Webinar: We Are Stronger Together

[00:01:11] Arunn Jegan 

Good evening, everyone. My name is Arunn. I work for Médecins Sans Frontières and I'm very grateful to be your host for tonight's webinar. I hope you can grab a tea or a warm drink and settle in comfortably as we listen to some incredible speakers on the topic of conflict and care and how we are stronger together.

We are meeting at a time where the world feels very heavy. There is more armed conflict in the world than there has been for a long time, certainly more than I can remember. Over one third of MSF's patients are people caught in armed conflict and there are over 117 million people displaced right now. It is a topic that is very important to us and the effects of war on people is often the reason why we are in many of the countries we work in.

I, myself, I'm a Tamil from Sri Lanka and I've worked across the Middle East, Africa and Asia in various communities. And to be honest, the news right now can make some of these wars feel so unrelatable even for me. But especially if we have lived most of our lives in Australia or in New Zealand, or for some of our migrant communities, these crises can feel painfully close and leave us with a sense of helplessness. It can also make the work we do at MSF feel somewhat extraordinary and exceptional. And yes, to some extent that is true. The medical care our teams deliver in war zones in places like Sudan, Palestine or Lebanon is an incredible and challenging task. But the values that underpin a lot of the work we do may not be so unrelatable. It is care. And care is something we all feel, something we all practice. We may care for our elderly parents, we may care for our local community. We might care for people we have never met simply because we believe their lives matter. I know this to be true as we are all here on this webinar today because of this universal feeling, because we care. I believe that care is a powerful motivator. It is a radical force and something the world needs desperately more of. And care can only be done in the only way we have ever known it to be done. And that is together. It is really great that we can be here together today. Thank you for coming.

We will first do a panel discussion with some fantastic speakers and then we'll move on to some questions and answers from the audience. Please feel free to put your questions in the chat and we'll try our best to get to them.

But before we get into it, it is important to note that care is not a new topic in this country. Our First Nations communities have been caring for this land and for each other for over 65,000 years. I wish to acknowledge the Gadigal people of the Eora nation, who are the traditional custodians of the land in which I'm speaking from today. I pay my respects to them and I extend that respect to any Aboriginal Torres Strait Islanders on this call tonight. I reckon there's a thing or two we can learn about care from our First Nations brothers and sisters who continue to survive despite colonisation.

Let's introduce our speakers. We have Dr Khairil Musa, who is an intensive care unit and trauma specialist. Now that is one of the most impressive job titles I've heard. He is also a fantastic storyteller. And alongside him, we have the very experienced Shelley Cook, a nurse and a medical team leader. And a fun fact, she was also awarded the national ‘Graduate Nurse of the Year’ some years ago. That's an incredible honour. Both of their work I have admired at a distance. It feels extra special today that we will get to have a yarn with them.

Welcome to you both and to everyone on this call. So Khairil and Shelley, could you please both briefly introduce yourselves where you worked with MSF and what care means to you? Maybe we'll start with Shelley.

[00:04:50] Shelley Cook 

Thanks Arunn. It's a real honour to be here today.

My previous career was psychology where I was a counsellor for 12 years, primarily with refugees and asylum seekers. Having burnt out, I moved my life to Uganda where I was just volunteering and then found some local work. Upon returning to Melbourne to investigate overnight deafness in my left ear and becoming the very lucky recipient of a cochlear implant that my dad was on the team that helped develop, I decided to study nursing in order to have more opportunities to work overseas. I had three years working with adults, then three years working with the paediatric population and then three years in Manangrida in West Arnhem Land at the top end of Australia.

So then in 2022, I was finally experienced enough to work for MSF. I had my very first assignment in Yemen. I had nine months there working in a huge paediatric neonatal maternity hospital. Then I had three months in Palestine supporting mobile clinics, 11 months in South Sudan, managing the outreach program and responding to a cholera outbreak. And then six months in Nigeria supporting a hospital. And then six months in Sudan opening a new project.

I guess care for me with MSF is flexibility, creativity, a deep awareness of the cultural and historical barriers that people face and the need to navigate that to provide the best medical care to those most in need.

[00:06:40] Arunn Jegan 

Thank you so much, Shelley. You are speaking some words there that really ring true to the essence of what care means. But before we get into that, we'll go to Khairil.

[00:06:50] Dr Khairil Musa 

Thank you. What a tough act to follow Shelley, so accomplished. My name is Khairil. I'm an intensive care specialist with a special interest in trauma and burns. An intensive care specialist for people who don't know means that I look after patients who are very unwell from car accidents, from terrible infections, all sorts of things and who need typically support for their organs that are failing. I also work quite a bit, especially in the MSF setting in the emergency department, as well as in the operating theatre to support the teams that are working in those areas.

