The Unsexy MSF Blog Entry

Sarah, a nurse from the USA, is working for MSF/ Doctors Without Borders in Honduras. She has been focusing on the response to sexual and gender-based violence, aiming to improve treatment and follow up, as well as links with existing services.

This is my first mission with MSF. As someone who enjoys writing as a form of reflection, sharing and therapy, I was eager to start my own ‘MSF blog’ and figured I’d be writing inspiring, grueling and dramatic entries on a regular basis. On the contrary, I have come to find that this mission does not lend itself particularly well to the standard ‘bush worker in war zone’ journal entry.

People are often asking me to write more, ‘What does your typical day look like’? ‘What are you doing?’ and while I want to answer those questions, can I really write blog entries about the millions of meetings that I have to attend every week, or the challenges of supervising staff, which often feels like babysitting? Or what about my struggles to find a gym…(I know that sounds ridiculous), but really, the pursuit of finding ways to exercise could fill the pages of several blog entries.

Before working with MSF, I thought I’d be writing blog entries from the light of a candle in my termite-infested hut, sharing stories of traveling for hours in a canoe down some exotic sounding river, in order to deliver care to displaced populations, or stories of feeding malnourished children pouring in from refugee camps on the border of war and more war, but no, this is not the case.

For those of you who are interested in working with MSF and for those of you who are eager to know more about my work here, you must know that being an MSF worker does not always mean you will be living in a tent in a war zone, where refugees are pouring in at all hours with war wounds and tropical diseases such as Kala Azar, Buruli ulcer, Schistosomiasis, Lymphatic Filariasis, Onchocerciasis, Dracunculiasis, Leishmaniases, Chagas and Dengue. Yes, MSF does work in these settings, but there are also the more atypical projects, such as where I currently find myself.

Here in Honduras, the situation is a bit different. The setting is urban. This means that I can find a fancy restaurant if I so choose. I also have a warm shower and the option of attending a gym (again, not so easy as I had thought). However, being in an urban setting, living in the homicide capitol of the world, also means that I have the illusion of freedom. While there are many things to do, my ‘security zone’ is quite small and my movement is quite restricted. Compare this to a refugee camp setting where security is also high, but when there is little to nothing to do outside the walls of the camp; the security limitations do not seem to be quite as suffocating.

While many MSF projects hold a Monday-Saturday workday with staff working through the wee hours of the morning, here in Honduras, we must be out of the office no later than 6pm as it is dangerous to travel past dark. I live in a small, gated ‘community’, if you can even call it that, and really, all of the communities here in Tegus are gated. Our motorists here have told me that at one time, it was easy to detour through the arterial side streets, shortcutting your way through the un-grid-like layout of the city. Due to heightened crime in recent years, this has become all but impossible. As fear of violence increases, one is hard pressed to find a side street, which is not blocked by a gate and a guard sporting a huge gun. Although illegal, neighborhoods pool their money together in order to pay for a guard to block off their streets. The result is one big traffic jam. With only one or two primary roads, which are guard and gate free, traffic can be a bit of a nightmare.

My job is also a bit different. Rather than working in a clinical capacity, my role here feels a bit more logistician/coordinator/manager-like. When I’m not running between health centers to coordinate and supervise care, I’m dodging the masses pouring through the narrow corridors of the ‘Green Monster’, or Hospital Escuela. Working within the hospital is challenging to say the least. The goal is to utilize and work within the existing structure to improve and support the care being given to victims of physical and sexual violence. Unfortunately, as the hospital is not our own, it is quite difficult to perform ‘quality control’ so to speak’.

How do you ensure privacy and confidentiality when the concept in itself is a bit foreign? And even after convincing key staff of the importance of privacy, how can this be accomplished when there simply is NO physical space? Or how do you avoid revictimization and provide the best possible care for the patients when there is very poor integration between the medical and forensic aspects of care? How do you ensure that patients receive HIV testing when the laboratory is often out of reagents? And how do you protect patients from angry gang members seeking retaliation when the hospital security is questionable at best?

While I have seen a definite improvement in care in the past eight months, there is still much work to be done and I am honestly unsure how to further improve the system given the challenging context. While I’m experiencing a bit of clinical withdrawal and would love to experience a bit more ‘instant gratification’; some reflection of all of the hard work that has been poured into this project, I also must acknowledge that the skills and tools, which I am learning here, although different, are equally valuable and that although change is slow in coming, it is coming!

So again, for all of those who have told me that they are interested in working with MSF and want to know if I have any advice, here it is: Not all assignments are for  the ‘sexy cowboy’ type. You must be willing to engage in postings which are more development rather than emergency focused, projects where you are supervising local staff rather than getting your own hands dirty, projects where frustrations run high because rather than running your own hospital or clinic, you are working in a government institution that may not be functioning at your golden standard.

You must be extremely adaptable and flexible, prepared to handle more red tape than you originally thought and prepared to deal with a constant exchange and influx of new staff, which means constantly changing dynamics and personalities. You must be willing to live and work within high security contexts, which speaking from the perspective of an independent woman who has traveled the world solo; this is not easy. And, depending upon the context, you must be prepared for more ‘office work’ and let me say again, ‘more meetings’ than you may have thought possible.

If you are just as willing to supervise staff and spend hours in meetings, as you are willing to live in a tent during the rainy season in a refugee camp with more work to be done than is physically possible, then MSF might be for you. While I am excited to experience a more typical posting, excited to get my hands really dirty again, I am also thankful for the opportunity to be part of such an atypical assignment and know that I will be taking away very different skills and experiences from this project than I would if I were living in the bush in an acute emergency setting.