"Working in MSF, I have the privilege to work with some extraordinary individuals. Since arriving in Zimbabwe, I have been fortunate enough to be working alongside one such medical professional, Zakariah Mwatia, the outgoing project coordinator in Epworth."

Working in MSF, I have the privilege to work with some extraordinary individuals. Since arriving in Zimbabwe, I have been fortunate enough to be working alongside one such medical professional, Zakariah Mwatia, the outgoing project coordinator in Epworth. Same as many of my colleagues, Zak carries his passion for humanitarian medical work with a quiet serenity and dignity that, until you get to know him better, could be mistaken for shyness. As he’s moving on after 2 years and 8 months in Zimbabwe, I took the opportunity to persuade him to share some of his experiences.

Here’s an account of our conversation.

Paul: “I know you, Zak, as Epworth’s project coordinator, and we’ll get on to that later. But the period before MSF is an interesting place to start, so what’s your background?” Zak: “I grew up in a rural town called Kakamega, which is in Western Kenya near the border with Uganda. Between 1993 and 1996 I trained as a Registered Community Health Nurse, and was then sent by the Ministry of Health to Northern Kenya where I worked in progressively more responsible positions in hospital ward supervision. I relocated to the District Hospital in 1999, where I was promoted to District Nursing officer, responsible for supervising 21 rural health clinics.”

Paul: “When did you first come across MSF? Tell me a bit about your experiences before coming to Zimbabwe” Zak: “In 1998-99 there was an episode of extreme weather in Kenya which caused unexpectedly high incidence of Malaria and also severe malnutrition. I was seconded by the Ministry of Health to MSF for a short time to work in a nutritional centre in Northern Kenya. I had read about MSF before that, when I was studying nursing, but this was the first time I saw MSF in action. After that, in Nov 2004 whilst on holiday from my job as DNO, a friend called me to say that there was an opening in South Sudan for a nurse supervisor with MSF. I applied by telephone, and was invited for an interview in Nairobi the next day.

The next 72 hours was a bit hectic – the only quick way to Nairobi was by air, but I was half a day’s drive from the airport, and there was no bus. So I hitched a ride, dressed for the interview, in the back of a truck transporting goats to market, only to discover when I arrived at the airport, that the plane was delayed by six hours. Arriving late for the interview, I was seen anyway, and offered a 12 month contract, starting immediately – it was a nutritional crisis, and they wanted me to travel as soon as possible.

I gave my notice to the hospital, packed a few things, and flew to South Sudan. It took three days, from leaving my home in Kenya for the interview to arriving in the project in Sudan and being put to work in an extremely busy nutrition ward.” “South Sudan was extremely challenging, but also very rewarding. In the first project we saw a huge number of malnourished children – up to 40 new admissions every day – in the therapeutic feeding programme. I followed on with another 1-year contract from ’05 to ’06, where we saw cholera and Kala Azar spread across a wide area. I was an outreach nurse, and the team would go on walking clinics, away from the base for days at a time, carrying all the drugs and equipment on donkeys.

Then, for the next two years, I was based in a number of large hospital projects, always working in extremely busy wards, and always learning more and more about good management in MSF programmes. In November ’08 MSF sent me to Geneva to do a specialist training course in the clinical management of HIV / AIDS and then, after a short break back home in Kenya, I came to Zimbabwe in March 2009.” Paul: “So what is it that makes you spend so much time away from home – what is it about MSF that you like that much?” Zak: “I’m a nurse. It can be a challenging profession in Africa, because you may have all the necessary knowledge, yet still you find obstacles to doing a good job due to scarcity of resources.

When I worked in Kenya, people would suffer due to the lack of basic things – drugs, equipment, medical items. MSF put a simple solution to this very basic problem in front of me. When you have all the necessary resources to use your skills, it is very gratifying. When you see a child with severe malnutrition, it is very disturbing; it’s hard to look on the suffering brought about by lack of good food, where the child’s system has actually started to break down its own body tissues. But with the right treatment, the change is incredible – when a child that seemed only a moment away from death smiles for the first time only two or three days after treatment started – when you see them running around a couple of weeks later – that’s the motivation.

Whether malnutrition or HIV, whether adult or child, the transformation that happens when the right course of treatment is given to someone that was on the verge of death is extremely rewarding, addictive even. I want to see it again and again. Paul: “More than two and a half years working in Zimbabwe – you must have seen quite some changes in the project. What do you think has been its biggest success?”

Zak: “Scaling up access to anti-retroviral Therapy (ART). When I started here, we didn’t have the capacity to treat everyone that needed ART – we had to limit treatment to pregnant women, people co-infected with other illnesses, and the very sick. Setting boundaries to treatment caused all sorts of problems. It was clear that a different, more inclusive approach was needed. When we started to scale up access to ART, the results were initially chaotic and challenging. The community began to understand that the programme was for everyone, and people were bringing their relatives in wheelbarrows and on beds – we had huge numbers of extremely sick patients. Now, more than two years on, when I see them walking into the clinic for a regular check-up and to collect their drugs, it’s very rewarding. Paul: “What would you say to the individual donors of MSF – the people whose private gifts support MSF?”

Zak: “Together, we are doing a good job, giving hope to the hopeless, reducing the number of orphans by saving parents’ lives; that means fewer broken homes, fewer children in poverty. Our intervention breaks the cycle of despair. I look at people on ART, two or three years on, taking their children to school, going to work – donors’ gifts have gone so far towards restoring the dignity of people in Epworth.”

Paul: “So what’s next?” Zak: “A good rest! I’ll take a week or two on holiday, and then I’m going home to see my family – to attend to some family business. In the New Year there’s an MSF training course that I have applied for, and then by March 2012 – another MSF mission – more to learn – new opportunities – let’s see.”