“Acts of service should come out of compassion and not from the ego; it is not enough to feel compassionate – this must be translated into action!” Anonymous
The Ideal seat of work:
I live my ideals in MSF, I extend my arms through the global arms of MSF for all the needy ones in distressed situations and advocate wherever possible for the oppressed, through the voice of MSF. I have found my seat of work in the globe with MSF.
Believe it or not, I had my own ideals borrowed from important people in history: to alleviate suffering, and preserve life and speak up for the needy!
And, surprisingly, when I stumbled on MSF in 2004, in Nepal, I found that so did MSF, although with a more refined purpose of saving lives, alleviating suffering, restoring dignity, and active advocacy. Interesting how the ideals matched!!
The entry into MSF:
I got an opportunity to work with MSF France as national staff in a remote area of Nepal, in a place called Rukum, which was affected by the conflict.
After working for about three months as national staff with MSF France in Nepal, I sent an application for an expatriate position to Amsterdam. Fortunately MSF in Holland accepted my CV and, after fulfilling some necessary requirements and a successful interview, I was happily called for the Preparation for Primary Departure (PPD) course in Amsterdam.
I started work as an expat with MSF Holland in July 2005. With a steadfast attachment to productive and thorough, detailed work through a holistic concept, I started to tune in to the work of MSF in resource-limited settings.
Somalia: the first mission
My first mission was to Puntland, Somalia, the north Galkayo project. The work mainly comprised of looking after a medical ward in a referral hospital. MSF’s way of delivering medical care “tailored” to resource-limited settings, as well as its management structure and firm security rules were the new big things that I started learning about..! Welcome to MSF!!
Security issues
At the time, Somalia was considered as one of the challenging and difficult contexts to work in. Gunshots, news of people getting killed, and hospital activities being stopped due to threats, were all part of routine life. MSF had armed guards at the gates who also escorted expats around the bazaar. Tight security rules applied and at times we received firm security directives straight from the country management team. Time and again the team would get evacuated to Nairobi, due to security issues, leaving behind only a skeleton team.
Sudden evacuation: The head of mission, who was in the field, gave orders to all expats to evacuate immediately!! We left the project in 30 minutes!! The project was closed after that with only some work run by remote control from Nairobi! Since 2008, many of the MSF projects (intersectionally) in Somalia are running in this “remote management” modus as a result of the unrelenting insecurity. In October 2011, two MSF aid workers, Montserrat Serra and Blanca Thiebaut, were abducted in Dadaab refugee camp in Northern Kenya while carrying out emergency assistance for the Somali population. They remain in captivity, and MSF, while still responding to acute crisis requesting live saving interventions, has put on hold the opening of any non-emergency projects in Somalia until their release.
Uganda – Lira: the second mission
I started my second mission in 2006. This time it was Lira, Uganda. The work was running basic healthcare clinics in the camps for internally displaced people (IDP) in northern Uganda. People by the millions left their own homes for more secure places, and grouped together forming massive IDP camps. However, the security issues, overall, were moderate, and not as intense as Somalia.
The first steps towards HIV medicine
Besides the basic healthcare clinics, the Lira project also had a 400-bed therapeutic feeding centre (TFC) for malnourished children from the IDP camps, one of the biggest TFCs run by MSF Holland. In the second half of my contract I was transferred to the TFC, which was my first experience working in one. Here, also for the first time, I started work in the TB programme and a newly opened HIV programme. So again there was something new to learn. I was definitely going through a steep learning curve.
With my new experience in the TFC, learning TB management the MSF way, and getting introduced to HIV medicine all at once, at times I used to feel a bit overwhelmed. However, later I got used to things and managed to get a good clinical grip in all the programmes there.
Interestingly, at that time the security situation improved in northern Ugandapeople began to leave the IDP camps and started going back to their homes. In just a few months, the IDP camps’ population of tens of thousands suddenly reduced to less than 100! The number of patients in the MSF clinics in the IDP camps and the TFC began to dwindle drastically. So, in July 2007, MSF Holland decided to close the project and leave Lira.
It was here in Uganda that I developed an interest in HIV medicine and decided to follow this medical line in MSF. I also observed how TB, sexually transmitted infections and hepatitis B and C were all interrelated to HIV. I was sent to Geneva, for the HIV/ AIDS training course, as the project was closing down.
Myanmar: the third mission
Later in 2007, after the HIV training in Geneva, I was sent to Myanmar’s Rakhine state, where MSF had an HIV/TB, malaria and basic healthcare project, in a place called Maungdaw, bordering Bangladesh. In Myanmar, MSF has HIV projects in Yangon, Shan, Kachin and Rakhine state.
The Rohingya
In Rakhine state, MSF works providing quality medical care to the Rohingya, a stateless Muslim minority who are marginalised in many ways and who are often excluded from seeking the most basic medical services. Activities for this target group focus on primary health care with a specific emphasis on reproductive health and malaria.
It is great that MSF is present in Rakhine state and is literally saving thousands of lives, alleviating suffering and, in whatever ways it can , is helping to restore dignity.