My MSF journey started in 2019 at the end of it. And then suddenly this thing came to the world called COVID. I was sent off on my very first deployment to Yemen to help set up a COVID-19 treatment centre in ICU. And that was a very eye-opening and frankly traumatic experience because of lots of different challenges. But following that, I then worked at a trauma hospital in Aden, Yemen. And then later in the same year, I was then deployed to Baghdad, Iraq to also help open a COVID-19 treatment centre. I then took a little bit of a break and then went back to Afghanistan for three times in total, actually over two years to work at MSF's trauma hospital in Kunduz. Most recently I was there towards the end of last year to help with the setup of a major burn unit that we were opening there.

Since being back, I've been working with MSF to help develop a trauma curriculum that we're hoping to implement in lots of different settings worldwide in places where many of our doctors and nurses don't have access to specialist training programs. So we're hoping to be able to increase the experience and the knowledge of the teams that we're working with there. And here I am today, talking to Arunn and Shelley, very excited for the talk today.

[00:08:54] Arunn Jegan

Yeah, fantastic. And I think both your experiences really have some differences and some similarities. Shelley, I really appreciate that you're sharing about your own personal journey with how care has motivated you to join MSF and the humanitarian world. And Khairil, I think that deep experience in that intensive and trauma scenes that you're in, you can really speak to a part of the world that we may never be able to see. So really appreciate you both being here. Khairil, maybe we'll start with you for one of the questions. So you've worked in, as you said, COVID, this thing that came around, COVID intensive care units, trauma hospitals, Afghanistan, Yemen, Iraq, and even helped open a burns unit. And I'm sure you have plenty of stories, but could you share one patient story or moment that really shows what care looks like in MSF?

[00:09:43] Dr Khairil Musa 

Yeah, there's so many, I think, that come to mind. I guess one thing that I have noted in terms of what the idea of care is, has changed over the years that I've worked for MSF. And I think coming from a very well-supported and healthcare system like Australia, I'm used to having basically lots of different tools, lots of different equipment, access to lots of different specialists. And many of these things aren't actually available in the settings that MSF work in. And for me, that kind of idea of care changed from being used to having lots of data and having lots of people to help to sometimes just realising care can be as profound as just being with someone and holding their hand as they're dying. I think that's something that I had to learn quite quickly, in my journey for MSF.

One patient story that does come to mind is when I was working at the trauma hospital in Aden, Yemen. I remember it was during COVID and I do remember there was a father who brought his child to the emergency department and the child was badly burned. Not every hospital is able to manage burn patients because burn care is actually quite specialised. It requires lots of different resources, equipment, but also specialists to be able to look out to burn patients properly. And the sad thing was the father had travelled through all the different hospitals in Yemen, in Aden, and was refused basically. And the reason saying that they're not equipped to be able to manage the level of burn the baby had. I remember him coming to us and we weren't set up as a burn unit, but I came from a burn unit in Australia so I did have some idea of how to be able to manage it, but it was also a tricky situation because the child was so unwell. And I did say very frankly to the father, I don't know, we're not quite equipped to do this, but I'm going to try my best to try and work with the team to look after your son. I think the thing that struck me is when he said, it's better that you try than for him to die at home. And actually that was very a tough case. We looked after him in the ICU for a prolonged period, but thankfully he recovered and was discharged from the hospital a few weeks later. And that's really testament to the work of the team. I think that sometimes care is doing things that you don't feel comfortable doing, but knowing that there's no other option. Many of the patients and people that we treat and the settings that we work in are in those situations where they are desperate. And I think for me, it's just trying to do the best we can in a very dire situation.

[00:12:33] Arunn Jegan 

Yeah, it's a very powerful story, Khairil. And I think what comes to me is that we're talking about Yemen, a real place that had a brutal civil war happening for many years. But what struck me is that your response was almost such a basic response, which was just to be there for people, just to hold the hands of someone who's passing on to have that conversation with the father, and those are all very relatable conversations, isn't it? Just a loved one trying to do their best for the child. Khairil, thank you for sharing that perspective.

Could you share a little bit about what was going on around you at that time in Yemen?

[00:13:17] Dr Khairil Musa

Yeah, so I was in the south in Aden, and Yemen was going through a civil war. And that effectively split the country into the north and the south. And it was also actually at the same time that COVID was happening. I do remember before being deployed to Yemen hearing about it and being described as one of the world's worst humanitarian crisis. So the things that we were seeing, not just war, poverty, there was significant outbreak of cholera, lots of infectious illnesses, then COVID came, and that completely devastated the region. They weren't able to access much of the equipment and resources required to sustain the hospital that we were running in Aden at the time. And then realizing the need for a COVID treatment centre, we then mobilised the team to open the COVID treatment centre, again, under desperate situations. Some of those challenges continue till now, unfortunately, due to, as you said earlier in the talk, the kind of instability that we're seeing a lot worldwide at the moment. So I think we're doing our best to try and kind of, I guess, do the bits and pieces that we can, but it is a huge challenge, I think, and we want to continue.

