Jenifer Reynolds is an anaesthetist and worked in Yemen and Pakistan.
What initially drew you to Médecins Sans Frontières?
I had always wanted to work in countries with limited resources, right from childhood. I like the idea of grassroots medical care and feel strongly about universal access to healthcare. There is certainly a real need and I felt my skills could be well utilised. I was drawn to Médecins Sans Frontières in particular due to the strong medical focus, its highly positive profile in the international arena and its core values.
You’ve recently returned from Yemen. Can you describe the project and your role?
I worked in Khamir which is about two hours from the capital, Sana’a, at an altitude of around 2700m. The project was supporting the local hospital so there was a mixture of Ministry Of Health and Médecins Sans Frontières input. Médecins Sans Frontières’ national and international staff provided surgical activities and obstetric care. The medical needs were related to violence, complicated obstetrics, general surgical emergencies, tropical diseases (from the surrounding valleys), domestic burns and malnutrition. My role was mainly as an anaesthetist and I had prime responsibility for the intensive care unit. I also helped out in obstetrics with resuscitation and in the emergency room.
How does working overseas compare with work in Australia?
You apply the same basic principles, but there are variations like different anaesthetic drugs and equipment. There are also big cultural differences, language difficulties and different levels of staff training and experience. The way local people cope and react to medical issues and trauma can also be very different. My experience and training in Australia certainly helped in terms of being able to apply the same principles for safety and quality of care. A greater deal of flexibility and thinking ‘outside the box’ is required than is specifically addressed through conventional anaesthetic training in Australia. I think my additional training in aeromedical retrieval work and attendance at ‘real world anaesthesia’ courses was particularly helpful.
"On a personal level, I find the work rewarding and challenging. On a big picture level, there is a great need that is not going to go away."
What would you recommend to other anaesthetists as the most valuable skills to have when working overseas?
General experience assisting with emergencies such as neonatal resuscitation, burns resuscitation and trauma are valuable, as the anaesthetists are often the first port of call when there are challenging medical problems in the absence of a senior emergency doctor. Language skills are always an asset (but not essential) – particularly Arabic in a project such as Yemen where English was not widely spoken and translators were not available after hours.
Over your three field placements, what have been the biggest challenges?
The challenges have all been quite different. In my first placement, the biggest challenge was working in a conflict area with air strikes and limited communications, plus getting ill upon my return. In Pakistan, the biggest challenges were dealing with medical emergencies that included a tracheal foreign body in a compromised 18-month-old child with no equipment to extract it, refractory eclampsia, massive haemorrhages sometimes in the setting of limited compatible blood, and complicated obstetric cases with no resident obstetrician - thank goodness for a top Aussie midwife! Yemen was of much lower acuity in terms of medical challenges but the one that stands out was a 16-year-old girl with organophosphate poisoning who succumbed despite our attempts at resuscitation. Language difficulties were more prominent in Yemen which made patient care quite challenging. As the Yemen and Pakistan placements were both in very conservative Muslim areas we were required to observe the dress code and respect a ‘no alcohol’ policy. The most challenging aspect of this was trying to keep the head scarf on and stop it from falling into the wounds while trying to resuscitate trauma or obstetric patients!
Can you describe any moments that were particularly rewarding?
The gratitude of the people is particularly rewarding – even if what you do sometimes feels very minor and routine, it can make a big difference to the lives of so many. Of course there were some patients who made quite an impact, especially young children with burns or facial trauma and women presenting with eclampsia or massive haemorrhage who made a full recovery.
After three field placements, what drives you to keep working with Médecins Sans Frontières?
On a personal level, I find the work rewarding and challenging. On a big picture level, there is a great need that is not going to go away. While I feel privileged to be able to live and work in such a fortunate country as Australia, I also feel privileged to be able to work in other countries where the needs are so great. It is humbling to work alongside people who live in such difficult circumstances and yet are always so keen to make you welcome and really appreciate your being there.