MsF's work is by no means in an isolated vacuum.
Written by | Wan Shunshun
Source | "Medical Community" public account
When Liu Yiyun told her family that she had decided to apply to join Msf, the family thought she was impulsive and must not have thought it through.
But the idea arose as early as when she was studying medicine. After graduating with a Ph.D., Liu Yiyun worked in the Department of Critical Care Medicine at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, and once she heard a friend mention that she wanted to join MSF and realized that this matter was not out of reach. At the end of 2017, Liu Yiyun submitted an application on the official website of Ms. Sans Frontières and successfully passed the resume screening, telephone interview, and on-site interview.
In September 2020, she quit her job at Shanghai Ruijin Hospital and went to Al-Kindi Hospital in Baghdad, Iraq, at the peak of the epidemic, to receive a four-month task to treat patients with COVID-19.
Helped, failed to help
It was the first wave of COVID-19 in Iraq, with nearly 4,000 new cases a day and about 500 deaths a week. MSF has set up a COVID-19 treatment ward at Kindi Hospital to treat patients with severe and critical covid-19.
Such projects are relatively rare among MSF. In places where medical resources are backward, it is very difficult to build an ICU ward, which is why Liu Yiyun has waited for the project to be dispatched for a long time.
The intensity of work on the project is not at all inferior to that of the domestic ICU. "The local COVID-19 pandemic is very serious, so the 24 beds in the ICU ward are basically full every day." In Shanghai, Liu Yiyun and his colleagues were jointly responsible for 12 patients.
Secondly, the working hours are quite long, every morning at 7 o'clock, starting from the MSF residence, arriving at the hospital at 8 o'clock, working until about 6 p.m., before leaving the hospital after work. There was half an hour of lunch in between, and the rest of the time Liu Yiyun was wearing protective equipment and staying in the ward.
"To be honest, the protective equipment I saw in the hospital on the first day was only a disposable anti-dressing and protective cap, an N95 mask, and a face screen. After putting it all on, I wonder if there's anything I haven't worn yet. Liu Yiyun said.
Dr. Liu Yiyun (middle) and local colleagues. Liu Yiyun
However, Liu Yiyun said that he worked on the project for 4 months and was not infected, indicating that these protective measures are still effective. She stressed to the local medical staff in the team that these protective measures must be worn as required. However, the family members accompanying the hospital will not wear masks, "we must constantly remind them to wear masks and pay attention to self-protection." ”
In addition to medical work, MSF trains local doctors, imparts its skills and experience to them, and observes the skills that local doctors lack and includes them in the training curricula of MSF's Human Resources Department.
MSF representative in China, Xue Guangjian, said that it must be emphasized that international employees are not necessarily more powerful than local doctors, and do not come out of a "I am here to guide you" attitude. It is normal for international doctors to be inferior to local doctors in some aspects.
MSF typically recruits more than 90% of its staff at project sites. The COVID-19 program in Baghdad, Iraq, has 2 international doctors and 2 international nurses, with the remaining 10 doctors and more than 30 nurses local.
Since there is no local critical care medical major, these local people basically do not have ICU-related monitoring and treatment knowledge and experience, Liu Yiyun is responsible for training them, "The doctors in the team are very hard and eager to learn, training for about one or two months, basically can assume the responsibilities of ICU residents." ”
Liu Yiyun (left) demonstrates to an Iraqi colleague how to do a test for a COVID-19 patient. Ghada Safaan/MSF
Before entering the project, the mortality rate of severely ill patients in the local area was close to 100%, and by October it had dropped to 80%. The most difficult thing for her is to face the death of the patient. After working in the ICU of receiving critically ill patients for 7 years, Liu Yiyun has seen death. But on the Iraq project, seeing such an intensive death for the first time, she wondered what was the point of her coming here to work?
Xue Guangjian said that this is a difficult situation that every doctor without borders will experience. If in the hospital where they worked before, these doctors are sure to stabilize or cure the patient's condition, but the project site does not have the conditions to pull them back from the death line.
