A speech on imperfection by Dr Joanne Liu, International President of Doctors Without Borders

Dr Joanne Liu is the International President of Doctors Without Borders, a global humanitarian agency providing medical assistance in conflict zones, natural disasters and epidemics. In this powerful speech from Stay Hungry. Stay Foolish, Dr Liu argues for the brilliance of imperfection, and how we can all find strength in what makes us uniquely imperfect.

Dr Joanne Liu
Dr Joanne Liu, credit Natacha Buhler/MSF

Thank you, President Goldberg, distinguished members of the Board of Trustees, esteemed faculty members, proud parents, siblings and friends. It is a wonderful, humbling honour to be with you today.

And to the Barnard Class of 2017: CONGRATULATIONS!! You made it! You have every right to be proud. So, do remember to celebrate! Celebrate your achievement. You deserve it.

I hope you will also remember this: your educational accomplishments, just like your achievements to follow, are not because you are perfect. Despite what your parents may have told you, I’m here to tell you how imperfect you are. How imperfect we all are. Including me.

Imperfection is what makes us human, and actually capable of achieving so much. It’s what we do with our imperfections – our acceptance of them – that determines our course in life.

For you, life in many ways begins now. You are leaving the comfortable and supportive confines of the academy, and entering a world of uncertainty.

You are also entering a world of promise, and of firsts. For many of you, following this first university success, your first jobs await. Perhaps your first true loves, callings, first real challenges, joys – and, yes, first true disappointments. Even your first failures or setbacks.

Despair not.

While your firsts are never perfect, they will define and direct you. This is a first for me today. My first time at Radio City Music Hall. Delivering my first commencement speech no less.

I was invited to deliver these remarks in the wake of the election in November. I hesitated before agreeing, overwhelmed by the honour and the responsibility.

To reassure me, I was told by someone within the Barnard administration: ‘We are overwhelmingly enthusiastic about honouring you and your work. Our past speakers include Barack Obama, Hillary Clinton and Samantha Power, so you would be in good company.’

No pressure whatsoever. I admit to having panic attacks since then.

I watched all the commencement speeches at Barnard that I could. I bought books on how to write commencement speeches. I even watched TED Talks. Here’s what I came up with:

I grew up in a 1970s French-speaking suburb of Quebec City. There were four other Chinese families in town. Two were my uncles’ families. The other two ran competing Chinese restaurants. I was a visible minority growing up. I knew I was Chinese before knowing I was a woman.

I collected hockey cards and dreamed of being a hockey player. I could have been labelled ‘gender fluid’. The youngest of four, I went to French school, while my siblings went to English school, along with most other children of immigrants. While my school choice was one of integration, it meant I had no big sister or brother to protect me.

After my first day of school, having left the protective cocoon of home, I returned with a bloody face. Some kids had punched me, accusing me of having a flat nose.

I sobbed before my mother. Now, I belong to a family in which caring is displayed through toughness. My mother stared at me for a few seconds. Then she solemnly declared that my nose was indeed flat.

I picked myself up and washed my face. A first had occurred. And it was a fundamental life lesson. I was out in the world now. Imperfection, even in the form of a flat nose, is an occurrence and fact of life. It happens. Never apologize for what or who you are. Never feel sorry for yourself.

Perhaps like many of you here today, I found my first inspiration in the pages of a book. As a teenager, I read The Plague, by Albert Camus – a book that changed my life. The novel’s protagonist, Dr Rieux, has very little to offer the dying all around him. Yet he persists.

‘Why are you so dedicated?’ he’s asked. He answers: ‘Quite simply, I am still not used to seeing people die.’

From that moment on, I promised myself to fight for life. Death indeed matters, and is not something to become accustomed to.

I was also inspired by the biography of a physician working in Afghanistan with Doctors Without Borders – also known as Médecins Sans Frontières, or MSF. It was then that I decided to become a doctor.

Several years later, when I told my father about my acceptance to medical school, he replied: ‘Too much education, you will never find a husband.’ It didn’t stop me. For the next 15 years, I based all my educational choices on developing skills I could use at the front line – from paediatrics to paediatric emergency training, including here in New York, at Bellevue Hospital.