[00:14:40] Arunn Jegan

I always thought about Yemen, because I worked in Yemen prior to COVID happening, and I wondered how it was going to affect, but yeah, thanks for sharing that story. Okay, so I'll move on to Shelley right now. So Shelley, you've worked in remote communities in the Northern Territory, and then with MSF in Yemen, Palestine, South Sudan, Nigeria, and Sudan. Is there a patient story or a moment that really struck you of what care would look like?

[00:15:05] Shelley Cook

The thing that comes to mind the story, I guess your first assignment's always special, because it's the biggest learning that you do in the shortest period of time. And I think mine was also Yemen, but it was in the north, and we're about 40 kilometres from the front line. And then there was a ceasefire. Suddenly, we had two months where the fighting would stop, and we saw a huge increase in malnutrition. So we already had a malnutrition centre. Malnutrition was already an issue in Yemen, but we saw a tripling of our patient numbers. And there was, so we had two children to a bed, beds all squeezed together. It was a huge learning curve for me. I'd never seen malnutrition before.

I was called to support the nursing supervisor and paediatrician, because we had a three-year-old, Mohammed, he had the malnutrition, but he also had pneumonia that wasn't responding to the antibiotics. And the father had arrived, and he wanted to take the baby off the oxygen, stop the treatment and take him home. So with this amazing medical interpreter and me, we talked through, and it was when I got the biggest insight into the challenges that people are facing and the decisions, these impossible decisions that they have to make. So they travelled from a long way away. That was one of the issues. But the mother had come with Mohammed, which had left another eight children at home. So then the father, men aren't caregivers in Yemen society. His sister had come because there were no grandparents. They'd all died in the war. His sister had come, but she'd come with her six children, which meant that then the house was overcrowded. We already knew that malnutrition was an issue, food security was an issue. It just struck me how difficult it is.

It really felt like there was no hope in talking to him and explaining. I'm a woman, I'm wearing the hijab and the abaya, the dress, but women there wore the niqab. So already I wasn't quite conforming and asking, begging him for 24 hours of extra time to treat his little boy to see if we could get him off the oxygen. We were able to, by being very patient and listening. I think he got that I suddenly had a deeper understanding of where he was coming from, but I was still asking for that 24 hours. In the end, it was the fact that I was MSF, that we'd been there for 10 years. We had community health workers working with community leaders. We were working with all the authorities and we were trusted. So standing there saying, "I understand what all of your barriers, but still please give us 24 hours." We managed to get him off the oxygen. In the end, because he was off the oxygen, dad gave us another 48 hours. It was a big learning for me on a whole range of levels.

[00:18:56] Arunn Jegan

The amount of trust and the amount of empathy that's required for both parties, for yourself and for that patient that you mentioned is quite an enormous thing to happen, especially with all these external forces like instability. When you said malnutrition, it's not just people hungry, it's when systems have fully collapsed that it's a real serious illness. That is something quite jarring when a country or city reaches that point where there's this widespread malnutrition.

One thing that comes through in both of your stories is that care doesn't really happen in perfect conditions. And MSF, our teams, we're trying to provide that care when health systems are overwhelmed, when communities are displaced or when healthcare is also under threat. Now we've talked a little bit about how the volume of war is increasing and the volume of displacement is increasing. I think it's important for our supporters on this call to hear a little bit about what often stops people from getting the care they need. And I might go to Dr Khairil first. In our previous conversations, you've talked a little bit about the targeting of healthcare workers and facilities. What does that mean for you as a medical practitioner in the field?

[00:20:10] Dr Khairil Musa 

It's tough. I think about, for example, the Ebola response that MSF is part of at the moment. Ebola, as many people know, is a highly fatal disease. I can't talk about myself because I haven't been to an Ebola project, but it takes a specialist kind of someone to be able to put themselves in a situation where they are being faced with a threat to life, essentially, and that's just considering the disease alone. It does feel like in the six years I've worked for MSF, the kind of instability, but also the uncertainty that kind of happens when you are being deployed to a very high security context is becoming trickier.

I think about Kunduz, where I was last year, and on the 3rd of October last year, they commemorated the 10th year anniversary of the bombing of the hospital in 2015, where 42 people were killed. I think about 20 of them were staff, patients, caretakers. You're seeing in the news now, this sense that more and more healthcare facilities are being targeted and people that are wanting to do the work to care and not being able to do it because of external forces that they can't control. That's a very heartbreaking thing to come to terms with.

In terms of even personally, I do remember this very distinct moment before I was deployed on my first mission to Yemen, in 2019. I've got a friend who's a lawyer and I told her where I was going, she said, oh, you'll be fine. They don't target hospitals, that would be a war crime. I kind of carried that sort of sense of like safety. I don't know, maybe perhaps foolishly over the deployments at MSF, but I do remember it quite distinctly last year when I went back to Afghanistan, oh, okay, that sense of security feels different.

