Overseas, Overseas coming and going, volunteering abroad
Interview: The value of humanitarian aid, overcoming politics and prejudices to provide care that really matters.
Medicins San Frontières (MSF) is an independent, impartial, humanitarian aid organisation that was founded in 1971 by a group of doctors and journalists who believed that every person, regardless of race, politics or nationality, was entitled to medical care. Today, MSF runs missions in 60 countries around the world.
We spoke to Rose Ansorge to find out the value of volunteering with MSF and what impact it has had on her work as a GP.
When did you first start working with Medicines San Frontières?
I went on my first mission in 2004 and worked for 6 months in a refugee camp in Eastern Chad.
What is your role with MSF?
My role during a mission depends very much on the type of project I am working on.
In Chad, I was the only doctor in a health centre that provided care for 20,000 refugees and people from surrounding villages. We treated about 100 patients every day. Patients were usually seen by local health workers, and if they needed help, they would ask me, so my role included supervising and training. I was also involved in organising vaccination campaigns to prevent outbreaks of measles, or to contain an outbreak of meningitis. We also visited smaller health centres along the border to Sudan, which we supported by supplying drugs and materials. Once or twice monthly, we went out with mobile teams going to areas where lots of refugees were staying, and there we just put up a table and chairs under a tree and did our consultations. Other tasks are collection and analysing of data, writing reports, taking stock or ordering of drugs and materials.
In the DRC, I worked on a project for severely malnourished children and just doing my ward rounds and reviewing all the children would fill the whole day. In Haiti, I worked in a project where I also had to organise and improve the lab (which being a GP, I found quite challenging). In Sudan, I worked on a project for women focusing on behaviour change with regard to Female Genital Mutilation - just to give you examples for the different roles and tasks.
What was your motivation for joining MSF, what was the joining process like?
I always wanted to work where it is needed most. When I joined MSF, I had already worked for other organisations such as VSO and WHO, and I held the Diploma of Tropical Medicine. My initial interview lasted 1-2 hours, and I was then invited for an induction course which lasted for one week. The course covered a range of subjects including security precautions, and ways to handle various situations in the field.
What were your thoughts about MSF before you joined?
I consider MSF as an organisation that is transparent and works very effectively, and I suppose it is their ethics that appealed to me. MSF mostly relies on private donations and is independent from governments and the big donors in international aid. It can therefore choose to work where the need is greatest. MSF observes impartiality and neutrality, so in a conflict, assistance is provided according to needs. However, if members of MSF witness atrocities and violations of human rights, they are not afraid to speak out and make it public.
Do you think volunteering as a humanitarian aid worker in these extreme circumstances is something every doctor/medical professional should do?
I think that although it is an invaluable experience, it maybe not be an option for everybody. It may be difficult if somebody has a family, or a mortgage to pay off. Aid work is not for everyone. It can be stressful, demanding and complex. You won’t get rich and you’ll be away from your friends and family. But for those that choose it, the rewards vastly outweigh the inconveniences.
What value does your experience have on your work in the NHS?
It made me remember what being a doctor is really about and refreshed my motivation and enthusiasm.
I gained more understanding about different cultures, and the way people present and articulate their problems, which can be very useful when working in a multicultural setting. I learnt a lot from local health workers with regard to the different ways of health education. I think that in general I have become more flexible and find it easier to improvise which is useful for work in General Practice.
A document produced by the Department of Health states that international work offers the opportunity to ‘develop a range of hard and soft skills such as clinical, managerial, leadership cultural and educational skills, which are beneficial to and transferable to the NHS’ (DH, 2010).
What are the benefits for a newly qualified doctor?
As above – to develop a range of soft and hard skills, learning to improvise…to understand what being a doctor is really about…
Doctors will need to have at least two years at SHO level, or one year post F2, before they can apply to work with MSF.
What challenges do you think you’ve had the hardest time facing?
