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provide HIV and TB care to a group of 25,000 patients who had been displaced through a deliberate government policy called ‘Operation Murambatsvina’.


Meaning ‘Clean out the Trash’, the policy had displaced 250,000 people from Harare to an area with no water, no electricity, a very low employment rate, little food and shelter, and a lot of crime and sexual violence. The Zimbabwean government was not particularly keen on the presence of NGOs. “It was like walking through treacle,” says Johann, who, unusually for an MSF volunteer, was working with his fiancée. “We had a lot of challenges with the local hospital because we were made to do a three-month introductory period under supervision and that included a lot of paperwork and obstruction. It was challenging in a rather insidious, undermining, quiet way, not like in other countries.” Upon arrival they had been briefed to be


very careful about what they said. “I felt very oppressed being there, not being able to really vent, to my partner at any volume, to my friends, certainly not to any Zimbabweans and not even over the phone to my parents in England, in case that was being listened in on.” The experience brought him very low and


he even considered giving up. “But then you remembered that if you gave up because of frustration with the government, it was the poor people who were going to suffer.” Johann developed a survival toolkit to help


him get through the difficulties with the authorities and those arising from treating a steady and insistent stream of 500 adult and paediatric HIV patients a day between one doctor and 14 other clinicians in a hugely under-resourced facility. Called HOPE, it stood for humility and humour; open-mindedness; patience and


Clockwise from left: Dr Johann McGavin treats a patient in an MSF clinic in Zimbabwe; Dr Angeline Wee at an MSF outpatient clinic in Haiti; and Dr Wee with outreach worker Gilbert at a refugee camp in the Congo


pragmatism; and expectation management. “I think the most important one was expectation management, which was the cure for frustration, disappointment and burnout,” says Johann.


Johann underwent this first mission at the


age of 28, after his foundation training, which is the earliest possible with MSF, whereas Angeline, who went to Haiti at 31, was further along in her career, already working as a GP after switching from respiratory medicine.


Careful planning Despite the differences in their experience, both discovered that a lot of the work required from the 4,000 MSF international volunteers, who are sent in to support 20,000 locally employed nationals, is supervisory. It is something that Liz Bowen – an MSF


human resources manager in charge of field staffing – is keen to emphasise. “It’s important to understand there is a strong supervisory and training element,” she says. “It’s not that you won’t do any hands-on work – sometimes you have to, because there aren’t any other staff there – but you’ll always be managing some staff and they deserve to have somebody who has an idea about managing groups.” Typically, among refugees, those most at


risk are children and young people, closely followed by pregnant women. For this reason, says Liz, young doctors looking to get into this kind of work should get as much exposure as they can to paediatrics, obstetrics and gynaecology. “Pregnant women refugees have


a really, really hard time,” says Liz, who has done missions as a nurse in Sri Lanka and Sierra Leone.


A diploma in tropical diseases is a


prerequisite, languages – particularly French and Arabic – are a definite advantage, and MSF prefers international staff who can commit to 9–12 months per mission. Planning is essential, then. As Angeline Wee


says: “It cannot be an impulsive decision. All in all, I had been planning this for nine years. You really need to know what you’re getting into and pick up the necessary skills. From what I have seen, people who are more experienced and with management skills tend to do better. It’s not easy for someone coming out of medical school – you really need a steady head.” And then there’s the question of security.


Volunteers may not all be flying into a war zone, but a mature attitude to risk is indispensable, says Liz Bowen. “We want people who are considered and


thoughtful. What experiences have they had of being in an insecure situation and how did they manage it? And what is their thought about where they’re going? Obviously the media portrays a certain angle, but often it’s not that exciting at all. But they are unstable contexts, so they might change. If we get people who say I only want to go and work somewhere stable then we wouldn’t accept them.” The reverse is also unacceptable – and here


the Hollywood version might well diverge from the reality: “You don’t want somebody who’s completely gung-ho, thinking ‘Oh I don’t mind about danger.’ We would reject a person like that immediately.”


Adam Campbell is a freelance journalist and regular contributor to MDDUS publications


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