Working with MSF: Essential Criteria Deep Dive

Alexandra Brown: Welcome everyone and thank you for joining us today. On behalf of MSF Australia, I would like to acknowledge the Gadigal and Wangal of the Eora Nation as the traditional custodians of the lands upon which I'm meeting with you today. I want to pay my respects to their elders past and present for they hold the memories, traditions, culture, and hopes of Aboriginal and Torres Strait Islander peoples of Australia. This land always was and always will be Aboriginal land. Kia ora too, to our audience from New Zealand today.

Whether you're actively considering applying to Médecins Sans Frontières (MSF) or are still exploring what working in humanitarian context really involves, this webinar is designed to give you a realistic picture of what MSF looks for in recruiting international staff, our essential criteria, and more importantly, why we ask for it.

We use the word essential very intentionally. These are not nice to have.

Ensuring candidates meet the essential criteria enables MSF teams to function safely and effectively in some of the most challenging contexts in the world.

To bring this to life, I'm joined by two highly experienced colleagues who've worked in multiple MSF projects, Kate Charlton and Jennifer Craig.

Yes, we've had to make some agile lineup changes today. Kate and Jen have stepped in at very short notice to replace Sam Templeman and Lucy Butler who send their apologies as they both have independently faced small emergencies that meant they could no longer join us. We're immensely grateful to Kate and Jen and you're in good hands with both of them.

We'll be discussing how MSF's essential recruitment criteria resonated on assignment for Kate and Jen, and the role of being flexible and adaptable in fulfilling those criteria.

We'll also open the floor for questions in the last 15 minutes. So please put any questions in the chat and we'll do our best to respond to them then.

Now it's time to introduce Kate and Jen.

Kate Charlton is a midwife from Cairns, Queensland, currently undertaking her 13th assignment with MSF. She has worked across humanitarian contexts in Palestine, Myanmar, Sudan and South Sudan, Pakistan, Ukraine, Afghanistan and Ethiopia.

Kate has held senior clinical and leadership roles including midwife activity manager, nursing activity manager, project medical referent, deputy medical coordinator and medical coordinator. Her work focuses on strengthening maternal healthcare services and supporting local teams in some of the world's most complex and challenging environments.

Jen Craig has built a career with MSF over five overseas assignments, starting as a supply chain logistician in Nigeria. She then went on to work in both Tanzania and Cambodia as a logistics manager, before working as a project coordinator in Cambodia and Palestine. She's now part of the international HR recruitment team in Australia.

Let's start with the foundation of everything we do, MSF's core principles and values. This includes adherence to the MSF charter and the principles of impartiality, neutrality and independence. These aren't abstract ideas. In our projects, they directly influence decisions about who we treat, how we operate and even whether we continue or close or hand over a project.

I have a question for Jen. For MSF, it is important to ensure that all staff are aligned and committed to the humanitarian values of MSF. Can you share a moment on an assignment where MSF's principles really guided or challenged your work? Or just sum up why a commitment to impartiality is so important.

Jennifer Craig: Thanks, Alexandra. Look, I think there's a couple of things that are really important here. And one is that if you are choosing to join MSF, you are choosing to join an organisation that is values driven. And it is important that our values and your values align as this is what drives the work that we do and the choices and decisions that we make. So at our core, we are a medical organisation, and our charter is heavily based on medical ethics and treating the patients who arrive in front of us regardless of who they are and according to their needs. And this is something that really underpins the decisions that we make on a daily basis.

For example, my first assignment with MSF was in Nigeria and I was in the north in Borno State. And the majority of the work that we do in Nigeria is in the north. The simple reason that this is where the need is the greatest. This is where, as an organisation, we have chosen to intervene. And this becomes important to remember if you're applying to work with MSF because in line with this principle, you will be sent where the need is greatest and not necessarily according to your own preferences. So it underpins both your commitment to join this organisation, but also the way that the organisation makes its decisions on where we allocate people and where we allocate the funds that we do have.

Alexandra Brown: Thank you, Jen. So to Kate, can you too share a moment on an assignment where MSF's principles really guided or challenged your work? So why a commitment to neutrality is so important in your eyes?

Kate Charlton: Thanks, Alexandra. Yeah, I can think of quite a few examples actually, particularly, related to areas where you work, where there's conflict in different armed groups. But one example I can give is working in Darfur in Sudan where we actually had healthcare facilities in multiple areas that were controlled by different armed groups. And the fact that we were neutral and we continue to provide healthcare to whoever sought it, meant that we had good acceptance from both armed groups, meaning that we could travel safely between the different areas of control, not just for us, but then also for our patients. When we had to refer patients from smaller clinics to bigger hospitals, from areas of different armed control, meant that we could do so safely. So that's one of the values, in real life practice.

Alexandra Brown: Thank you so much. I'll now go to the deep dive that we promised of three of our essential criteria. And the first one relates to experience working in remote low resource and low-tech settings. A key requirement for MSF roles is solid experience in low resource settings, where you have worked in remote locations with limited staff, shortages of materials and unreliable infrastructure. So Jen, what remote and/or low resource experience did you bring when you first applied to work with MSF? How did that equip you professionally and personally on assignment that first time?

