Guest Articles

A different path: taking medicine beyond borders

Dr Stewart Condon

I have been interested in humanitarian work since high school. I was always looking for a career that allowed me to help people, using the combination of science and communication. Medicine seemed to fit perfectly.

By the end of my medical degree I was thinking about how I could start working in the humanitarian sector. I liked the idea of taking my skills around the world, to places like South Sudan or Pakistan. We had a field worker come and talk to our Medsoc at a symposium around “travelling with your degree”. This inspired me and showed me that I didn’t have to take a standard path in becoming a specialist or a GP, living and working in Australia for the rest of my life. Alternate possibilities were out there.

It was at this time I also started orienting my work towards building skills that would be useful overseas. Paediatrics stood out for me – being able to treat sick or injured kids in third world contexts was always going to stand me in good stead. I worked my PGY3 as a paediatric resident at Sydney Children’s Hospital at Randwick, and then half the year at Wollongong Hospital in general paediatrics. Having my diploma of paediatrics gave me a sense of confidence.

Working out bush

The next step was to get experience in remote medicine. I had lived in Sydney for all of my study years, and aside from a couple of years in the Illawarra, I’d remained city-based as I started to work. I needed to get out, and an opportunity to work in the centre of Australia came at almost the perfect time. I headed out to the Northern Territory for six months to work in the Yuendumu community, with the Warlpiri people.

Dr Stewart Condon attending an MSF refugee camp awareness raising campaign in Martin Place Sydney. Copyright: MSF

Many Australians who work with MSF have experience working remotely, particularly with the Indigenous communities in Australia. Working within these remote communities is a challenge, for so many reasons. It’s about resources, distance but perhaps most importantly a different concept of health and disease.

These circumstances exposed me to the idea that you cannot have access to everything that you need all the time, and at times it is necessary to trust your clinical gut to make a decision. You learn to be able to look at a patient and decide whether they need an urgent test today, in which case you can organise an immediate evacuation to hospital, or whether it’s something you can keep an eye on. Working in the bush gave me the confidence to be able to do that, as well as the ability to work unsupported – an essential skill in remote areas.

Working remotely also opened my eyes to those patients who live in truly difficult circumstances and don’t get the care they need. I knew about other organisations that did similar work to MSF but I was attracted to MSF because it worked right on the frontlines of international humanitarian crises, treating those patients that weren’t being reached.

It was this experience in the Northern Territory that really prepared me for my first field assignment with MSF in Bentiu, in what is now South Sudan. It was 2004 and there were only three medical doctors at our project- two were international staff, including myself, and one Sudanese doctor. We had very basic medical resources, no access to tests and some very sick patients who you had to take care of, quite often on your own. It was here I was able to challenge myself and recognise I had been taught what I needed to know – how to examine and treat a patient, and how to make a diagnosis. In modern medicine we often rely on a full battery of blood tests, x-rays, scans and specialist opinion. But from my experience in the Northern Territory I knew I could make a clinical judgement, and that not having the tests did not necessarily mean that patient care was compromised.

Dr Stewart Condon on his first field assignment with MSF in Bentiu, (now South Sudan) 2004. Copyright: MSF

My time in South Sudan gave me a taste for this humanitarian side of medicine, but it was really my second assignment in Aceh, Indonesia following the devastating tsunami in 2004, that opened my eyes up to the humanitarian issues around the patients we were seeing every day. It was in Aceh that I began to recognise that it was not just about the patients that we were seeing nor the medical care, it was just as much about humanitarian need. It was at that point I realised I was interested in becoming a Coordinator, rather than solely a doctor. During my next assignments in Pakistan, Sri Lanka and Bangladesh I took on roles as Project Coordinator and Country Medical Coordinator. In these roles I was able to work together with other humanitarian organisations, as well as government authorities. It gave me a sense of other parts of MSF that I could give value to, beyond medicine.

MSF, Amman Hospital – 2016.  This man is a 23 years old Syrian. he used to study law in Damascus. He was among the first revolutionaries in Deraa, in the ASL brigade. This is the third time he is wounded, a bomb took his leg away.

