DOCTORS ARE ACTUALLY THE LEAST IMPORTANT MEMBERS OF THE TEAM

Doctor Cecile van de Konijnenburg knew early on that she wanted to work in the humanitarian sector. Studying medicine seemed the safest option in order to find a job abroad. Following a two-year medical internship, successfully completing her tropical medicine training at the ITG, her first work experience at Fedasil and Kind & Gezin, and volunteer work in Uganda, she applied to work for MSF in early 2015 and was promptly taken on. This was just the start of the adventure.

You have completed five missions to DR Congo, South Sudan, Greece and Afghanistan. How have you evolved through all these missions?   

To be honest, I was lucky with my first mission. I worked for nine months with the ‘Pool d’Urgence’ in Congo (the mobile rapid response team that deals strictly with emergencies), where I was able to practise my clinical skills and learn about a supervisory role at the same time, as the local colleagues were so competent. In Greece I had a safe environment in which I could develop my supervisory skills further still, thanks to the Nursing Assistant Manager who allowed me to assist her. On my third mission, to South Sudan, I was no longer acting as a doctor but as medical supervisor, and as IPD supervisor in Afghanistan I was responsible for all long-term patients in a hospital with 69 beds.

MSF has given me incredible support in growing into a more coordinating role. After every mission we discuss what went well, what suited me and the areas in which I want to continue to grow and learn.   

Talk us through a typical day on your mission in Congo.

There was no such thing! (laughs) I always tried to get there early, before the hospital’s morning meeting in order to visit the weakest patients. The morning meeting was followed by the ‘tour de salle’, the round, where I trained the local employees and consulted with the nutritionist, the other doctors and the nursing staff. Next, I would usually visit the pharmacy to check up on the drug orders. In the meantime, various patients would usually arrive in the emergency ward. In the afternoon I would find the time to ask my colleagues in logistics questions and, before leaving for home, I would try to visit the most seriously ill patients.    

What are your favourite and least favourite things about the work in the field?

The feeling when a very sick patient came in and the whole team immediately got to work together to fight for the patient’s life. Or the friendly greetings you get when you live in a small village where everyone knows you. You can build really intense friendships in the field. On the other hand, that can have its downside: if you’re having difficulties working with a particular colleague, it’s harder than it would be at home and more difficult to distance yourself from it without it having an impact on your work.

What’s the most important thing you’ve learned?

That the doctor is the least important member of the team (laughs). We are completely dependent on other colleagues who provide clean water, build hospitals, clear the roads, deliver medicines, set up beds and mosquito nets, etc. My colleagues in logistics have taught me to also think about medicine in practical terms.

I’ve learned an incredible amount from my local colleagues, particularly in dealing with child mortality. I am full of admiration for their resilience.    

Is there a patient that will always remain with you?

A miracle patient in Bili, Congo. A two-year-old boy was brought in with complex cerebral malaria. I had never seen such low readings: we couldn’t test his sugar or blood and he was suffering from severe dehydration and hypothermia. He had epileptic fits, sepsis and was in shock.

After we gave him oxygen, a small amount of fluid and balanced his sugar levels, we gradually gave him more fluid in anticipation of a suitable donor and blood. Next came the medication to treat both the malaria and a severe bacterial infection. He was literally close to death when he came in, but against all expectations he was out of danger within three days. After a week he was even ready to leave hospital and start the long journey home with his mother. The only visible sign of his hospital admission was a weird mohawk: we had to shave part of his head in order to find a suitable vein! 

What are the qualities you need to be a doctor with MSF?

You have to be capable of outlining a good differential diagnostic landscape, and good at clinical decision-making. So in other words you need to be able to reason and make choices in a clinical sense with poor resources and tools, primarily through having a sound knowledge of the serious, treatable diseases in the region. 

As a person, you need to be curious and keen to learn. You have to look at a situation with an open mind and then think: what can I learn here and what do I have to offer? As far as the management component of the job is concerned, you have to be conscious that management is something you can learn. There are also different styles of management. Most of all, don’t be afraid to fail and learn from your failures.

What would you say to another doctor who is thinking of applying?

Do it! It’s not all or nothing. You don’t have to give up your whole career to work for MSF. You can take breaks between missions. I’m on a year-long hiatus at the moment and I’m studying for a Masters degree in public health. This will help me to evolve into a medical coordination role with MSF. You can adapt the fieldwork to suit your lifestyle.

I also find it personally enriching. Keeping in touch over a long distance has made my friendships more meaningful. 

Treating extremely unwell patients in precarious conditions will also make you a better doctor in Belgium. I have more self-confidence in my skills, I’m now very good at determining when to refer a patient on, and I’m better at interpreting my lab results.    

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