Maria Guevara

'I have learned so much from living in different cultures, working with people from all over the world, and, most of all, caring for patients whom I would never have met were it not for MSF.'

 

 

 

What is your professional background and what did you do before joining MSF?

I am a pulmonary and critical care specialist. I worked in a private practice in Atlanta and worked in the internal medicine department at the VA and the surgical intensive care unit at the University of Florida hospitals.

Why did you choose to work with MSF?

When I chose to be a doctor it was to do service work and MSF was the perfect medium for my intentions. I admired MSF’s non-partisan stance and its medical humanitarian ideals.

Describe your first assignment in Liberia and your subsequent return and change of role?

I worked in a 60-bed hospital with 120 national staff. We saw about 30 to 55 cases a day, mostly children with respiratory tract infections, malaria, diarrhea, and overdoses from traditional remedies. I directed patient care and conducted staff medical trainings. I returned for a second assignment in Liberia to work in another MSF-run hospital which had a 95 percent occupancy rate. I was the Medical Focal Point and later became Field Coordinator, which meant that I had overall responsibility for the medical, logistical, and administrative activities, along with security issues.

How did working as a Medical Coordinator in a small project in Haiti differ from working in one with several project sites in DRC?

In Haiti, I coordinated the medical activities in a trauma/rehabilitation center and spent most of my time trying to rebuild a new facility so that we could improve the quality and delivery of care. In DRC, we had three projects, so this was more of a true coordinating position with regular contact with the project managers at headquarters and multiple daily calls to the project sites, along with meeting staff at other NGOs and government officials.

How did violence impact the projects and your work?

In Haiti, there was urban gang violence, but MSF had good contacts with the leaders and the groups. They understood MSF principles and the importance of our presence and work for their people, so we felt sort of protected. We were able to get to and from the hospital as long as we were careful. In DRC, the fighting between government forces and various rebel groups was done in an expansive region and on a much larger scale. Since the fighting was everywhere, MSF had to decide where the greatest needs were and weigh the risks to the team. I had to be very nimble in order to keep up with the changing environment, our response, and keeping tight security at all times.

As a pulmonary and critical care specialist, how did you manage cases outside of your specialty?

Clinical medical diagnosis is really the same, and I did have experiences in internal medicine and surgery. The MSF guidelines were very useful as they stressed how to adapt what you know to developing-country settings. What you did need to learn was how to work without a lab or an x-ray, so you were a pure clinician.

What kind of flexibility should people be prepared for before going to the field?

You need to be open to many surprises. You arrive not knowing your housemates who will also be your workmates and whom you will be around for months at a time, 24/7, in the same space. You’re immediately immersed in a new culture without your family and friends to depend on or any of your normal creature comforts. When I meet someone going to the field for the first time, I always tell them to give themselves at least a month to feel comfortable again in their skin. Even after five years, I still experience a low level of anxiety.

What character traits were most put to the test in the field?

Patience is needed – you need to take the time to absorb the work and live-in situation on the ground, understand and be sensitive about the local culture, and allow each person to be himself.

How does being away from a U.S. medical environment for a period of time affect your work when you return as a locum?

As a pulmonary and critical care specialist you work with a lot of technology, medications, and guidelines that change constantly, so I’m on my toes to keep up when I return.

How has field work affected you?

I’m a gypsy at heart who feeds on the newness of things. I have learned so much from living in different cultures, working with people from all over the world, and, most of all, caring for patients whom I would never have met were it not for MSF. This work has expanded my sense of humanity, for sure.

How have you been able to incorporate working with MSF into your life?

It’s been my life since 2004. Each time I return to the U.S., I manage by doing locums work. This schedule allows me to go to the field and also continue medical studies. I earned a diploma in tropical medicine in between assignments. One day, I hope to do a Master’s in International Health.