You're having to now weigh up that kind of risk while still wanting to do the work because the work is ongoing and is perpetual and it's important. I sometimes, not so much maybe for me, but for my family, but for my friends that kind of care about how I'm doing sometimes, I don't know if that risk is too much. And I think that's one of the barriers that I think that does come with the work that MSF does to the fact that maybe we can't kind of ensure the safety of our healthcare workers. And that's quite shocking, quite sad to me.

[00:23:04] Arunn Jegan 

Khairil I think you're absolutely right. Maybe later on, we'll talk a little bit about how we manage security and safety because it's a big point that you've just mentioned and important for us to talk about that. Things have changed. I'm a head of mission in the field and that's when my job is to manage security. I can see that the patterning against targeting of health workers and humanitarians, it's a pattern now, it's not just incidental. So something for us to keep in mind when we're working and make sure we do our best to manage it.

Shelley, we've got a little bit of time left for a few more questions, but is there something from your experience around the different kind of barriers that patients face even before they reach MSF? What are people going through in their countries that stop them from receiving healthcare?

[00:23:57] Shelley Cook 

Thanks Arunn. They're so varied and each context is different. I mean, in Hebron, in the West Bank and Palestine, people couldn't reach us. They physically couldn't, they couldn't pass the checkpoints, they couldn't travel the distance. It was so far, or they were stopped by settlers trying to reach care. And so we ran mobile clinics, MSF adjusted and ran mobile clinics. It was the same in Malakal in South Sudan. We did outreach because people… it wasn't safe enough. There were so many different violent things going on that it just wasn't possible. I mean, there were cattle raiders as well as the tribal wars. So it was, in the end, we had to adapt. Distance to healthcare is a really big one.

But even things like lack of vaccines and lack of contraception, which then has a flow and effect to mean that people need the care more or more urgently. And then they have to make these really tough decisions about how they're going to reach healthcare and reach us. Mahram law in Yemen, means that a woman can't travel without a male relative, is a huge barrier. Checkpoints, ongoing conflict, food insecurity, trauma that people have already had, multiple displacements. I think there are so many different factors that mean that people really struggle to reach us or reach us in time.

[00:25:38] Arunn Jegan 

Shelley, that's a very important point. And someone has written a question in the chat and a trigger warning for people on the call. Sexual assault is rife in Sudan. Do girls and women present to MSF? And what are the unique challenges in helping sexual assault victims? If you can speak to that a little bit, Shelley, if that's possible. And also talking a little bit about, care is never done alone. It's done by many people. So if you can speak to a little bit about who also supports the work that you do when you're there.

[00:26:19] Shelley Cook 

In Sudan there's an incredible amount of sexual violence. In South Sudan also, we treated a lot. I guess we've been talking about the targeting of hospitals and healthcare facilities. Sexual violence as a weapon of war is only increasing. The treatment within that important 72-hour window, so that they can get the full package of care is really, really tough. Gender-based violence is huge.

In terms of the people that contribute, probably the best example I have is Malakal, where in one week, we took an empty field and created a 100-bed cholera centre. It takes incredible commitment and hard work and long hours from absolutely everybody. Drivers, logisticians, cleaners to keep everyone safe once it's up and running. Doctors who just drop everything and come off night duty and dig in. I was supposed to leave and go home. I'd been there 10 months, and I had one week to go and then cholera happened. I said, I'll stay, of course. Everybody contributes in so many ways, including the community healthcare workers who go out into the community and work with the community leaders and let people know how to keep themselves safe. It's absolutely everybody.

[00:28:08] Arunn Jegan 

When you work with that kind of speed and efficiency, building a hospital in a field in such a short amount of time, how has it been to work back in Australia again when you've seen that?

[00:28:27] Shelley Cook

I think I have almost personalities. Somebody said, how do you deal with the, they called it human rights restriction in terms of wearing a hijab and abaya and it's just, I have one mindset for where I am. You just do what has to be done. And then you come back and you, the re-entry is always the most difficult part of the whole process because suddenly you're in supermarkets with all the choice. I remember bursting into tears in the supermarket because little button batteries that we needed for glucose machines to check the baby's blood sugar weren't available, we couldn't get them. Then there was a row of them in like the confectionery aisle before you got to the checkout and it was the poor checkout woman was worried. It's one of those normal things that re-entry is tough.

[00:29:28] Arunn Jegan

Absolutely, I appreciate you sharing that. And you're right. We are guests in the countries that we go to and it's a very privileged for us to be there we respect the laws, traditions and cultures that are there and we provide our care as best as we can. So thank you, Shelley. And Khairil, maybe if you would like to share a little bit about the people behind the care that supporters on this call may not always see any.