When faced with clinical challenges that I was unable to solve, e.g. patients with tumours. When despite all medical efforts, patients died, e.g. as in the Democratic Republic of the Congo, or in Haiti where I worked with severely malnourished children, and their condition suddenly deteriorated.
How does a typical mission go, for instance when/where/how do get your briefing? How long do they last typically?
Missions with MSF last for a variety of lengths - from six to twelve months for a first mission. Sometimes in emergencies these can be shorter. My first mission was for 6 months in a refugee camp in Chad providing medical care for the refugees from Darfur. My other missions in Sudan, Pakistan, DRC, and Haiti lasted 3-4 months.
People receive a comprehensive briefing before they go on a mission. This includes going to an induction day in the UK office. Often, there is a week long induction course with the operational centre.
MSF is currently working in more than 60 countries worldwide, from Chad to the Democratic Republic of Congo, Syria to South Sudan - in some of the most challenging environments to provide medical care and humanitarian assistance where the need is greatest. People are asked to be as flexible as they can about where they are willing to work, to meet the needs of MSF and the countries in crisis.
Before a mission, volunteers receive a lot of information for preparation. Usually, they will then have a briefing at an operational centre, e.g. I went to Amsterdam and Brussels for my briefings. Further briefings are provided after arrival in country, initially often in the capital, then later in the project itself. I felt quite well prepared on all my missions.
What are the most difficult places you’ve worked with MSF?
I think every place can have its different challenges, whether it is the extreme suffering one is facing, the clinical challenges, the security situation, or extreme weather conditions. With MSF, you always work in a team so there is usually somebody you can talk to for support. However, working and living with a team of people from various cultures can sometimes be challenging as well. I think most difficult for me where those situations where I felt helpless and people died despite all our efforts.
When working in a low security area, does the danger continue to ‘register’, how do you handle it?
Security is very important for MSF, and the security guidance is constantly updated. I have always felt quite secure given the circumstances. Luckily, I have never been in a situation where I felt threatened or endangered.
When did you first realise that what you were doing was making a difference?
When I worked with severely malnourished children. They are usually very ill when they get admitted and are prone to medical complications. However, they mostly recover very well on the nutritional treatment so this is really about saving lives. I think mass vaccinations can make a huge difference, e.g. vaccinating against measles in a refugee camp can prevent a lot of complications and deaths. Too many children are still dying of diseases that could be wiped out by immunisation.
Can you pinpoint an experience that made you think deeply about the nature of humanitarian aid?
A child that has been saved will return to a life of poverty, the next harvest could be poor again, and then it will be malnourished again, and the cycle continues. Conflicts continue, and people we have saved may get killed. So I often think that all the work we do is just a drop in the ocean. However, I heard people often saying how much they appreciated our presence and just being there and made them feel that they had not been forgotten.
What are the main challenges facing MSF in the future?
MSF specialises in working in challenging situations! MSF will always have to rely on the willingness of warring parties to uphold minimum security guarantees for patients and staff when working in conflict zones. MSF just recently ended the programmes in Somalia because the situation in the country had created an untenable imbalance between the risks and compromises for the staff.
Another challenge will be to increase the availability of live saving essential medicines, such as treatment for sleeping sickness. MSF’s Access Campaign’s key focus is on the difficulties people face in getting hold of effective diagnostic tests, drugs and vaccines. The Access Campaign currently addresses six key medical challenges: HIV/AIDS, tuberculosis, malnutrition, malaria, vaccines and neglected diseases.
To do its work, MSF depends on volunteers who are willing to give up their time and put their lives on hold to go abroad and work. The emergency nature of the work also means that MSF relies heavily on regular donations to be able to respond to emergencies immediately. We are lucky that so many hundreds of thousands of people around the world make regular donations but with more support we can reach more people, respond faster to emergencies and broaden the range of medical services we provide.
Medicines San Frontières is currently running a Syria Crisis Appeal. To donate or research volunteering opportunities click here