the violence continues

Dispatches
MSF CANADA MAGAZINE
Volume 17
Edition 1
Winter 2013
Syria:
the violence
continues
Syria: Lifesaving care in a war zone, p. 02 | mali: “We will not abandon our patients”, p. 04
south sudan: Night shift in a refugee camp, p. 06 | maternal health: Safe delivery, p. 08
swaziland: Expert clients bring hope, p. 10 | innovation: Technical innovations that save lives, p. 12
profile: Wendy Rhymer, nurse-midwife, p. 14
02
Lifesaving care in a war zone
No one said anything about missions
in cold places.
T
his is what I thought to myself as I
huddled under five layers of blankets, wearing three layers of clothes,
on my second night in northwestern
Syria. Before leaving for my first mission five years ago, the words Médecins
Sans Frontières (MSF) conjured up images of sweltering African heat, dusty
landscapes, and malaria-carrying mosquitoes. Now I often wonder how to
organize my laundry, since it is difficult
to send things to the wash when you are
wearing all your clothes all the time.
True, this is not my first mission in a
non-tropical climate (northern Pakistan
in January could hardly be described as
toasty), yet the absence of reliable and
effective heating brings a whole new dimension to “life in the field.”
The cold also means other things. Ironically, it means an increase in burn patients
arriving at the hospital. People in the area
face fuel shortages and a lack of proper receptacles for burning materials in. A large
number of displaced persons living in
camps lack effective shelter from the cold.
What this means is people will burn anything, and burn it in anything, in order to
stay warm. But as these methods are often insecure and unsafe, accidents are all
too common – particularly for women,
responsible for meal preparation, and children, who suffer most acutely from the
cold and are therefore often closest to the
source of heat. I am greeted some mornings by a small contingent of “masked
crusaders”: children wearing facial burn
dressings made of bandage material, with
holes for their eyes, nose, and mouth making them look like a tiny band of balaclavaclad bank robbers ready for their next heist.
And of course, the violence of the war in
Syria continues. Even as the front line, ever
changing, moves farther away, the aftereffects remain – a plethora of arms means
that disputes take on a more lethal tone, stray
bullets are indiscriminate in their targets. We
also see the effects of delays in treatment, or
improper management in those patients arriving from centres ill-equipped and not at
all trained to deal with the war injuries they
now face on a regular basis.
MSF has been working in this particular
region since June 2012, operating a small
surgical trauma unit, initially set up to
treat war injured. While these activities
continue, evidence of the conflict’s toll
on the availability of other health services becomes increasingly apparent.
People are unable to find treatment for
longstanding chronic disease, leading to
an increase in complications from things
such as diabetes and heart disease.
© Nicole Tung
Dispatches Vol. 17, Ed.1
syria
© Nicole Tung
© Brigitte Breuillac / MSF
Dispatches Vol. 17, Ed.1
© Brigitte Breuillac / MSF
© Nicole Tung
03
My job here officially is to be responsible for the supervision and function of
several advanced medical posts, known
as AMPs. This means making contact
with, and providing training to, some
of the civilian-run field posts that are
closer to the front lines of the fighting.
I have so far managed to make two visits – a combination of security and lack
of staff here making more visits impossible thus far. Many areas are shelled on
a near-daily basis.
gether to fill some of the gaps in health
service delivery that has come with the
destruction of hospitals and the loss of
trained staff. They are students – of law,
of engineering, one medical student,
two dentists. Together with others they
have joined the group with the hope of
just lending a hand. They are eager to
learn, but sure have a lot to learn. I am
hoping a series of days in the hospital
here can help them consolidate some
basic skills.
be bombarded with lower extremity injuries in order to consolidate the words for
“knee,” “foot,” “toe” and “leg.”
I am hoping, in the upcoming weeks, to
bring some of the non-MSF staff from
one particular post here to our emergency facilities and give them training
to improve their capacity to treat the
most common problems seen at their
post. Yet here’s the wrinkle: the majority of the staff at the health post have
no medical training. They are a group
of local young men who have joined to-
Training is further complicated by my utter lack of ability to speak Arabic, although
I am trying: I have started informal lessons
with one of our translators, and have so
far mastered: “hello,” “how are you,” “no
problem,” “OK,” “my name is...” and
“good bye.” Every day I also try and work
a new body part into the mix, and use it
as often as possible in conversation. Today I caught myself fervently hoping to
AnneMarie Pegg
Doctor
And now, my follow-up clinic beckons.
Our care doesn’t stop at hospital discharge – the dressing changes, wound
assessments, and post-operative management continues. And I have some
tiny bank robbers to entice into mischief
before the end of the day.