The encouragement and affirmation from local doctors and patients gave Liu Yiyun the motivation to continue. "The vast majority of patients and family members are very cooperative with treatment. Some family members will say that no matter what the outcome is, they are grateful that we left our hometown to help them. ”
By December, later in the course of Liu's mission, a new building dedicated to treating COVID-19 patients was opened, with single wards and enough ventilators, reducing the mortality rate for critically ill patients to 60 percent.
Among the tasks, the most concerned and the most difficult to take care of are the family. Liu Yiyun still remembers that on Christmas Eve, the team members all changed their clothes and prepared to attend a small party held internally. She suddenly received a call from a friend, and her grandmother had sudden acute heart failure and was already hospitalized.
Under the laughter and laughter around me, my tears couldn't stop flowing. At that time, I was very anxious, and even wondered if I wanted to return to China immediately. Because my parents were afraid of my worries at the beginning, they did not tell me, and then they called my friend for help. Later, I contacted a familiar colleague and asked him to help put it into the ICU. ”
Fortunately, Grandma's condition stabilized relatively quickly, and she continued the 4-month mission without quitting halfway.
Liu Yiyun said that this is the biggest concern of all MSF: when the family has a problem, they cannot rush back to their side in time.
There is no absolute security
MSF needs to work in dangerous places such as natural disasters, wars, plagues, etc. Afraid that his family was too worried, Liu Yiyun did not dare to tell them that he was going to Iraq.
Before leaving, Liu Yiyun was also afraid, she had not faced the new crown virus in China, and the new crown infected people in Shanghai were concentrated in designated hospitals for treatment. But before she decided to join MSF, she was mentally prepared to work in dangerous places.
"Since so many health workers around the world are willing to go to places where the COVID-19 outbreak is serious, I think I can too." I am confident that MSF will do its utmost to keep us safe. ”
"A lot of people have romantic imaginations about MSF, and when they go to the front lines, they find that they are just doing some very mechanical, dangerous work." Xue Guangjian said. The representative in China worked as a project support department to visit MSF's relief project in Afghanistan. A large explosion occurred at the hotel more than 10 kilometers away from them, waking him from his sleep.
MSF representative Xue Guangjian in China. Yang Dan
MSF classifies the hazard levels of a project's missions, and members must strictly adhere to safety guidelines.
Most projects have a medium level of risk, and the regulations in the medium-risk area include the imposition of curfews, the restriction of partnering in and around the dwelling, and the observance of local cultural customs.
In high-risk areas, member actions are strictly controlled. For example, you can't leave the courtyard of your residence, and you are picked up and dropped off by MSF vehicles every day at two o'clock and one line between the residence and the hospital.
"So someone goes to a MSF project, goes to a certain country, they go from the airport to the project site, then they move between the residence and the hospital at the project site, and finally they leave the airport." Xue Guangjian said.
MSF gives as much real information and data as possible to frontline personnel. Before departure, there is pre-mission training, including basic information such as what to prepare before departure, how to face stressful work psychologically, the local situation, and the organizational structure of MSF.
"When you arrive at the project site, the staff of each department will give briefings one by one to introduce the local and project situation and work tasks. During the mission, there were at least two security training sessions that provided detailed instructions on the security norms of the Iraq project and how to deal with critical situations. Liu Yiyun said.
In addition to the necessary security measures, MSF maintains ongoing communication with local stakeholders, especially those in conflict. Ensure that they are able to accommodate MSF's work on the ground and are committed to respecting medical equipment and medical personnel.
"In addition, we maintain a high degree of transparency in our work on the ground. In addition to the patient's privacy, other information will be disclosed to all parties as much as possible. We also respect the local culture. Local staff provide various cultural briefings on the local culture and situation. These staff are also important bridges between MSF and the local community. Local employees feel respected by international employees, and they bring that information back. ”
"We will strictly implement safety measures and rules and regulations to keep everyone as safe as possible." But MSF is working in high-risk areas after all, and we can't do 100% safety. Xue Guangjian said: "Applicants need to have a clear understanding of the risks they experience, because everyone's acceptance of risks is different, and their own decisions are important." ”
Humanitarian conscience
Msfs Sans Frontières (MSF) works in a variety of non-governmental organizations, including organizations that work for poverty alleviation and livelihood development and for peace reconstruction and conflict resolution. But MSF's role has always been that of providing medical assistance, not as a problem-solving agency.
