The Big Leap

30 July 2009

Sixteen months.
That's how long it took me to get here.
In March 2008, I submitted my application to Médicins Sans Frontières/ Doctors Without Borders (MSF). I wanted to work as a field volunteer, to be placed somewhere in the world to better the healthcare of people less fortunate than myself. I had done some shorter term overseas volunteer work before, but this would be The Big Leap. Six to nine months doing something somewhere for someone who was not lucky enough to be born into a middle class educated American family.
I got my answer from MSF quickly. They were interested in talking to me in person in their New York City headquarters. I had a three hour meeting with Human Resources; who explained some of the structure and function of the organization, but also tried to get to know me, my experiences, and how I might best work within this huge group of like-minded people. My interviewer also tried to get a grasp of my knowledge of French, a language I had studied thirty years ago.
Successfully concluded, I told MSF I could not commit to start working with them until 2009. I had to extricate myself from my job (head of the department of neurology at a private hospital in Albuquerque, New Mexico), convince my spouse that this was a good thing (very easy), and try to better my level of spoken French (not so easy working full time and concurrently learning to speak Spanish).
But I did it.
Almost exactly a year after my interview, I was back in New York for Information ("Info") Days, a busy three day indoctrination into all things MSF. The best part were the returned volunteers who spoke to us at the end of each day; all enthusiastic and helping us to place ourselves in some far off corner of the world, idealistically working away.
Info Days concluded, I went back to my rather contented life in New Mexico to wait for The Email that would announce my field placement.
I am a trained pediatric neurologist, happily married with no children, two dogs, and a nice home. I get to travel a lot, and am overall healthy and happy and lead a contented life.
Fortunately I also have this well developed compassion for others. Two years previously I had been sponsored by the World Federation of Neurology to teach and do clinical work in Malawi. I saw cerebral malaria and malnutrition and AIDS and untreated epilepsy and meningitis and rabies and I was not happy. Why , simply because you are born in a poorer country are you virtually condemned to a life of ill health? And with that ill health you have little chance of being able to succeed in school or better the life of your family?
It is chance, a big roll of the dice, and a big chunk of the world has come up losing.
Enough white middle class liberal guilt.
Two months after Info Days, I got The Email. They had found me a spot . It was exciting and frightening to read what I would be doing and where I would be going. They wanted me to work in a project in Lubutu, Democratic Republic of Congo.
In 2007, MSF had done an investigation into mortality rates in the Democratic Republic of Congo (DRC). They found dramatically elevated mortality in five areas, the highest around Lubutu. Most health care work in the developing world is aimed solely at primary care in small health centers. Although slightly helpful in reducing disease burden, mortality rates stay elevated. MSF was trying a different approach this time. First they had quickly opened a large 160 bed referral hospital and now were setting up small primary care clinics called "Centres de Santé." These Centres de Santé would do primary care but have the ability to refer complicated or sicker patients to a central hospital. It was this ability to refer patients for more intensive inpatient care that had been missing from past projects.
Would the newer vision of a central hospital with several Centres de Santé be successful in Africa?
My job was to work in one of these Centres de Santé. I would be part of an international staff of about 20 expatriates working with over 200 national (Congolese) staff, all of us working in the central hospital or the Centres de Santé.
Yikes.
Although I had done something similar in northern India several years before; I had not done it in Africa and I had not done it in French:
But why not? The people in New York thought I was qualified and I thought I was qualified. So I said "yes." I would go.
I would take The Big Leap.

4 August 2009
Kinshasa
After endless briefings in New York and Brussels, it was an early morning taxi ride that brought me to the airport for my flight to the Democratic Republic of Congo. Nine hours later, I arrived.
Kinshasa. In hindsight, a truly unpleasant city.
The city is MSF-Brussels headquarters for all of its operations in the DRC. The international staff are housed in basic concrete homes scattered around the city, all surrounded by high walls, razor wire, and twenty four hour guardians. Upon arrival at the chaotic airport, I am handed a detailed security memo, detailing the many prohibitions for MSF staff posted here.
At our first briefing the next morning, I am cautioned to be especially careful when walking in the streets during the rain. Despite the fact that it would be incredibly muddy, one risks one's life. It seems that in order to access the underground electric lines, people have resorted to digging up the streets. After their job is done, they cover the hole but not quite well enough. The rains come, the street collapses, and some unlucky pedestrian is electrocuted. So no walking the streets in the rain.
Not that I can walk the streets when it is not raining, mind you. Small sections of Kinshasa are deemed safe for walking. Want to go anywhere else? You must be driven in MSF vehicles.
I know it is for my safety and am glad of it, but feel sorry for the local population and the MSF staff who work here. The organization has a large HIV project in town and for month after month my fellow volunteers must follow these rules. Fortunately for me it is only temporary.
My fellow MSF volunteers, each one friendlier than the next, recount to me the glories of Lubutu, my eventual destination- small town, nice local population beautiful hospital, collegial co-workers. But that is four days from now. I have to survive Kinshasa for four days.
So I make friends. We go out to dinner, play soccer, go running together, go walking in the embassy quarter, eat Italian gelato (!), and talk and talk and talk. My fellow expats are mostly 30-somethings and the majority in Kinshasa have worked with MSF before. They are physicians, nurses, logisticians, and administrators and come from a huge variety of backgrounds. They are all deeply committed to humanitarian work and their jobs with MSF.
So I survived Kinshasa.
This morning I got up at 5 a.m., got ready, and some really nice person whisked me off to the airport. Along the way we passed dozens of women balancing large colourful plastic containers on their heads. Inside each container were dozens of loaves of freshly baked French bread, vertically arranged. The women would go back to their neighborhoods to sell the loaves, making a little money on each one purchased. Enough money to live for another day in Kinshasa.