Episode: "Cool Hand Luc"

Full name: Richard Mowll
Nationality: British
Profession: Civil Engineer
Birth Place: Croydon, England
Hobbies: Following football, particularly the Crystal Palace Football Club, a team from South London, reading novels of any kind and socializing with friends
Years with MSF: One and a half
MSF missions completed: Uzbekistan

What brought you to MSF?

Having worked for another NGO previously in Ethiopia, and subsequently worked again in the commercial world, I was drawn back to humanitarian work because I could believe more in the aims of the work I was doing. Commercial work can be fun and productive, but for me, the goal of making money was not enough. Helping people in distress make things better for themselves is so much more fulfilling for me.

What was the most memorable moment for you in this mission?

Giving the Swiss foreign minister a tour of possibly the world's smelliest basement.

How did the visit from the Swiss minister come about and what was his reaction to the basement?

Happily, showing him the basement helped put him on the path to getting funding for the TB dispensary rehabilitation, which the Swiss government ended up funding. The Swiss foreign minister was on a quick tour of Nukus - fortunately for us the Swiss ambassador for Uzbekistan had highlighted the dispensary as a funding opportunity, hence the arrival of the minister to assess the project.

His reaction on seeing the basement was remarkably restrained - he was a true professional - a nod, “aha - so that is the basement in question” and we were on our way to see other things. That it resulted in very generous funding from the Swiss Government was fantastic – everyone involved was very grateful. Incidentally, we were able recently to give our thanks directly to the Swiss ambassador when he visited the dispensary to see the finished product.

In retrospect, what was your overall impression of your mission in Uzbekistan last year?

I think my experience was very positive – there was a very tangible and positive result to my work. It was also a time in which I met some great people and made some really good friends.

In terms of this tangible result, how did cleaning up the basement contribute to MSF's TB treatment program, and the hospital's TB care in general?

With the conditions as they were (before the cleanup) it was a very unpleasant environment for the patients to stay in, so even though the treatment was for their own benefit, there was a possibility that some would leave the dispensary and stop treatment. This would be a disaster for the patient involved, as defaulting (stopping) a TB treatment part-way through makes it likely that the patient will build up a resistance to the TB drugs... making it much harder to treat the patient in the future.

Better conditions at the dispensary made it a nicer place to stay, and hopefully will help patients remain through their TB treatments. The cleanup of the basement helped MSF's TB treatment program and the Ministry of Health's efforts to control the disease in that it helped provide much better conditions for patients at the dispensary.

Another way in which the project helped the Ministry of Health and MSF's TB programs was that conditions were improved for the staff and the visitors. Staff morale was not helped by such a horrible working environment (although some staff had been working there 17 years), so hopefully a better environment lifted staff morale and lifted the standard of care generally.

Of course this was not a primary goal for the project, but certainly a good by-product. Another good by-product was that the dispensary’s neighbors were also very grateful for the drop in the mosquito population.

What were your first thoughts when you arrived at the hospital and saw the job you had to do?

I had been pre-warned about the state of the basement before I arrived, so I was not shocked by the conditions. I was however very curious as to how such an environment would affect the structure of the building, which turned out to be fine.

I was lucky in that I carried out my initial assessment of the building during the winter (December), so the smell and mosquitoes were not at their worst. They were still bad enough though.

Did you get used to working in such conditions? If so how? If not, how did you cope?

I quickly got used to working in those conditions. It is surprising what will seem normal after only a few days. Focusing on the job at hand rather than conditions helped at lot.

What did the mission mean to you as a professional or personal learning experience?

Professionally and personally I am still learning... sometimes slowly... but being immersed in a new context – I had never been to the former Soviet Union – helped me learn from a group of people I would never otherwise have had contact with. As a British person I tended to want to do things differently... Learning from people from a different culture can be at times frustrating (why do you do it like this? you’re constantly asking), but often insightful and normally a lot of fun too... I think I learned much more from them than they did from me.

What was the most difficult part of the whole experience and of your work?

I was very lucky - I was working with a very good group of people at MSF and I have to say I was particularly fortunate with my Ministry of Health counterparts – Dr. Dashetov, the dispensary’s chief doctor, and Kenesbay, the Ministry of Health construction expert. Both were very flexible and helpful at all times, they had few difficulties and many solutions.

The contractors we used for the work were also very helpful and cooperative. Because of their help, it is very hard to pick out the most difficult part of the job or of the whole experience. Of course there were difficulties, but put into perspective, they were minor compared to the help and assistance we were getting.

What are your hopes for the population you were serving in Uzbekistan?

Simply put, that they can significantly reduce the incidence of TB.