"The role of nurses is absolutely central to MSF"

A conversation with Patricia Carrick, nurse practitioner and MSF-USA vice-president

MSF health workers speak with a group of sex workers in Nsanje, Malawi, during a “one-stop” outreach clinic in 2019. These clinics take place in different parts of the community on different days and provide a comprehensive package of sexual and reproductive health services and referrals.
Malawi 2019 © Isabel Corthier
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What is the role of nursing within MSF?

The role of nurses is absolutely central to MSF. Nothing can happen for our patients without nurses. It is nurses who are at the bedside in hospitals, nurses at the consultations in health centers, nurses who provide vaccinations and preventive care in communities. It is nurses who accompany our patients throughout their health care journeys. Nurses have a special role and responsibility in ensuring the quality and patient-centeredness of our care.

Nurses are trained to be listeners—not only to our patients, but to the families and communities of our patients. Part of our role also is to be sensitive to the perspectives and the input of our colleagues and coworkers. Remember, some 90 percent of MSF staff are members of the communities we serve. The knowledge, skills, observations, and insights of our local staff are essential to the success of our efforts. In order to benefit from those gifts, we must listen to and hear each other.

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SUMMER 2020: NURSES AND MIDWIVES ON THE FRONTLINES

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One area in which MSF has long valued nurses is infection prevention and control—a topic that is getting much wider recognition now in the context of the COVID-19 pandemic.

Nurses are trained to be listeners—not only to our patients, but to the families and communities of our patients.

 

Patricia Carrick, nurse practitioner and MSF-USA vice-president

Another important aspect of our work—and this is also especially relevant in the context of COVID—is with end-of- life and palliative care. Because we accompany our patients throughout their journey, it is often nurses who are present in the final stages of life and at the time of death. In many places, we simply do not have the availability of lifesaving treatments and technologies. Nurses face this reality with our patients every day, and struggle to help people face moments of suffering and death with compassion and dignity, often under devastating circumstances.

Photos: Honoring nurses and midwives

Nurse Patricia Carrick (left) at work with MSF in 2010 in Agok, a town in the disputed border region between South Sudan and Sudan.
© MSF
Palliative care
Emmily Mkumba’s advanced cancer makes it too difficult for her to sit or lie on her back. She rests on her stomach for a consultation with Christopher Chalunda, an MSF palliative care nurse in Blantyre, Malawi.
Malawi 2020 © Francesco Segoni/MSF
Malawi - Advanced HIV
Maria Goretti Uwamahoro, an MSF nursing team supervisor, tends to Austin, a patient being treated for advanced HIV in Nsanje district hospital, Malawi.
Malawi 2019 © Isabel Corthier/MSF
Kenema Hospital - Intensive care
MSF nurse Jerwin Capuras holds one of the youngest patients in the intensive care unit of MSF’s pediatric hospital in Kenema, Sierra Leone.
Sierra Leone 2020 © Vincenzo Livieri/MSF
MSF COVID-19 Response in Lebanon
MSF nurse Hala Hussein works in the Burj al-Barajneh refugee camp in Lebanon, where she was born and raised.
Lebanon 2020 © Diego Ibarra Sánchez
MSF Mobile Clinics and Tea Teams in Somali Region
MSF nurse and midwife Hamdi Abdi Osman, nurse aid Fartun Adan Dahir, and nutrition assistant Asad Doll Ali stand together at a morning meeting at an MSF project in the Somali region of Ethiopia.
Ethiopia 2019 © Susanne Doettling
Gambella Ethiopia: South Sudanese refugees
Lelise Bultoma is MSF’s nursing activity manager in Kule refugee camp in the Gambella region of Ethiopia.
Ethiopia 2019 © Susanne Doettling/MSF
COVID-19: challenges in Bangladesh and the Rohingya refugee camps
Bangladesh 2020 © Daniella Ritzau-Reid/MSF
Coronavirus: MSF's mobile clinic for vulnerable groups
MSF nurse Charline Vincent consults with a patient during a mobile clinic at Porte de la Villette, France.
France 2020 © Agnes Varraine-Leca/MSF
Nurse Louise
Louise is the sexual health nurse at the MSF-supported hospital in Kigulube, South Kivu, Democratic Republic of Congo.
Democratic Republic of Congo 2020 © Davide Scalenghe/MSF
Agok hospital
MSF staffer Ana Paola Barba tends to a young patient in the neonatology unit of the MSF hospital in Agok, South Sudan.
South Sudan 2019 © Laurence Hoenig/MSF
Mundri Community Outreach
MSF nursing care provider John Malish Bismark stands with the bicycle he uses to reach remote communities in Mundri, in the Equatoria region of South Sudan.
South Sudan 2019 © Tom Casey/ MSF

What are the mental health impacts of this kind of work?