AnneMarie Pegg (pictured on cover
and top left on this page) is a family
doctor from Yellowknife. She has worked
for MSF since 2008, in Ethiopia, Haiti,
Republic of Congo, Pakistan and Central
African Republic.
04
“We will not
abandon our
patients now”
Access to free, quality
healthcare still vital
T
he volatile situation in early 2013
around Gao, Mali meant fewer
patients were able to come to the
Médecins Sans Frontières (MSF) health
facilities, but physician Jose Bafoa says
the priority for him and his teams was
always to continue providing care to
their patients.
It remains the leading cause of death in
the country, including for children under the age of five.
An average of 120 patients were making their way to the MSF-run Wabaria
and Sossokoira health centres near Gao
every day as of mid-February. Even
though the rainy season was over, 70
per cent came with malaria, a parasitic
disease that leaves sufferers exhausted
from high fevers and uncontrollable
shivers. Despite the war, it is malaria
that the medical teams battled against.
“Although there is a hospital and 10
health centres in and around Gao town,
this is for a population of 400,000 and
we realized that some people still had no
access to medical care. And with the current insecurity, where people are on the
move and often have even less means,
giving them access to free and quality
care is even more vital. So far we have
seen 16,000 patients.”
“Since we started working in the health
centres in September last year, we have
generally seen a constant number of patients,” says Bafoa.
© Trevor Snapp
Dispatches Vol. 17, Ed.1
mali
In January of this year, French and Malian forces launched an offensive against
various armed groups operating in the
north. In Gao, the most significant force is
the Movement for Unity and Jihad in West
Africa, a splinter group of the better known
Al-Qaeda in the Islamic Maghreb.
“People fled in fear of the air strikes and
reprisal attacks. Some went to neighbouring countries, but others found shelter in small villages or in the bush where
living conditions are harsh. So aside from
malaria, we have seen an increase in the
number of patients coming in with diarrhea and skin diseases due to the lack of
hygiene, as well as an increase in cases
of acute respiratory infections caused by
the dust and wind,” says Bafoa.
In the vast desert areas of northern Mali,
bringing treatment closer to patients is
another essential aspect of the project.
Mobile teams work in remote areas, the
rationale being that if patients can’t come
to MSF, then MSF has to go to them. But,
with fears of land mines on the roads,
MSF has been forced at times to temporarily suspend the work of those teams.
Epidemiological surveillance is another
key part of the project, ensuring MSF
staff are able to respond to disease outbreaks rapidly. “We need to be ready
to respond to any medical eventuality, be it an outbreak, war wounded
or people affected by displacement. In
Ansongo we see some 100 patients a
day,” says Bafoa. “Our patients tell us
© MSF
“Through our mobile clinics, we of
course offer primary healthcare, but
we also try to ensure that pregnant
women have routine prenatal consultations,” says Bafoa. MSF also
supports community health centres,
supplying them with medicines and
essential materials.
that all they hope for is peace. And we
are with them; we stayed here throughout the air strikes, we will not abandon
our patients now. We hope that the
health system will develop and eventually replace us. But until then, we will
stay and ensure that the people of Gao
and Ansongo continue to have access
to quality and free healthcare.”
Physician Jose Bafoa (pictured below,
right) worked in Mali as a medical team
leader for MSF this past winter. He has
worked for MSF since 1999, including
in Uganda, Chad, and Central African
Republic, as well as in his home country,
Democratic Republic of Congo.
Dispatches Vol. 17, Ed.1
© Trevor Snapp
© MSF
© MSF
The main aim of the project since it opened
is to lower mortality rates by increasing
access to healthcare and responding to
emergencies. In the town of Ansongo,
where MSF supports a referral hospital,
mortality rates in the centre went down
from more than eight per cent to 1.2 per
cent in less than three months.
05
south sudan
“A strange and rather magical time”
© Olga Overbeek / MSF
Dispatches Vol. 17, Ed.1
Night shift
in a refugee camp
06
As of the end of 2012, more than 170,000 refugees had crossed from South Kordofan and Blue Nile states in
Sudan and gathered in five camps in remote and inaccessible areas of South Sudan. Because of the camps’ geographical location – on a flood plain in the rainy season and a parched wasteland in the dry season – the refugees
rely on humanitarian assistance for the food, water and healthcare they need to survive. Médecins Sans Frontières
(MSF) is the main healthcare provider in all of the camps. Here, one physician shares his experience working a
typical night shift at the field hospital in Batil refugee camp, as the work to keep saving lives continues around
the clock.
