'There was a nice skills transfer—I did a lot of training but I learned a lot from my Nigerien colleagues as well.'



What was your professional background before joining MSF?

I had just finished my residency at Harbor-UCLA Medical Center in Los Angeles, and before I started a 2-year policy fellowship, I wanted to experience humanitarian work.

Why did you choose MSF?

I knew MSF had strong logistical capacity and wanted that support. Also, I believe in their principles of impartiality and neutrality and felt it was a good fit for me.

Describe your typical day-to-day duties in Niger?

In Niger, we drove to ambulatory feeding centers where we screened and treated children for malnutrition, carried out measles vaccinations, and distributed ready-to-use-foods. I attended to the sicker children, supervised the nurses, and made sure we were collecting the data properly. When we returned to the base, we entered and analyzed the data before calling it a day.

How much of your day was spent providing care, coordinating, and supervising?

I spent 60 to 70 percent of my time coordinating activities, such as addressing human resource issues, data analysis, reports, and training. The rest of the time was spent providing direct patient care.

In CAR (Central African Republic), I was the medical director of a 60-bed hospital, which had a TB/HIV ward, an intensive care unit, and a theater for ob-gyn and basic surgeries. Although I rounded every day, more than half my time was spent supervising hospital hygiene, managing staff, and collecting data.

What were the specific purposes of the data collection?

It’s important to evaluate TB treatment programs to identify failure/cure rates so we can follow drug resistance patterns and medication adherence. In Niger, we kept records on measles cases and other infectious diseases in order to anticipate outbreaks and be prepared to help the Ministry of Health launch a vaccination campaign.

What did you find most challenging about your work in the field?

Managing human resources was challenging because we had 400 national staff. Our goal was to create a good work environment where everyone got along and felt that their work was important. We emphasized on-the-job training so that the staff could develop their skills not only to do a better job but also grow professionally.

Was it difficult to work without the tests and equipment you were accustomed to in U.S. hospitals?

It was hard, but it made me much more reliant on my own hands and stethoscope to figure things out. There were times when I wished I had more tests or specialists to consult with, but in the end, with an excellent team, we were usually able to provide a level of care that was satisfying to us and to the patients.

You can’t just replicate our system over there. The best approach is to adhere to rigorous protocols and practice the best medicine you can. In the end, often it’s the simple things, like bed nets and anti-malarial medications that save lives.

Without specialists, how did you feel about making decisions on cases that were not your expertise?

I became more familiar with the local spectrum of disease with time. However, the difficult decisions didn’t get easier just because I’d made them before. I still had to face one patient at a time, and learn to recognize my own limitations.

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

My people skills: being able to negotiate with people and communicate with others across cultural differences—not only with the national but also the international staff. Our team had members from Algeria, France, Congo, Canada, Italy, and Guinea. Everyone had different assumptions about what it meant to live together. Also, it’s hard to be funny in a different language, so you come across as a different person.

What was the security situation like in your missions and did that affect your work?

In CAR, even though a ceasefire was signed, there was still a lot of insecurity. People were out with guns. Patients had trouble getting to the hospital because the roads weren’t safe. We took precautions by traveling in convoys and restricting travel to emergency patient transport. We lived with a curfew.

What did you find most rewarding about your work in the field?

In the nutrition program, we had a very effective therapy, so we saw hundreds of children regain weight and start to play and laugh again. There was a nice skills transfer—I did a lot of training but I learned a lot from my Nigerien colleagues as well.

Apart from your professional duties, what was most challenging about life in the field and how did you de-stress?

I was in a city of 300,000 people in Niger and was able to go out unescorted, but as a foreigner there is no anonymity. Kids followed me around and wanted to touch my skin to see if it felt different. To decompress, I brought a yoga video, so a few of us did yoga together.

In CAR, because of instability we were in our compound every evening. We cooked together on weekends. On Sundays, one of my English teammates liked making sausage and eggs for breakfast. At night, we chatted and listened to music.

What recommendations do you have for other doctors, especially students and residents, interested in applying to MSF?

I suggest training broadly—internists should be comfortable working with kids and pediatricians with adults—and getting some international experience where you work with limited technology.