I have known about MSF for years, at least since the time I was in medical school. I have wanted to do a mission with MSF for as long as I can remember, because of their excellent international reputation for humanitarian work and medicine. In some ways working with MSF always seemed like the ultimate challenge for a Canadian GP.
Prior to joining MSF in 2004 I worked as a locum physician in a number of communities, in BC and in the North, doing family medicine, inpatient care and ER. I also worked for several months with the Sir Edmund Hillary Foundation at a rural hospital in the Everest region of Nepal. Following this, I did a three month diploma course in Tropical Medicine in London, UK. I wanted to expand my knowledge of medicine in developing countries, so that I would be better equipped to work overseas again in the future. These different experiences certainly helped prepare me to work with MSF.
In 2004, MSF sent me on my first mission to the Democratic Republic of Congo, working on an HIV treatment project in the eastern city of Bukavu. The eastern Congo is a beautiful region of lakes and volcanoes; sadly it has been affected by years of civil war, and the conflict in the region is ongoing. Much of local health care infrastructure is undermined or destroyed. At the same time, HIV is a very real problem, as it is in most regions of Sub-Saharan Africa. The MSF project is the first and only in the region to introduce comprehensive HIV care for the population, including treatment with anti-retrovirals. HIV care and treatment in a developing world context is a rapidly changing field, and it was great to feel that I was participating in new and instrumental medical work. Working with the Congolese nurses and doctors was a real pleasure, because HIV is a new field for them as well, and we were able to learn so much together. One of our doctors, Tina, made a tremendous impression on me. She has a great passion for learning, and really cared for the patients. She seemed to be able to get results in the face of all sorts of inefficiencies in the country. In the DRC only 3% of doctors are women, so the fact that she was able to practice and to reach her goals required amazing commitment on her part. It was an exciting and challenging place to work, and a tremendous learning experience for me as well.
An important aspect of HIV treatment is to ensure that patients take their anti-retroviral drugs (ARVs) regularly, and understand the importance of good medical adherence. One of the arguments against introducing ARVs in Africa is that people would not have good adherence, and resistance would develop rapidly. In fact, MSF’s experience has shown that the opposite is true. With good education and group support, patients have excellent adherence to their medications, because they realize the importance of the drugs in saving their lives. They have seen neighbours and relatives die, so they take their treatment very seriously. ÊIn May 2004 Bukavu was under siege by rebel groups, and it was very dangerous for people to move about. Despite on-going gun fighting, many patients came to the clinic at great personal risk in order to pick up their medications! Their commitment to their own health care is impressive.
My one piece of advice for someone who would like to volunteer with MSF is to not underestimate your ability to work overseas. It’s true that the work is challenging, but MSF offers quite a bit of support as an organization, and I believe people have a fantastic ability to adapt and be resourceful when given a chance.