T
he night time is considered a critical moment in the field hospital
here. We start with a round of the
wards so the doctors on the day shift
can tell me about their patients. Last
night we started with a man in the inpatient department who had just been
brought in with suspect meningitis. We
did a lumbar puncture, taking a sample
of the spinal fluid, and the result was
cloudy, which meant we needed to send
it off for further laboratory tests. He was
in critical condition.
Non-stop care
The other place I need to know about is the
intensive care ward for severely malnourished children. Last night all the patients
were stable apart from one girl who was
extremely dehydrated and was having constant diarrhea. We had to give her a special
fluid to replace what she was losing with
the diarrhea and vomiting. We needed to
weigh her every hour because we were giving her a lot of this fluid, but we needed
to make certain we were not overloading
her system as that can be very dangerous.
These children are so weak that we need to
give them this fluid extremely slowly with a
syringe. And you have to do this carefully all
through the night, give fluid, check weight,
wait, give fluid, check weight again…
Remaining focused
But we always have some patients who are
very ill and who can go from just about
stable to seriously sick in just a few seconds.
The other day a child we were treating for
severe cerebral malaria started having convulsions. That was two hours of intense
activity. When a child goes into seizure it
can bring on a respiratory repression and
so you have to stop the seizure immediately
as the shortage of oxygen can bring about
cerebral damage. We followed the usual
emergency protocol for seizures, but then
she stopped breathing. So we had to start
manual respiration with a breathing aid,
but this was difficult as she was having really bad convulsions, shaking and writhing
around on the bed.
It was a hard decision to make because the
drug to stop the seizures has a side effect of
lowering the breathing rate of the patient.
We had to stop the seizure so we needed
to keep giving the drug, even though it was
having a bad effect on her breathing. After
about 25 minutes we managed to stop the
seizure, but this was really long for a seizure
and the risk of cerebral damage was high.
And throughout all this we were ventilating
manually because if you stop ventilating for
two or three minutes the patient could die.
Dispatches Vol. 17, Ed.1
Sudden emergencies and
difficult decisions
07
© Olga Overbeek / MSF
In a way you get much more of a connection with your patients and the medical staff
during the night shift. For me it’s a strange
and rather magical time: everything is quiet
after the rush and noise of the day, just the
sound of the generator and the falling rain,
and you get to pause for a minute and drink
some coffee with your Sudanese and South
Sudanese colleagues. In between emergencies you get to stop and think.
© Olga Overbeek / MSF
The patients who are not stable often become critically ill during the night. And
that can be difficult. You need to keep
totally focused on the most critical cases.
If you leave a weak patient for too long,
they can become really unstable and die.
Sometimes we are lucky
which is really exhausting. And then suddenly her chest started to move and so I
stopped and she was half breathing. So I
continued to support her breathing for a
while and little by little she started breathing by herself. Throughout the rest of the
night she was unconscious but stable.
At one point I started thinking that this
child was eight years old, the same age
as my daughter. I think this somehow
helped me to keep going, and I kept
ventilating the girl for 40 or 45 minutes,
The next evening, when I came back at
6 p.m., she was sitting and drinking. She
stopped and smiled at me. She must
have recognized me from the previous
night. So I did some quick examinations
and yes, her life was saved and it seemed
without any obvious cerebral damage. I
don’t believe in miracles, but sometimes
we are lucky.
Roberto Scaini
Doctor
Roberto Scaini (pictured above) is a physician working with MSF in South Sudan.
maternal health
Dispatches Vol. 16, Ed.1
Burundi and Sierra Leone have two of the world’s highest
maternal mortality rates. A 24-hour, emergency obstetric care
and ambulatory care system started by MSF has helped save
the lives of thousands of women.
© Sarah Elliott
Safe
delivery
© Lynsey Addario
© Sarah Elliott
© Sarah Elliott
© Lynsey Addario
08
Dispatches Vol. 17, Ed.1
© Lynsey Addario
© Lynsey Addario
09
Left to right
Row 1:
• Patients at MSF’s emergency centre for gynecological and obstetric care in Kabezi,
Burundi line up for breakfast. All services at the centre, including meals, are free.
• MSF staff examine a patient at the Gondama Health Centre in Bo District,
Sierra Leone.
Row 2:
• An MSF nurse does a prenatal exam on a patient at the Gondama Health Centre.
• An MSF nurse prepares to take a patient by ambulance to the emergency
centre in Kabezi.
• An MSF doctor meets with a new mother and her baby at the Gondama
Health Centre.
