Episode: "Cool Hand Luc"

IVORY COAST| UZBEKISTAN | SIERRE LEONE

In this episode, nurse Luc LeGrand mentions that MSF gives him more responsibility than he would have at home in France – what are the responsibilities of nurses with MSF and how does MSF ensure that they are adequately prepared for the work that they do?

MSF relies heavily on its nurses, and as a general rule they do receive more responsibility than they would at home, but MSF does not expect them to perform medical procedures that they are unqualified for. The expanded responsibility comes in the form of clear protocols and guidelines that allow volunteer nurses more autonomy in diagnosis and prescription than they would usually be granted at home. That said, the responsibilities they have are no greater than those of nurses working in emergency rooms and intensive care units in the United States and Europe.

Why is MSF working in La MACA prison? Shouldn’t the health care of inmates in a federal prison be the responsibility of the Ivoirian government?

In a word, yes. Beyond immediate emergency medical relief in the wake of war and natural disaster, much of the medical care that MSF provides would ideally be undertaken by national governments. When a government health ministry lacks the resources or the will to provide necessary medical care for a population in dire need, MSF will provide medical services while advocating for a long-term, sustainable solution.

In the case of La MACA prison, MSF witnessed atrocious conditions in the hospital while responding to several cholera outbreaks during the 1990s. In 1997, prison authorities acknowledged these conditions and invited MSF into the prison to improve primary health care and conduct logistical improvements to the water and sanitation system in the hospital. In the years since, MSF has worked alongside Ivory Coast Ministry of Health medical personnel and prison administrators while pressuring the national government to improve conditions and apply more humane detention procedures.

As a direct result of MSF’s intervention, the rates of illness and mortality in the hospital have plummeted even as the prison’s population has risen, and the Ivoirian government has drastically improved the conditions under which inmates are detained. MSF was on track to hand the project over completely to local non-governmental organizations (NGOs) and the Ministry of Health before fighting in 2002 severely increased the needs in the hospital.

As MSF effects long-term improvements to the hospital’s health and sanitation infrastructure, and as prison authorities continue to address the problems that lead to disease and malnutrition in the hospital, MSF will phase out its activities in the prison, leaving the project in capable local hands.

In the Sierra Leone segment of this episode, as nurse Dominique Dujardin prepares to transfer a sick boy (Mohammed) to the local hospital, he is delayed while Mohammed's parents decide which parent will acompany him. Why is it necessary for one of the parents to go?

Since many hospitals in Africa have limited resources to employ staff to feed and bathe patients, if a friend or family member is available, they will be required to come with the patient in order to tend to these needs. In this case, Mohammed would not have been denied hospital care if his mother wasn’t able to come, but since both of his parents were present, nurse Dominique Dujardin requested that one of them accompany him.

In this episode, we meet a Sierra Leonean health worker named Prince Jongo, who helps nurse Dominique Dujardin. What is his role and his relationship to MSF?

Prince Jongo is an employee of MSF, one of approximately 15,000 “national staff” members around the globe, who play an integral role in MSF’s operations. National staff work alongside MSF “expatriates” or volunteers who come from a different country than the one they are working in for MSF. National staff members regularly have the same responsibilities and roles as expatriates – the only distinction is that they frequently work on one project for a much longer period than expatriates, who complete standard six or twelve month missions. It is not uncommon for national staff members to become expatriates, making themselves available to MSF for assignment to other international projects.

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