Arax Bozadjian

'Being a pharmacist in an MSF mission means having to work very closely with all members of the team, especially the medical and the logistics teams. Pharmacists are the link between those two groups.'

 

I graduated from the University of the Sciences in Philadelphia in 2003 with a doctor of pharmacy degree. In the United States pharmacy is very clinical, and so I also did a year of general practice residency. I’ve always had an interest in humanitarian work, so for a few months in 2005 I worked with the World Health Organization in Khartoum, Sudan. When that was over, I returned back to the [United] States where I started a position at Thomas Jefferson University Hospital in Philadelphia as a clinical pharmacist. I worked there for almost four years, but I never lost interest in humanitarian work. Through one of my searches, I came across the Doctors Without Borders website, and decided to apply. I remember it was around the end of 2008—December 2008. In January 2009 I got a phone call to come in and interview at the MSF offices in New York. And that's when my MSF career started.

My first mission with MSF was in Nhlangano, Swaziland, and I was there from July 2009 to June 2010. I went there as a project pharmacist, and my main responsibility was to manage and be responsible for MSF’s stock of medicines, medical supplies, and lab items. I was also responsible for the management of the pharmacy team, which was composed of five pharmacy technicians and one storekeeper. As I was more familiar with drugs, the management of the medical supplies and lab items was new for me—and somewhat of a challenge—and I certainly learned a lot. My role as a pharmacist in the United States was quite different from my role as an MSF project pharmacist.

My second mission was in early 2011 in Khartoum, Sudan. I was based in headquarters in an intersectional capacity for MSF-Switzerland and MSF-Spain. There, my main roles and responsibilities were to liaise with the national pharmaceutical sector, to provide support to the MSF missions in Khartoum, and to write a standard set of procedures and guidelines for the missions there on importation and national lab testing of MSF's drugs and medical items.

My other responsibility in Khartoum was to strengthen the relationship between MSF and the pharmaceutical partners—and by that I mean the National Ministry of Health, and the National Medicines Board. Some of the negotiations with the authorities were quite challenging, and that was slightly out of my specialty, but I had great support from my technical referents, and I learned to adapt quickly. It also helped that I spoke the local language; that was a big positive in that regard.

Challenges in the Field

In every MSF mission there will definitely be challenges, both personal and professional. I think the most important thing is to be aware of that and do the best you can to cope with them. I think any and all existing notions and expectations have to be removed prior to departure. You have to be open to new experiences, and I think that most people who join MSF are aware of that. And it certainly helps if you've traveled in Asia, Africa, and/or Latin America. The living situation in the field can be quite challenging, and sometimes interactions with other team members can be difficult. There are certainly many people from many different cultures within MSF, so that can definitely cause some tension. You live and work with the same group of people every day for prolonged periods of time—there isn't really much separation of social and work life. I think the most important thing is to just stay positive, be patient, and open yourself up to this new and challenging experience.

I think any and all existing notions and expectations have to be removed prior to departure. You have to be open to new experiences, and I think that most people who join MSF are aware of that.

As I mentioned earlier, prior to joining MSF, I practiced pharmacy on a very clinical level—that was my daily routine. There was an integrated team of doctors, nurses, nurse practitioners, a nutritionist, and a pharmacist rounding in the hospital and seeing the patients. But in the field, depending on the type of project you're in, the work of a pharmacist is usually not very clinical—it's more managerial. You’re ultimately responsible for the management of MSF’s stocks of medicines and medical supplies, and you also have to manage the pharmacy staff. Managing a big team was difficult, initially. When I worked in the [United] States I had supervised a maximum of three people at a time, whereas by the end of my first mission in Swaziland I had twelve people directly under my supervision. There was a steep learning curve. Before being in the field, I had never had to deal with the human resources and administrative issues that come with being a manager, but in MSF you're expected to do that, even if you’re on your first mission. You’re never completely on your own, though—on my first mission I had very good support from both my medical team leader and field coordinator in the field and the medical coordinator in coordination. As a pharmacist, you always work very closely with the medical coordinators, and I think that's a very important relationship.

Asking Questions

I had to learn the way things worked very quickly, so I asked questions. My motto was "never be afraid to ask questions," especially since I was new to the organization. I asked questions and I listened, I observed, and I learned the way things worked in the field. Every mission is different. The best advice I was given prior to my departure was to sit down with your direct supervisor once you arrive in the field, look at the goals and objectives as stated in the job description, and set a realistic time plan for when you'll be able to achieve them. That said, it's quite normal if one does not achieve every goal and objective listed in the job description—they’re often quite ambitious.

It’s also important to know that work in the field is very dynamic. There will always be something new coming up or something that's due urgently, so you should know that you're never—I mean never—going to have to do the same type of work two days in a row. You must be flexible, and you have to be open to new experiences. Being a pharmacist in an MSF mission means having to work very closely with all members of the team, especially the medical and the logistics teams. Pharmacists are the link between those two groups.

When I see people walking around in suits with their BlackBerries or smartphones—things that cost so much more than what an entire family has to live off of for an entire week or even a month in most parts of Africa—that’s the real heartbreak; that’s the challenge to re-adjust.

It’s important to know that MSF is not like having a regular 9-to-5-type job. It usually takes about three missions to be absolutely comfortable in your role with MSF and to know exactly what’s expected of you. The work load can be quite heavy at times, so it is important to be organized, and to prioritize. It’s not necessary to work on the weekends, at least not regularly, and there’s always R&R, which I believe is crucial to take when due.

One piece of advice I'd give to people interested in MSF is to not undermine the interactions with the national staff. I learned a great deal from them on all of my missions. I think it's really important to take the time to talk to them, to listen to them, and to consider what they have to say. I mean, they're the ones who live there, and they're the ones who are going to continue to stay on even after us expats leave.

This does not apply to all MSF missions, but one of the major and common challenges in the field is the lack of local specialized (or professionally trained) staff, whether medical or non/medical. This is a key part of our role as expats: to train and support the team to continue to function without our presence.

Adapting to Extreme Scenarios

I was quite lucky that on both of my missions I stayed in really nice towns, and the living conditions were very comfortable. In general, I think MSF likes to mentally prepare everyone, especially those who are joining for the first time, for an emergency mission, because nobody knows or can guarantee what type of mission you will get. I think they present the most extreme scenarios just to prepare people, but that doesn’t necessarily mean that every mission is like that. In general, with MSF you can be guaranteed to have a decent arrangement. It’s not going to be luxurious or anything—it’s just going to be basic, but I think that’s good. For example, in the field in Swaziland, we had no telephone line, no internet in the house, and no TV. I stayed there for an entire year! And, surprisingly, you adapt. You can survive. You can live without all that.

Going to the field certainly broadened my horizons. It really can be one of the most enriching—and most humbling—experiences you can have. The hardest part isn’t going to the field; it’s when you have to come back home—especially if home is in the Western world. When I see people walking around in suits with their BlackBerries or smartphones—things that cost so much more than what an entire family has to live off of for an entire week or even a month in most parts of Africa—that’s the real heartbreak; that’s the challenge to re-adjust.

I really encourage pharmacists to apply to work with MSF. We really need this specialized profession in the field. There’s an opportunity to make a real difference where we work, and I never experienced the kind of immediate gratification I got in the field when I was working in the United States. There are great opportunities to learn, several training opportunities, and the chance to see and learn new things. It’s very fulfilling and very rewarding.