Row 3:
• Staff prepare a patient for a C-section at MSF’s emergency centre for
gynecological and obstetric care in Kabezi.
• Women are transported by ambulance to MSF’s Gondama Health Centre.
swaziland
Why
Swaziland?
© Giorgos Moutafis
How does this tiny, landlocked kingdom have the highest rates of HIV in
world? It’s a simple question with a
very complex answer that involves
traditional values, poverty, an absolute monarchy, gender inequity and
a host of other factors.
Dispatches Vol. 17, Ed.1
Some 31 per cent of adults are HIV
positive and tuberculosis (TB) is rampant with 1,275 cases per 100,000
people. The result is that life expectancy has plummeted from 61 to
40.2 years in just two decades in this
country of 1.2 million.
© MSF
10
Expert clients bring hope
to HIV-positive Swazis
S
ylvia Khuzwayo became an activist back in 1998 when she learned
she was HIV-positive. “I was outraged,” she says, when physicians initially withheld the diagnosis from her
because she couldn’t afford antiretroviral therapy (ART). They had also lied
to her about her husband’s cause of
death. “They said it was throat cancer.
It was AIDS.”
Khuzwayo’s CD4 count (the measurement of a type of white blood cell) was
210, making her eligible for ART. She
couldn’t afford the medication, but
knew that without it she would never see
her three children as adults. She overcame her fear of discrimination and stigma, taking the risky but necessary step of
disclosing that she was HIV-positive. She
asked friends and family for help; some
promptly ended the relationship.
“Some friends don’t want to be seen with
you because people would think they were
positive too.” But others came through
For Elias Pavlopoulos, head of mission
for MSF in Swaziland, it is one of the
biggest crises he has ever seen. “I’ve
been in Darfur [Sudan], in Burma too,
but I couldn’t believe this.” Swaziland
has a solid healthcare infrastructure
with 13 public hospitals and health
centres plus 186 clinics, but it’s not
up to handling the dual epidemic
of HIV and TB, especially given that
there are only two physicians and 28
nurses per 10,000 people.
Cultural traditions further complicate
matters. Polygamy is common and 73
per cent to 95 per cent of transmission is through heterosexual contact
between longer-term, older partners
according to a UN and Swaziland report. (HIV Prevention Response and
Modes of Transmission Study).
In addition, the fertility rate is 3.8
children per woman, but since 69
per cent of Swazis live below the national poverty line, many women are
forced to engage in transactional sex
to obtain food or other necessities
for their children. In general, women
have very few rights amidst patriarchal traditions. One in three Swazi
women is sexually assaulted in her
lifetime; 25 per cent of pregnancies
are among teens.
At the time of Khuzwayo’s diagnosis,
Swaziland’s government was in denial
about HIV prevalence. Today, the landlocked kingdom has the world’s highest
rate of HIV; some 31 per cent of adults are
HIV-positive. In addition, tuberculosis, an
opportunistic infection, is rampant with
1,275 cases for every 100,000 people.
After being diagnosed, Khuzwayo
worked as a research consultant and on
various pilot projects before Médecins
sans Frontières (MSF) hired her in 2008
as one of eight expert clients. Expert clients work at the community level, conducting campaigns, meeting with chiefs
and other leaders and working with
patients living in remote areas, among
other things.
Swaziland faces a chronic shortage of physicians and nurses so shifting certain tasks
to lesser trained workers is essential. Expert
clients are the key to MSF’s emphasis on
task shifting. “The current system [staffing]
couldn’t cope with demands,” says Pieterjan Wouda, the field coordinator at MSF’s
project in Shiselweni region. “It’s a waste
to use a doctor to do follow up. We’ve
managed to achieve results through expert
clients. It’s a beautiful system.”
Initially, Khuzwayo’s job was to recruit and
train expert clients in Shiselweni, the hardest
hit of Swaziland’s four regions. The number
of expert clients grew to 22 by 2010.
“[We] are the key to reducing stigma because clients see someone who is positive and healthy, and then they believe
they can also live a healthy life,” she says.
Expert clients initiate testing and treatment
and encourage adherence. Some experts
specialize in TB, others work in hospitals.
Today, 44-year-old Khuzwayo is the community psychosocial supervisor in one of
three zones of Shiselweni, looking after
12 community expert clients.
Cynthia Cebo Dlamini, who works at
the Hluti clinic, is one of them. Cebo
Dlamini was diagnosed with HIV in
2004 when she was pregnant; her child
subsequently died at just six months of
age. Every day, Cebo Dlamini visits five
to seven patients in their homes. She
also hosts meetings for up to 40 clients
at a time. “I get women together to talk
about their HIV status at Liguma (a gathering for married women) and in traditional settings, as well as in schools.”