My first field assignment was in 1996 in Mauritania, in northern Africa. I was the only physician in a camp of 40,000 refugees from Mali. A United Nations officer, approaching the end of his assignment, wanted to move the camp closer to the border before he left – to demonstrate that he had done something – anything – to get the refugees closer to home.

But it was during the rainy season. I objected forcefully, and reported the plan to my headquarters in Paris. Nothing happened. People squatted for days under heavy rains, without shelter. Many became sick. I was shattered, and kept asking myself: ‘This is humanitarianism?’

I resigned in protest. It was the only thing I could do. So, my assignment was shortened to three months. I agreed to wait for my replacement – I’m a responsible quitter, after all. And it was an imperfect decision in so many ways.

Imagine: a dream carried within for 15 years, ultimately reduced to bitter confusion and disappointment. I could have succumbed and ditched my dream of a lifetime. Instead, I went to Sri Lanka a few weeks later, and on to multiple other assignments thereafter.

Be assured that each field posting featured its own disappointments and shortcomings – its own imperfections. But also, at times, they were the perfect incarnation of our common humanity. Be it a severely malnourished child brought back from the brink; a father walking again after a leg amputation; a woman, who could otherwise die during childbirth, safely delivering a baby.

So, accept the disappointments in life, for there will be many. But push through them stubbornly, so that you may find what balances them: the successes, the joys, the opportunities to contribute – and to make a difference.

In 2006, after several years in the field, I sought election as the international president of Doctors Without Borders. I lost. And I was devastated. I began to doubt myself, my drive and what I had to offer.

One must expose oneself when aspiring to any leadership role – to become vulnerable. And I remained hung up on the defeat for years. Until one day, when someone told me to snap out of it. Very few people, of course, get elected president the first time around. Well, I suppose there are exceptions…

It took seven years to again find the conviction that I had something to offer – with all my imperfections – in a leadership role with MSF. In 2013, I had the immense privilege to be selected international president. It happened just as the conflict in Syria was escalating, and right before the devastating Ebola outbreak in West Africa.

Beyond the massive responsibility, being the voice of a 35,000-person workforce – and of our patients – presented another very humbling ‘first’ in life, for which there is no instruction manual.

I vividly remember my first press conference at the United Nations in Geneva, upon my return from visiting the Ebola-affected countries in West Africa. The flight was delayed by heavy tropical rains, and I landed in Geneva just a couple of hours before the scheduled conference.

Sleep-deprived, and feeling quite intimidated, I faced the swarming media to talk about what I had just seen. And I remember so well the email my husband sent to me after I delivered the briefing: ‘My love, you are the only person I know who has subtitles when you speak in French, and when you speak in English.’ So much for my self-confidence. My own, permanent imperfection, for all the world to see.

So be it.

But within the Ebola experience lie broader, core life lessons. In the face of the world’s indifference, my colleagues and I were forced to turn back sick and dying people for lack of bed space in our treatment centres.

We scaled up, constantly asking ourselves: ‘How far can we go, how long will we last?’ Despite the loss of patients, the loss of colleagues and despite being so lost in our losses, we persevered.

Ultimately, though, our medical teams confronted me directly, telling me that if the world did not show up, MSF should leave. I promised Liberia’s president, Ellen Johnson Sirleaf, that although we were stretched to the breaking point, we would try to do more, and that I would use my voice and position to alert the world to what was happening.

When I briefed the United Nations General Assembly in September 2014, I admitted MSF’s failure to tackle the pandemic. I issued a desperate, exceptional plea, asking the world to deploy civilian and military assets to West Africa to stem Ebola’s tide.

MSF was portrayed as the poster child of the Ebola epidemic response. The perfect heroes. Far from it.

At the level of patient care, we lamentably failed. In unchartered territory, we ultimately failed in the standard of care we could provide. We had to settle for imperfection, because imperfection was better than no care at all.

It meant medical care stripped to its bare bones. At best, it was rudimentary palliative care. At worst, we gave people a cot to die upon – maybe. Some didn’t have even that. Certainly, we made some difference for many – but our offering was ultimately imperfect.

While hopefully not to this extreme, you too will face these moments. And you too will have to settle for less than perfect. It’s what you do with the imperfections that matter. Despite our flaws and imperfect offerings, we stood by our patients – even if we weren’t making a huge medical difference.

