Working in extreme settings
Natalie Roberts works as a doctor and operations manager for Médecins Sans Frontières
Natalie studied medicine at Cambridge University and Imperial College London, before completing core surgical training in Plymouth, moving into emergency medicine in Bristol, and then completing a diploma in tropical medicine and hygiene at the Liverpool School of Tropical Medicine. In 2012 she went on her first mission with Médecins Sans Frontières (MSF), which was responding to a typhoon in the Philippines. Since then, she has worked full time for MSF, initially as a medical doctor and then as an emergency coordinator across the world. She lives in Paris and works as an emergency operations manager for MSF France.
How are the skills you learnt in the NHS transferrable to your role with MSF?
Basic clinical skills have been useful in the management of trauma and mass casualty events. Soft skills have been the most useful, however. My first mission to the Philippines was not based in a hospital, but in a tent. My medical skills were not really required, but my problem solving skills were, and communicating effectively with other people was essential.
What has been your most challenging mission so far?
In terms of fearing for my own safety and security, the missions in northern Yemen and Aleppo in Syria were particularly challenging because they were active war zones with daily airstrikes. It was difficult to provide care within a bombed hospital; patients were scared to come because they thought further strikes would happen, there was no electricity or water, and few medical staff. Yet those missions were also the most rewarding, because I felt that we were making a tangible difference. Other missions have been challenging for different reasons, such as dealing with bureaucracy and limited resources in Ethiopia.
Have you ever thought that being a woman has affected your safety?
As long as you respect the rules and culture around you, I don’t think that being a woman puts you at more risk than being a man. In some places, I have found it easier to work—people treat you with less suspicion than they would a man because you are unlikely to be working for the military. Also, in Ukraine, I found it easier than my male colleagues to pass checkpoints because there is a deep cultural respect for women there.
Have you ever been ill on a mission?
Discounting the odd stomach bug, I have never been seriously ill. On missions I am responsible for the health of other team members, so I have always been careful to take every precaution to avoid getting ill. It’s a huge responsibility and it is always on my mind.
What are the big challenges for MSF in the future?
A key problem is keeping our workers safe. I would argue that the dangers have not increased, but perhaps expectations of security have. The bombing of hospitals in Afghanistan, Yemen, and Syria is on our minds. There is also the question of how much MSF should be involved in situations that are largely political, such as the refugee crisis in Europe. Is it our responsibility to give refugees a political voice, or simply to provide medical aid? How much aid can we provide when it should be managed by European governments? Another challenge is deciding to what extent we should provide the latest advances in modern medicine? In countries like Syria, people were used to good healthcare when we first arrived, so we set up dialysis and chronic disease clinics—but to what extent can we afford to do this?
What can medical students with an interest in working for MSF in the future do to gain relevant experience?
Get involved with your university’s Friends of MSF organisation. This is the volunteer-led branch of the organisation, which raises funds for and awareness of MSF’s work. Languages (particularly French and Arabic) are useful, as is experience of travelling or working in developing countries, and rotations in general practice, paediatrics, emergency medicine, surgery, or tropical diseases. Consider how well you cope with sharing your space, dealing with different cultures, and making decisions independently. A lot of people think that humanitarian work is a bit scary, or that they don’t have enough time. You don’t have to dedicate your life to it—you can be deployed for a single mission—and our work is not just related to Ebola and war zones, there are a lot of long term programmes too.Alexandra Caulfield, final year medical student
University of Cambridge, UK
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.