How MSF works with families and communities during humanitarian emergencies

Nurse Mary Jo Frawley has worked for Doctors Without Borders/Médecins Sans Frontières (MSF) for 27 years, doing everything from examining patients rescued on the Mediterranean to responding to Ebola outbreaks. Here she shares one of the most important lessons she’s learned.

What have you taken with you from all your years with MSF?

Mary Jo Frawley: In all the projects I have worked in, it has become clear to me how important it is to understand the place you are in, the community, and the people. It is important that both MSF as an organization and each employee as an individual have this cultural understanding. It is a form of respect that begins with each individual patient you meet and ends with the dialogue you have with local authorities. 

Does this also apply to emergency situations where it is a race against time to save lives?

MJF: Yes, respect goes hand in hand with dignity, and not prioritizing dignity can have negative consequences. Take Ebola, for example. During the Ebola outbreak in West Africa in 2014, many people were skeptical of health care because we did not have good enough dialogue with the community.

Many people in Sierra Leone, where I worked, did not understand why they were not allowed to bury their dead in a dignified manner, in accordance with their cultural customs. As a result, some people did not want to seek medical care.

Why were they not allowed to bury their dead as they usually do?

MJF: Ebola is transmitted through bodily fluids, and washing and touching a dead body is one of the greatest risks of infection. Since 2014, we have placed greater emphasis on talking to the community during Ebola outbreaks, thereby increasing understanding of the disease and the risks associated with burial.

What does dignity mean to you?

MJF: Treating a person with dignity means treating them with respect; seeing and listening to them. Dignity does not have to be something big. In our projects, it is usually about spending time with patients and their families. In malnutrition projects, for example, it is important to talk to the mothers of malnourished children and emphasize that you understand that they are doing their best to care for their children. They often find it extremely difficult to have a malnourished child.

How do you treat a patient with dignity as a nurse?

MJF: It is very important to be able to communicate properly. As an internationally mobile staff member you usually need an interpreter. In places where many different languages are spoken, even locally hired colleagues may need someone to interpret for them. In such cases, the interpreter may sometimes be a guard or a cleaner who works on the project and speaks the same language as the patient who is present during the consultations.

In some situations, it becomes more concrete. Patients who have been subjected to sexual violence, for example, receive what we call a dignity kit. This may include clean underwear, sanitary pads, soap, a towel, and some clothes. After the earthquake in Myanmar last year, we distributed such kits to people who are particularly vulnerable, such as sex workers.

What do people do for themselves to maintain  their dignity?

MJF: Over the years, I have noticed that people often put on their best clothes when they seek medical care. And I have often been offered food or drink by people in need, for example in Syria during the war.

Did you accept?

MJF: Yes, it felt important to accept that cup of tea, sit down on the floor, and talk with them. Just as tea was important there, in a tent in Syria, coffee was important during the last Ebola outbreak I worked in, in Bulape, Democratic Republic of Congo. There, a group of patients at the Ebola center had started a small coffee club. Every morning, they sat under a tree with their coffee cups. Even though an emergency was unfolding around them, they made sure to keep that little moment of dignity.