Jennifer Craig: I had a fairly broad spectrum of low-resource and remote experience. My family background is in rural Western Australia. I grew up in the city, but I spent considerable amounts of time in rural Western Australia, where you don't have access to mobile phone coverage or internet and you're used to having to sort of fix things yourself and find your own way. But then I also worked overseas in many, many different contexts, wearing many different hats and had a stint with a different NGO prior to joining MSF in South Sudan for eight months. I came to MSF with quite a broad spectrum of low-resource and remote experience.

And where this really, really helps is we often work in places where you can't rely on the things that you would regularly rely on in everyday life in a country like Australia or New Zealand. You may not have reliable internet. It may go down if you're in South Sudan and you're relying on satellite internet and there's a really bad storm, you may not have access to the internet for a day or two. And it does happen. And so if you're reliant on this sort of constant access to information to be able to solve problems, you're going to struggle a little bit. It's going to be a bit of a tough task for you sometimes.

But also, you go down to your local shops, and they don't have the things that you're looking for and you have to find something else that you can use to make do. So there's a lot of this sort of real flexibility and adaptability that comes into play. And what we're looking for with this criteria is people that are not going to be experiencing this for the first time in a very high-pressure environment where they don't have any of their support networks around them. So we want to know that people have experienced these challenges and this sort of flexible mindset and adaptability from having to operate in low-resource settings prior to joining MSF. You know, good examples that we often use of this, it's in non-medical positions. It's quite common that people come in and they can see all of these things that we could do that could save time and we could put everything online and it would be amazing. But then if you don't have internet for four days, nobody can work. So we rely quite heavily often on paper as well, which can feel a little bit like going back to the dark ages.

I remember very clearly being on a project in Tanzania where we had a very, very big maternity project. And because of supply issues coming into the port in the country, we had a shortage of ultrasound jelly. And so there were multiple meetings about what we could possibly use instead of ultrasound jelly because we couldn't get it. It just, it was nowhere to be found. And so, you know, there are all of these sorts of challenges that you come up against. And ideally you don't want to be facing them for the first time, as well as sort of trying to get your head around everything that MSF is.

Alexandra Brown: I feel like I saw Kate's ears prick out because there's a midwife that's like, what did they use instead of that ultrasound gel? Maybe we'll find out later. Kate, in your own experience, what was that experience that you brought to work with MSF when you applied and you thought, do I fulfil this criteria for a remote or low-resource experience? And how did that equip you professionally and personally in those… on that first assignment, even?

Kate Charlton: Yeah, within Australia, I did work in some rural and remote areas. Also, I worked in Alice Springs, for example, and rural New South Wales. It's very different from MSF. I still think that there is a lot of, it's obviously a high-resource setting still, but it highlighted the challenges you have in the distances, right? And I think that Australia is quite unique for international staff joining MSF because we are used to these really big distances from healthcare for people. So that definitely helped me moving into MSF. But I also volunteered in Papua New Guinea and in Ethiopia in the two years prior to applying for MSF. And yeah, I would really encourage it if people have the opportunity to do so with local national organisations in countries. It's really important, it's really helpful. And it does give you a bit of an idea of what you're signing up for prior to applying for MSF.

Alexandra Brown: So low-resource can actually mean many things. And Jen you touched on some of them, but it can mean the context overall. It can mean the Ministry of Health setup that we're working with within or alongside. It can relate to, be because of some decisions by MSF that we want to sort of work with this and not try to work with more. So yeah, how have you experienced that? You gave us the example of Tanzania, Jen, but in terms of dealing with the challenges or the setbacks and sort of finding a successful way through might be something that you did yourself or with others you sort of found that way through.

Jennifer Craig: I think the example that I would like to give here, and it's not so much a personal example, but it's something that I have witnessed repeatedly both in my prior positions and something that I witnessed in my current position through the Sydney office, is one of the things that people really can struggle with is this idea that we have patients who come to us in the context that we work in, that we could do so much more for if we were in Australia or New Zealand. And this sort of coming to terms with the fact that you might be looking at a palliative solution for somebody that in Australia, you might be able to look at a treatment solution. It can be incredibly confronting and incredibly challenging. And whether you're medical or not medical, these sorts of decisions sit very heavily on an entire team.

It is the unfortunate reality that we don't have the resources at our disposal that we have in a country like Australia, and that has consequences. It's important to sort of be aware of this and to make sure that people have their support systems in place to manage these sorts of challenges when they're on projects, but also when they return home. And I've found this is particularly challenging sometimes for midwives, okay, we'll be able to speak more to that, but in particular, paediatricians, it can be a very, very challenging situation.

But for me, from a personal perspective, one of the, I think one of the interesting examples when I was in Cambodia, we were running a screen and treat program for hepatitis C in conjunction with the Ministry of Health. And it was to show a model of screening and treating for hepatitis C in low-resource settings that could be implemented in other low-resource settings. So of course, the data was incredibly important, but trying to get an accurate population number so that you knew what percentage of the population that you had screened in a country that doesn't have really clear population records and in an area of that country where the population are quite fluid and often move over borders to be able to access work opportunities was incredibly challenging.

I would sit there with these documents and I would have four or five different population numbers and go, well, how are we possibly going to know what percentage of this population we've treated when we don't even know what number of population live in this village to start with? So, you know, it's sort of dealing with those sorts of challenges and ambiguities. And it can be very, very interesting, but it takes some flexibility in thought.

Alexandra Brown: Kate, what's your experience of, again, challenges or setbacks for whatever whatever the constraints were and how you worked through those and again, possibly worked through them with colleagues or, you know, members of the team or even the community?

