different meanings and different historical conjunctures etc. I would have a lot more to say about that but that would be what I would note about MSF you are much more situationalist you are much more willing to think about the contingencies of a particular moment as opposed to being purists in interpreting an ethical code and I think that that there are advantages to that or disadvantages to what there are advantages. A positive note with which to end. Peter, thank you very much.