Lending a hand

For some, the desire to be a good doctor extends across international borders and lands them in some of the most challenging medical scenarios in the world. It is here that volunteers work with global peers to bring health services to those who are vulnerable and in need.

Last year Dr Jenny Jamieson jumped from a Melbourne emergency department into a war zone, taking up her first post with Médecins Sans Frontières (MSF).

Based for six months in Kunduz in northern Afghanistan — an area she describes as being prone to violence, and which was previously a Taliban stronghold — Dr Jamieson worked in an MSF-run trauma hospital in the province, which dealt with a high level of trauma related to violence, as well as an increasing number of road traffic accidents.

“We had quite a number of mass casualty events during my time there, so one of the most challenging aspects for me involved learning how to respond when 20, 30, 40 or 50 multiple trauma patients turned up to the hospital at one time”, explains Dr Jamieson, who is an emergency registrar at Alfred Health in Melbourne and has been particularly drawn to the critical care aspects of medicine.

Her role in Kunduz was to act as supervisor for a new four-bed intensive care unit (ICU), which was the first ICU in any MSF project to have ventilators. It was an eye-opening experience that gave her new insight into this area of medicine.

“It was definitely an enormous medical and technical challenge, but for many this was also deemed an ethical challenge which contravened traditional ‘cost-effective’ approaches to humanitarian medicine”, she explains. “Intensive care is a highly sophisticated specialty and often viewed as an unaffordable luxury in low-income countries. This role certainly made me reflect on the challenges, but also the importance of integrating critical care into low-resource settings.”

Dr Jamieson is one of only 37 Australian and New Zealand doctors on MSF’s list of available or active field workers, which includes surgeons, obstetricians/gynaecologists, paediatricians, general practitioners and anaesthetists. Since MSF Australia began in 1995, over 550 doctors have been sent out into the field, providing a medical response to epidemics such as measles or meningitis, assessing medical needs after a natural disaster, treating HIV/AIDS or tuberculosis patients or treating survivors of armed conflict.

A spokeswoman for MSF explains that the work can be challenging.

“Clinical skills and resourcefulness will be put to the test while working in locations where the health care infrastructure may have completely fallen apart, or while diagnosing and treating medical conditions not found in Australia and New Zealand. Managerial and administration skills will be called upon as with supervision of large teams of local staff”, she says. “[However], these challenges are not faced alone — MSF provides expert technical support including extensive guidelines and protocols.”

Global motivation

For Dr Jamieson, a career in medicine has always had global health at its core.

“I was always drawn to medicine because of my strong interest in the humanitarian aspects of practice, so working with MSF will remain a long-term commitment of mine”, she says.

Professor of public health at the Melbourne School of Population and Global Health, Rob Moodie, has spent much of his career working with vulnerable communities globally.

His overseas aid work began in refugee health care in Eastern Sudan for the Save the Children Fund and MSF. He then spent five years working in Aboriginal health before going on to work on HIV/AIDS programs for the World Health Organization and UNAIDS (in Cameroon, Uganda and Geneva) as well as undertaking consulting work on setting up HIV/AIDS programs (in Papua New Guinea, Vietnam, China, India, Indonesia and the Pacific). More recently his focus has been on the prevention and control of non-communicable diseases (cancer, diabetes, cardiovascular disease, chronic pulmonary disease), which are becoming major causes of premature death and suffering in most low- and middle-income countries.

“I am a global citizen and I love it. I love working in and with other cultures — it helps me learn and we get a privileged ‘entre’ into other cultures. We have a very unfair world and I would like to do more to contribute to a healthier and fairer world”, he says.

Appropriate care

Work in overseas aid is ongoing and multifaceted. While there are many established organisations offering effective and appropriate care to those in need, concerns have been raised in the past about a concept known as “voluntourism”.

Dr Joel Negin, senior lecturer in International Public Health and director of research at the University of Sydney, says this is when doctors go overseas for short stints (such as a day or week) without partners on the ground, to do clinical work that could be done by locals or performing surgeries that best practice dictates require ongoing care.

A recent study he was involved in reviewed some 230 published accounts of short-term medical missions, uncovering concerns over sustainability, financial transparency, ethical standards and appropriateness in meeting the real needs of communities (http://www.biomedcentral.com/1472-6963/12/134).

“If a doctor is interested in helping out on an overseas project, they should seek out an established partnership with a non-government organisation (NGO) or ongoing program”, he advises.

This is a point Dr Jamieson agrees on.

“Always reflect on why you want to engage in humanitarian work and never buy into the medical tourism side of overseas aid”, she says.