Kate Charlton: Look, to be very medical, there's definitely medical equipment you often wish that you had. I mean, Jennifer touched on it for her midwives and paediatricians not having a simple, you know, breathing circuit called a CPAP for a newborn baby is incredibly frustrating. It's very lifesaving, very simple, and it's something that we rarely have access to. But maybe I think it's important also, Alexandra, to zoom out that, you know, low-resource means a lot of things, not just what you have in your hospital or your clinic, right, it's also things like water infrastructure in the countries you work. So dealing with disease outbreak is so much more complicated when you don't have safe water infrastructure already within a country.

I mean, from a personal perspective, something that I find challenging and a little bit selfish is, you know, we often work in these countries that are under an emergency, whether it's a natural disaster or conflict. And so even the systems that were in place have broken down. So things like getting a visa or a permission to travel from a state to another state can take so long because, you know, governments and authorities are so low resourced in those settings. And that really does obviously impact the work that you can do for patients as well.

So again, there's the micro level of missing medications and supplies and, you know, logistics equipment in the project, but there's also that macro level of entire country being low resourced, which impacts a lot of things. And Jennifer touched on it, especially the import of supply as well as massive challenge in low-resource settings.

Alexandra Brown: Yeah, so the country itself being low resourced or because for example of conflict or a disaster, in fact, as you said, the systems they had have broken down.

Kate Charlton: Exactly, yeah.

Alexandra Brown: So it's not only MSF, therefore that's struggling at the time, right? It's everyone else around us as well.

Jennifer Craig: One of the other things, just hearing Kate say that, one of the other things that of course comes to mind is that low resource, it is that micro level, it is that macro level. It's also what's going to impact you at home. So you go home at the end of the day to the guest house, you may not have electricity, you may not have air conditioning, you may not have running water, you may not have hot water, you may only, you may not have access to fresh food, but MSF is very, very good in that we look after our staff generally very well. And there is always food available, but it may not be to your taste. And if you have particular dietary requirements, you may really, really struggle. I know people who lived on rice and beans for months because they were vegetarian in a context where it wasn't easy to get vegetarian food. So this sort of low-resource really impacts every element of your life in projects sometimes and then there are other projects where it weren't at all, but it certainly can.

Alexandra Brown: Yes, your mention of rice and beans reminds me that, I know a colleague who actually did have a lot of lobster in the country that they were living in. So there are contrasts, right? And actually, that was what we were going to cover next in the next question was some contrast based again on your experience because the setup can vary so widely because what we're responding to, because of course there's variety regionally, sub-regionally in different parts of different countries, different parts of the world. So Kate, what would be an example just if you gave us a not necessarily chalk and cheese, but you know, it's like in this context, in this situation, it was like this and then the contrasting it with another.

Kate Charlton: Look, from a medical perspective, when you're talking about, you know, filling gaps of what's not fulfilled by a health system, we really have to be really adaptable and flexible and we talked about that, but the health program you're going to provide in a context like Ukraine, which has a very established health system is going to be very different from a health program that you provide in Sudan, which is a country, a conflict with a healthcare system has all but collapsed. So I think, you know, resetting your expectations and it's not a copy paste approach, right? You really have to adapt to where you are and identify what the gaps are, what the real needs of people are and then fulfil it that way. But yeah, it really depends for me on what country you're working in and what the baseline level of healthcare was prior to MSF working in that country.

Alexandra Brown:  And Jen, you've talked about some of your experiences but are there any sort of contrasts that you can, yeah, you can provide just some examples.

Jennifer Craig: I'm going to give the living example, the living situation example. In Nigeria, in Borno State, I lived and worked in the same building for three months. I left it once in three months.

In Cambodia, I didn't have security guards. I went running every morning before work. I actually ran a half marathon while I was in Cambodia, which was quite a surprise to me.

But it was absolute chalk and cheese. There was an international community. You could go out on weekends. It was very relaxed. It was a bit like having a normal life. Or you live and work in a compound where you don't leave the building at all and your life is your colleagues and your work. And those sorts of contrasts are quite normal.

And it's really hard, in South Sudan, I was right up in the north and it was very, very basic, but it was one of my absolute favourite projects. We had an outdoor volleyball court. I think volleyball court – we had a net. But you had this incredible bonding experience with your team because there was nothing else. There was no electricity, there was no television, nobody went to their rooms and hid. You were out there together with your team, and it was really, really enjoyable. And those are quite typical, I think, of the three contrasts. High security, very normal or very isolated, but actually quite pleasant, just very basic.

Alexandra Brown: Yeah, that's an amazing threesome for the contrast. Now we'll go into the second criteria that we wanted to cover, which is experience and interest in supervising and training others.

MSF teams are diverse, they're multicultural, and they're constantly changing. That's why teamwork, experience of supervising and training others are essential and not optional. All international staff will be responsible for managing a team of some kind and as such, strong management skills are critical. So Kate, what were some of your early experiences supervising or managing staff or providing training? You know, you've arrived as the new face in an MSF project, if you consider that many of the locally-hired staff have been there for much longer than you, but how did that go, those early experiences of supervising or managing staff?

