Doctors without borders or Médecins sans frontières

Interview with Luwam Bede, Caroline Norderhaug and Shanti Gylseth Sachane about Médecins Sans Frontières


Theme: Psychiatry at war

 

Doctors Without Borders is a well-known organization in many countries, and for many doctors also an organization of choice when one wants to give monetary support. Let’s talk about it with Luwam Bede, Caroline Norderhaug and Shanti Gylseth Sachane.



Where in the world is there on-going activity these days, and what kind of work is done?


Luwam Bede: Doctors Without Borders, or Médecins Sans Frontières (MSF), is an independent medical humanitarian organization. MSF was founded in 1971 in Paris by a group of journalists and doctors, in the wake of the Biafra crisis. We provide medical assistance to people affected by conflict, epidemics, disasters, or exclusion from healthcare, and have humanitarian projects in more than 70 countries today. Our teams are made up of tens of thousands of health professionals, logistic and administrative staff.

Our actions are guided by medical ethics and the principles of impartiality, independence and neutrality. In addition to providing lifesaving care, we also bear witness to what we see in the field. We bring attention to the suffering that we witness – with the hope of ultimately improving the situation. Because – as our then International President, Medical Doctor James Orbinski said when accepting the Nobel Peace Prize on behalf of MSF in 1999 – "We are not sure that words can always save lives, but we know that silence can certainly kill".


The readers of The Nordic Psychiatrist are psychiatrists or training to be. Is there psychiatrist working in MSF? What kind of work do they do?


Caroline Norderhaug: Mental health is of great importance in field clinics. Many projects can benefit from having a psychiatrist as a part of both longer-term projects as well as the emergency response teams. I have worked in a clinic in Lebanon, bordering Syria. The population in this area is cut off from health services both from Syria, as the border has been closed for years, as well as services in Lebanon. The awareness of mental health in the area is low and many of the patients in the clinic have traumatic experiences from the war in Syria. We saw a high incidence of psychotic symptoms, developmental disorders as well as trauma related disorders. The psychiatrist helps with the diagnostic understanding and provides training in this area for the general practitioners, as well as making medical and drug evaluations. Combined with mental health teams providing therapy sessions and outreach related activities to provide awareness and psychoeducation, the work is both preventive, curative and maintaining.


My last mission was in Sudan with the refugees from the Tigray region. The emergency response included mental health services as the only serious provider in the camp. We saw people in the refugee camps with both acute onset of severe mental health symptoms, as well as patients with longer term mental health illnesses who had been forced to leave their medications under traumatic circumstances. Many patients also arrived in the clinic with psychosomatic symptoms, various types of dissociative symptoms and epileptic-like seizures. The mental health team is crucial in providing proper evaluations and treatment for these patients as this specialization is not common in areas where MSF responds. The psychiatrist is an important medical professional in the clinic when it comes to providing treatment, training for the general MD´s and collaboration with the psychologists and counsellors in the team.


Social psychologists from MSF, working with victims of sexual violence in Acapulco, Mexico. Since 2016, together with the Ministry of Health, MSF has been offering accompaniment and medical and psychological care to survivors of sexual violence in two hospital units in Acapulco. In 2017, together with the municipal authorities, MSF teams treated 190 cases of sexual assault. 52% were children. Image by Christopher Rogel Blanquet (MSF).
Social psychologists from MSF, working with victims of sexual violence in Acapulco, Mexico. Since 2016, together with the Ministry of Health, MSF has been offering accompaniment and medical and psychological care to survivors of sexual violence in two hospital units in Acapulco. In 2017, together with the municipal authorities, MSF teams treated 190 cases of sexual assault. 52% were children. Image by Christopher Rogel Blanquet (MSF).

What kind of support systems do MSF have for people working for the organization? Many health professionals must have seen and experienced a lot of suffering and dramatic incidents?


Caroline Norderhaug and Shanti Gylseth Sachane: It is not only dramatic incidents that can cause distress. Working and living in demanding conditions far away from friends and family might also cause psychological and emotional distress. MSF provides training in what to expect in the field, which contextual and inter-relational stressors or challenges are most common during an assignment. Staff is also trained in how to cope with dramatic incidents, accumulative stress, and working in difficult conditions before going on your first mission. During the mission, staff has access to support from both HR and psychologists in their local offices when needed.


All our Operational Centres also have their respective Psychosocial Care Units, consisting of up to three psychologists, depending on the size of the Operational Centre, which provide psychosocial support when needed during a mission. After a mission you have a debrief session with a psychologist, and follow-up sessions if needed. You can also ask for a referral to an external psychologist if you feel you need longer term follow-up. MSF is furthermore working on raising awareness of how working in the field can impact a person and underlining how important it is to talk about this not only with psychologists, but with peers, in order to normalize and support fellow colleagues – both internationally and locally hired staff.


Would you recommend MSF as a place to work for psychiatrists?


Caroline Norderhaug: If you would like to use your field of expertise to service a population in crucial need of mental health care, where you as a practitioner can have an impact on individual patients as well as local workers for MSF - I would highly recommend working for DBW.


If so, how can people get in touch with the organization to find out if they can contribute in any way?


Luwam Bede: If you are in Norway, you can send an e-mail to rekruttering@legerutengrenser.no with your CV and all your questions. We want all potential applicants to participate in an information meeting about fieldwork, to really know what we are looking for and to learn more about what we offer – and find out if fieldwork with MSF is something you wish to engage in. You can find all relevant information on the website of your local MSF office. We continue to see a need for mental health workers in MSF and look forward to hearing from you!