Working in Myanmar:
My stay in the Maungdaw project was a great opportunity to develop more knowledge and skills in HIV/TB, sexually transmitted infections, malaria, basic healthcare, counselling, programmes for high risk groups, and health education. There were no security issues in the Myanmar mission – the extreme opposite of Somalia.
On the HIV side, I did a lot of bedside examinations, coaching and trainings. I initiated an HIV peer self-help support group, which started with a few members and, over the course of a year, grew to have over 100 members, and was later formally registered. I also started a needle exchange programme for intravenous drug users.
Myanmar has vertical HIV projects, but Maungdaw had the country’s first integrated HIV clinic with basic healthcare components. MSF similarly lobbied and started a new basic healthcare site in a place called Zay De Ping.
The project also had a huge malaria programme, and a strong programme for community sex workers, men having sex with men, and later the intravenous drug users.
It was not only clinical work that I brushed up in Myanmar. I was also supervising and managing three separate clinics and was responsible for counselling and health education. In time I became the most senior expat and was literally taken as an “institutional memory” for the Maungdaw project; I later became in charge while the project coordinator was away.
I stayed a total of two and a half years in Myanmar and I must say it was one of my most cherished missions with MSF. I left Myanmar in May 2010.
I not only enjoyed my work in Myanmar, but I also had a very positive relationship with both the national staff and the expats, and I visited many Buddhist sites, especially in Sittwe. Of course I also visited the grand Golden Shwedagon Buddhist Temple, every time I was in Yangon.
Uganda – Kitgum: the fourth mission
After a rest at home for six months with my family, I started my fourth mission with MSF in October 2010 as the HIV medical doctor in Kitgum, in northern Uganda. This was my second time in Uganda, and many things and some staff were already familiar. Kitgum project had been operating since 2004, and HIV activities started in 2007 with 16 patients. By the time we handed over the project to the Ministry of Health, Kitgum project had an HIV cohort of approximately 2,000.
Working in Madi Opei:
I, along with an expat nurse, lived and worked in a place called Madi Opei, about an hour’s drive north towards the South Sudan border from Kitgum town. My main role was to look after a level four health centre, which is equivalent to a district hospital in the South Asian context. My main responsibilities were looking after an outpatient department, a 30-bed general ward and the HIV and TB programmes.
Changes in Uganda:
Two things had changed in Uganda since my last visit. The LRA rebels had literally been flushed out of Uganda, and Kony was busy somewhere else in Africa. The situation was much more peaceful. Many more people were using mobile phones and I noticed more internet facilities, even in the villages.
Time for handover:
In 2011 it was agreed that in Uganda there were not enough humanitarian issues for MSF to remain any longer. MSF felt the Ministry of Health had the capacity to handle HIV and TB projects. On these grounds, MSF decided to pull out and hand over to the Ministry of Health, first the HIV and then the TB activities. However the multidrug-resistant TB project would remain till MSF felt confident that the Ministry of Health could take over properly.
This project was special to me because I was able to use my HIV knowledge and skills to coordinate the HIV programme initially, and later handed over the whole HIV programme to the Ministry of Health “smoothly”. I think I received very good feedback from all levels about the quality and productive HIV work, especially the most complicated part – the handover. During the course of my work, I was recognised as the focal person for the HIV part of the project.#
Tranings:
I attended the Field Management Course in Kampala and later also the FUCHIA (follow-up care of HIV infection and AIDS) in Nairobi, which helped me enhance my management work and also gave me an insight into the HIV database.
Filmmaking and Radio Mighty Fire:
During the course of my work in Madi Opei, there were some issues around patented drugs by pharmaceutical companies. MSF in Amsterdam sent some filmmakers down to Madi Opei to make a documentary whose title translates as Neither to swallow nor to throw up. They also included me in the film. I hear the film had a good impact on the patent issues around which MSF was lobbying.
I was also proposed for a talk show on “Radio Mighty Fire”, a local FM station, for World AIDS Day on 1 December 2011. I think everyone liked the talk show; after that I was even called “Mr Mighty Fire”…I liked that!!
Transferred to MSF India
After more than five years with MSF- Holland, at the end of my Kitgum mission in 2011, I was transferred from MSF Holland to MSF India. I think it’s time to work from my home region of South Asia. This reminds me of a Hindi song “Jeendagi aa rahaa hun mein….!” (Life, I am coming…)
Uzbekistan: the fifth mission
Since February 2012, I have been in Central Asia, in the former Soviet state of Uzbekistan. Here I have been given the task of starting up a new HIV project in Tashkent, as the project coordinator /medical doctor.
This place is so different from all the other projects I have been to, and has its own challenges. I would definitely like to share my experiences at a later date; till then…Dasvi Dania (goodbye)!!
Appreciation:
Thanks to everyone
Who has helped me along
In this path of service with MSF,
You have instilled enthusiasm in me!
Thanks also to all those
Who have opposed or challenged me and my ways
You have given me the insight!
Thanks to MSF for providing me a forum
To help alleviate suffering and preserve life,
I reach out through your global arms
And I speak up through your mighty voice
In real, for the needy ones
Slowly but steadily!!
May I be able to develop deeper compassion in this act of service and be able to translate that into action, ever more skillfully! May all possess health, healing and happiness, may all benefit!!
– Dr. Ramesh Dahal