Kate Charlton: I mean, challenging at times for sure. I think especially speaking from, I mean, actually also not just from a medical, but from the non-medical perspective, you're working with people who know the context much better than you, they live in the context. So whether it's medical conditions or clinical presentations, that they're much more familiar than you are as a medical, I'm sure for HR processes, you have staff who are working who are very familiar with how to apply for a visa in certain countries, and then you have a new international staff member who doesn't know processes at all.

So I really think that listening to your team and learning from them is also part of the beauty of MSF, right? You may be a manager and you do bring a lot of experience in training and mentoring and people skills, but also being humble and learning from your colleagues has been really, really important to me.

And yeah, it's a bit difficult from the medical perspective. We also come from, you know, in Australia and New Zealand, a really gold standard approach to how we clinically manage a lot of healthcare and trying to kind of reset expectations and then be able to coach and train teams in ways that are practical for them and understanding to them is something that, you know, takes some adjustment.

Alexandra Brown: Yeah. Jen, how about you that the early days, again, training or supervising or managing and how you adapted and how it went, you know, with your own sort of plans for what you might do and how it went in the project?

Jennifer Craig: I've had a bit of an interesting mix of projects. So I've sort of, I've walked into projects that have been running long-term where the staff knew much more about the context and about the project itself than I did. And I worked in brand new setups where I was training staff from absolute scratch up to a standard that MSF would expect of them. So to train them on MSF protocols and ways of working and all of those sorts of things. And I've had both experiences and they both come with their own set of challenges. I think, I absolutely echo what Kate said, humility is key. You can't go into, and a flexible mind set, you can't go into a situation expecting that you're going to be the expert or that you're there to manage your staff and be the boss and tell them what to do because that's not going to work in some circumstances.

You need to walk in and you need to take a step back. One of the best things that I was told before I started on my first project with MSF was when you walk into a project, stop, listen. If you see something that doesn't make sense, ask your staff why it's done that way and listen to what they tell you. Don't just walk in and try to change things because they have a new manager coming in every six to 12 months. And what you want to change has probably been tried before and they're doing it the way they're doing it now for good reason. And maybe they're not, but maybe they are. So the first trick is to step back, listen to your staff and try to understand what's actually happening and what the history of it is. Not to go in with this sort of preconceived idea of what you're going to achieve.

Then also there's this real need to meet your staff where they are. So some of your staff are going to be incredibly experienced, incredibly accomplished. Some of them are going to struggle with not having a background in Excel, which is something that most of our projects run on. And so I've certainly run Excel training to bring, which isn't an MSF protocol, but it's something that staff need to be able to do their jobs effectively. And to be able to sort of bridge that gap, that's the sort of thing that we step in and we really help with. Or to recommend them for particular development training. If you see gaps that are happening, it's just a matter of being really flexible and having that level of humility.

It's important that, especially for medical people, if you go into a project as a medical doctor or a paediatrician, for instance, sorry, I feel like I'm always using paediatricians as examples today, but you go into a project as a paediatrician, your medical team leader may not have any background in paediatrics. So they're your manager, but they might not technically be versed in what you're doing. They might be, you might be a surgeon, and your direct line manager could be a nurse. And so it's being aware of these sorts of things and not coming in with a fixed mindset, being willing to learn from the person that's in front of you and respect their experience and respect their expertise, sort of regardless of preconceived notions, I guess, is what I would say. Kate, how do you feel about that? I feel like I fumbled through a medical answer.

Kate Charlton: No, it was perfect. And I actually, I know that Alexandra wanted to ask us what our advice is. And my advice echoes yours. I always arrive and I just observe for a few weeks. Don't change anything, ask questions and understand. And maybe the other thing I wanted to add, if that's all right, Jennifer, is that I also think it's so important as a manager to have empathy.

Jennifer talks about that MSF tries to really, look after living conditions, international staff and make sure we have enough food and electricity when we can. But I've recently worked in Darfur, in South Sudan and Gaza and our staff live in tents or mud huts. They don't have electricity, they don't have running water. So managing with empathy and also understanding where they're coming from and what they're living through, I think it's also really important if you're working in MSF and these contexts.

Jennifer Craig: I remember in South Sudan, as soon as it rained, all of my drivers were late. And of course, they were late because the roads were incredibly muddy. They didn't necessarily, we lived in a refugee camp. They didn't necessarily have access to gumboots and a dry change of clothes. And so they would wait until the weather was a bit better and then they would come to work. And so it's sort of, it is, it's that, there is that empathy and sort of understanding that people come to work with all of their background and their challenges and our staff live in the contexts that we are working in. And they are as impacted by the context as our patients are often.

Alexandra Brown: Yeah. And because, we're talking about managing and supervising and I thought, so there's a hierarchy there if you come in as a manager, if you come in as a supervisor, and because you are both women, and because Kate, you might've been managing your supervising doctors, maybe we'll go with you first, just anything that you would like to share or comment on about that scenario and any tension that may or may not arise.

Kate Charlton: No, there's definitely been points of tension. I would say my personal experience; I haven't had too many challenges being a manager of doctors. I'm a nurse and a midwife, I've been quite okay with that. Some challenges, to be perfectly transparent is working in contexts where women are not educated and women don't often hold managerial positions and that can be challenging at times. I think some of the beauty of MSF is that we all come from different backgrounds, so we all have different things to bring to the table and people do recognise that.

