Cambodia: Briefings and Longings

"Years ago, when I was first dreaming of working with MSF, I thought that being in the field would be an adventure."


Years ago, when I was first dreaming of working with MSF, I thought that being in the field would be an adventure. Little did I know that just getting to the field was an adventure of its own!

I’m off to spend nine months in Phnom Penh, Cambodia, working with MSF on a hepatitis C treatment project. Cambodia is a low/middle income country where the new direct-acting anti-viral medicines (DAAs) for hepatitis C treatment are not affordable to the vast majority of the population. Thanks to the MSF Access Campaign—which advocates for increasing access to essential medicines, vaccines, and diagnostic tests for for patients in developing countries—we will be providing DAA treatment to hepatitis C patients in Cambodia for free.

DAAs have completely changed the landscape of hepatitis C infection in countries where they are available. Patients with hep C used to have to suffer through almost a year of subcutaneous interferon for a scant 50 percent chance of clearing the virus from their bloodstream. Almost every one I ever met endured incapacitating side effects during treatment.

Now DAAs furnish effective hepatitis C treatment using pills instead of injected medicines, with minimal side effects, in less than half the time. I remember when I first heard about DAAs at a conference in 2012. I thought: This is going to be one of the most important medical breakthroughs to happen during my career. The opportunity to help deliver DAAs to patients who could not otherwise afford them is a privilege I can’t put into words.

I had little time to think about hepatitis C during the weeks leading up to my departure. I had to pack up my house for an extended absence, then I had to pack for the trip itself. Unlike many MSF field workers, I will be based in a capital city, so you’d think I wouldn’t need to pack many belongings, but you’d be wrong. There’s something about the anxiety of going into the field that makes you reach for just one more comfort item to add to the 20 kilograms of luggage you are allowed to bring

Theresa Chan

Comfort items: yoga mat (below), battery operated fan, back scratcher, foam roller, mint-flavored Chap Stick, 3M Ultrathon (my favorite DEET formulation), Neutrogena sunscreen (also a favorite). Photo: Theresa Chan

To get to Phnom Penh, I went the long way. Living in San Francisco, I could have flown across the Pacific and made the trip in two flight segments and 20 hours. However, I first had to go to New York for briefings with my home MSF office, then to Paris for more briefings at the MSF Operational Center in charge of the hepatitis C project. By the time I dragged my 20 kilograms of luggage into the MSF lodging in Phnom Penh, I’d flown four flight segments and ridden two trains, one bus, two taxis, and one Metro to get there. The journey took four days.

Theresa Chan

Told you, just getting here was an adventure.

The first week in Phnom Penh has been dedicated to more briefings: the social/economic/political context of the hepatitis C project, the eventful history of the clinic opening last September, the data collection process, my role in the project, and how patients move through the treatment process at our clinic. The resulting information overload has been truly daunting.

When I calculate the number of hours I’ve spent in briefings, it occurs to me that the term "briefing" is a misnomer, because briefings aren’t brief. They’re long. So I amused myself by wondering what would happen if we called them "longings" instead: "Okay, Theresa, you’ll be longing in New York, then longing in Paris, then you’ll have to long with the project staff when you get to the field. I’ll email your longing schedule later today."

Hm, maybe not. The world isn’t ready for office longings or field longings, but I felt compelled to share the play on words because it captures something essential about the long trip I took to Cambodia, and the longer journey I have traveled professionally and personally to become an MSF field worker. After all those years of longing, I am now simply amazed to be here.