Life on assignment: Paediatrician, Dr Josephine Goodyer

What motivated you to work with MSF?

I had always wanted to work internationally, and especially with MSF. The principles of independence, impartiality, neutrality have always identified with me and have formed part of my professional identity and paediatric practice.  

It’s unique to have a career that can take you globally, and I was keen to learn more about pediatric practice in other settings. The medicine that you are exposed to internationally is fascinating. When I did work overseas, I was keen to ensure that I had a high level of technical skills and knowledge to be able to contribute as well as learn from the team.

What skills do you think are important to work with MSF as a paediatrician?

You need to be confident in your clinical skills. Working overseas involves making a judgement based on your own clinical knowledge, because the projects won't have the resources such as scanners and tests for you to rely on.

An important part of the work with MSF is building local team capacity by supervising and training the local staff who will carry out the medical care long after your assignment. In Liberia I completed a teaching ward round every morning, and in Kiribati I held education sessions and bedside teaching. So, you also need to be confident in your clinical skills and have the soft skills to teach your local colleagues.

You worked on the Helping Babies Breathe program in Kiribati, how did your work in the Sydney Children’s Hospital Critical Care Simulation team prepare you for this?  

MSF have been focusing on improving newborn care in the first twenty-four hours of life in Kiribati, by training local staff the Helping Babies Breathe program which has been shown to reduce early neonatal mortality by up to 47per cent. This approach is a simulation-based neonatal resuscitation program, an area that I had a lot of experience in coming from the Critical Care Simulation department at Sydney Children’s Hospital, so I enjoyed contributing to this program on this assignment.

Did you develop any new skills on assignment?  

Yes absolutely. Kiribati doesn't really have a primary healthcare system, so the hospital where I worked on the main island was the referral hospital for the whole country. Clinicians in the hospital provided the scope of care that would be given by around five specialist teams in Australia; paediatric emergency medicine, simulation, neonatal care, retrieval medicine, and pre-hospital medicine. This meant that I had the opportunity to extend my own skills and work on retrieval medicine, which was a sensational opportunity because in Australia that is another specialty that I would not have the chance to work in. 

What challenges did you face on assignment?

In Liberia I worked in Barnesville Junction hospital, an in-patient paediatric hospital run by MSF. There is a high death rate for children in Liberia, so the clinical needs are very high. This meant that the work was quite confronting. My day would usually involve two resuscitations and supporting parents after the death of their child. We also had some problems with bed capacity, we would often run at a 90-95 per cent capacity so there was a lot of work involved.

What was your proudest moment on assignment?

The graduation that I introduced in Kiribati for the babies who were born at 27 weeks in the neonatal intensive care unit. In a high resource setting, these babies would have been on a ventilator for a long time, had special feeds and lots of monitoring. To provide a high level of care the Kiribati team spent many weeks with the baby and their mothers and families, so they really got to know them. Once the babies were healthy and well enough to go home, we held a graduation ceremony in the ICU. It was special to see them return home after being in the hospital for months.  

In Liberia, Médecins Sans Frontières (MSF) runs a mental health and epilepsy program and supports paediatric care in a Barnesville Junction Hospital in the capital, Monrovia.

In Kiribati, MSF has been working in partnership with Ministry of Health and Medical Services (MHMS) colleagues to improve health outcomes for maternal and paediatric patients since October 2022.