And whilst I don't always love, I mean, MSF very much does have a hierarchy actually, in managerial and coordination positions, despite the fact that we are very much a team, there is a hierarchy. And at some points that is actually helpful because you do in these fast-paced emergency contexts, you do need end decision makers, right? You need to make decisions very quickly and be semi-confident in your decision making. I think that the fact that MSF does have a hierarchy in decision making is very useful.

But yeah, me personally, I think I've had challenges in some of the male decision-making led context that I've worked in, but it's easy to do. But it's easier the more experience you have and working out how you adapt to those contexts and how you work with your colleagues on that.

Alexandra Brown: Jen, do you have an example that you want to share?

Jennifer Craig: I probably won't give you specific examples because it'll get a little bit long winded, I suspect, but yes, absolutely. And especially being a woman who started in logistics, there is, you do have a bit of an uphill battle to prove that you know enough to be there. What I would say is this is one of the reasons that we look at things like the essential criteria.

One of the biggest challenges that I've seen in projects is for, one of the biggest management challenges that we have is people who are not confident in their own ability to manage teams and then aren't able to take feedback or criticism from their team and become really sort of dogmatic almost.

So it's really, one of the reasons that we look at things like significant management experience is so that people go in with the confidence to be able to say, well, look, I don't know something or the confidence to learn from people who are in positions that are more junior to them without feeling like that makes it, without that impacting their view of their capacity to do their job. I'm sort of phrasing this badly, but I think I'm getting my point across. You need to go in with confidence in yourself and that confidence gives you the ability to make mistakes and to ask questions. And I think that that is so, so important.

Alexandra Brown: Then my last question for this overall criteria is what feedback have you had? Have you ever had feedback on assignment? And if you can't think of something, that's fine, but that you thought, oh, that was brave of them to say it to me, or maybe you worked in a project where there was sort of structure around that, just anything about feedback, receiving feedback and can you think of anything on the fly?

Kate Charlton: I recently had feedback just in my last assignment from, I work as a medical coordinator and my medical coordinator support, sat down for coffee with me one day and said, "Hey, you've got to include me more in X, Y and Z."

And I thought, oh my goodness, yeah, I do actually. But I mean, what I took from that is that how great that I've managed as a leader to create an environment where he felt comfortable to tell me that and approach me. So I mean, that's the other advice, right? You need to create an environment when you manage a lot of people that you're approachable, that they feel safe to give feedback. So yeah, that's the other really big advice that I would give. And I think that, yes, you need to be confident, but then it also ties into the humility aspects that we talked about as well, right? That you can learn from others and you want to hear from them as well.

Alexandra Brown: Jen, is there something that you think of?

Jennifer Craig: I really don't think I can think of anything that would be suitable. No, but look, I 100 per cent agree with Kate. You've got to have people, you've got to encourage staff to be comfortable speaking to you and asking you questions. And you've also got to be so aware that, you know, we often work in cultures where there are really strict hierarchies, where there's this really strong concept of face where people don't want to look like they might not know something. And so they're much, much less likely to ask you questions and you need to go into it being aware of that and being, having techniques to manage that so that you can make sure the work gets done and that everybody is safe.

And it's so important. You don't want staff… You don't want staff sort of finding their way through something that they don't know how to do because they're not comfortable asking you. Our job ultimately is to provide a good quality of care for our patients, but also to keep everybody on projects safe and looked after regardless of who they are. So it's a really important one. I think it's really good that Kate raised that.

Alexandra Brown: Thank you both. So the third criteria, which we're going to touch on with a little less depth, but that's okay, is about language skills. So as an English speaker, having a second language, especially French or Spanish, means you can join a project based in that language. And that opens up more opportunities for you to participate in MSF's medical humanitarian action. Jen, could you tell us from a recruitment perspective, how valuable language skills are to have?

Jennifer Craig: I was going to say, I'm going to put my recruitment hat on for this one. The reality is at the moment that we are facing an increasingly competitive process to get our staff, our Australian and New Zealand staff onto our international projects. The landscape has changed quite drastically in the last 10-15 years. So what might've been true for people who worked for MSF 15 years ago is not going to be the reality anymore. And so it might be if you're a particular skillset, that there may only be one English-speaking project that we could put you forward for. But maybe there's 10 French-speaking projects. And the thing is, these change.

The needs of the world, they change all of the time. Sometimes it's going to be more in French-speaking context. Sometimes it's going to be more in English-speaking context. Sometimes it'll be in Spanish-speaking contexts. But there is a preference to, if there are two profiles going forwards for a position and one is bilingual and one is not, there will be a preference for the bilingual because they will be able to be placed on more assignments. So it gives you a distinct competitive edge to have a second language.

Ideally French, Spanish is also very helpful. And then Arabic, Portuguese, they're helpful. We don't have assignment, we don't have projects where that is the assignment language, which means either written documentation and all of the communication won't be happening in that, but it can still be helpful.

But ideally, if people are thinking about applying for MSF or having a career with MSF and they're still a few years away, start on French. We have a lot of support that we can give from MSF Australia to help you improve your French. But the more you come to us with, the better it will be and the easier it will be to find placements for you. Plus, it's just so, it opens so many doors. You can go to all kinds of different contexts and have all kinds of different exposures and experiences. And even in the guest houses at night, to be able to communicate easily with international colleagues is a wonderful thing.

