Being on a mission with MSF is unlike other experiences. It’s uncomfortable. I’m not talking about living with strangers from different countries, or having to brush my teeth with bottled water. For the first month I am inadequate, even useless. Yet no one questions my competence and I’m supposed to be the expert in my field. I’m on my second mission, and it’s worse because this time I can’t hide behind the ignorance of not knowing any better. Then there’s the complication of trying to do my job in an unknown context. I’m a post-9/11 American in a Muslim post-Soviet country – a bit of a forbidden land. I have no family or friends and my housemates are quickly tested by my frustrations in the first few weeks. For some reason my friends back home think this sounds glamorous and exciting, but every day feels like a test of stamina, endurance.
I’m still in my first month, so I have to remember to pace myself – it’s a 6-month marathon. The acclimation phase is when you notice many differences and similarities. I had a cultural briefing when I first arrived in the field. Bread seems almost sacred, and I’m obliged to at least taste a round loaf if someone offers it. There is an informal tea ritual, poured into a cup and back into the pot three times to make sure it’s reached the right concentration, color. Only half a cup is poured, to designate respect, because the host would like to continue serving you. I had pictured a town of women in colorful oversized housecoats - Russian peasants, and indeed there are plenty of Babushkas with golden teeth and shapeless dresses. But all the young women wear skinny jeans, tall black boots with 3” heels, even in the snow. Many people travel to India for studies, and the Internet provides ready access to the world. I’m beginning to wonder if a place with no outside influence actually exists. Some differences are surprising. “We have two types of marriages, arranged and kidnapped.” I had the same quizzical look when I heard that the first time. My fellow expats have warned me with a wink, but I told them I’m too old to be eligible for either.
As the epidemiologist on the MDR-TB mission, I’m fortunate to get a bird’s eye perspective of MSF’s progress since they began this program in 2003. I’m also burdened with so much data that it’s a full time job piecing this picture together every month. MSF has been successful in bringing the latest diagnostic tools to the field to quickly identify patients and their most appropriate treatments. Now the challenge lies in handing over this program to the Ministry of Health. The task is not so easy as the patient population tends to be marginalized, the drug supply can be interrupted, and infection control may not be enough. But the team is dedicated. Staff, both national and expat, MSF and MOH, work late into the night, and sometimes weekends. I’ve watched doctors passionately urge patients to stay on treatment, and I’ve seen nurses compassionately hold the hands of patients trying to consume a handful of pills every day without vomiting. Even our drivers are on-call 24 hours, and there’s always a receptionist by the phone in case one of our non-Russian speaking expats like myself needs an interpreter. Good managers help, people who are incredible judges of character, and can find strengths in everyone on the team. These are essential criteria for managing a random collection of expats in the middle of an Uzbeki desert trying to work within a post Soviet system to change the way health care is managed for a vulnerable, marginalized population. Perhaps the greatest challenge is figuring out what can realistically be improved, and making small changes to move in that direction. I suppose working with people like this is the reward for all the inconveniences that come with mission life. I remind myself that being on a mission means trading in comfort for experience. Anyway, there’s plenty of comfort back home, and that’s not what I came here to find.