Despite her managerial duties, Khuzwayo still sees clients.
“It’s here,” she says, tapping her chest.
“As a long survivor I can show people
you can live with treatment. Without
treatment you die in five years. I am giving them hope.”
Barbara Sibbald
Journalist
Dispatches Vol. 16, Ed.1
with support she desperately needed.
She’s been on ART since 2001 and has devoted herself to being a front-line activist
by encouraging others to test, to treat and
to live healthy, productive lives.
11
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Surgeons, Water and sanitation experts, Physicians,
Nurses, Midwives, Supply chain specialists, Epidemiologists,
Mental health specialists, Anesthesiologists,
Gynecologists, Technical logisticians,
Financial specialists, Pharmacists, HR coordinators,
Laboratory specialists, Nutritionists
© Brendan Bannon
this could
be you
MSF RECRUITMENT EVENTS IN YOUR REGION
www.msf.ca/recruitment/recruitment-events/
Contact us for more information
Toll free: 1-800-982-7903 or Email: [email protected]
12
Technical innovations
that save lives
W
hen Toronto emergency physician
Raghu Venugopal worked in eastern Democratic Republic of Congo, he met patients with spinal tuberculosis (TB) whose backs were bent at an angle.
Staff put these patients in corsets that kept
them completely straight. One patient was
wearing a cast that reached from his chest
to his knees so that he was barely able to
move. Venugopal was puzzled. “I had not
come across this disease before,” he says “I
was not sure if the treatment was good or
bad for the patients.”
Venugopal knows a wide personal network of medical specialists, including
TB experts. He consulted with them by
email. He learned that a simple soft back
support combined with TB treatment
was the best solution, and the treatment
for the condition changed.
Many doctors working for MSF in the
field face similar problems. They are often confronted with complicated medical issues they are not familiar with or are
unsure about. Working in remote, isolated places, they usually don’t have access
to a team of colleagues they can ask for
advice as they would have at home. Not
everyone has access to specialists they
can contact.
To support its medical staff and help
them offer the best care possible for patients, MSF introduced a telemedicine
system – or e-referral – at the end of
2010. The web-based, confidential, password-protected interface allows doctors
and medical coordinators in the field to
post questions about real, complicated
clinical cases that require specialist help.
They are able to not only describe the
clinical case but also to upload photos,
X-rays or ultrasounds if needed and if
those are available. To ensure anonymity, referrers are asked not to include any
identifying information about the patient.
The system breaks the isolation of MSF
physicians from the medical community,
and allows physicians elsewhere, including
those in the academic world, to contribute
to MSF’s lifesaving work. It is administered
in multiple languages by two operators in
Europe and a third in Canada, physician
and former MSF president, Joanne Liu from
Montreal. “As soon as I get an email alert
that a referral has come in through the system, I try to find a specialist that can help,”
she says. ”We generally get an answer in
less than 20 hours.” Many cases are answered within a few hours, with the more
complicated ones taking longer.
© Peter Casaer / MSF
Dispatches Vol. 17, Ed.1
innovation
Venugopal, who is currently working as
a medical coordinator in Chad, is confident he will use the system during his
time there to ensure his patients receive
the best care possible.
Simplifying TB testing,
improving diagnosis
In the city of Nukus in Uzbekistan,
Newfoundland-based physician Jamal
Ahmadian Yazdi learned to appreciate
access to another technical innovation
that helps save lives: a new, molecular
TB testing device called Xpert® MTB/RIF
(also known as ‘GeneXpert’) that makes
TB diagnosis more accurate and faster in
many cases.
ficult to detect tuberculosis. People with
compromised immune systems – for
example those with HIV/AIDS – often
test negative for TB using microscopy although they are sick with the disease. If
their TB is left untreated, not only is there
a higher risk of death, but they can also
spread the disease to others.
The device also helps improve the diagnosis for multidrug-resistant TB,
which is on the rise in many parts of the
world. In an MSF test site in Zimbabwe,
for example, a threefold increase in the
number of multidrug-resistant TB cases
was observed in the six months following the introduction of the new testing device, meaning that more people
could be started on appropriate treatment sooner.
Peter Saranchuk, TB-HIV adviser for
MSF’s South African Medical Unit, says
that while the new testing device is not
perfect, MSF’s experience has overall
been positive. But there are a few issues,
he says.