Alexandra Brown: And as you said, Jen, so MSF can offer some training for people who are committed to learning, right? And going on assignment in a second language. Coming with a good start is good, but we can offer it if people are prepared to commit to both do the learning and then of course, take that language on assignment.

Jennifer Craig: And that's absolutely true. But the ultimate thing is that we have, it's so important for people that are interested in applying with MSF Australia to understand that we have a central criteria and you do need to meet all of those. But then even if you meet all of those, it's still a competitive process. It's competitive to join MSF Australia. It's competitive once you're in MSF Australia to get a position that might be going out to four or five different MSF entities. It's all competitive. So the greater your skillset, the more, it's going to say strings you have on your bow. I don’t think I'm quite getting that right. But the more of these things you have, the better. Like the more competitive you're going to be, the more opportunities you're going to have. And that's so, so important.

Alexandra Brown: Alright, we can go to the Q&A now. And I forgot to prompt people to put questions in the chat. I'm sorry about that. But you're very welcome to put questions in the chat now. They're going to be filtered through to us, which is great. We have some lovely colleagues supporting us in that way. But please don't hesitate. We'll try and do our best. And some of the questions might be taken offline, but we'll meet your needs as best we can. I do have a question just while we're seeing, if anyone does want to share one with us. What caught you most off guard on your first assignment? Kate?

Kate Charlton: Well, mine is definitely from the medical perspective. So if there's anyone here who knows, you know a lot about obstetrics and maternity care. I mean, I was really completely out of my depth clinically on many things on my first assignment, but I obviously learned a lot. MSF has great protocols and training, and I got on board very quickly.

And yeah, the experience I've had since then is fantastic. But I would say, you know, if your medical experience predominantly is in Australia, be prepared to be caught off guard. And that's not just pertinent to maternity. You know, I've also worked as a nurse in the field with MSF and, you know, many of the medical conditions you'll see in children you'll never see in Australia. So that definitely caught me most off guard.

And then also maybe just that I think I naively didn't realise like how big MSF was, right, before going into my first assignment and learning that there's all these different headquarters in different European cities and different positions than how MSF works. And that was a real learning curve in itself. And so different from how the healthcare system works in Australia and New Zealand. So that also was a big thing. But yeah, on reflection, I think, wow, I was very, very naive.

Alexandra Brown: Jen, is there something that comes to mind for you in the sense of, yes, caught off guard? We actually do have some questions queued up. So I can also flick to those if nothing comes to mind.

Jennifer Craig: Look, I think Kate has pretty well covered it. I don't think I've got anything to add to that one at the moment.

Alexandra Brown: That's okay. So we have a question. What advice would you give for early career people, I guess, for getting your foot in the door? I have volunteer and intern experience across Thailand, Cambodia and Indonesia as well as professional development. I don't know the profile of the questioner, but yes, advice for early career, people wanting to get into MSF.

Jennifer Craig: Look, as I said earlier, the most important thing is you identify which position you think you would be most interested in or most suited to, and then you look at the essential criteria. So there's essential criteria on our website for the position itself, but then there's also essential criteria for all positions.

And that's what we've been talking to tonight. So gaining management experience. As I said earlier, French is always going to be useful. Spanish as well, but French more so. Yeah, you've already got experience in low-resource settings. It depends a little bit on the sort of length of time and the sorts of experiences, but gaining that sort of experience is incredibly, incredibly useful. But then making sure that you're getting management experience. You have experience leading teams. You have the technical proficiency of the position that you're looking for. There's sorts of things that I would focus on. And if you do apply, and I'd say this to everybody, if you apply and you're not successful, you can ask us for feedback on why. And we are usually more than happy to give you that guidance and then you can go out and continue to build those skillsets and reapply. And we quite often, it's not uncommon that we have people apply a couple of times before they're successful, and they go on to have very long, very happy, very successful careers with MSF.

Alexandra Brown: Thank you. So this is actually another question for you, Jen. So what is the age limit to work for MSF? And then another question about are there any projects in New Zealand or MSF?

Jennifer Craig: So we don't have an age limit. I say that the only thing that does tend to come into play, there's two things that come into play. One, everybody who applies with MSF needs to have a medical clearance from their doctor saying that they are suitable to work in places where there's going to be limited access to healthcare and that you may have exposure to things like malaria or dengue or poor water quality. So everybody needs to have that regardless of age.

And the other thing that can impact is access to insurance. And that, I don't know the details off the top of my head. It wouldn't be a no for us from a recruitment perspective, but I know that there can be some insurance issues above a certain age, but I don't think we've ruled people out on that criteria. There was a point that that became an issue during the early days of COVID because people over a certain age became uninsurable internationally, but this is something that's 100 per cent outside of our hands.

Alexandra Brown: Yeah, thank you. And then the question about any projects in New Zealand.

Jennifer Craig: And look, I've worked with some people of very advanced experience on some of my projects and they're amazing. People come to MSF at the early stages of their very, their professional career once they've met our recruitment criteria, or once they are at the end of their career sometimes and they're like, well, I'm facing retirement, but I've got so much still to offer. I don't think I'm ready to just sit and not do anything. And I want to give something back. And we certainly get a lot of people at that end of the spectrum as well.

