Refugees in Jordan: Losing my manager

Mike is a family doctor (GP) from the UK, currently working in Irbid, Jordan, at a project which focuses on treatment for refugees and vulnerable Jordanians with chronic diseases. Here he shares his reflections about the upcoming departure of his manager, and considers the unique dynamics that can arise from being part of an MSF team...


Earlier this week my manager, our Medial Team Leader, came back from her extended leave and not long later decided that she needed to stop working in the project and has now resigned.

Whilst she’d been away, various health issues had come to light in her family and being away in Jordan is not practical when you need to be at home with family in a country quite a distance away. Her leave had been extended already to try to allow her to have enough time with her family… but her decision is that Irbid is not the right place to be for her.

Image shows the bustling street outside the MSF non-communicable diseases clinic in Irbid, Jordan

One of the clinics for people with chronic illnesses in Irbid, Jordan. Photo: MSF

Looking back on the time our Medical Team Leader has been away, I’ve both enjoyed not having a line manager (there is more flexibility, one fewer rung on the hierarchy to manage, so things can happen a bit faster, and I like a challenge for a while) and I’ve looked forward to having her back because of the skills and expertise that she brings. So I’m confused by the prospect of a change in manager, and the possibility of covering the role again if that becomes necessary.

As a first time MSFer I’m interested by the challenges of maintaining an organisational history in a project in which even the more experienced members of the international team may be only in post for a year or so.

We now acknowledge, as we begin to look at a particular area, that we are likely to start in very different ways…

I wonder if maintaining this kind of history is particularly important is a project like Irbid where the situation is changing less rapidly than in a classical humanitarian crisis. I’ve seen that here it is important that there is connection with the discoveries and errors that have been made in the 3+ years that MSF has been here.

Some of the knowledge of the project can come from the Jordanian staff, though few are involved in the management team. So, losing my manager also means another loss of knowledge of why things have been done in certain ways, as she’s the longest serving member of the international team. (Irbid a couple of years ago was a very successful project and then had a difficult period, from the various accounts I’ve heard, with the team not working well together and stress oozing out of this in many different ways. She arrived at and saw the end of this phase and the positive steps since.)

Organisational memory is important, though day to day it may not affect me much. I’m  aware that losing my manager will also mean that I lose close contact (at least until she has been replaced, which could take a while) with a colleague who is embedded in MSF protocols and processes.

Medical Team Leaders also have always got many years of experience in MSF or other humanitarian work

I’ll be honest and clear that being embedded in those protocols has not always made life easy for the two of us. MSF as an organisation seems to love its Standard Operating Procedures (SOPs) and my manager loves to do things by this book. This has been a challenge for me and my desire to get on with the things that obviously (to me!) need to be done by contacting the people that need to be involved. 

Our different styles have meant this has not been an easy challenge for either of us, but it’s one which I’m probably proud to say we have managed to live with. We now acknowledge as we start to look at a particular area that we are likely to start in very different ways… and that I may need to keep in mind the importance, strategically, of listening to her description of the default MSF approach to things and then choosing whether to try going with the grain rather than overtly offering ideas which may be locally challenging.

There is a challenge for both Medical Team Leaders and Activity Managers to achieve mutual respect before the day-to-day differences cause too much difficulty

So the advert is going out, she has been re-writing the job description (and I’m glad that I was offered an opportunity to give input to this!) and soon it will be up and advertised.

I had a brief hope that we might be able to recruit as the medical team leader (MTL)  (though officially called ‘Project Medical Referent’) the MTL in a neighbouring project which is being closed, who’d have brought with him knowledge of Jordan and lots of energy and skills too, but he is only available for a short period so a permanent replacement and  advertising it is ….

And then there’s the fear that rather than the rewriting of history that the current MTL and I have managed, we could be back to the recurrent challenges of MTLs and Medical Activity Managers (MAMs – which is the official title of my role) fighting and not finding ways to play to their strengths.

I’ve got just four weeks to learn from her skills and knowledge of MSF

Part of this challenge (as I was told by MSF’s Medical Coordinator in Jordan at my arrival) is that very often the MTLs come from a nursing background with its different training and views of processes and the importance of rules etc.

Medical Team Leaders also have always got many years of experience in MSF or other humanitarian work. Whereas Medical Activity Managers are all doctors (and in this project have recently tended to be older and often have been very independent as GPs or hospital consultants before coming here on their first MSF posting).  

Most of my predecessors, I think, have been pure clinicians for whom coming with MSF is their first experience of being a manager and away from hands-on medicine, which may also have brought challenges to their relationships with their team leaders who may need or want their role to be in management and organisation.  

So there is a challenge for both Medical Team Leaders and Activity Managers to achieve mutual respect before the day-to-day differences cause too much difficulty. It has been a journey for the two of us, and I’ve had to go back to management advice on how to manage upwards, remind myself that some things are worth backing down on, and learn from the history. She too has probably been working to find ways forwards with her mentor and senior colleagues, etc.

I’m also aware that there could be quite a pause before we get a new Medical Team Leader and that I could end up covering this role for quite a while.

It was lovely to get a message from my colleague that she was surprised that I’d managed to get so much done whilst she was away, this was significant praise to get. But I’m also aware that this was over Christmas and less happened, and there were fewer of the apparently endless daily demands on the MTL that I’ve observed. (Possibly it is not surprising that in a medical project the Medical Team Leader seems to have to be involved in some way almost every decision, and I’ve seen that this has been for her a pretty frustrating and stressful challenge.)

It is important to end reminding myself that her decision means that I’ve got just four weeks to learn from her skills, knowledge of MSF and (as we also live in adjacent flats) support her with the difficult decision she has made. Hopefully we will also go on learning from each other too!