'Having curiosity, a sense of adventure, and enthusiasm are essential. It’s good to know your professional and personal limits—what you can do and cannot do.'
What is your professional background and what did you do before joining MSF?
I did an internship in internal medicine, a residency in anesthesia, and two fellowships in pediatric and cardiac anesthesia. I worked in an inner-city private practice for 19 years and now work for the Massachusetts General Hospital/Cambridge Health Alliance on a special arrangement where I can take a 4-month unpaid annual leave to go to the field with MSF.
What were your typical day-to-day duties during each of your assignments?
In Ivory Coast, my focus was pain management and infection control. In the operating room, I supervised three very competent nurse-anesthetists. I’d help them start the cases, round in the intensive care unit, and return to help them with emergencies. I also started a pediatric burn unit in response to the large volume of cases and unacceptable high mortality, so I would make a stop there to anesthetize patients for dressing changes.
My work day in DRC (Democratic Republic of Congo) started at 7:30 a.m. and ended around midnight. I was the only anesthesiologist and was on-call every day. After a late supper and a couple of hours’ sleep, I would be summoned to return to the hospital. I rarely had a full night’s sleep. We had one operating room, two surgeons, and me. The team did a lot of general surgical cases and a high volume of obstetric cases—about 90 C-sections a month. I noticed that the burn victims were not getting anesthesia, as in Ivory Coast, for their dressing changes, so in my spare time, I gave them IV sedation.
We were also short on staff in Nigeria, so the work load was phenomenal. We logged the highest monthly volume of cases since the opening of the trauma center two years previous. We saw many orthopedic traumas from knife, gun, and machete wounds, and injuries from road accidents.
How equipped were the hospitals?
Nigeria was the best equipped. We had a ventilator attached to an anesthesia machine, an EKG, pulse oximetry, capnography, and oxygen extractors. In DRC, I had to improvise with an uncalibrated vaporizer and an oxygen extractor. I did as much as I could using spinal anesthesia, sometimes without benefit of an introducer.
How did you adapt your practice to work around those limitations?
In DRC, my iPod came in handy especially with the teenage soon-to-be mothers. I plugged them in, pressed ”play”, then placed the spinal. My overriding preference was to keep the patient breathing spontaneously in case the power and, therefore my oxygen supply, failed. If I had to do a general anesthetic at night, I had to ask the night watchman to stand next to the emergency generator in case the power went out.
What kind of flexibility did you have in the field to improve the quality of care?
In Ivory Coast, I noticed that there was a high mortality of 30 to 40 percent from burns, which you would not see in the U.S., so I set up a pediatric burn center and our mortality rate went to zero. This is what I like about MSF. If you identify a problem and have a solution, MSF is open to seeing it through.
How do anesthesiologists and surgeons work together in the field?
We work as a surgical team. There’s a high level of communication, cooperation, and consultation between the surgeon and the anesthesiologist. There are no assumptions about who knows how to do what.
Have you seen cases that were clinically interesting that you haven’t done before?
There have been some unusual cases, such as the conjoined twins and the person who arrived carrying an armload of his own intestines. Some were horrible, like the two-year-old whose arm had been chopped off with a machete during a violent attack.
What did you find most challenging about life in the field, apart from work?
For my first three weeks in Ivory Coast, I shared a dormitory with two men who snored. There was no hot water, so each morning, the guards boiled some for us. Because of language and cultural differences, communication was always a challenge, whether at the dinner table or at the hospital.
What character traits do you think were most necessary while in the field?
Having curiosity, a sense of adventure, and enthusiasm are essential. It’s good to know your professional and personal limits—what you can do and cannot do.
How has working in the field impacted your work back home?
I appreciate everything so much more—oxygen for every patient, a clean suction catheter, and working equipment. The politics and the day-to-day annoyances don’t bother me anymore. Also, my relationship with surgeons has changed. Now, I work with surgeons, not around them.
How have you been able to incorporate working with MSF into your professional life?
I’ve been able to structure my job so that I can do field work four months a year. As a board member, there are a lot of teleconferences and reading, which I do in my spare time.
What information do you have for anesthesiologists interested in applying to MSF?
Your skills need to be very good because the environment is quite challenging, so expand your knowledge and skills, and sharpen your intuition and instinct by broadening your experience.