“The main challenge is logistics,” says
Saranchuk. “For the device to work
properly we need stable power supply and an operating temperature of
less than 30 degrees Celsius. In many
of the settings where we work, this re-
quires us to set up additional equipment that stabilizes the power supply
for the machine and the air conditioning of the room it is in.” Once those
conditions are in place the machine
can be used even in smaller, decentralized health facilities.
Another issue is cost: the current price
of the machine is about $17,000 and
the cost of each cartridge required
to perform a single test is about $10,
making it prohibitively expensive for
many resource-limited health facilities
– those that need better TB testing the
most. However since the machine can
potentially reduce the time to diagnosis of TB and the need for other tests
(e.g. chest X-ray), it can reduce the
workload of clinicians and laboratory
technicians and so may still turn out to
be cost-effective.
Since 2011, MSF has introduced these
testing devices in 25 sites in 14 countries,
including South Africa, Mozambique,
Myanmar and Uzbekistan.
Claudia Blume
Communications officer
Dispatches Vol. 17, Ed.1
Liu and the operators in Europe call on a
pool of 400 volunteers who live across the
globe, making it easier to get help around
the clock. They offer support in English,
French and Spanish. Many of them have experience working in developing countries,
enabling them to give advice to colleagues
working in low-tech environments. Each
field hospital has its own profile within the
telemedicine system, giving the specialist
the chance to review the kind of facilities
and equipment that is available at the site.
According to Canadian physician Leslie
Shanks, medical director at MSF’s operational centre in Amsterdam, the monthly
average of referrals has increased from only
a few cases a month when the project started, to more than a dozen a week.
13
“GeneXpert not only makes the testing
faster, it is also extremely easy to use and
a lot more reliable,” says Yazdi.”Now we
have a better idea what medicine the TB
strain is likely to be sensitive to and what
anti-TB drugs we should give to a patient. The cure rate should improve. With
the old way of testing there was often a
lot of uncertainty.”
The higher accuracy rate of the new device is important because it is often dif-
© Pierre-Yves Bernard / MSF
The machine (pictured, right) can detect
within two hours whether a person has
TB and whether or not the TB strain can
be treated with rifampicin, one of the
most common and important anti-TB
drugs. This is a significant development,
as the standard test for TB – looking at
sputum under the microscope – has
some serious limitations.
Previous page: Mothers with young children wait to be seen by an MSF doctor in Guri El,
Somalia, part of a telemedicine consultation with a medical specialist in Nairobi. Above: The
GeneXpert machine can identify the bacteria responsible for tuberculosis (Mycobacterium
tuberculosis) and also drug resistance.
profile
Wendy
Rhymer
W
hen people are fleeing armed
conflict or when a healthcare
system is failing, pregnant
women and women in labour are left
vulnerable. Maternal care is a critical
part of many Médecins Sans Frontières
(MSF) projects for women who otherwise may have little or no access to lifesaving medical care.
Dispatches Vol. 17, Ed.1
Wendy Rhymer is a nurse-midwife from
Winnipeg. Since 2007, she has worked in
six field projects with MSF, including in
Ethiopia, Somalia, Sudan, India and most
recently Pakistan, where she worked as a
deputy medical coordinator.
Why did you join MSF?
14
WR: From the beginning I liked the
idea that MSF often goes where others
don’t. People caught in a war or living through disaster have the right to
lifesaving medical help. Also, we give
quality care to our patients. These aspects were and still are part of what
draws me to MSF.
Providing care for people in such vulnerable situations can be emotionally
draining, and the often long hours and
workload can be tiring. However, even
on my hardest day, I know am helping people and making a difference
in their lives, and that this is where I
should be.
© Isabel Corthier
MSF nurse-midwife
Who is part of your team in the
field? How do staff work together?
WR: It really varies, depending on the
size of the project and people’s medical needs. Close to 90 per cent of MSF’s
staff are from the countries where we
work. In India, I worked with 100 Indian
staff, including doctors, nurses, drivers
and translators among others. The international members of the team included
a project coordinator, a logistician, two
doctors, a nurse, and myself, the nursemidwife.
In South Sudan, the team included 10
international staff and 150 South Sudanese staff in both medical and nonmedical positions. My role in Pakistan
was different because I was part of the
coordination team and, in collaboration with the medical coordinator, was
responsible for overseeing the medical
programs for four hospitals. I supported
the Pakistani and international doctors,
nurses and midwives doing hands-on
medical care. I still covered for them
when it was needed and was always on
call if there was an emergency.
Syria. South Sudan.
Mali. Swaziland.
Follow us across
borders.
What is the best part of your job?