In New Zealand, no, we have an MSF entity. In Australia, we are considered Australia and New Zealand. So we do have some presence in New Zealand, but the office is located in Australia. We don't run projects in New Zealand simply because that's not where the need is greatest. And I understand 100 per cent I'm from Australia. There is a lot of need here, but there's also a lot of resources here. And so MSF, it's not our place. We also need to, we would also need to be working. It gets complicated from a – who invites us in sort of perspective, but no, we don't have projects in Australia or New Zealand.

Alexandra Brown: Yeah. And you kindly answered that question early about professional development, but because I don't know the background of the person who asked the question, I might get you Kate also to answer that question, like from the point of view of a nurse midwife, midwife. So advice for an early career midwife for getting their foot in the door, just in case there's any midwives online.

Kate Charlton: Yeah, I mean, not even just for midwives, but for any medical profession in general, I think there's a lot of courses out there that you can do. Something that I did, for example, was I, actually it was after I joined MSF, but I quickly found that my basic ultrasound training in university was not enough. So I did a dedicated ultrasound course, for example.

If you are accepted to work for MSF, there's many training opportunities, which are really helpful, but I think beforehand, yeah, upskilling on really like hands-on clinical work is really great. And it's not just training but also getting that diversity in the different kinds of hospitals or clinics that you work in in different areas, getting more accustomed to rural and remote work and it's also really helpful.

Alexandra Brown: Yeah, thank you. We have a question from a clinical psychologist. So this might be again, for Jen, but Kate and you may/may not have an answer. So I'm a clinical psychologist working with trauma using EMDR and narrative exposure therapy as tools to facilitate dealing with traumatic experiences. Any opportunities in Cambodia, Gaza? So if there are opportunities in MSF anywhere, I think we'll talk about them rather than being specific to the country because you can't choose where to go when you work with MSF. But yes, Jen, can you chime in on that?

Jennifer Craig: There are a lot of things that I would say with that question. Look, we can't give specific feedback in this webinar, specific career advice to specific profiles in this webinar simply because we don't have enough information. We need to see your CV, we need to see your full application, and you would be more than welcome to submit one.

Certainly, they are skill sets that we look for in clinical psychologists and we deal with trauma. Like trauma is a very, very common thing that we deal with in our mental health projects. I managed the, I was the project coordinator of the mental health project in Palestine in the West Bank when I was there.

And I know that we do provide mental health in Gaza. However, I also know that at the moment we do not send first departures to Gaza. So, and we certainly, as Alexandra has mentioned as well, we certainly don't, you need to join with the mindset that you will be sent where you are most needed in the project and that decision will be made by our operational centre and it won't be made by you. So, if you have a very, very strong desire to go to one or two particular contexts, we may not be the NGO for you. If you're willing to be a bit more flexible, then yes, absolutely go ahead and apply please.

Alexandra Brown: Yeah, thanks a lot. So we did talk about early career midwives, also doctors, Kate, you spoke to that. There actually is a question someone's asking if they'd like to know what scope there is for junior, i.e. as yet unspecialised doctors in MSF, Australia and New Zealand. So we do have pretty well, yeah, a standard thing we can say, don't we Jen, about how much experience people need to have in terms of their qualifications?

Jennifer Craig: Look, to be absolutely frank, there are very, very few positions available anymore for unspecialised early career doctors or nurses. And there's a few reasons for that. Our projects are becoming more and more specialised. Our locally hired staff are becoming more and more specialised. And so we struggle to balance bringing people internationally into projects where we can use, we've got the skillsets on the ground already. So that becomes very, very challenging. But it's also that we need to know that somebody is, if they go into a situation where all of, none of the equipment is working, and Kate might actually be better off answering this than I am, but we need to know that if we're putting somebody in a situation where they don't have access to the internet, they can't check their phone, if they're unsure of something, there isn't often if you're, always come back to paediatricians, let's say obstetricians, say you're an obstetrician on a project, you will likely be the only obstetrician on the project. You're not going to have colleagues that you can go and ask a question of after the shift during the corridor, you're going to be there having to make the decisions by yourself on the spot. And you need to have enough experience and enough comfort in your own capacity to be able to do that, even if you don't have access to other resources or equipment that you're familiar with using. But Kate, what would your take on that be?

Kate Charlton: No, I very much agree. And I mean, from my perspective, you may also be a midwife in a project with no obstetrician and only a general surgeon, right? But beyond also the clinical aspects that you have as a more experienced or a specialised doctor, that you also have more managerial and people management experience, which I think is also ties into a bit of the experience that you need.

I mean, I think the criteria is similar to the nurses in midwives, right? There's a certain number of years experience needed and experience in training or managing people as well. So I think that ties in, but yeah, certainly in most of the projects now, we absolutely do need medical doctors who have specialised or have very specific experience in your certain departments of the hospital rather than an unspecialised.

Jennifer Craig: The one exception to this, I just saw a quick note that popped up. The one exception to this is paediatric experience. So where we have somebody with significant paediatric experience, but isn't a paediatrician, we can still often find placements for them because there is so much need for paediatric experience. So that would be the one thing. And on that note, if you were a medical person and you desperately want a career with MSF and you're at the early start of your career, get as much paediatric experience under your belt as you possibly can and learn French.

Alexandra Brown: Children being the largest cohort of people that we treat.

Kate Charlton: Yeah, absolutely. She's right, I was a paediatric nurse actually, as well as a midwife. So there you go.

Alexandra Brown: Yeah, so Zach from Sydney says, "What has surprised you most about working with MSF?" Apart from how big the organisation is, Kate, any other surprises over the years?