It’s important to note that nurses are often de facto mental health workers. While I fully support MSF’s efforts to increase specialized mental health care for our patients, we should recognize the skilled mental health interventions that nurses conduct as a natural part of their everyday patient care—active listening; reframing experiences; validating and sometimes sharing emotions.

At the same time, we absolutely need to support the mental health of our nursing staff as well as that of our patients. Imagine working at the bedside in an Ebola epidemic when as many as 70 percent of your patients are dying. Or in a trauma ward in a war zone where children are mortally wounded because they were playing in the wrong place at the wrong time. We must recognize and address the incredible torment—the sense of sorrow and loss—this can create. Nursing is a soulful occupation. We give from the depth of our souls. But sometimes we need help and support in order to help our own and other souls survive.

Violence and neglect in the remote northeast of South Sudan
MSF nurse Bárbara García and Nyamach, a young patient, play with a balloon made from a surgical glove in the inpatient ward of MSF’s hospital in Ulang, South Sudan.
© Igor Barbero/MSF

We should also recognize how resilient nurses are; how tough people have to be to do this work. In Kailahun, Sierra Leone, during the Ebola outbreak in 2014–15, many of our nursing staff returned every night to homes where they likely had no electricity nor running water at the end of their day’s work in a highly contagious disease ward. One day, as the outbreak was winding down, the staff were talking and playing this grim game—which was worse, Ebola or the country’s civil war? Remember, this was a war in which limbs were deliberately amputated. One woman on our team said, “Oh, Ebola has been much worse.” Her colleagues were surprised until she explained, “For the past year, I have not been able to hold my children.”

As nurses, we are bound by our profession and driven by our ethics to provide care with compassion and respect for the inherent dignity and value of every person.

 

Patricia Carrick, nurse practitioner and MSF-USA vice-president

That really affected me. Nursing was her job. But I had never recognized the depth of the sacrifices, the incredible selflessness that brought her and so many of her colleagues back day after day, to work that could have cost her or her family their lives.

Now, in your role as an MSF-USA board member, how are you thinking about supporting our staff and strengthening health care capacity in low-resource settings?

One thing I’d like to do is strengthen the representation of nurses within MSF, to recognize current nurse leaders and identify new opportunities for nurses in leadership roles. More broadly, we need to recognize and develop the talents of people throughout MSF who are leaders, who have been working in our projects in some cases for years. I hope we can promote more locally hired staff into leadership roles and elevate the work of local experts.

Now of all moments we must look at how to do things differently. Response to sudden change — this is what MSF is all about. For example, in the face of travel restrictions, perhaps we could consider how much travel is really needed to accomplish our goals. Couldn’t this be the moment to concentrate on remote training and support for local staff? Perhaps this is the moment to combine the strengths from diverse settings to improve nursing throughout our medical projects.

Some people have said we should be “Nurses Without Borders” to recognize the vital role of this profession. What do you think?

Our title, Doctors Without Borders, suggests the hierarchical importance of a single role to the apparent exclusion of others—and, as a nurse advocate, I have always railed against that. What I really think is that all roles are critically important. Who working on an MSF project could live without a logistician or a WASH [water, sanitation, and hygiene] specialist? We have just been talking about the importance of mental health, about being connected to communities—what would we do without psychosocial counselors, health promoters? How would we manage our activities without our drivers, our cooks and cleaners, our human resources and finance managers?

Medical Academy ceremony
Nurses and midwives attend the graduation ceremony of the MSF Medical Academy in Kenema, Sierra Leone, on January 31, 2020.
© Vincenzo Livieri/MSF

So, yes, it’s important for us to raise up the profiles and voices of our nurses and midwives—absolutely! But it’s also important for us to recognize and credit the contribution of every single role, every single member of every one of our teams.

We talk about the incredible value of diversity in our organization. We say we are, and I truly believe we are, committed to equity and inclusion among patients, communities, and staff. Now, with the disruptions caused by a worldwide pandemic, and the stark realities of racism and health disparities glaringly obvious here in the US, we are called to right action: to raise up the contributions of every employee, to recognize the humanity of every patient; every being we touch. As nurses, we are bound by our profession and driven by our ethics to provide care with compassion and respect for the inherent dignity and value of every person.

>> Read more from Alert Summer 2020: Nurses and midwives on the frontlines.