'It involves a lot of clinical skills, some guesswork, watching, and waiting. You’re not always right.'


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

Currently, I am an infectious disease fellow, but I have been on the faculty in the Department of Medicine at Columbia University, a primary care doctor in New York City, and I spent four years teaching medical students and residents before I left for MSF in 2006.

What motivated you to apply to MSF?

I wanted to see how medicine was practiced in other settings.

What were your typical day-to-day duties?

In Guatemala, I worked in an HIV/AIDS clinic, where I did consultations and provided care. I also trained local staff, provided technical advice, and collected project data and outcomes.

My second assignment was a much larger HIV/AIDS project in Kenya. I managed and supervised national staff with many clinical officers. I helped teach the clinicians about HIV/AIDS and advised them on HIV care.

I returned to Kenya to do operational research in April 2008. We were studying a cohort of AIDS patients who have been on ARV treatment for more than one year to determine whether viral loads point out ARV failure sooner than clinical and immunological outcomes.

What diagnostic tests and equipment did you have access to?

There were few diagnostic tests in Guatemala and even fewer in Kenya. In Guatemala, we had a basic X-ray and a lab to do blood smears, hemoglobin, creatinine, and CD4 count for HIV.

How did you work around not having the medical tools and equipment you were used to?

You use what you have and do the best you can. Often you’re not sure what the patient has and you have to use empiric treatment and see if the patient gets better. It involves a lot of clinical skills, some guesswork, watching, and waiting. You’re not always right.

What other professional skills were put to the test while in the field?

Communication is a big one because the colleagues who you’re working with are from different cultural and language backgrounds. You also need a lot of patience because of unique field challenges, and limited resources, especially diagnostic tests or treatments.

What did you find most challenging about your work?

In Guatemala, it was a Spanish-speaking-only project and my basic Spanish wasn’t adequate for patient consultations and to communicate with the local and international staff, who were either from Spain or South America. I even had to write reports in Spanish.

My challenges in Kenya were managing a large staff and dealing with cultural barriers because medicine is practiced differently there. In the U.S., doctors aren’t trained as much in management and supervision as they are in clinical work. Learning how to manage a large staff is a skill that comes only with practice.

Did you have a steep learning curve or did you learn very quickly and adapt?

There’s always a big learning curve when you’re on your own, as opposed to when you’re in a practice with a lot of specialists or colleagues you can rely on for support and to bounce questions off of.

What did you find most challenging about life in the field?

Sharing living space with your colleagues was challenging. I got on very well with everybody in the house in Guatemala. I had mixed experiences in Kenya.

Was treating women for sexual violence part of your work?

Sexual violence is a big problem in Kenya. One of the components in the HIV program was treating survivors of sexual violence and rape with post-exposure prophylaxis, providing them psychosocial counseling, and treating wounds and STDs.

What did you find most rewarding about your work with MSF?

The most rewarding aspect of field work is seeing very sick patients arrive who had lost 10 to 40 pounds or 10 to 20 percent of their body weight and were at death’s door, starting them on antiretroviral therapy, and then seeing them get better quite dramatically in a short amount of time. In Guatemala, patients came in with very advanced HIV—CD4 counts of zero or one—but after a couple weeks of treatment they would gain some weight and go from being very sick to feeling quite well.

Do you think your experience treating immigrants in the U.S. helped you interact more easily with people of different cultures?

My work with immigrants did make it possible for me to conceive of working in different cultural settings.

Has it been hard leaving your family behind for long periods of time?

In Kenya, the internet was often down or slow and the phone service was not great, so it was definitely hard to communicate regularly with family and friends.

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

I had to quit my job to work overseas with no guarantee of job protection.

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

They should take a very close look at what it means to work in the field. Go to an information session and meet the recruiters who are experienced aid workers. I don’t think it’s for everybody, but for me it’s been a great opportunity and I want to continue doing it.