And so here you are, graduating from Barnard. You’re regarded as golden, with so much opportunity ahead. With so many hopes and expectations vested in you. That’s a lot of pressure. That’s a lot to live up to. It may not be the same as treating a dying patient, but it’s no less significant.

You don’t have to be perfect. You just have to do your best. And the reality is that your best may be imperfect. And that’s OK. Because our imperfect offerings set us on a path towards improvement, adaptation, creativity, perseverance and hard work. And towards humility. For perfection is an elusive pursuit.

Acknowledging and embracing your limits, indeed some of your imperfections, is an act of grace. Don’t let anyone tell you otherwise.

There are also imperfect choices. A short time ago, I was among refugees and migrants on the Greek island of Samos. Most had come from Syria, Afghanistan and Iraq. After fleeing for their lives to Europe, they found themselves effectively trapped on the island, with no idea of what the future would hold.

A colleague told me a story about a Syrian mother and her three children. She became separated from her husband after they fled Syria and she assumed he was dead. Her family now lives clandestinely to avoid being sent back where they came from.

During one conversation, the mother mentioned something about a fourth child. My colleague said to her, ‘I thought you only had three children.’ The woman then opened up.

She paid a smuggler to send her fourth child, a 14-year old girl, to Germany. She played the odds, putting her daughter at extreme risk to try to save her, and by extension her family. If the daughter made it, reunification inGermany could be possible.

We know the reality her daughter could face. She could be abused. She could be trafficked. She could be raped. And her mother is not naïve. She knows all this, too.

These are the so-called ‘choices’ people make, when there really are no choices at all. Being the daughter of an immigrant family, I know that the motivations for migrant parents to offer a future for their children are unshakeable, unbeatable.

No one sets out through hell like this for no reason. No one puts their children on flimsy rubber boats on a perilous sea, unless there is no other choice. No one sends them off with strangers to save them, unless they are forced to.

And so, what does all this mean for you? You, who are so blessed with opportunity and freedom. And with real choices.

At times, the blessing of your choices may feel like a curse. Do not lose yourself in chasing so-called perfect decisions and perfect solutions. For there are none.

Don’t become paralysed by the quest for perfection. You may have to accept setbacks, but do not be undone by them. Always remind yourself that every problem, every complex situation, has a solution – as imperfect as it may be. And, always choose action.

It is not enough to say that something is unacceptable. Bad policies, injustices and violations will still move forward in the face of choosing not to act. If something is unacceptable to you, go beyond just saying so. Or resending a tweet that says so. Words bereft of action are just that: words.

I learned that Barnard has declared itself a migrant sanctuary. Bravo. Now what are you going to do about it? For we are indeed in a time when the welfare of human beings is not necessarily placed at the centre of policy and government action. And this forces a fundamental question we must all ask ourselves:

How do we preserve our humanity?

Wherever you end up: the corner office; the hospital ward; the board room; the trading floor; the classroom; the performance stage; or the government agency – always ask yourself that question.

If I may, I’d like to return briefly to the Ebola outbreak. It serves as a meaningful metaphor.

The world ultimately acted when our own ways of life in the West appeared threatened, after so many had already needlessly perished.

Think about that.

If we only assist others when we think our own interests are at stake, we’ll likely have acted too late. But if we choose to act out of the belief and basic logic that our own well-being is intertwined with – and dependent upon – the well-being of others, we will make better choices. Not perfect, but better.

Parents, you have raised brilliantly imperfect daughters in this Class of 2017. And you daughters now belong to an educated elite. But an elite with responsibilities. Among your responsibilities is to own your imperfections, without apology or shame. Because imperfection makes us crave more. It also keeps us humble. But first and foremost, imperfection grants us our humanity.

I have worked in the most modern medical facilities and in the most challenging war zones and epidemics; in world-class emergency rooms, and in isolated, forsaken refugee camps.

People always ask me: ‘What drives you? Aren’t you tired of those hopeless situations with no perfect solutions?’

My answer never changes: ‘No.’

My colleagues and I work for people who have no choice. And we try to give them our best. It is through action based on need and nothing else that we confront the imperfections of our world. By giving. Not always perfectly, but by giving nonetheless. Faced with so many choices, you all are uniquely positioned to give.

So, Class of 2017: my warmest congratulations to you. Be proud, live fully in this moment of true achievement. You deserve it. Then get out there and be brilliantly imperfect.

Thank you.


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