'Even if you are somebody who plans to specialize, don’t lose track of your basic medical skills because in the field that is what you really rely on.'



What is your professional background?

I am trained in family medicine and was the medical director of a refugee clinic in San Francisco for three years before I started working abroad. I first worked in the Caribbean, then in Micronesia, and since 2000, I’ve been with MSF.

Each of your assignments has been very different; please give a snapshot and describe your responsibilities.

My first assignment was a "classic" MSF posting. I worked in a very remote valley in Eritrea that had no roads, running water, electricity, schools, or access to healthcare. Our small team also included a logistician, two interpreters, and two donkey-tenders. We carried out 10-day circuits in the valley, vaccinating children and providing primary care to Eritreans displaced by fighting with Ethiopia.

In my second mission, I worked in a garrison town called Bentiu on the northern side of the front line of fighting in Southern Sudan. MSF ran a field hospital, which had busy out- and in-patient departments, as well as TB and kala azar programs. Locally trained medical assistants carried out most of the consultations, so my role was to supervise their work and oversee the general hospital activities. Beyond the hospital, we worked to expand access to medical care in the community, including an outreach program for wounded soldiers detained in their military compounds.

Because I had a lot of prior experience in management and direct patient care, I took the role of medical coordinator for my next assignment in Southern Sudan. In this role, I oversaw medical projects in two different parts of the region. In the six months I was there, our teams staffed a sleeping sickness project and a hospital much like the one in Bentiu. We also responded to a number of emergencies, including two measles outbreaks, an Ebola outbreak, as well as seasonal malnutrition and malaria peaks.

When I left Southern Sudan, I took a year off to study tropical medicine. In the midst of my studies, there was a Marburg hemorrhagic fever outbreak in Angola, so I went for a month to help set up the emergency response.

My most recent assignment was based in Moscow where I supported a field team working inside Chechnya. We ran primary care clinics for children and women, as well as a reconstructive surgery program for people wounded during the wars. Due to the difficult security situation for international staff, our access to the field was very limited. The majority of our work was carried out by remote supervision of the local field team.

Choose one of your assignments to describe how you conducted consultations and whether you had adequate diagnostic tools and treatment.

In Eritrea, I practiced very basic medicine. My consultations were carried out in a tent, sitting on the floor, listening to patients’ stories, using my stethoscope and brushing the dust off my bags of medications. I worried most about the emergency cases because we were at least a full day’s walk to the nearest hospital. In the moment, I often wished that I had better tools with which to diagnose or treat patients, but in the end, I think that MSF provides the appropriate technology for the conditions in which we work.

What professional skills were most useful while in the field?

Often times, we were training health workers who have very little education and no formal medical education to provide medical care. It’s so rewarding to see them demonstrate that they can carry on what they learned though the process. It was challenging because many of us don’t have experience teaching others.

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

The health care needs are tremendous. While MSF can make an impact, in the end, we cannot help everyone . . . cannot save everyone, though personally you want to do it all. We often have to choose where we can have the greatest impact. It’s easier to make those decisions when you’re at the coordination level and you don’t have people directly asking “Why aren’t you doing this?”

In one instance, I was covering for the midwife who ran the obstetrical program in the Akuem hospital in Southern Sudan. A woman came in with a fetal demise (death of the fetus in utero). We were unable to deliver the baby, which put the woman’s life in jeopardy as well. Two to three times a day, her family would beg and ask: “Please get her out. Why can’t you get an airplane?” But we didn’t have transport to a facility that could help her. She did survive, but some don’t. Those losses weigh on me, but overall the program was having a big impact. We prevented a lot of premature deaths and illnesses during pregnancy.

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

I can’t say enough about the dedication of the local staff. One of the most rewarding moments with MSF was returning to the hospital in Bentiu after being evacuated due to insecurity. While away, we imagined the worst—that the staff and patients would have fled to safety or that they were killed in the fighting. But when we returned, we found our patients still alive and safe in the hospital. The local staff we trained held everything together by continuing the medical treatment and maintaining the neutrality of the hospital in the conflict.

What recommendations do you have for doctors, including students and residents, who are interested in applying to MSF?

Generalist skills are very useful. Even if you are somebody who plans to specialize, don’t lose track of your basic medical skills because in the field that is what you really rely on.