[00:29:51] Dr Khairil Musa

Yeah, so many, like Shelley said, many, many people are involved in making MSF happen. I always think about one of the doctors I've worked with in Yemen, he was in charge of the antibiotic stewardship program and what that means is basically what kind of system that's set in place to use antibiotics appropriately. Antibiotic resistance is a big problem that we're dealing with in many places. This doctor was in charge of this program, and I remember him being one of the most brilliant people I've actually met. That counts in all the other places I've worked in both in Australia and the UK. He would come to the ward round having read this very recent study or research about this antibiotic and just we've always had these very intellectual discussions. I remember asking him one day: "so you're brilliant, you can easily work in Oxford in any of the esteemed institutions around the world and why don't you leave?" I was curious because again, Yemen was in such a tough place at the time. I remember him saying, "my duty is to my people." I just remember feeling so humbled by that response because we do the work and obviously, we get to go to these incredible places and meet incredible people and experience the culture, but that does come with a ticket out and many of the people that we work with don't have that option. Many still choose to remain because of the duty that they have to their people and the kind of burning passion to want to make things better. That kind of hopefulness and that kind of passion is really quite inspirational to me.

That's part of the kind of beauty and the reason I think many of us like Shelley return to work for MSF because we get to meet people like that and be inspired by their love and their passion and their drive. I think about him a lot.

[00:32:04] Arunn Jegan

Absolutely, absolutely. And I wrote down the word, what makes an institution respectable? And the way you've talked about Yemen tonight, Khairil, when we talk compared to Oxford and other areas, like it sounds like you've had an experience in Yemen that you would never ever get in some of the more traditionally esteemed institutions. You know, incredible. Wow, okay, great.

We are halfway. So I think it'll be nice for us to maybe move towards the audience.

But before we do that, I would like to ask one final question. So everyone joining tonight, they're supporting MSF work in some way. So when people donate to MSF, what are they helping make possible? We can quickly go to Shelley first and then maybe Khairil afterwards.

[00:33:00] Shelley Cook 

They make MSF possible. The thing that really strikes me with MSF is that because the money doesn't come from government or corporations, we can live to our principles. We can be impartial, we can be neutral, we can be independent. And really in every assignment, I've relied heavily on that for my safety, for the decisions that I'm able to make in the field, because we don't take sides. We really, we treat patients based on their medical need. And it means that we can stand there and say, no, you can't take that. And we've already set up all the networks to make sure that everybody knows that we're neutral and impartial and independent. We treat everybody based on medical need.

[00:33:59] Arunn Jegan 

Absolutely Shelley, the amount of times I've used that when I've negotiated access into places like Syria and Yemen, people do want to work with people who are not party to the conflict. And we fill that role very well. Dr Khairil, is there anything you'd like to add to that?

[00:34:18] Dr Khairil Musa

One very recent example of my own, I said earlier that I was in Afghanistan at the end of last year to help open a major burns unit and I also mentioned earlier how highly specialised burn care is. That's still an area that MSF is hoping to develop. Actually many of the contexts that we work in don't have access to high-quality burn care because it is so expensive and so resource intensive. When we were opening this  major burn unit in the north of Afghanistan, it was I think the fourth major burn unit in the country. Afghanistan is about twice the population of Australia, just to put that into context. Australia, I think has got 13 burns units. And before we opened our project, they had three. For the people that were living in the north, they had to travel sometimes 10-12 hours to get to Kabul or Herat, which is where the burns units were. With the donation that MSF received, we were able to establish this project. Basically, it's a need that was recognised in the country that was lacking and we were able to meet it. It still has a long way to go. We're hoping to be able to open more burn units around the world. But that's a practical example of how the donation is actually helping us help people. That's I think really, really incredible.

[00:35:47] Arunn Jegan

Thank you Khairil. One of the things that struck me with Afghanistan, I worked there as well, there's been so many different stages of the conflict, and we've been able to work in each stage of this conflict and treat different parties to the war of civilians and others. Because we were independent, our access was somewhat accepted by all the parties moving forward.

Thank you both. That's the end of my questions. I'll go to some questions from the audience. Thank you both. This is the perfect place to bring in the questions, from the audience.

We have heard tonight that care is practical. It can be small, it can be big, it is emotional, it is rich with stories, and it is best done together. So we'd love to hear from everyone now about what questions you all have. I can notice that we've received a lot of questions about how people can support MSF. If you'd like to support us financially, you can use the link you can see in the frame, one of the frames for the Australian link and the New Zealand link. And there are other ways on our website too. Another great way to support MSF is to share this webinar with your network.

My first question is from Rebecca, and it is to you, Shelley. It is something we touched on earlier: “How is safety of staff and patients managed in these conflict zones?”

[00:37:16] Shelley Cook 

It's an excellent question and it's incredibly complicated. MSF has been around for more than 50 years. And we've learned, we have very strict security protocols and procedures. And we know, as soon as you join MSF, you're told if you break a security rule, you've endangered everybody and you'll be sent home. It's taken incredibly seriously. We also have things like having watchmen at the gate. In Yemen, it's traditional for men to wear a knife around a belt in their middle. Everybody knows at the gate, they have to give up their knife, it goes into a locked trunk and they can get it when they go back. It's also based on the context and every context is different.