Kate Charlton: Yeah, I mean, I think, well, I'll give an honest answer. There are some negatives, right? That surprises you. You don't always feel super aligned with all the values that you think you are aligned with. So some challenges, some contexts are very challenging.

You also find that there can be a lot of bureaucracy, like anywhere that you work, sometimes you think, "Oh, we won't get bogged down on small things because we're in the middle of this war." But somehow you still do. And sometimes, so I think, just taking everything with a grain of salt is really important – that surprised me.

But I mean, overall, what surprised me is how much I love it. I planned to do one assignment and return to my normal Australian life. And that was six years ago. And I'm just back-to-back in the field all the time. It's, yes, the best, obviously, life decision I've made was to work for MSF and how in love I fell with different countries and cultures and religions and people. It was a big surprise and changes your perspective on how you see the world. So be prepared, I think. I think I wasn't prepared to have my whole worldview shift, but it will, definitely.

Alexandra Brown: Yeah, that's a big one. Jen, what surprised you most about working with MSF.

Jennifer Craig: The thing it took me the longest to adapt to was the hierarchy. In Australia, I'm very used to being able to, and I mean, this is a bit of a mean thing as well, but I'm very used to being able to speak my mind to people who might be in positions of authority to me. And if I think they're wrong, to somewhat tactfully be able to tell them that.

But in MSF, there is a hierarchy and you're expected to follow it. And that took me a while to find my way within it. And, but once I did, life became a lot more comfortable. So, you know, you sort of need to adapt to the organisation that you're working with. It's not necessarily, it's not an Australian organisation. It's not this sort of flat management structure that we tend to have here. So you need to adapt to that.

Look, I 100 per cent agree with Kate. Like I loved it. I would be in the field in a heartbeat if I didn't have young children. So I miss it. I'm so jealous of you, Kate, still being out in projects. It is a, it's a wonderful, wonderful organisation to be a part of. And you learn so much and you can gain so much from it.

Alexandra Brown: Thanks for the question, Zach. That worked really well. That was lovely to hear those answers from me as well. So the last question is actually quite a big one! How does MSF determine what kind of medical care is needed and where? So between you have about two and a half, three minutes max, Kate.

Kate Charlton: Yeah, yeah, I can jump in. Look, yeah, it's a massive question, but it's really, I mean, I think Jennifer or you Alexander mentioned before, it's where we go where we're needed most, right? And it can be something where we see a chronic needs or it can be an acute emergency that's popped up.

We're very assessment driven, right? We do assess what the needs of a population are, what the healthcare system is providing, what other organisations are providing because we are financially accountable to our donors and to the organisation and we want to act in the most responsible way for the people who need it the most.

So, I mean, as a medical coordinator, I really need to work when I'm working in the country, we need to really assess thoroughly that we're working with people who need it most, but also taking into account what resources we have and what capacity we have. You know, you might have a context where oncology cancer is a huge need, but you know that MSF is not providing that kind of care. So it's also about balancing what our capacity is.

But I would say it's very assessment driven, which sometimes is super easy. It's very obvious you have a war, hundreds of thousands of people are displaced and hospitals are closing. It's very obvious for another time that's a bit more nuanced in trying to understand. And it might be things like where there are specific minority groups who can't access healthcare.

So how do you know that they're there, right? If they're not coming to the hospital, you go to the community and find these groups who are missing out. So it changes in different contexts as well, how we determine that.

Alexandra Brown: Yeah. That's a great explanation. Jen, please.

Jennifer Craig: I'll super quickly add to that. I've been in a position where as project coordinator, I'm advocating for funds for a project and it's a matter of… one of the joys of working with MSF is that we are not reliant on large donors. And so we are in control of our funds. And what that means is that if you are on the ground and there is a sudden shift in need, you can apply for additional funding. And it does not mean that you will get it because it is not endless, but it does mean that there is the possibility to apply for it through the organisation and go, look, this has happened. I'm seeing this in front of me. We need more money, we need more resources, and it can be reallocated.

The other side of that is the need to be really, really aware of the fact that we need to be responsible with the money that we're entrusted with and to look at projects and say, alright, you know what? We don't need to be here anymore. This doesn't need to be us. We can hand over to somebody else. We can hand over to the Ministry of Health. We can hand over to a local NGO who can easily do the job that we're doing. And we can take these funds and reallocate them somewhere else.

There's no need to spend money just because there's money there. And this is something that I love about MSF. And I think it is so powerful. And it is what allows us to do such an incredible job is this sort of flexibility of funding and being able to allocate it where the need actually is the greatest and to be flexible with that.

Alexandra Brown: Thank you, Jen. That's a great way of wrapping up because we have reached time and we answered all the questions except for one, which was if we had time. But here we are. We don't have time. Thank you everyone for joining us for this past hour. Thank you so much to Kate and Jen for joining us at the last minute.

What we hope you, the audience, take away from today is this that MSF's essential criteria exist to protect patients, teams and the integrity of our work. If you meet these criteria or if you're working towards them, we encourage you to explore opportunities with MSF. And if you realise this isn't the right fit now, that clarity is just as valuable and we encourage you to continue to build your skills and experience.

Thank you again to Kate and Jen for sharing your experiences. Thank you all for joining us today. And please don't hesitate to share this with anyone you might think might be interested in learning about our essential criteria too.