WR: The best part of the job is that moment
in the delivery room, when every possible
problem and complication has occurred
and you don’t realize you have been holding your breath, just hoping that it works
out...and then the baby is delivered and you
wait a second, and then the baby cries, and
everyone starts cheering and laughing, and
you smile to yourself and think yes, it’s going to be OK. Life is good.
What would you say to a midwife
thinking about applying to MSF?
WR: Working as a midwife for MSF will
be one of the most challenging, frustrating, exhausting and rewarding experiences you will ever encounter. Some moments you will be heartbroken, as you
can only do so much with the resources
available. On the other hand, you will
have so many miracle moments, when a
baby or mother survives against all odds,
and you will know that you are in the
right place at the right time, doing what
you were meant to do as a midwife.
MSF staff work around the world, providing emergency
medical relief to people in crisis. Connect with us
through Twitter and Facebook for our latest updates.
@MSF_Canada
msf.english
Canadians on mission
Dispatches
Médecins Sans Frontières (MSF)
720 Spadina Avenue, Suite 402
Toronto, Ontario, M5S 2T9
Tel: 416-964-0619
Fax: 416-963-8707
Toll free: 1-800-982-7903
Email: [email protected]
www.msf.ca
Sébastien Gay Montreal, QC
Logistician
Oliver Sven Schulz Toronto, ON
Head of mission
India
Patrice Beaulieu Montreal, QC
Logistician
Iraq
Lorna Adams Toronto, ON
Doctor
Sarah Vanessa Atkinson
Pemberton, BC
Mental health specialist
Joseph Baugniet
North Lunenburg, ON
Project coordinator
Lori Demontigny Erickson, MB
Nurse
Stephanie Gee Vancouver, BC
Nurse
Nidal Tbaileh Toronto, ON
Anesthetist MD
Kenya
Christina Cepuch Fonthill, ON Medical coordinator
Kyrgyzstan
Alexandra Vanessa Ascorra Torres
Quebec City, QC
Biomedical analyst
Malawi
Nancy Semkin
Toronto, ON Human resources development officer
Myanmar
Jean Bédard Quebec City, QC
Logistician
Elaine Roy Montreal, QC
Nurse
Niger
Sonia Jérémie Cadet Laval, QC
Doctor
Stéphanie Lebel-Rispa Greenfield Park, QC
Nurse
Alphonsine Mukakigeri Montreal, QC
Logistician
Nigeria
Nicolas Bérubé Quebec City, QC Logistical coordinator
Geneviève Biron Montreal, QC
Nurse
Anna Funk Chilliwack, BC
Epidemiologist
Ivan Gayton Nelson, BC
Head of mission
Patricia Gould Courtenay, BC
Nurse
Kanadi Ibrahim Ottawa, ON
Logistician
Crystal Van Leeuwen Toronto, ON
Nurse
Pakistian
Peggy Mei-Yuk Chan
Coquitlam, BC Mental health specialist
Asha Gervan Toronto, ON Humanitarian affairs officer
Karel Janssens Toronto, ON
Head of mission
Alexandra Marcil Montreal, QC
Pharmacist
Miroslav Stavel Burnaby, BC
Doctor
Republic of Congo
Sara Badiei Coquitlam, BC
Logistician
Editor: linda o. nagy
Editorial director: Micol Zarb
Translation coordinator: Jennifer Ocquidant
Contributors: Jose Bafoa , Claudia Blume, AnneMarie
Pegg, Roberto Scaini, Barbara Sibbald
Cover photo: © Brigitte Breuillac / MSF
South Africa
Avril Benoît Ottawa, ON
Nicholas Gildersleeve
Frelighsburg, QC
Project coordinator
Logistical coordinator
South Sudan
Syed Imran Ali
Toronto, ON
Water and sanitation specialist
Nicole Desi Toronto, ON
Nurse
Pascal Desilets Ottawa, ON
Logistician
Anabel Deumier
Montreal, QC
Water and sanitation specialist
Jean-François Dubé Stratford, ON
Logistician
Tyler Foley
Oromocto, NB
Deputy logistical coordinator
Melissa How Calgary, AB
Nurse
Michael Minielly Belleville, ON
Logistician
Claudine Marie Peleo-Castro Toronto, ON
Doctor
Robert Sanda Calgary, AB
Surgeon
Rachelle Seguin Longueuil, QC Medical team leader
Abdullah Shah Toronto, ON Logistician
Nila Somaia Vancouver, BC Mental health specialist
Michael Talotti Bowmanville, ON
Administrator
Michael White Toronto, ON
Head of mission
Rosanna Wilson Vancouver, BC
Nurse
Jason Van Dyke Pembroke, ON
Logistician
Sudan
Kevin Coppock Toronto, ON
Head of mission
Swaziland
Jessica Burry Ottawa, ON
Pharmacist
Joanne Cyr Montreal, QC
Mental health specialist
Serge Kaboré Quebec City, QC Medical coordinator
Pieterjan Wouda St-Lambert, QC Project coordinator
Syria
AnneMarie Pegg Yellowknife, NWT
Claudette Seyer Outremont, QC
Doctor
Nurse
Tajikistan
Andrew Bohonis Thunder Bay, ON
Logistician
Uzbekistian
Gregory Scott Delta, BC
Administrator
Alia Tayea Mississauga, ONEpidemiologist
Trevor Toy Calgary, ABPharmacist
Yemen
Miriam Lambert-Lindsay
Saint-Joseph-de-Coleraine, QC
Céline Langlois Montreal, QC
Project coordinator
Nurse
Circulation: 109,000
Layout: Tenzing Communications
Printing: Warren’s Waterless Printing Inc.
