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This article by HAYDN PERNDT (Hobart, TAS) first appeared in ASA News (the Australian Society of Anaesthetists) World Anaesthesia Special, April 2012. The original article can be found via the following link

For many, the international humanitarian aid organisation Médecins Sans Frontières (MSF) is synonymous with emergency medical teams tackling disasters, wars and epidemics around the world.

Every day more than 25,000 MSF field staff provide assistance to people whose survival is threatened by violence, neglect or catastrophe. These human tragedies are largely due to armed conflict, epidemics, famines and natural disasters. Altogether MSF has projects in more than 60 countries worldwide.

Almost as important as this practical life-saving work is the organisation's commitment to 'speaking out'. This means that MSF acts as a witness, speaking out in public and in private about the plight of populations in danger - those to whom it provides medical care. In so doing the organisation and those who work for it strive to alleviate human suffering, to protect life and health and to restore respect for human beings and their fundamental rights.

It is by raising awareness and bringing the world's attention to these crises that MSF tries to redress some of the manifest injustices in the world today. Think of contemporary humanitarian calamities, the current nutrition crisis and ongoing conflict in Somalia, last year's siege of the Libyan city of Misrata, the earthquake in Haiti and inevitably a 'sound bite' comes to mind; an MSF doctor or nurse voicing the plight of the powerless many who have been rendered mute by their suffering and vulnerability.

MSF was created in 1971. Its founders had been working in northern Nigeria for the Red Cross in a civil war where government forces fought against rebels from the region of Biafra.  At that time the Red Cross pursued a policy known as 'silent diplomacy', meaning its representatives would very rarely speak publicly about what they saw during the course of their work, no matter the scale of these atrocities and crimes. The Red Cross believed it risked offending parties in a conflict and this in turn would reduce its access and ability to work.

Hundreds of thousands of people died in the Biafran War because of a delilberate Nigerian government policy to enforce blockades of aid and food entering the region. On their return to Europe, a group of young French doctors were frustrated and outraged by the failure of the Red Cross to talk publicly about what had happened in Biafra.  These French medicos joined journalists from a French medical journal to create an association, Médecins Sans Frontières. This new organisation aimed to both provide aid in war zones and talk about what it saw to bring to light the abuses it witnessed. This new humanitarian group refused to watch in silence despite the risks because it believed that silence could kill, making those who watched complicit in the atrocities. "Acting and speaking, treating and witnessing" were the key words used during the creation of MSF. They are equally important today.

What does this mean in practise for an Australian and New Zealand College of Anaesthetists Fellow wanting to work for MSF? It means accepting that the work might well be in a place somewhat more challening than one's last registrar rotation or current appointment at St Elsewhere's Private. Most placement destinations are on the Department of Foreign Affairs and Trade's "do not travel", "reconosider your need to travel" or "exercise a high degree of caution" advisory list. They are risky places to take a holiday.

How does thise sense of risk affect one's decision to work for MSF? For me, the risk is in two parts: the often poorly quantifiable 'real' risk and the much more potent 'perceived' risk. The real risk can be rationalised, informed and cognitively managed. The perceived risk remains a demon of our imaginations.

The real risk is dealt with through exhaustive briefings from MSF in Sydney, the Operational Centre in Paris (or Amsterdam, Geneva, Brussels or Barcelona) and finally from the in-country staff. Security briefings, evacuation and emergency contingency plans and very robust operational rules provide considerable reassurance.

Having some idea of the motivations behind your decision to work for MSF helps. Clearly thought out reasons for going away helps to keep the demons at bay. As you go about the daily tasks of assessing, resuscitating and anaesthetising patients, the work feels worthwhile. and this helps too. This emotion remains long after returning home. It's a professionally empowering experience to have such very direct connection between our medical skills and real need. Simple surgical interventions save lives.

Inevitably the MSF ethos imbues many returned volunteers. Potent memories and a new world view from the powerful shared experiences compel us to speak out on behalf of the people we have assisted, to bring abuses and intolerable situations into the public eye, to act in a small way to change things that often our friends, colleagues and acquaintances would prefer not to see.

Haydn has worked with Médecins Sans Frontières in Burundi.

For more Field Worker stories, visit our international blog site.