Be There 1st MEDECINS SANS FRONTIERES DOCTORS WITHOUT BORDERS

At the end of my mission in DRC, I went to Tanzania, and broke every security rule I had enforced for a year…riding on trucks, local buses, and motorcycles, and staying out late at night without any means of communication. Of course I wasn’t in an insecure environment, but still…

I just needed to be close to people. In the grand scheme of things I didn’t really do that much. I ended up in Zanzibar—checked into an air-conditioned hotel on the beach and ate, slept, swam, ate, napped, swam, ate, read, slept.

You’ll need to do something similar (the sleeping eating swimming reading napping part, not the breaking security rules part).

You’ll get a phone call from our Peer Support Network—MSF aid workers who volunteer to call their colleagues and check in with them—a couple of weeks after you get back, to see how you are doing.

Everyone responds differently to emergency work. If you find yourself having nightmares or are unable to sleep or concentrate or find yourself behaving in ways that are troubling to you—or if you hear that your colleagues are having problems—you can ask your peer support colleague what kind of mental health support MSF offers.

Being on a beach and swimming, napping, eating, reading, and sleeping some more usually works for me…

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I remember when we were in Sudan, we heard that George Clooney was visiting programs on the other side of the border, in Chad. Needless to say, he was trailed by a huge number of press.

It’s a complex thing when press comes, or on the rare occasion when a celebrity visits. Especially when you are all out responding to an emergency, your team is exhausted, and you end up having to devote resources to answering questions and arranging tours.

The press can bring much-needed visibility to a crisis—which can be a good thing, of course, as happened in eastern Democratic Republic of Congo to raise awareness of sexual violence there.

But if there is public criticism of the authorities or a risk to the confidentiality or safety of our patients, then we have to be careful—because we don’t want to put our ability to operate in jeopardy.

The Emergency Coordinator needs to balance many priorities, and manage unexpected events that require a lot of energy and diplomacy—communications being one of them.

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When I was head of mission in DRC, we received a threat by one of the armed groups following a misunderstanding generated by a news report on the local radio. This caused us to stop all movement and I had to go to discuss with people at all levels of the rebel groups to ensure that the teams could move safely again.

Ongoing communications with the local communities is a key factor in making sure that MSF is accepted—and, in war zones, that our work is understood as serving the best interests of everyone involved so that we are not targeted.

Partnering with the local MOH is also important to make sure that MSF can do its work— import drugs, use existing hospital facilities, get authorization to treat patients—and sets the stage for handover of projects in the future. Not that we could hand over responsibility for a meningitis vaccination campaign. The outbreaks are just so enormous that local authorities anywhere would have a hard time responding to them without outside assistance.

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There are lots of things you just don’t rationally believe you can do in the field until they are actually done. On my third mission I was a logistics referent and managed the receipt of 140 tons of food. Before that day I used to plan for and worry about offloading just one truck – but then one day there were 15 huge trucks to unload, and it was 100 degrees and the Muslim holiday, Ramadan, so the loaders hadn’t eaten or had anything to drink all day. That was a solid day’s work.

As Emergency Coordinator communication–with everyone–is a huge priority and really challenging to manage. You spend a lot of time in meetings. You meet with the teams that did the explo and compare the briefing you got from headquarters with what you find on the ground. You meet with local leaders to learn what their understanding of the problem is, and to share MSF’s plan to move forward. You meet with the MOH to either finalize the authorization to work there, or even to start the process.

And don’t forget the desk – you’ll likely be sending daily updates to the team at HQ managing your emergency (we call this team the emergency desk) on the needs from your side—and getting daily updates back regarding the evolution of the epidemic and response and resources from their side.

On top of that, you’ll be managing your team, establishing lines of communication, clarifying roles and responsibilities, setting priorities, identifying gaps, and making sure the coordination team meets regularly—probably daily in the first week and possibly tapering down after a couple of weeks.

You’ll need to resolve resource problems, make decisions when there is a conflict for resources, and make sure there is beer available for the team at the end of the day (oops, no, that is the log’s job).

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The first time I was called to the field on short notice to manage an emergency response I was on vacation in France with a colleague from MSF. They called him to see if he could go to Indonesia immediately – he was just back from Darfur and exhausted, so he handed the phone to me and just a few minutes later I agreed to leave right away to brief for the assignment in Paris and then to head for Indonesia. By the time I arrived in Paris my assignment had been changed to Sri Lanka instead…

As an Emergency Coordinator, you’re always on standby to respond to any kind of emergency at any time. It’s important to be flexible and to have coordinators with experience so that things can get up and running as quickly as possible.

There are many layers to starting an emergency intervention, including a lot of diplomacy required in negotiations with authorities, and sometimes with your own colleagues. When an Emergency Team is called in, they essentially work in parallel with the existing team, the people who have identified the crisis, and who do the initial work before we all arrive and take over. That can be hard for them when they have really invested themselves in the response. But their day to day work is essential, and it is important that existing programs are not interrupted by an unexpected emergency.

In the case of a meningitis intervention, to prep I’d be reading the MSF field guidelines on supplies, staffing, and logistics—because this kind of response requires enormous and rapid logistical coordination. I’d also be talking to colleagues who had done it before.

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