To date, Doctors Without Borders (search) has deployed more than 160 international aid workers and 200 tons of supplies to those affected by the earthquake and resulting tsunami (search) in South Asia, and relief efforts are ongoing.
Although Doctors Without Borders has received an overwhelming response from health care professionals to volunteer for emergency relief to those hit hardest by the tsunami, only those professionals with considerable experience and training on other Doctors Without Borders missions are eligible for this mission.
However, Doctors Without Borders is actively recruiting medical personnel to volunteer in the more than 70 countries it now serves.
To learn more about how Doctors Without Borders is using doctors and other health care professionals, WebMD’s Laurie Barclay, MD, interviewed Christophe Fournier, MD, desk manager for Doctors Without Borders-USA in New York. Fournier is a French general practitioner and surgeon who recently returned from setting up a surgical program for Doctors Without Borders in Port-au-Prince, Haiti.
WebMD: What types of health care professionals is Doctors Without Borders recruiting?
Fournier: Basically, doctors and all medical professionals, from surgeons -- especially general and orthopaedic surgeons -- to obstetricians, anesthesiologists, pediatricians, psychiatrists, nurses, midwives and lab technicians. We are also asking for general practitioners, of course -- this is the most needed kind of provider.
WebMD: What type of experience or skills should they have?
Fournier: Professional experience, as well as having trained or served in remote areas, is very helpful. Surgeons must be able to operate in very remote places, even with poor materials, and be able to face any kind of situation.
For nurses, experience in managing operations is very important, as is management experience because many of our nurses hold management positions.
Experience with tropical diseases is also an important asset, even though they are not found in all the countries where we are working. Putting aside the South Asian crisis for the moment, most of our interventions are in Africa, where diseases like malaria, visceral leishmaniasis (search), trypanosomiasis (search), and other tropical diseases are prevalent, so it is really a plus when volunteers have experience dealing with them.
Language skills are very helpful as well. U.S. citizens have the advantage of speaking English, which is the most useful language in many countries. But in many African countries, you really need to speak French, while in other parts of the world it is better to speak Spanish or Arabic.
WebMD: How long a commitment to service do doctors need to make?
Fournier: It’s a minimum of six months per mission, but after that it could be one year or more. For acute emergency situations, like after the tsunami, we only send people with experience. Actually, the ones who responded at the very beginning had more than 10 years of experience with Doctors Without Borders. Experienced volunteers can join what we call the “emergency pool” and go for emergency operations that can range from one to two months. But you have to have that prior experience.
For people applying for the first time, we ask a minimum of six months commitment, with the exception of the surgeons and anesthetists; we think it’s enough if they can commit themselves for one month.
WebMD: Is there any special training that volunteers undergo before they are deployed?
Fournier: Volunteers have three days of training in what we call departure preparedness, when we give them a better idea of what kind of operations they will have to deal with, the usual contacts, and the rules and behaviors we ask them to respect when they are working with Doctors Without Borders.
After that, in the course of a volunteer’s commitment, we have several different medical training programs ranging from immunization, to how to deal with malnutrition, to the management of outbreaks and epidemics. We also have more general training programs, for example, in team management.
WebMD: How is it determined where the doctors will be assigned?
Fournier: A doctor is assigned partly according to his or her preference. When you are applying, it’s best to say, OK, I want to go for a mission and I'm open to any kind of situation. But if you have some restrictions, like not wanting to go to a violent area, or not wanting to go to a particular country, of course we will take that into account.
Assignments are also given according to the background you have. We have very well-defined teams and very well-defined positions to fill, so the pediatrician will most likely go to a pediatric hospital, or a psychiatrist will be assigned to a post-conflict or post-disaster setting, or to countries where people have good reasons to be traumatized.
WebMD: For doctors assigned to areas affected by the tsunami, what type of conditions and duties are they likely to experience?
Fournier: According to what we have seen so far, they can expect to find three things. First, we sent a few surgical teams, but there is not a need for surgical intervention everywhere. Caring for the injured is an emergency in the first few days, and local people are usually able to deal with this. Relief organizations like ours often arrive too late for this.
After that, we provide classic and general primary health care. We are setting up dispensaries everywhere, and preferentially in the more remote places, so the volunteers have to deal with many kinds of diseases, just like general practitioners. For the time being, it’s mainly acute respiratory infections and small wounds or infected wounds.
After that, volunteers will deal with post-traumatic stress disorder (search) (PTSD) and other stress disorders. So we are now sending specialty teams of psychiatrists and psychologists because many survivors have seen a huge part of their families disappear with the tsunami. We have seen villages of 3,000 people where less than 300 survived. All of the ingredients are there for lots of stress disorders, so we will try to deal with it over the coming months.
WebMD: How are security issues being addressed in terms of children possibly being kidnapped or sold?
Fournier: That is something that has much more to do with international policy. We focus on the most remote places, so we are not dealing that much with big concentrations of people as other agencies do. So I would say that would be a major concern for U.N. agencies like UNICEF.