Independence is also protection. Less and less so, in terms of the attacks like Khairil was saying on healthcare workers, but it's still a huge part of our protection because we don't get involved in the conflict at all.

[00:38:33] Arunn Jegan

Absolutely, and I often found that if we have high quality medical programmes that listen to the community, that negotiates access well, a big flag on the top of our hospital, it's usually the best protection that we can have in a place, but of course, there are things like road traffic accidents, robberies, stray bullets, and those things need to be taken care of as well. And there are very practical things that we can do, as you've mentioned, Shelley, in your response.

We'll go to a question from Joy right now, and maybe Khairil, you can answer this: “How do you keep grounded when working in such difficult, unsafe, and emotionally charged circumstances? Does the suffering and sadness side of things overwhelm you at times?”

[00:39:24] Dr Khairil Musa

Good question. Simple answer to the second part. Does it overwhelm me? Yes, I think it can continue to overwhelm me. That's kind of one of the key things that I keep in mind. I remember a very wise humanitarian worker once said to me that once you stop feeling, it's when you have to stop doing the work, because your humanity is actually what sustains you. With that humanity, it doesn't mean that sometimes you're exposed to very traumatic things.

What I have learned over the years is that I have worked for MSF, not just in MSF, but also in my career as an intensive care specialist, as you have to have your ways of dealing with that. For me, in MSF, we always have a gym, which is nice. You can do, you know, some weights and a bit of yoga. We always have internet access. You can always, usually, most of the time, that's not super reliable sometimes, but generally. You can always reach out to your friends and family back home sometimes, you know, just talking about things that aren't related to the things you're seeing is quite nice.

Probably an important thing that sometimes probably isn't spoken about enough is psychological support. That's actually really crucial. MSF has got a very, very incredible, team that helps support us when we, you know, before deployment and during deployment and after, and I certainly owe them big thanks for helping me be healthy, because it's not a normal situation that we're encountering really. Therefore, then you have to kind of figure out your strategies to keep yourself healthy. So that's some of mine.

[00:41:16] Arunn Jegan 

Nice, yes, good tips for life in general, but also it sounds like it has really helped you in working for MSF as well.

Two questions came in through the live chat. One is: “How do you all stay so positive and how do MSF staff detox? And are you forever changed through your humanitarian work experience?” Shelley, I'm going to throw you a curve ball here and see if you can answer that one.

[00:41:50] Shelley Cook 

I think the last part of that question is easy. Yes, I'm forever changed. Every context I go to, I'm changed a bit more. My worldview has hugely expanded. I considered myself quite well informed, but I'm going to places I would never get to go if I was just a paediatric nurse in Australia. They're not holiday destinations. So to be able to go with all that security in place and to be able to make a difference, it means that I'm lighter. I feel more comfortable in my own skin when I'm doing the work of MSF. 
And I've forgotten the first part of that question, sorry.

[00:42:36] Arunn Jegan

How do you stay so positive in all of this?

[00:42:38] Shelley Cook 

Because you're with a team of people who are all so passionate, shared values. As a visitor, you know that you get to go home and people are still working in those conditions and nothing compares to that. It humbles you in a way that means that you, I guess, like Khairil was saying, it gives you a different perspective in terms of the relativity of what's important and what's not. When you step back, you can be positive.

[00:43:25] Arunn Jegan 

When you talked about the teams on the ground and some of my closest friends now are from people that I've worked with in Bangladesh or in Yemen or in Syria. In my position in the organisation, I don't speak to the community as much as, you know, people who are working in the projects. I work in coordination and usually in the capital. And it's so important for the team to get along. And as you said, like in conflict zones and when people are going through a hard time, just knowing that you're there for a population, going through what might be one of the most important periods in their life, whether that be traveling through the Mediterranean as refugees or in a refugee camp, this is a very important period in their life. And knowing that you and your team are there with them during that moment has forever changed me as well in ways that I can explain and in ways that I probably might not be able to explain here as well.

So one question we have from Uyen, they've asked: "How do you move staff equipment and materials to all the places you provide healthcare, particularly regions with challenging safety and infrastructure?" And this is a side comment, "I've always been in awe of the logistics efforts." That's from Uyen, not me.  Shelley, would you like to talk a bit about that?

[00:44:59] Shelley Cook 

The logistics team, when I first joined MSF, somebody said to me, "The logistics team will be your best friends." And far out, their job is very, very difficult. From packing up a ute to running a mobile clinic, hours and hours away in Palestine, to creating that cholera centre, that 100-bed cholera treatment centre in South Sudan, they do an incredible job. There are small things that I think people don't realise. Like in Yemen, there's a distrust of foreigners. We would have containers finally arrive from Bordeaux full of medical equipment and medicine that we desperately needed, and it wouldn't be released. It was part of the logistics job to try and negotiate with authorities and with the head of the project and try and get those released, they're so creative in finding solutions for things. It's incredibly difficult.

