Louise Fang

'It’s not—at all—your daily working environment back home, and you have to be able to improvise in many situations.'

Interviewed in September 2009

What you did do before joining MSF?

I have worked as an operating room (OR) nurse since 1972, including two years in Taiwan. In the US I worked at trauma hospitals in San Francisco and Seattle, and for 20 years I worked in a veterans’ hospital in Seattle. In 2004, I retired from the veterans’ hospital and started working for aid agencies. That is when I joined MSF. 

What motivated you to go on assignment with MSF?

Ever since I came to the United States, I have always had people help me. New immigrants always need help, so I started in San Francisco and then in Seattle working with the American Red Cross.

The decision to join MSF happened after one of the doctors at the VA hospital introduced me to the organization and encouraged me to apply. He had gone on assignment with MSF a few times and always shared his stories when he returned. 

Describe your duties as an OR nurse and how they varied from project to project.

The first mission in Nigeria, I was working as an OR manager and first assistant. I had national staff, maybe 15 to 20 people under me. So, I was basically running the whole OR. The national staff created the operation schedules and they functioned as physicians’ assistants on the trauma cases. If they needed me to circulate, I would circulate. I was on-call 24/7.

On the second mission in Southern Sudan, I was basically a one-person surgical team. I did everything from top to bottom. In the beginning it was a little difficult because in the US we are used to being pretty specialized. As an R.N. working in the OR at home, I usually have nothing to do with things like daily sterilization procedures, even though we are required to have knowledge of it. When I arrived in Southern Sudan, I needed to learn how to do it in this setting. So, I got a book out and started reading MSF policies and protocols. That way, I learned by myself how to do it.

On the third mission, the one I finished recently in northern Nigeria, I was an OR supervisor. I had two national staff under me. I also functioned as circulating nurse and was in charge of the sterilization room, laundry service, and waste management. So, basically I just kept the OR running daily. 

What kind of surgical equipment did you not have access to and how did that impact your work?

The instrumentation in the field is usually not as adequate as it is back home. On top of that, our entire instrumentation catalog is from Europe. So that caused a bit of confusion, but not a whole lot, because if you are experienced, you look at the instruments and you know what they’re for, even though they have different names. 

Furthermore, it was hard to get specialty instruments. On my first mission in Nigeria, we had thoracic cases and vascular cases—but we had no specialized supplies for those cases and we had to improvise. We managed to do it and we were able to save lives. 

Could you give us an example of a clinically interesting case you worked on, something you wouldn’t normally see in the US?

I had never done Vesicovaginal fistula (VVF) repair before I went to the project in northern Nigeria. That was actually the main reason why I accepted that assignment, because I wanted to see how they do it. 

That project also has an emergency obstetrics component. I had no experience with obstetrics since my entire career I have been working on trauma in orthopedics. So it was a big shock to me at the beginning; these patients were coming in with the baby stuck during labor… I had never done a craniotomy on a baby before, but sometimes we had to do it. That was a big challenge. 

You did a lot of training of national staff. How did you experience your role as a manager in the field?

I kind of learned on the job. You are put into that position and you have to learn quickly. I started out just treating everybody as I wanted people to treat me, putting myself in the other people’s shoes, and trying to mediate the conflicts they might have. It did not always work, but most of the time they listened. 

I’m older than the majority of the national staff, and age is a factor. A big factor, even, because in Nigeria and Sudan, they are very family-oriented and have respect for their elderly. So that was an advantage for me. On my first mission, everybody called me “Mama”. So I said, “OK, since I’m your Mama, you have to listen to me. If you have a problem you can come to me.” On the last mission, I was three years older, and everyone called me “Caca”—which means “Grandma.”

But even though I didn’t have a managerial background, I managed to handle things pretty smoothly. If I had to bring out the disciplinary policy to get them to change their behavior, I would. And, usually, it worked. 

How were the living conditions in the field?

In Port Harcourt, Nigeria, we had a house in a very nice area. In Jahun, northern Nigeria, we had a house too. It was pretty good except for the water, which had to be manually brought in to fill up our well and then be pumped up to a tower, which allowed us to shower. 

In Sudan, it wasn’t that good because we lived in a tent and we got flooded. The program had expanded rapidly, so for a short period, we had some-30-plus people in a very small compound while MSF was building a new bigger compound. So everybody was cramped in their tents, one next to the other. Finally, we moved to the new compound completed by MSF logisticians, which had tukuls set up.

We also had to do the bucket shower. That is very challenging because the bucket is not very big. You cannot shampoo your hair and bathe at the same time. I’m glad I had the experience. Now when I look back, I laugh and think “How did I do that?” 

What traits are most important for working in the field with MSF?

Well, I guess just being flexible helps. You have to try to adapt as fast as you can. It’s not—at all—your daily working environment back home, and you have to be able to improvise in many situations. You have to be able to handle the situation and to adjust to what is thrown at you. That comes with your experience and professional background.