Brooke McReynolds is a Midwife and has worked in Liberia and Pakistan.
Why did you decide to work with Médecins Sans Frontières?
I fell in love with Médecins Sans Frontières when it first started back in the 1970s and followed its work over the years. I love the fact that 80 per cent of the funding goes into field projects, that it's a genuinely non-profit organisation. I had a very good experience in Liberia in 2005 and always wanted to do a second placement, but life kept getting in the way which is why my two placements are eight years apart.
What was your role in Liberia?
I was working in Lofa County, during the disarmament process after the war. I was in charge of two mother and child health clinics that were two hours apart. Part of my role was to escort emergency caesareans to the nearest surgical hospital, which was across the border in Guinea, six hours away over really bad roads. There had been 90,000 people displaced out of Lofa County but they were starting to come back. Families were being reunited, homes and businesses were being rebuilt and fields were being planted. There was a sense of hope.
"With Médecins Sans Frontières I'm always sent to the field to teach, but I learn so much, I almost feel like I'm cheating the organisation! I learnt about the Pakistani way of life, but I also learnt a lot about midwifery"
You've recently returned from Pakistan. Could you describe the project you were working on?
I was in Hangu, a rural area in the north of Pakistan, near the Afghanistan border. Médecins Sans Frontières works in the hospital's emergency department, operating theatre and maternity unit. The hospital provides free healthcare, and we had a very good reputation so women travelled three, four or even five hours to deliver their babies in Hangu. We had a lot of critical cases, so it was fantastic having a surgical team right there. Unlike in Liberia, it wasn't six hours, it was more like six minutes to get to the operating theatre for emergency caesareans. We also had the support of a referral hospital a few hours away in Peshawar, a Médecins Sans Frontières women's hospital. That was a relief knowing that we could refer women there if they arrived early enough.
What did your role involve?
My role was mostly about supporting the Pakistani staff and building up their skills. There was also a lot of hands-on work because so many emergencies came through. It was a wide-ranging role because I not only covered the labour ward and the mother and child health ward, I also frequently got called to the emergency room. We also had patients in the surgical ward, such as for caesareans. With Médecins Sans Frontières I'm always sent to the field to teach, but I learn so much, I almost feel like I'm cheating the organisation! I learnt about the Pakistani way of life, but I also learnt a lot about midwifery. You have more responsibility as a midwife in the field and I think it does make you a better midwife - there aren't too many emergencies I haven't dealt with now.
Did any patients make a particular impact on you?
I remember one woman who was pregnant with her ninth baby. She had tried unsuccessfully to deliver in her community, then travelled two hours to the Médecins Sans Frontières hospital in Sadda. She still couldn't deliver there, so they brought her to us and we were able to give her an emergency caeserean. The baby unfortunately didn't survive, but the woman did, and she was able to go home, healthy, to her eight other children. She and her husband also agreed to a tubal ligation so that something like this wouldn't happen again, and she could remain healthy and look after her children. Another woman I recall had just delivered her fifth baby normally, without complication. I was in the labour unit at the time, and then 15 minutes later I was on my way out, when I saw that she and her baby were leaving too! I looked at my watch and thought, 'well it's 11.30am, she's got four kids at home who all need lunch!' I asked her to stay for at least another 45 minutes - we were all laughing.
Do you have any advice for other midwives considering work with Médecins Sans Frontières?
It's an amazing experience. What helped me was understanding that you're not going to save every life, and that you're dealing with the adults who make decisions that you don't necessarily agree with. For example there were cases where women refused potentially lifesaving caesarean sections because they didn't want an operation. So be prepared for the hard decisions.