Caring for those in desperate need

Coffee with an Islamic Jihad or a dinghy as transport doesn’t sound like the life of a nurse, but for some it’s just part of the job, writes Annie May.

Brian Moller was always going to do humanitarian work. It was why he became a nurse in the first place. Fourteen years after entering the profession he realised his dream when he left Adelaide and arrived in a literal war zone.

Joining the non-government organisation Médecins Sans Frontières (MSF) in 2004, Moller’s first mission was to Liberia. The country’s civil wars had just ended and more than 200,000 people are estimated to have been killed.

The situation couldn’t have been further from the one he left in Australia.

“After 15 years of warfare, not one single child in the country had ever known peace. The whole country was a mess,” Moller says.

The hours were very long and the work strenuous, but he was hooked within a week of being on the field.

“I can’t say that it was easy, because it wasn’t,” he says.

“It was the ruin of the country and the plight of the children that was hardest to deal with. Especially when it came to treating child soldiers.

“They were children that committed horrible crimes. It’s difficult to explain the feeling of facing an 11-year-old who was a four-year veteran, who had lost count of how many people he had killed and raped. But not once did I ever question the pertinence of the work.”

Since those six months in Liberia, Moller has been on seven missions in five years with MSF, starting as a volunteer field worker and progressing to a paid coordinator position. He has worked in Nigeria, Haiti, Chad and Gaza – all which are conflict zones.

Moller has lost two members in the field and while MSF is serious about security, knows there is always a possibility of something going wrong. The Gaza Strip was very volatile.

“We had rounds come through the walls and also received a death threat from an individual who claimed to be Islamic Jihad. It isn’t something you want, so we contacted them and after having a coffee were assured the threat wasn’t from them,” he says.

Paediatric nurse Louise Devereux didn’t have to dodge any bullets during her time in Papua New Guinea, but she faced a set of different challenges.

“In PNG because there is such a shortage of doctors – just one per 7900 patients – nurses and community health workers operate at a different level to nurses here in Australia,” says Devereux.
“Limited resources mean that health workers take on considerably more responsibility in the diagnosis and treatment of common conditions using standardised treatment guidelines.”

Like Moller, doing international volunteer work was always on Devereux’s list of things to do. In 2009 she packed her bags for a six-month assignment as field manager for medical aid organisation Australian Doctors International (ADI) in PNG’s Western Province.

Clad in khaki jungle attire and immersed in tropical diseases, it was a long way from the career she left in Melbourne where she worked on projects at the Royal Children’s Hospital and Department of Human Services.

Based in the port town Kiunga with frequent travel by boat, plane and foot to outlying areas, Devereux’s first job was to facilitate an in-service training seminar for 59 health workers and hospital staff.

“For many, this was the first clinical seminar they had attended since their original training,” she says, listing tuberculosis, filariasis, HIV/AIDS, drug supply, snake bite and perinatal care as some of the essential topics covered.

“Many had to travel long and difficult distances to attend. For some it was 14 hours in a dinghy, and two days walking on foot for others.”

She was also tasked with trying to expand ADI’s volunteer doctor deployment program from North Fly to South Fly (which is just five kilometers away from Australian territory), managing ADI’s field office, supporting the Catholic Health Service in Kiunga and improving drug supply to health sub-centres.

The Catholic Health Service has eight health centres throughout North and Middle Fly districts.

Each centre is responsible for a number of aid posts typically operated by a lone health worker in a remote village.

“There are some real challenges in managing a health service that covers such a wide area, especially in an environment where radio is the only form of communication, travel is slow and difficult, and the supply of drugs and equipment from Port Moresby is unreliable,” says Devereux.

One of the highlights of her time was a 10-day doctor patrol to Boset, an area afflicted by leprosy and domestic violence.

“The villagers were very welcoming, and we set up multiple stations for immunisations, antenatal checks, doctor’s clinic and eye and ear testing. It was good to work alongside the local staff and learn from one another,” she says.

There were also distressing moments.

“It was heartbreaking – not to mention frustrating – to see patients in an advanced stage of disease and have nothing to offer them, especially when I knew they could be easily treated in Australia,” Devereux says.

She remembers with particular regret a young boy with a bulging eye tumour where nothing could be offered except palliative care.

Having mixed emotions is common among nurses who volunteer or work in overseas conflict zones or countries experiencing extreme poverty. But you won’t regret it, says Moller.

“It sounds cliché but the experience is incredibly challenging and incredibly rewarding,” he says.

“As a nurse you accept responsibilities you wouldn’t get in other contexts and while the lack of resources is frustrating you learn to do what you can do with the little you have. You really discover your abilities.”

Moller says it’s important for those considering overseas humanitarian work to understand it takes its toll physically and emotionally, but if you have realistic ideas, are flexible and willing to work, the experience is very much worth it.

“If somebody finds themselves with the skills and time, I completely recommend it. To me it’s the purest form of nursing. It’s giving care to people who are in real need of it and isn’t dictated by bottom lines and politics.

“It wasn’t my intention, but I now feel like I have a career path with MSF. Sometimes I catch myself while on a mission and think, I’m just a nurse from Adelaide.

“This is my first time back in Australia for over three years and already I have itchy feet to get back in the field.”

Patience, diplomacy, flexibility and a willingness to get “stuck in” is what is needed to really enjoy your time, says Devereux, who experienced a new form of education in PNG.
She discovered that things work differently in a developing country and require lots of patience, that systems are often lacking for even the most simple stuff.

She also learnt that while it’s is okay to go in with big ideas and grand plans, you need to start with the basics if you want to effect change.

“I think I made small inroads and provided a way forward for the next person to make a significant difference. But it takes time to be accepted,” she says, revealing that the local children are sometimes told that if they misbehave the white people will “get them”.

“There is certainly no shortage of variety. One day you can be immunising children in remote villages and the next participating in health planning meetings with church and government officials.
“If you want to use all of the life and professional skills you have – and find a few new ones – then this is an opportunity to grab with both hands.”

Médecins Sans Frontières is always looking for experienced nurses who would be willing to share their skills and dedicate their time to support the organisation’s medical-humanitarian work around the world. If you have worked in management, in remote settings or have experience working with patients with tuberculosis or HIV/AIDS, go to www.msf.org.au for more information.

Australian Doctors International has a similar volunteer position to Louise Devereux’s available. For further information on the organisation and opportunities available go to www.adi.org.au.

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