Sixteen months

Sixteen months. That's how long it took me to get here.

Sixteen months. That's how long it took me to get here.

In March 2008, I submitted my application to Médicins Sans Frontières / Doctors Without Borders (MSF). I wanted to work as a field volunteer, to be placed somewhere in the world to better the healthcare of people less fortunate than myself. I had done some shorter term overseas volunteer work before, but this would be The Big Leap. Six to nine months doing something somewhere for someone who was not lucky enough to be born into a middle-class, educated, American family.

I got my answer from MSF quickly. They were interested in talking to me in person in their New York City headquarters. I had a three hour meeting with Human Resources; who explained some of the structure and function of the organization, but also tried to get to know me, my experiences, and how I might best work within this huge group of like-minded people. My interviewer also tried to get a grasp of my knowledge of French, a language I had studied thirty years ago.

Successfully concluded, I told MSF I could not commit to start working with them until 2009. I had to extricate myself from my job (head of the department of neurology at a private hospital in Albuquerque, New Mexico), convince my spouse that this was a good thing (very easy), and try to better my level of spoken French (not so easy working full time and concurrently learning to speak Spanish).

But I did it.

Almost exactly a year after my interview, I was back in New York for Information ("Info") Days, a busy three day indoctrination into all things MSF. The best part were the returned volunteers who spoke to us at the end of each day; all enthusiastic and helping us to place ourselves in some far off corner of the world, idealistically working away.

Info Days concluded, I went back to my rather contented life in New Mexico to wait for The Email that would announce my field placement.

I am a trained pediatric neurologist, happily married with no children, two dogs, and a nice home. I get to travel a lot, and am overall healthy and happy and lead a contented life.

Fortunately I also have this well developed compassion for others. Two years previously I had been sponsored by the World Federation of Neurology to teach and do clinical work in Malawi. I saw cerebral malaria and malnutrition and AIDS and untreated epilepsy and meningitis and rabies and I was not happy. Why, simply because you are born in a poorer country are you virtually condemned to a life of ill health? And with that ill health you have little chance of being able to succeed in school or better the life of your family?

It is chance, a big roll of the dice, and a big chunk of the world has come up losing.

Enough white middle class liberal guilt.

Two months after Info Days, I got The Email. They had found me a spot. It was exciting and frightening to read what I would be doing and where I would be going. They wanted me to work in a project in Lubutu, Democratic Republic of Congo.

In 2007, MSF had done an investigation into mortality rates in the Democratic Republic of Congo (DRC). They found dramatically elevated mortality in five areas, the highest around Lubutu. Most health care work in the developing world is aimed solely at primary care in small health centers. Although slightly helpful in reducing disease burden, mortality rates stay elevated. MSF was trying a different approach this time. First they had quickly opened a large 160 bed referral hospital and now were setting up small primary care clinics called "Centres de Santé." These Centres de Santé would do primary care but have the ability to refer complicated or sicker patients to a central hospital. It was this ability to refer patients for more intensive inpatient care that had been missing from past projects.

Would the newer vision of a central hospital with several Centres de Santé be successful in Africa?

My job was to work in one of these Centres de Santé. I would be part of an international staff of about 20 expatriates working with over 200 national (Congolese) staff, all of us working in the central hospital or the Centres de Santé.


Although I had done something similar in northern India several years before; I had not done it in Africa and I had not done it in French:

But why not? The people in New York thought I was qualified and I thought I was qualified. So I said "yes." I would go.

I would take The Big Leap.