Deborah Jenkins

'Take as long an assignment as you can so you can give more to the project but also get more from it.'

What is your professional background?

I am an anesthesiologist and work in a large private practice in Idaho. Prior to MSF, I went on short assignments in the Dominican Republic with an Ohio-based surgery group.

What motivated you to apply to MSF?

I subscribe to MSF’s philosophy of temoignage (speaking out) and going where the needs are the greatest. Also, I wanted to work for a group that had longer-term assignments.

Having been on ten assignments, describe your role and responsibilities in each?

When I was providing direct care, I did pre-, inter-, and post-operative care. What was different were the cases; for example, we didn’t have cardiac or neurosurgery cases. On one of my assignments in Sri Lanka, I was in the operating room the entire time. Another time, since it was a maternity project, and I was the anesthesiologist/neonatologist, I was responsible for the medical evaluation and care of the newborns. On another assignment, I substituted for the emergency doctor doing basic medical assessments.

In Haiti and the Ivory Coast, I supervised local anesthesiologists or anesthetists and was responsible for the medical coordination of the intensive care unit. I even served as a pain consultant and did some general medical care for surgery patients.

What was the work load like, in terms of hours?

Generally, the work load varied between a 40-hour to an 80-hour week, depending on staffing and emergency situations.

What did you find most challenging about field work?

The language barrier presented unique difficulties. It was hard to communicate to patients and staff through an interpreter. I had to deal with not having an x-ray or an anesthesia machine. I even got used to not having anesthesia support personnel, which meant that you had to depend on yourself. Also, it was difficult to not have the range of medications or the diagnostic support you would have in the U.S.

There have been circumstances where all you had was a rough estimate of a patient’s hemoglobin. Your only choice is to return to the physical examination, consult with colleagues, and make the best judgment. You sure learn to appreciate epidemiology.

How did you adapt to work around those limitations?

There have been circumstances where all you had was a rough estimate of a patient’s hemoglobin. Your only choice is to return to the physical examination, consult with colleagues, and make the best judgment. You sure learn to appreciate epidemiology.

Were there assignments that were more difficult than the others?

The most difficult ones were in conflict zones. At the height of the conflict in eastern Congo, 50 percent of our patients were war-wounded. In Sri Lanka, some nights when I was trying to sleep, the room would shake periodically because the mortars were only a couple of miles away.

Can you give examples of some clinically interesting cases you’ve seen?

Infectious disease cases piqued my interest. In DRC, we had multiple laparotomies, which are abdominal operations for relatively young people whose bowels are partially ruptured due to typhoid. I’ve seen meningitis from toxoplasmosis and the devastating effects of malaria. Also, a lot of women come to the hospital with a baby hanging out because of unsuccessful home deliveries.

How did you handle diseases that you have not treated before?

MSF helps you be a better health care provider. They supported my studies in tropical medicine and I pursued a certificate in travel medicine. Also, in the field there are MSF reference books that help you understand the frequency of the disease and the techniques and interventions that are most useful for field settings.

What was most challenging about life in the field, outside of work?

In conflict zones, you don’t go beyond the hospital and the compound, so you are with the same people night after night. They may not be the people you would choose as your friends, but when you get to know them there is a beauty and intensity that stays with you for the rest of your life.

What character traits are valued for field work?

After ten assignments, I reinforce the traits of flexibility and adaptability. Also, do take time to know what your personal needs are because you will find that the needs of the team should be put first. You learn to be honest with yourself and honest with your team.

You have worked with so many national staff members, what stands out from this experience?

Everyone I’ve met has been so dedicated and talented. It was a privilege to sit and eat with the local staff because you got to learn about their lives and what’s important to them.

How has field work changed you?

I’ve become more patient and more accepting because of my field work with MSF. I understand why and what it means to put the project first. I have a better perspective of the beauty of the human spirit - the love that people can still have despite their circumstances.

After multiple assignments, is there other training to become a better health care provider?

I feel I will benefit from learning more about public health, so I’m going to pursue an MPH.

How have you incorporate MSF into your professional life in the U.S.?

I give talks to help MSF find more professionals. Also, I work with MSF’s peer support network, which helps returned aid workers to reintegrate back into their communities and family life.

What recommendations do you have for an anesthesiologist interested in applying to MSF?

Take as long an assignment as you can so you can give more to the project but also get more from it.