Obstetrician-Gynaecologist Shanti Hegde reports on her 16th assignment with MSF

What motivated you to work for MSF?  

After graduating as an obstetrician-gynaecologist in Mumbai, I worked in the rural town of Karnataka, India, for 27 years. I was getting restless and felt eager to work for a humanitarian organisation, which was my wish since I was 16 years old.  

In 2008, MSF was not widely known in India. I came across the organisation at the All India Congress of Obstetrics and Gynaecology conference in Delhi in 2008, where I found a brochure about their work and the requirements for working on their projects. From that moment I knew this is what I wanted to do.  

I went on my first assignment to Darfur in Sudan on 1 August 2008. I have never looked back or regretted this decision.

Tell us about the project you are working on in Blantyre

I have worked on many maternal and child health projects with MSF. This project provides care for patients with cervical cancer and genital malignancies. I knew working in a new area was going to be challenging as I had no gynaecological oncology background, but I was curious and keen to learn more. For a gynaecologist with basic ultrasound skill, it is not a big thing to learn as everyday you see the same cases!  

Cervical cancer accounts for 37 per cent of new cancer cases in Malawi. In 2018, MSF started providing healthcare services to reduce the incidence and mortality of cervical cancer in the Blantyre and Chiradzulu districts. It is a comprehensive programme providing the following:

• primary prevention - vaccination
• secondary prevention - screening
• treatment – surgery, chemotherapy, radiation
• supportive therapy - social support, counselling and physiotherapy
• palliative care.

As a gynaecologist I am involved in outpatient assessments, colposcopy screenings of abnormal tissue, staging, ultra-sound, treatment of precancerous lesions, and cervical conisation (removal of abnormal tissue from the cervix). I also look after the inpatient ward where all patients’ conditions are discussed in a multi-disciplinary team meeting and decisions about individual care are made.

The healthcare system in Malawi has suffered from funding cuts and a critical lack of qualified healthcare staff. A lack of early screenings and preventative human papillomavirus (HPV) vaccinations has meant that more than 50 per cent of the women coming to our care in Blantyre are in an advanced stage of disease. But it is also rewarding when patients come in for screening and can be treated for cervical cancer.  

What does a typical day as an obstetrician-gynaecologist with MSF entail?  

Each project is very different. Your role will vary by the amount of hands-on work necessary and the need to supervise and train doctors in countries where there are few local obstetricians.

On of my most memorable projects was the maternal and child health project in Jahun, Nigeria. The maternal mortality in Jahun is very high. Approximately 70 per cent of the admissions are women with obstetric complications like hypertensive disorders of pregnancy, antepartum and postpartum haemorrhage, obstructed labour, ruptured uterus, severe anaemia, and all the “textbook" complications.

I would start the day doing a ward round of labour and delivery, the high-dependency unit, and the antenatal and post-natal wards, with the team of midwives and doctors. The ward round was also undertaken as a training round, and decisions were made as a team. Then the day would get busy dealing with obstetric emergency procedures—this was a busy project with 1,000 admissions per month, so this was a very rewarding part of my day being able to treat mothers and babies with high needs. However, it was also a sad and frustrating part of the job when young mothers would pass away despite of all the efforts of the medical team. 

Tell us about a memorable moment you’ve had working on assignment

You make lot of memories on projects with MSF. One that sticks out in my mind is a girl of 19 years, who will remain with me forever, going home with her tiny baby after being in the hospital for a long time.  

She was admitted with severe anaemia, severe pre-eclampsia and a premature twin pregnancy in heart failure. We delivered her babies weighing just 900grams and 1100grams. We focused on “kangaroo care” [a form of skin-to-skin care] as they did not qualify for incubator care based on our criteria. But their mother was in such a bad condition that she could not breast feed, so their grandmother was taking care of them. Every staff member on the ward helped them by providing milk, clothes for the babies and some nutritious food for the mother. The team nicknamed this patient ‘our Jahun daughter’ as we all grew very fond of her. It took her a long time to recover, and unfortunately only one baby survived. When the mother did recover, it was amazing to see her walk home with her baby.  

Can you give some examples of how working overseas as an obstetrician-gynaecologist varies to your job at home?

Working on MSF projects as an obstetrician-gynaecologist involves working with limited resources, but we follow MSF protocol which is based on standard WHO protocol.  

There are limited investigations available, such as a basic ultrasound machine, but no fancy lab investigation, and there is often no ICU in most projects. Usually there is just a high-dependency unit with a monitor and oxygen.

We are dealing with complicated used cases who had no previous blood work or antenatal care for example, so the way in which we treat patients is very different from a high-income country context. 

This is your 16th assignment with MSF, what keeps you coming back?

I love working with MSF. We get the opportunity to save lives, if not always everyone’s, in spite of working with restricted resources.  

One of my favourite things about working with MSF are that the medical protocols help you to offer evidence-based treatment to mothers, so the quality of care we provide can be far superior to what is offered elsewhere in the region or country.  

It is a pleasure to work with national staff in each project and to know about their culture, food habits, and difficulties in life. I also enjoy that each assignment is different, and the type of emergencies vary. So, you will never be doing the same thing which keeps the job very interesting.

What advice would you give to someone considering working with MSF? 

Go with an open mind without any expectations. Be prepared to learn and respect the locally hired staff as they have seen it all, and they can be your best adviser. Do your best and don’t worry too much about the results, as it can be frustrating sometimes, and you might feel helpless.  

Working with MSF is addictive. After working with MSF for so long, I feel the best thing that has happened in my life is finding that MSF brochure all those years ago.