WebMD: What are the dangers or risks associated with serving with Doctors Without Borders?
Fournier: In the tsunami-affected region, there’s no major risk to doctors for the time being. Of course, we always try to make sure that each volunteer understands the context. If it’s a region of ongoing war, we try to make sure the volunteer understands the situation. We will have strict rules and regulations to follow once on the field so that he or she is not exposed to danger, but at the same time the risk cannot be zero. By going on a mission, they have to accept that we will try to minimize risk to each team as much as possible, but it is never zero.
Some of the countries, like Afghanistan or Iraq, are countries where we can no longer work because we are targeted. But in the more than 75 countries were we still work, we are not targeted.
WebMD: Are there specific benefits associated with serving with Doctor Without Borders?
Fournier: When doctors and others go on mission, they do not have to do it for free. Doctors Without Borders provides a small allowance to cover their usual expenses while they are on mission, such as apartment rent or loan payments. Of course, someone who volunteers for a mission is not doing it for the financial benefits, at least not with Doctors Without Borders. The money we give them is just to help face the usual expenses. But Doctors Without Borders does offer more for people involved in a longer term commitment, another “status,” especially for those who are willing to take on some positions of responsibility.
WebMD: Please describe professional benefits associated with serving with Doctors Without Borders, as well as psychological and emotional benefits.
Fournier: I don’t know if it’s emotional, but I can tell you from my own experience that it is certainly very useful. It helps you build an expanded vision of the world and I think it just opens your mind. The main thing is that it is so much of a human experience.
It also gives you lots of different professional experiences. I’m a general practitioner and also have experience in tropical diseases and epidemiology, but with Doctors Without Borders I have seen things regarding tropical diseases, the management of malnutrition, and many other diseases that I have never seen in other places. The most rewarding professional aspect is the reliance on clinical senses. Doctors usually return to their home countries with a renewed confidence in their clinical skills.
The surgeons have to deal with very complicated cases, and every case is traumatic, but at the same time it’s nice when a case can be solved. Before you go on a mission, you have to really have that willingness to go there and to help. But you should know that you will come back with human, personal, and professional experience you cannot get in other settings.
WebMD: Are there any particular experiences you could relate that would illustrate what service in Doctors Without Borders is like?
Fournier: My missions have been as a field doctor, as a general practitioner; some have been helping surgeons in operations; I also have had a position as medical coordinator. I especially remember those children we operated on in our centers in Sudan and elsewhere in Africa. When they arrive in the therapeutic center, clinics or hospitals, they are in such a traumatized condition, and when you manage to cure them after the operations, or if when they arrive they are almost dying because of starvation, and then three weeks later you see them leaving the center perfectly healthy, hand-in-hand with their relatives, those moments are so nice.
I know these types of moments can be experienced by any kind of medical professional in any setting, but in the middle of nowhere with very poor materials and bad conditions in the middle of a war, it takes on another meaning.
WebMD: How does Doctors Without Borders determine the optimum allocation of resources to each area?
Fournier: It’s according to what the needs are. For example, in Haiti right now there’s a huge need to rebuild the whole health system. But for medical emergency organizations such as ours, our concerns go to conflict that is taking place now in the capital, Port-au-Prince, where more than 100 people are injured by guns and other weapons every month but they are not being surgically treated. So that’s the reason why we decided to set up a surgical program there.
In Darfur, Sudan, the needs were much more about primary and secondary health care programs. So it’s according to the needs and the emergency associated with those needs. Fortunately, we have the experience to set up quick operations to deal with such needs.
For the financial resources with these kinds of operations, 80 to 85 percent of our funds come from individual gifts, and around 85 percent of the money we get from people goes to our operations. We allocate these funds according to the operations we have on the field. For example, in Darfur, Sudan, we have now more than 150 volunteers, and in south Asia after the tsunami we already have 160 volunteers, and of course those resources are in relation to the scope of those operations.
WebMD: If health care professionals decide not to volunteer for a full-term commitment, are there other ways in which they can help?
Fournier: The mission is the main one, but as a medical organization we also try to have links with the medical world. We try to always use the best drugs and the best diagnostic tools, and to determine what those are. We try to conduct clinical trials and other research projects from time to time in quiet settings. For that we have to be linked with universities, medical schools, and research centers. So doctors who are not able to go to the field for whatever reason sometimes work with Doctors Without Borders in that way. We are always interested in links with academic research centers just to be able to perform the best medicine possible on the field.
WebMD: Is there any advice you have for physicians who would like to volunteer in a mission?
Fournier: Your professional experience is something that is very important, but also be aware that you will never do a good job if you have not managed to be integrated in the context of the country where you work. What we are expecting from you is not only your medical background, but also your open mind, your curiosity, and your willingness to integrate yourself within the population you will try to help.
By Laurie Barclay, MD, reviewed by Michael W. Smith, MD
SOURCE: Christophe Fournier, MD, desk manager, Doctors Without Borders-USA, New York.
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