Aileen’s typical day “It is difficult to say what a typical day was. There was no typical day or week for me really, as I had to move around a lot. But, usually, I would start with getting up at 6am. We could not leave base before seven am for security reasons, but by seven the Land Rover would all be packed up, with national staff on board, ready to leave for the clinics that were scheduled for that day. The journey to the clinics took from between two to five hours depending on what clinic it was, and if it was in the rainy season or not. For the more remote clinics we would stay the night there, sleeping in the clinic. When we would get to the clinic, there would be lots of people waiting to be seen. I would try to plan my schedule to inform the clinics when I was coming; thus if they had particular cases they wanted me to see, it could be arranged. After seeing patients in the clinics, we would have some food there, usually prepared by a woman in the village. We had to be back at base by six pm at the very No wonder some skills are difficult to find! “We need more surgeons and anaesthetists,” said David. In Ireland, one of the problems is that there is resistance within the medical professions to taking breaks in the course of the training cycle for overseas work. “Doing aid work is not something that was encouraged in medicine when I was training, particularly in hospital medicine,” Aileen commented. Unlike EU countries like France, the Republic does not have specific schemes actively encouraging doctors and nurses who wish to take short-term leave to provide much-needed assistance to aid agencies. “I feel that overseas work experience is something that should be encouraged more for doctors in Ireland,” Aileen said, “as it is in the UK, where time spent in the developing world can be counted towards specialist training in Paediatrics, Obstetrics and Gynaecology, and Public Health,” she added. However, the situation here is improving. As David pointed out, MSF is building links with the medical community in order to secure accreditation with medical bodies; even though he agreed that this is only at an initial stage.
latest (security reasons), so we had to plan our departure according to that. Often the Land Rover would be very full travelling back, with staff and patients on board. Some days, we might not make it to the clinic, if we met someone ill on the road, e.g. a woman in obstructed labour who needed to get to hospital urgently. Other days I stayed at base — for meetings with e.g. the TB programme manager in Grand Bassa county, or with other NGOs or to do some teaching, or run workshops. But, anything could happen. One day, the police came, saying they needed a doctor to examine a “possible homicide”. So we ended up travelling miles to a rural village, having a meeting in the centre of the village with the whole village present — elders, possible suspects, family of the bereaved, children, UN and local police — and then examining the body in a little hut nearby. We also did some outreach visits to villages where we seemed to be getting a lot of TB cases from. There was always something to be done.
Challenges
Recruitment is only one of the many obstacles facing the MSF mission. The challenges are also political and economic, and MSF staff set out to tackle most sensitive issues — drug production, pricing and delivery, targeting diseases in places that have been completely forgotten, places where people and governments have no money at all to spend on healthcare (see panel next page on drug access). The MSF response to those critical issues is to raise awareness — i.e. raising awareness of the need to use generic drugs and research for new drugs for developing countries. “Many otherwise unreported stories get out there thanks to MSF,” said David. “Real stories, where we speak on behalf of the patients.” But, at the end of the day, the main MSF challenge lies with the individual staff members on the ground. The extent of the aid which is needed is enormous. Aileen tried to explain some of the challenges she had to tackle: “there were many difficulties working in Liberia. It was a country coming out of 14 years of a brutal civil war, where more than 200,000 people were killed.”
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“We were based in Buchanan, the second biggest ‘city’ in Liberia, in Grand Bassa county,” she continued. “We supported four clinics in the interior of Grand Bassa, and three clinics and a small hospital in River Cess county.” She then explained how MSF were the only healthcare NGO in River Cess, and as there were no Ministry of Health doctors, effectively she was the only doctor available to this county. Between their seven clinics and the St. Francis hospital, with a team including just one doctor, they had a catchment population of 191,000 people. Their task was made even more difficult as they had to face basic problems in Liberia — no running water, no electricity (apart from power provided by private generators), and roads that were in a very bad state (or no road access at all). “Because people had no refrigeration, as there was no electricity, salt was used a lot to preserve food and in cooking, and we saw many people with high blood pressure and subsequent heart disease as a result.” There was also a lot of tuberculosis (TB). “This was a big public health problem as one person with infectious TB can infect 10-15 others per year if left untreated,” Aileen said. “This means treating TB was crucial for prevention.” But the main medical problems Aileen and her team encountered were malaria, diarrhoeal illnesses, or chest infections and pneumonia. “Many deaths were from these diseases — all easily treatable, and/or preventable if people had access to clean water, and simple antibiotics,” she commented. “We saw many children with malnutrition,” she added. “It was very difficult seeing children die from what are preventable diseases, particularly the vaccine-preventable diseases such as seeing newborn babies dying a painful death with the spasms of neonatal tetanus because their mothers had not been vaccinated due to problems in getting the vaccine.” In response, MSF in Liberia have set up several programmes including a feeding programme for malnourished children and a TB programme. Aileen also started a programme to tackle sexual violence, a serious problem which appeared during the war, but which also persisted afterwards. “Rape was a particular characteristic of the war there, and some UN figures estimate that more than 70 per cent of