Amman hospital reconstructive surgery project is meant for the wounded of Jordan’s surrounding countries that undergo war, armed conflict or violence. The reconstructive surgery hospital offers integrated care and sophisticated surgical operations, physiotherapy and psychological support. All patients admitted are considered being “impossible to treat” in their original country, because of either access problems or technical complexity. Since the opening of the structure, MSF has been taking care of 3 600 patients. photographer: Chris Huby

Examination in the laboratory of the hospital of Souleymanieh, October 2008.In the medical bacteriological laboratory teams prepare culture media and reagents in order to carry out the bacteriological analysis. photographer: Jean Baptiste Ronat

Attacks on hospitals

I have been President of MSF Australia for nearly three years and on the board since 2011. The most important part about being President is my responsibility to our field workers and patients. One of the most alarming trends we have faced in the last couple of years is the attacks on hospitals and medical facilities. In Afghanistan, South Sudan, Yemen and Syria we have seen our hospitals repeatedly attacked. Unfortunately, these are not isolated events and the normalisation of such attacks is intolerable. For us attacking hospitals and medical workers is a non-negotiable red line. International humanitarian law protects medical facilities, the people working in them, and the people receiving treatment.

Another challenge, more medical but no less critical, is antimicrobial resistance. Drug-resistant infections are a looming challenge for our humanitarian work. We see them in the war-wounded people we treat in Jordan, in newborns in Niger, and in our burns unit in Iraq.

Kunduz Hospital After the Attack:  The remains of a bed frame in a room on eastern wing of the main Outpatient Department building.
Burnt-out corridors, collapsed roofs, twisted metal and ash, is all that remains of many building at the MSF Trauma Centre in Kunduz, northern Afghanistan, following the 03 October US airstrike on the facility which killed more than 20 MSF staff members and patients.
photographer: Andrew Quilty

Our medical staff are increasingly seeing people with infections that can only be treated with the last lines of antibiotics. When I was in Pakistan in 2006, post-earthquake, we recognised quite early on many patients were not improving after treatment. Some of these patients were already on very heavy antibiotics because in this particular community they had been given antibiotics for anything and everything. As a result, many had resistant bacteria on their skin which would then go into their bones, giving them bone infections. We were having to use heavy antibiotics (e.g. meropenem) that we are only now really starting to use in a similar way in hospitals in Australia.

Central laboratory of Koutiala hospital.  End of 2013, MSF initiated the restructuring and renovation of the central laboratory of Koutiala hospital, where MSF manages the pediatric unit. MSF has added a department of bacteriology, operational since March 2014, to improve the diagnoses made in the laboratory and meet the requirements of quality of medical care at the hospital. Through the department of bacteriology, MSF is now able to diagnose all bacterial diseases which are affected children. photographer: Aurelie Baumel
Haydan Hospital.  Haydan Hospital, March 2016, after 5 months of air strikes.
Constant bombing , blocking of aid, non-observed truces … In six months , the Yemeni conflict has claimed thousands of lives, including many hundreds of children, and reports of more than 1.5 million displaced. photographer: Atsuhiko Ochiai

There are many global challenges caused by antimicrobial resistance. Countries must do much more to better use existing antibiotics by strengthening health systems, human resources and laboratory capacity. There also needs to be improved access to existing medical tools, including reduced prices for existing vaccines to prevent infections, as well as research and development of new products that are patient-focused, affordable and appropriately available to all who need them. MSF is participating in global efforts to control drug-resistant infections by increasing our capacity to diagnose infections, improve the use of antibiotics, prevent the transmission of infections in hospitals and monitor rates of resistance, as well as supporting efforts to develop new, affordable diagnostic tools and treatments.

Northern Yemen, Oct15-Feb16.  A man clears debris revealing the Médecins Sans Frontières logo 29 October 2015 painted on the roof of MSF’s hospital in Haydan, Yemen after an airstrike on the facility. photographer: Rawan Shaif

Ask yourself “why medicine?”

For those who are looking ahead to their future in medicine and are interested in working in the humanitarian sector my advice is very simple, get out and challenge yourself. Remove yourself from the big city hospitals and work remotely. You will not typically be provided this opportunity without asking. Ask your hospital for a rotation to a regional centre or request something a bit different. Take a leap and show up.

You need to be interested in things that are not strictly just medical. I am sure that you already are, of course! Working at MSF we look at so many issues outside of the first emergency response. It can be anything from access rights to medications, the humanitarian needs of a particular context, the effects of war on communities or what happens to women after a natural disaster. This information influences how we treat a patient and what kind of patients we see.

And most importantly make sure you’re asking yourself the really important questions. Why are you studying medicine? What type of patients do you want to be treating in ten to fifteen years? Why do you think you will get a buzz out of being a doctor? Understanding your ‘why’ will help you understand how to get there and what your career will look like in the future.

Working in the humanitarian field can be dynamic and volatile. If you don’t mind that lifestyle partnered with medicine, then it’s the perfect job for you.