Having it all

Dr Lisa Searle is a young doctor with invaluable experience running hospitals and clinics in the world’s hot spots, courtesy of her commitment to Médecins Sans Frontières. It makes her a better GP, she says

LISA Searle knew what she wanted to be from the age of 16 and has never wavered from that course.

Her ambition was to work for Médecins Sans Frontières (NSF). It was that simple.

“It definitely influenced my decision to study medicine,” Dr Searle tells the MJA.

“I wasn’t really sure what I wanted to do and then I heard about this incredible-sounding organisation and so decided to go down that path. There was a lot going on around that time on the Rwanda genocide.

“I was also studying French at high school and it was my French teacher who first started talking about MSF. It just clicked with me and sounded like what I wanted to do with my life.

“I signed up for MSF as soon as I could after graduating from medical school. I have never once regretted any of those decisions that I’ve made along the way.

“I really appreciated their principles — neutrality, impartiality, independence — they don’t take money from any government agencies, they don’t pick sides.”

A 2006 graduate from the University of Tasmania, Dr Searle is close to completing her general practitioner training but already has more experience than the vast majority of doctors her age, and perhaps more than most doctors gain in a lifetime.

From Tasmania to the Democratic Republic of the Congo, Pakistan and, most recently, a 4-month stint in Haiti, Dr Searle has done and seen a lot.

In Haiti, she was responsible for setting up, staffing and running a sexual violence clinic from scratch, a start-up project that would daunt many a veteran medical administrator, let alone a young doctor in the middle of a community still in chaos, 5-and-a-half years after a devastating earthquake.

“So much of the infrastructure still hasn’t been rebuilt,” Dr Searle says.

“And what we know about sexual violence is that, in any time of mass population movement, whether that’s caused by natural disaster or whatever it is, we see an increase in the rates of sexual violence.

“We had this double whammy of pretty much all the existing structures caring for victims of sexual violence were destroyed and the staff were killed in the earthquake — so you’ve lost all that expertise and [facilities], and there was a massive increase in the rate [of sexual violence].

“We identified that there was a real gap there so we decided to go in and start this project.”

Dr Searle had always had an interest in women’s health, had trained in obstetrics, reproductive and sexual health, contraception, and pre- and antenatal care. While in the Congo she had also worked with victims of sexual violence.

It was experience MSF wanted in Haiti, where part of the job would be training new staff at the clinic, which is run completely by Haitian doctors, nurses, psychologists and social workers.

“But a lot of those staff had very little experience working with victims of sexual violence, so that was part of my job — training them up, seeing them through their first patients and getting the clinic up and running,” Dr Searle says.

Job number one was finding a location for the new clinic.

“We worked out what we wanted it to look like before we started,” she says. “We need a location, we need to potentially renovate that clinic and make it useable as a clinic space, and then we need to start recruiting staff, starting with the logistics staff — drivers, guards, cleaners, cooks — and then moves on to recruiting the medical staff.

“We put up notices all over the city, and advertised by whatever means we could.”

Most of the medical staff are female, and it turns out, not so hard to find.

“There is a large number of female medical staff in Haiti,” says Dr Searle. “One of the things I found particularly devastating was that there are so many skilled, trained, intelligent people that just can’t get jobs. The unemployment rate is phenomenally high and there are a lot of unemployed doctors in the country.

“It’s also very difficult for the doctors to work with the government hospitals because they just don’t get paid, or [get paid] very sporadically and not very much.

“So whenever we opened a position we were absolutely inundated with applications. And often we would end up with people who were rather overqualified for the jobs that they were doing.”

Self-care in such situations is vital, not just for MSF staff, but also the locals working in the clinic.

“Everybody has different strategies and it was definitely something I put a lot of emphasis on when training our Haitian staff — the importance of self-care. Debriefing is a really useful tool that we’ve used.

“When you’re working in sexual violence, every case is traumatic, but if there’s a case that has particularly affected you or the team, then it’s very helpful to get together afterwards and go through it.

“I also think that the time that I spend in Australia, whilst I’m always busy and working when I’m here, it’s a bit of a healing time. It’s taking a step away from all that, and realising that the whole world is not a horrible place.

“You can get a very skewed view of the world — thinking that everything is violence and pain — so it’s important to have breaks away from that, and appreciate that there are good people.”

The Haitian situation was in stark contrast to that in Congo, where, Dr Searle says, “there pretty much are no doctors”.

“The training is such there that most clinics and hospitals are run by nurses.”

In Pakistan, Dr Searle was running a referral maternity hospital near the border with Afghanistan, with a 50–50 mix of locals and refugees coming in from Afghanistan.

“We did everything there … emergency c-sections, antenatal care, we had a neonatal nursery for the newborn bubs who needed a little extra support … it was a very different situation.”

In between missions, Dr Searle comes home to general practice training in Hobart.

“It’s very different. The work I do for MSF is very different from the work I do here. A lot of the time [for MSF] I’m working in a supervisor capacity, worrying about medical supply and rostering, and all the kinds of things that I never have to worry about when I’m working here [in Hobart],” she says.

“But I really do appreciate the differences in the two styles of working. I appreciate the skills I get from both aspects and I do find, surprisingly, that there’s a lot of crossover. The work I do with MSF can make the work I do here more rewarding — I notice more things that maybe I wouldn’t notice otherwise.

“I do think it makes me better at my job here. And vice versa.”

The general practice in Hobart that Dr Searle works in does a lot of refugee health care, she says.

“I see a very diverse range of people, often from very traumatic backgrounds and they really appreciated having a doctor who understands a bit about where they’ve come from, and isn’t from their area.”

Dr Searle is planning to finish her GP training in the second half of 2016 before heading off again on another MSF mission, destination unknown at this time.

“Where is usually the last thing I find out,” she says. “I prefer to work French-speaking missions so it will probably be either Haiti or another French-speaking African country.”

As for the future, Dr Searle has a firm view.

“Me and the word ‘settle’ don’t go too well together,” she laughs. “I think I will continue to work for MSF for a good while. I would like to keep incorporating it into my life.

“I will always keep coming back to Tasmania. It will always be my home. But I feel like I’m working towards a reasonable balance of working away and being here with my family.

“[Aid work] is such an incredible, amazing, rewarding thing that you can do, and it’s not just doctors. MSF also need nurses, pharmacists, psychologists, admin staff, architects, construction workers, water and sanitation experts – they need all kinds of different people.

“I talk to a lot of people about it and encourage them to do it.”