MSF Interview

Interview with MSF Written by Anna Cairns

Since her first MSF mission in 1998, Mary Houldsworth, who goes by the name of Flowa, has worked as a Nurse/Midwife and Health Promoter in many of the world’s conflict zones and crisis areas. From treating displaced peoples during the famine in Ethiopia, to being on the frontline of the Ebola virus pandemic in Liberia, she has experienced the many complexities of delivering healthcare to those caught in the crossfire of conflict or in the epicentre of humanitarian catastrophe.

I spoke to Flowa about her experiences working for MSF and the lessons that can be learnt from the Ebola outbreak in light of the current Coronavirus pandemic.

AC: What were your initial motivations for working for MSF?

MF: When my two sons were teenagers, I really wanted them to have gap years, but they refused, so I had one instead! I travelled to Calcutta, in India, where I discovered that an English doctor, Jack Preger, ran a street clinic. He had six hundred patients a day. We set up a mother-and-child unit and, and treated patients living in the slums. Our clinic was the only place that offered free treatment to the extremely poor. I saw, first-hand, the difference that accurate diagnosis, medication, and prescribing made to people’s lives, which eventually led me to MSF.

AC: Do you have any stories which you feel encapsulates your experiences working for MSF?

F: During my last mission in Ethiopia, we were deployed to care for five thousand internally displaced persons (IDPs). Houses had been torched and plantations taken over. Families were forced to grab their children and flee at short notice. They were housed in five, large concrete coffee warehouses, where the babies were delivered on the concrete floor. As well as antenatal care, I taught infectious disease recognition to a respected woman in each warehouse. Patients suffering from TB and tropical disease were referred to the local hospital. As you can imagine, the tension in the camp led to outbreaks of violence. The mental health team treated women, set up a football team for the men, and set up play sessions for the children. We set up a vaccination programme in the local clinic and organised contraception - which was in high demand. All this was achieved in the context of a difficult political situation, and all within two months.

AC: Did you notice that there were different challenges from mission to mission or did you notice a common theme throughout?

F: Security is always one of our main concerns. In South Sudan, on Christmas Eve, there was firing over the compound and we slept fully clothed with our emergency bags packed, ready to run. I always want to know about the political situation and I always ask about the weather. In South Sudan, I was living in a tent in 44 degrees and the clinic was under a tree. Whereas in Afghanistan, it was -20 degrees at night, so I went to bed with more clothes on than when I went to work. I also found that local hospital treatments could be a challenge. We often solved these issues by sharing our knowledge and our skills.

AC: How do you deal with the psychological aspects of Aid work?

F: The psychological effects of Ebola affected the whole team when I was in Liberia at the height of the outbreak. It was the first time that Ebola had reached a city and it was the largest team that MSF had ever had on a project. I kept saying to my staff, “Come on team, we’re making history”. They ended up winning the TIME magazine’s award for workers of the year. We had 110 deaths a day and you have to suppress that grief, which is horrendous. We needed to build trust with the community, who had difficulty accepting that their intricate burial rites spread the disease rapidly amongst the family members. We were working very long days and I had three days off in five weeks. It was

demanding and, of course, it all erupts when you get home. We have a debriefing session in the country and a volunteer coordinator rings you within 24 hours of getting back to see how you’re getting on and offers psychological support.

AC: After a mission like that, how do you adjust to life back in the UK?

F: When I came back from Liberia, I had to self-isolate for three weeks. While I was in Liberia, I had sent a photo of myself in full PPE to a friend who forwarded it to the local paper. People were scared about Ebola so when I came back people were absolutely petrified, and I’m still not allowed back to my local choir.

When I’m in a refugee camp anywhere in the world, it takes me five minutes to work out an outline of things that need to be addressed. It takes me five months to readjust to England. You’re bursting with everything you’ve experienced but people don’t want to know.

AC: What drives you to keep going back?

F: When I hear about conflict on the news, I always think, “Will I get a phone call?”. I like to be challenged. There’s also the curiosity - I wonder about the main concerns. For example, in Goma, in the Democratic Republic of Congo, we were expecting people to be worried about Ebola, but their main concern was the infected water supply. We brought in water and sanitation engineers to address the issue, as it was their priority. You always feel very apprehensive about going, no matter how experienced you are, because you know that you’re going to meet new challenges.

AC: How do you balance working for MSF, working in the NHS and your personal life at home? Have you had to make sacrifices in any of those areas?

F: I’ve never felt as though I was making sacrifices to work for MSF. My children had left home and there were no family ties. I consider working for MSF as a privilege because I’ve travelled to remote corners of the world. The people I’ve looked after have given me far more than I’ve given them.

AC: You have talked about being on the ‘frontline’ dealing with the Ebola pandemic in 2014, do you think there are any lessons that we can learn from that outbreak, in the context of the current COVID-19 pandemic?

F: Ebola was named as a virus of fear and ignorance and I see that played out in the COVID pandemic. Some people won’t go out and they run the risk of mental health problems. My friend’s daughter is part of a group who don’t believe that COVID exists. It reminded me of my time in Liberia as a health promoter. I used to speak to the local hygienists, and they worked out that roughly 10% of the local community didn’t believe that the virus existed. We invited local midwives, religious leaders and traditional healers to discuss the realities of Ebola and relay accurate information to the community. I think that it requires specialists to debunk the myths about Coronavirus and deliver the truth to people who don’t understand the purpose of the guidelines and regulations.

AC: Do you have any advice that you’d give to anyone dealing with the COVID-19 pandemic first-hand in hospitals at the moment?

F: I do. MSF has been established for almost fifty years and has dealt with many disease outbreaks. We recognise that it is emotionally, physically and mentally demanding. I think that the NHS probably needs to implement a way of monitoring staff well-being and standards in regard to the Coronavirus pandemic. There needs to be someone who listens and gives staff psychological support. Ebola was a new situation even for MSF. Every day we had several staff meetings where we had to come up with solutions to problems that we had never had to deal with before. It was a huge learning curve and I think, in the context of a pandemic, constant communication is very important.

AC: What attributes do you think that you need to be part of an MSF team?

F: You need to be flexible and adaptable and able to work in a team. You need to be prepared to encounter traditions that you have not seen or experienced before. For example, in Ethiopia, during the daily coffee ceremony, mothers were giving young babies the strongest coffee I’d ever tasted. Another example was in Afghanistan, where I noticed that babies weren’t being breastfed for the first