[00:46:13] Arunn Jegan 

You know, when you were talking, I remember of an experience in Syria. We were working in the northeast of Syria, which was contested by three different armed groups. You've got the Turkish government conducting assaults there; you've got Syrian Defence Forces going there; you had the Islamic State at one point. It was a really difficult job to manage that. The border for where we got our supplies in through would close on any given day. We had to kind of preposition stocks in three different locations, just in case one route wasn't able to go. That's a very expensive endeavour, and we have to make financial decisions around how much stock we leave there and  a lot of the drugs that we use are also requiring cold chains. It's not just putting things in a warehouse. It's a cold, specified room, needs to be kept at a certain temperature. If they don't, if we don't reach that temperature, then we'd have to throw them out.

A lot of things need to be decided upon in the best of circumstances, but then take a country that might not have electricity, that might have to run on generators, and then war happening around you, it makes for a very, what, interesting job for the logisticians, they're incredible people, but also a very difficult one as well.

Khairil, do you have anything to add to that from your experience?

[00:47:40] Dr Khairil Musa

I was in awe, when Shelley mentioned your first mission kind of being a very life altering situation. When I arrived in Aden to help with the COVID-19 treatment centre, we arrived at the same time as the logistics team, and I saw pretty much next to me as I was treating patients, toilets being built and rooms being built, electricity being connected, oxygen being connected, and just again, seeing a side of the work that I was never privy to working in Australia because you work in a hospital that has all these shiny important bits all kind of ready for you two to use and it is quite a remarkable machine, that MSF has in place. People think of the doctors, but the doctors are just very much a small part of the machine. We actually have so many people that are involved in being able to do the care that we get to do, and logistical, HR, administrative, finance, supply, all these different teams that are working desperately hard to make me be able to actually treat a patient, that's quite an impressive thing that I'm always in awe of.

[00:49:08] Arunn Jegan 

Thanks Khairil, yeah, that is quite impressive.

We've got a question, and we might change track now because Alison has asked a question: “MSF used to promote bearing witness” I'll correct you, Alison, we still promote bearing witness, it's actually core of our job, but Khairil, while I've got you here, “how does this apply in a world where your workers can be accused of spying?” That's a very interesting question. I'm sure it's something you might have thought about. Do you have any reflections on that question?

[00:49:44] Dr Khairil Musa

Yeah, it's a tricky one. Part of the specialness of MSF is, again, that independence and neutrality, because we don't have funding from governments. I hope that when people hear about the stories of what we see in the field, that you realise that it's a true account of what we're experiencing, and as wonderful as it is that we get to have this chat here, it'd be even better if it was a Yemeni colleague or a colleague from Afghanistan that gets to share their stories and the things that they're seeing, but unfortunately, the circumstances are such that that's not possible. Therefore, the bearing witness part is actually something I carry very deeply, and I think is a very, very big responsibility of our work. I do hope that people realise that that is something that we do. Of course, sometimes there are constraints against our ability to do that, but we still try, we'll still try our best. Some of the kind of political things that happen in the context.

I try not to kind of be too caught up in that, because to me, ultimately, my job is to look after patients and to try and train the team that I'm working with and try to create a sustainable infrastructure that can continue beyond the time I leave. As long as we have that shared value of wanting to just look after patients, that rises above a lot of the other noise that sometimes you might get lost in.

I do still believe that now that I'm not in Afghanistan, I'm here, I get to talk about the people I've met in Afghanistan and the work that we get to do there, and I see that as important as the work that I was doing in the field.

[00:51:38] Arunn Jegan

It's really important for governments and people and the media to hear from people like yourself and Shelley. You work there, you can testify the good work that we're doing, we're sticking to those principles that you've just shared. I really appreciate that, Khairil.

There's a question from Omer, who is a little bit linked to this question, and I might have a go at answering it, which is: “How do you strike the balance between working and collaborating with governments that may actively reject or thwart your efforts whilst also calling those governments out when appropriate?”

And this is where that tension comes into play, right? If they're calling your attempts to keep governments in line out and then they start accusing you of spying, how do you make that balance?

I think that's just the job. And the honest answer is, I think it depends on the problem in front of us. Thankfully, as you said, as we both have mentioned, that we don't take government funding for the vast majority of our work. So our interactions with governments are not about money and they're often about access into a country, permission to operate, the negotiating space for our medical teams or advocating for some change to take place. But that ethical question is real. How do you collaborate with governments or authorities or armed groups whose actions may actively be against humanitarian values? Now, that can range from armed actors who are widely condemned to very bureaucratic governments to so-called friendly countries like Australia, where we may strongly disagree with some of their policies, such as offshore detention or their position on alleged war crimes or crises.

