Episode: "Cool Hand Luc"
IVORY COAST| UZBEKISTAN | SIERRE
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,
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
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.