Episode: "The Conflict"

Full name: Laura Lobera Arguelles
Nationality: Spanish
Profession: Medical doctor
Birthplace: Madrid, Spain
Hobbies: I like to exercise because it helps me to get rid of some stress. So I jog regularly, hike whenever I have a free weekend and dive from time to time. Not very exciting. One of the painful things about being on mission is that you can do almost no exercise, but in Siberia I managed to take some aerobics clases.
How many years with MSF? 3 years, from 1999 to 2002, but I did my first mission back in 1994.
Previous MSF Missions? Ethiopia, Afghanistan and Russia.

What brought you to MSF / sparked your interest in humanitarian work?

I suppose the same thing that brought many others – the idea that you could contribute with your work and change things. I want to create a more sensitive and committed environment for the poorest and forgotten ones and also to contribute fieldwork at ground level that is capable of changing decisions at the top. More generally, I want to share my experience with others and to learn from others’ experience.

In retrospect, what was your overall impression of your mission in Siberia?

For MSF, the point of this mission was to extend past working in the Siberian prisons and start to support TB programs in the civil society. This was a big challenge for MSF. Russia in general is an extremely complex place – every issue is very touchy, but especially TB treatment, so you have to be very careful. Given that, even though the project was designed to be a small pilot project it did had a great impact in the health system in the region.

Training was one of the important elements from the beginning. We decided to train the trainers, thus strengthening the local capacity to conduct this type of program. Our goal from the beginning was to work very closely with the local partners. Working in a small district allowed us to remain very close to our patients, and we managed to know all of them by their names. We made analysis an integrated part of our step-by-step implementation and we gathered all the information as we went, establishing a guideline that will help local authorities replicate our success.

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

Professionally I have developed my skills enormously in TB management and I have learned a lot from the extensive experience of Russian TB doctors. From a personal point of view I have made a dream of working in Russia into a reality. I think I have also contributed to a change in MSF’s general approach and the content of our humanitarian work in Russia.

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

Tuberculosis is an infectious disease that affects many thousands of people in Russia and is responsible for a high mortality and morbidity if not correctly treated for minimum of six months. Furthermore it is affecting the poorest and most disadvantaged people the most – the ones with the least resources. The authorities need to integrate social care with the treatment of TB if they want to tackle the epidemic. So I hope social aspects and the inherent constraints of the patients will be introduced to facilitate containment of the disease.

Specifically, what were the most difficult parts of the treatment work that you did? And what are the most difficult aspects, generally of TB treatment in Siberia. Are there any things that make the work easier there?

The most difficult aspect of the treatment is the treatment adherence. It is very difficult to follow patients daily for six to nine months, unless they are in a closed environment, like a prison. So you are obliged to introduce a package of activities directed to increase the adherence, like incentives (weekly food parcels), enablers (free transport), contact tracing, and treatment at home. Usually these activities are very costly and are mainly supported by international agencies – they’re difficult to hand over to local authorities.

What made the work easier in Russia was the dedication and professionalism of the Russian doctors and nurses. It takes some time to learn to figuratively “speak the same language” but when you build a trusting relationship with them, they work very hard – they are open with you about the changes that they consider to be sensible and will push the project in a good direction.