So what do you do? That's a very generally a very difficult question. As you mentioned, Khairil and Shelley, you've got to start by making sure your own values are strong. And for MSF, we're talking about humanity, we're talking about impartiality, neutrality and independence. These principles are not just nice words. They're actually how we try to make our decisions when the politics are around us are very difficult. Then you have to bring it back to the patients and the communities. What do people need? What are they asking for? What are the risks they're facing? And to understand that properly, we have to listen to them and make decisions with them. In practice, we're often trying to make these decisions on two levels.

First, we need to provide enough access to provide medical care. But secondly, we also need to retain the ability to speak out when people are being harmed or when those conditions are being deliberately undermined or our care is being deliberately undermined.

On a more human level, it helps us to remember that these actors, they're not always static blocks. Governments are made up of people. Institutions are made up of people. And people are processes. Most of the time, the person you're trying to influence did not wake up in the morning thinking: I want to make MSF's life difficult and make people suffer as a result. You know, in my humble experience, it's usually not that case. There are definitely those types of people. I say this with the biggest pinch of salt possible. But you try to find common ground where you can. You try to keep the door open where it's useful and you speak clearly when you must.

I do think it's getting harder and harder. The politics around humanitarian work are becoming more difficult. And that prompted probably Alison's question about being accused of spying. This is probably where ourselves as MSF workers and supporters have an active role in promoting humanitarian work and principles. It's a space we cannot neglect. It's a space that really is important for people for all the reasons that you've heard today. That would not have happened if there are misinformation, disinformation campaigns against humanitarian workers.

So, yeah, that's the job. And if you're interested in in helping us figure that out, come in work for us as well. We'd gladly take you on board.

We have time for maybe one more question. We've got about three more minutes left and maybe this is a question from Shampa: “What steps do you take to build foundations for sustained health system strengthening and reform beyond the crisis period?” I'm going to throw this one to Shelley as a medical team leader who has been working in projects there.

[00:55:57] Shelley Cook

It's really difficult. The minute we open a project, we're looking at how we would leave it. So it's about the networks that you build, the capacity building that you participate in with all of the staff. Often that's the legacy, like you're increasing the skills, you're making sure that the Ministry of Health staff that you're training so that when MSF leaves, they're still there. There are some contacts we've been for 20 years and there are some where we can come and have quite a strong impact and then hand that over to the Ministry of Health. So I think it really it's in the forefront of our thinking from the very moment we decide to open a project. It informs all of our decisions to make sure that people have the best skills and abilities that they can possibly have.

[00:57:03] Arunn Jegan

That's really important. And if I go to Khairil now, you opened up a burns unit and you worked in these facilities. How was that process for you when you were opening these facilities?

[00:57:15] Dr Khairil Musa 
It's as Shelley said, I think we kind of function in parallel because it's not only just about the kind of immediate clinical care that we're providing, we're always thinking about how it can be sustainable. That's done through lots of different means. A lot of it is about the capacity building, like this kind of phase where it just essentially means that we train the national teams to be able to do the work that that can continue even beyond when MSF has left if that was the situation.

There's also other means I talked about this curriculum that we're developing with MSF Belgium. That's another way where we're trying to create sustainable infrastructures, because we do appreciate that lots of places that that MSF work in don't have an education system, for example, that's self-sustaining or able to train their doctors and nurses to a high level. So then MSF is trying to address that need as well. It's not just about the boots on the ground type work, which is obviously a big part of what we do. We also are trying to think quite laterally and in parallel, try to create these sustainable systems. We're hoping to keep being able to do that.

[00:58:36] Arunn Jegan

MSF is increasingly using partnerships as a good model to help that sustained approach.

Thank you to the both of you, because we are at the end of this webinar and we have had some incredible stories from you, both Khairil and Shelley. I can't thank you enough for your time, your dedication, and for teaching us a few things about care that I've written down. I personally have taken lots of notes and I, you know, give you both a standing ovation, but that would be quite strange as I'm already standing. I'm alone here in the room. I don't need to paint that picture.

I want to thank you all as well for the audience as well for taking the time out on a Tuesday night to attend this webinar and for your continued generous support to MSF and the people that we work with. Please do donate to us. It's the right time of the year and it's the best way to be part of the great work that you've had tonight. Your contribution goes very far. It's the very reason why I work for MSF because of our independence. It makes my job a lot easier when I'm negotiating with armed actors. That is made only possible because of you. So thank you. And you can find all the links on the screen and in an email that we will share.

Another great way to support MSF is to share this webinar with your network. I started off by saying that we are all bonded by common thread, that we all care. And I'd like to close this webinar by wishing you all well.

Take care of yourselves, take care of each other. And I look forward to the moment we all meet again.

[01:00:04] Dr Khairil Musa

Thank you.

[01:00:06] Shelley Cook

Thank you.