In Xue Guangjian's view, the work content of MSF is relatively narrow. "When the health system is on the verge of collapse, we provide emergency medical assistance to train doctors locally, and the project time is usually short."
MSF must remain neutral and impartial. Failure to do so would result in no access to conflict zones and no security of personnel.
At present, more than 30 people in Chinese mainland have joined MSF, including Dr. Tu Zheng, Dr. Zhao Yifan, Dr. Anna, Dr. Jiang Li, Dr. Zou Wei, Dr. Aisha Navan, etc., who have been reported in the media.
Video screenshot source: Zhao Yifan"Why doctors are the greatest profession" a moment talks speech
"These MSFs are passionate about humanitarian aid and medicine." Xue Guangjian said that unlike other regions, Chinese mainland applying to join MSF are very senior and professional doctors.
According to the recruitment requirements on the MSF website, MSF needs to have two years of work experience, have professional qualifications in the place where she works and lives, and be able to work in English or French.
In addition to surgeons, anesthesiologists, obstetricians and gynecologists, and operating room nurses, other frontline medical personnel are required to take courses in tropical medicine, which can be considered after the application is approved.
In addition to professional skills, MSF will focus on the doctor's comprehensive quality in the interview to determine whether he is suitable for frontline work, including whether he can respect multiculturalism, whether he can comply with safety measures and management systems, and the sensitivity of safety and the principle of neutrality.
During its mission, MSF receives a monthly grant of approximately €922, which is remitted directly to personal bank accounts, as well as a monthly allowance in local currency. But the money is not huge, but is only used to subsidize the family or the transition to unemployment.
According to statistics, as of the end of 2019, the total number of Chinese physicians reached 3.867 million. Compared to this figure, the number of frontline responders Chinese mainland join MSF is relatively small.
Xue Guangjian believes that this is related to the popularity of MSF in China and the greater emphasis on family in East Asia as a whole. If you are a surgeon, the working time abroad is relatively short, 3 months; if it is another doctor, the project duration may be half a year or even 9 months.
In order to participate in the Médecins Sans Frontières project, Liu Yiyun resigned directly from the hospital, Liu Yiyun is not alone, but more doctors will choose to negotiate with the hospital to stay without pay.
The reason for Liu Yiyun's resignation is simple, "On the one hand, I have worked in China for a long time, and for me, the working status of the next 5-10 years is similar to that of these years." I hope there are some new challenges and changes in my life. On the other hand, I have never been abroad and would love to go abroad to see what is happening elsewhere in the world. ”
More than a year has passed since the first project, and Liu Yiyun still wants to go to more places to help more people who have suffered difficulties. "It's the same everywhere you go to be a doctor, but the environment and diseases you face are different," she said. Going where I need medical staff to do my job is what I'm supposed to do. ”
MSF's work around the globe
In Baghdad, Iraq's capital, MSF nurse Mohammed examines patients in an organized-run COVID-19 critical and critical care unit at Al-Kindi Hospital.
Hassan Kamal Al-Deen/MSF
Before COVID-19 hit Yemen, Aden's health system collapsed as a result of a five-year war, and MSF focused on providing medical care, maternal and child care and paediatric care to the wounded.
Maya Abu Ata/MSF
In Bamenda, northwestern Cameroon, a young farmer was attacked and tortured by armed men, taking five shots in his hand, arm and thigh. He survived a serious injury, got help from passers-by, and finally escaped after two surgeries at a hospital supported by MSF.
ALBERT MASIAS/MSF
At a critical time of change in Afghanistan in 2021, MSF remains in the country to provide basic health care. The picture shows the medical team in the Kunduz emergency trauma ward performing surgery.
EVANGELINE CUA / MSF
At the nutrition feeding center in Herat, Afghanistan, the wards were very crowded, with 84 patients admitted to 60 beds.
Sandra Calligaro
Source: Medical community
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