ISSN 1484-9372
Dispatches Vol. 17, Ed.1
Afghanistan
Layebe Ignegongba Montreal, QC
Pharmacist
Georgann MacDonald Shelburne, NS
Nurse
Ryan MacIver Stouffville, ON
Logistician
Thierry Poirier Montreal, QC
Logistician
J.L. Talbot-Crosbie Toronto, ON Project coordinator
Bangladesh
Paulo Rottmann Toronto, ON
Finance and human resources coordinator
Central African Republic
Lucie Barré Quebec City, QC
Nurse
Étienne Blais Montreal, QC
Logistician
Piyali Chakraborti Thornhill, ON
Logistician
Daphne Hemily Toronto, ON
Logistician
Mark McCaul Mississauga, ON
Logistician
Todd Phillips Winnipeg, MB
Project coordinator
Kirsty Robertson Toronto, ON
Nurse
Jaime Zhen-Mei Scarborough, ON
Nurse
Chad
Comlan Paulin Amoussou Montreal, QC
Doctor
Ève Charbonneau Sainte-Flavie, QC
Nurse
Réjean Côté Wickham, QC
Project coordinator
Ritu Gambhir Toronto, ON Humanitarian affairs officer
Fabienne Gilles
Toronto, ON
Human resources coordinator
Diana Nicholson
Rosser, MB
Water and sanitation specialist
Raghu Venugopal Toronto, ON Medical team leader
Democratic Republic of Congo
Grant Assenheimer Edmonton, AB Project coordinator
Janick Audy
Gatineau, QC
Human resources coordinator
Julie Bédard Salaberry de Valley, QC
Nurse
Laélia Bilodeau Belœil, QC
Nurse
Franciscus Blom Westmount, QC Financial coordinator
Martine Bouchard St-Jérôme, QC
Nurse
Patrick Boucher Quebec City, QC Logistical coordinator
Dawn Catherine Brinkman Vancouver, BC Logistician
Laura Crickett Toronto, ON
Logistician
Bertha Fuchsman-Small
Sainte-Anne-de-Bellevue, QC
Doctor
Tomislav Jagatic Tecumseh, ON
Doctor
Sarah Lamb Kanata, ON
Project coordinator
Hélène Lessard St-Georges, QC Financial coordinator
Judith Letellier Montreal, QC Deputy head of mission
Melissa Maurus-Liben Montreal, QC
Nurse
Ellen Rachel Morgan Toronto, ON
Administrator
Anne O’Connor Toronto, ON
Nurse-midwife
Nicolas Perez Montreal, QC
Logistician
Ashley Sharpe Halifax, NS
Nurse
Elise St-Denis Quebec City, QC
Information, education, communication officer
Ethiopia
Stephen MacKay Halifax, NS
Logistician
Haiti
Maryse Bonnel Morin Heights, QC
Nurse
Lindsay Bryson Beaconsfield, QC Medical coordinator
Judy-Fay Ferron
Louiseville, QC
Water and sanitation specialist
Delphine Ferry
Montreal, QC
Human resources coordinator
15
When people lose everything in disasters, wars and conflicts, they cannot
plan. But we do. With your future support, MSF can respond quickly and
effectively, often within hours of an unexpected medical emergency.
By planning your estate today, you can care for people in life-threatening
situations tomorrow.
To learn more, please call us at 1-800-982-7903 and ask to speak directly to
someone about legacy gifts, or email [email protected]
1999 Nobel Peace Prize Laureate
© Giulio Di Sturco
MSF Legacy Giving